"Attractive" symptoms of histrionic personality disorder

The concept of “personality disorder” is defined as a peculiar, persistent character pattern in which a person’s personal characteristics and behavior go beyond the norm.
There are several types of pathology, among which is hysterical personality disorder. All existing constitutional psychopathy (outdated name) are united by one fact: they begin to manifest themselves at the end of childhood or adolescence, and accompany the patient until the end of his life.

Definition

Hysterical disorder is a pathological personality disorder accompanied by the following mandatory symptoms:

• emotional instability with bright, expressive outbursts;
• desire to always be in the center of attention;
• theatricality, drama, exaggeration of reality;
• the desire to look attractive (by the standards of the individual).

Often the vulgar appearance and behavior of such a person express unnatural attempts at seduction that run counter to the canons of attractiveness.

Hysterical is the most common, accepted definition of this psychopathology, but a little outdated. In a new manner, the disorder was called histrionic.

One of the reasons for changing the previous name is its offensive nature, used in everyday life. In fact, hystera means “uterus” in Greek. Previously, it was believed that women were more susceptible to the disorder, and the reason lay in the unconscious suppression of sexual desire. Freud put forward this theory.

The psychoanalyst believed that the formation of the defect was facilitated by the rejection of the child’s sexuality during puberty by the parents: the coldness of the parent of the opposite sex and competition with the same-sex “ancestor.” Subsequently, the child develops a devaluation of his own gender and a fear of the opposite. He develops three main unconscious psychological defense mechanisms that lead to the occurrence of a disorder:

• reference to earlier stages of development, infantile behavior;
• containment, rejection of one’s own sexuality;
• unconsciously giving negative events an erotic meaning, giving them a positive connotation.

Therefore, hysterical individuals often look overly sexual, vulgar and provocative, but they themselves are not aware of the message they are sending to others. Agreeing to the proposed intimate contact in order to subconsciously justify their own behavior, they often do not receive sexual satisfaction.

The modern interpretation says: pathology develops as a result of suppressed emotions. When a child or teenager experiences attention deficit, loved ones are cold towards him. Any attempts to show feelings are ignored, ridiculed or given another negative imprint.

A 40-year-old patient describes her relationship with her mother: “My parents divorced early. I don’t remember my own father. My mother was a cruel, prejudiced woman who wished me harm. Once she even kicked me out of the house, “in what I gave birth.” She was terribly jealous of her stepfather. The relationship with him was good until he became addicted to alcohol, after which he began to show aggression and physical violence.” Subsequently, the woman, having ended up in the hospital, claimed that she saw her mother’s face on the ceiling, who hurled insults at her. But, according to the patient, she began to pray, and everything went away.

Compensating for suppressed emotions, the individual resorts to demonstrativeness and inappropriate behavior in order to attract attention. The current name of the disorder is histrionic, which is translated from Latin as “acting,” characterizing with incredible accuracy the patient’s manners.

Institute of Clinical Psychiatry and Psychology

Psychopaths are the most unpopular and frightening patients a psychologist encounters. The essence of psychopathy is aptly captured by the diagnostic criterion that the organizing principle of the antisocial personality is to “make” everyone or to deliberately manipulate others. Experienced clinicians have observed that psychopaths—those who avoid incarceration—tend to burn out by middle age, often becoming surprisingly good citizens.

Antisocial individuals have innate tendencies toward aggressiveness and a higher than average threshold for pleasurable arousal. Instead of expressing (voicing) their emotions in words, psychopaths act. When these people do feel, they seem to be experiencing either blind hatred or manic joy. A psychopath needs a jarring, jolting experience to feel energized and good, which explains their constant desire for thrills and their apparent inability to learn through experience. The clinician cannot hope to establish a connection with such a patient through recognition of his feelings - the psychopath does not know how to determine what he is feeling.

The main psychological defense of psychopaths is omnipotent control. They also use projective identification, a variety of subtle dissociative processes, and acting out.

Psychopaths will openly brag about their victories, conquests, successful schemes and deceptions if they think that the listener will be impressed by their POWER. Such a criminal easily confesses to the murder, but at the same time hides taking a few dollars from the victim’s bag, regarding the insignificance of the amount as a sign of weakness.

An important diagnostic criterion for psychopathy is dissociation of personal responsibility. A remorseful cheater might say, “I thought badly about that,” but when asked to specify what he thought wrongly, the psychopath will regret being caught, not that he committed the scam.

When psychopaths are irritated or upset, they have an internal urge to act. Unlike healthy people, they do not control their own reactions. Taking control of one's own destructive impulses for psychopaths is NOT a manifestation of willpower that brings self-satisfaction and strengthens self-esteem. This is directly related to their early childhood experiences.

Childhood of a Psychopath

The childhood of psychopaths is often characterized by an abundance of dangers. They grow up in a chaos of harsh discipline and over-spoiling: the parental couple is a weak, depressed, masochistic mother and a hot-tempered, inconsistent, sadistic father. Patterns of moving, loss, and family breakups are common. This forces children to spend most of their lives searching for confirmation of their omnipotence.

The roots of this nature can be found in personal history, when parents or other important figures demonstrated power and enjoyed the fact that no one could limit it. Such parents tend to resent the actions of teachers, psychologists or law enforcement officers when they try to impose restrictions on the antisocial actions of their children.

Psychopaths cannot recognize the presence of ordinary emotions in themselves, since they associate feelings with weakness and vulnerability. An antisocial individual simply never experienced attachment to a normal degree, did not want to be the same as those who cared about him (did not identify himself with other people).

The potential psychopath has serious difficulty developing self-esteem by experiencing the love and pride of his parents. His parents either beat him severely or gave up helplessly, not knowing what to do with him. No one was proud of him, no one loved him. Anyone whose self-image reflects unrealistic ideas of superiority, one who avoids the obvious fact that he is only human, will try to restore self-respect through the exercise of power.

A congenitally hyperactive, demanding, absent-minded child needs much more active parental care than a calm and easily consoled child. The more helpless the parents were when faced with an aggressive child, the fewer clear restrictions there were in his childhood and the less he understands the consequences of his impulsive actions. From a social learning theory perspective, a child's grandiosity is an expected result of being raised without proper discipline.

Another feature of the self-experience of psychopathic patients is primitive envy - the desire to destroy everything that is most desired. Antisocial people of a psychotic level are known to kill those who attract them.

Psychopath at the reception

Antisocial individuals typically intend to defeat the therapist. Some psychopaths are so flawed, dangerous, and so intent on destroying the therapist's goals that their psychotherapy can only be an exercise in naivety.

The main transference of psychopaths towards the therapist is the projection of their inner animal self onto him - the assumption that the clinician intends to use the patient for his selfish purposes. Completely lacking the emotional experience of love and empathy, the antisocial patient tries to gauge the therapist's "interest." A naive therapist may not be able to resist the temptation and try to prove his intentions to help.

A common countertransference to the patient's desire to "not be fooled" and his desire to outsmart the therapist is shock. Sometimes the therapist becomes overwhelmed by the feeling that his identity as a “helper” is being destroyed. Common in such cases are countertransference feelings of hostility, contempt, and moralistic admonishment towards the psychopathic personality. Such reactions are called concordant, i.e. identical for both the therapist and the patient.

Another countertransference reaction is terrifying fear. This is complimentary, i.e. a complementary reaction to the patient's coldness and ruthlessness. In addition to fear, therapists report countertransference concerns that such a patient will subject them to his influence. Gloomy forebodings are common.

It is important that the clinician is able to tolerate these sensations rather than trying to deny or compensate for them.

The psychopath may be jealous of the therapist and cope with his envy through sadistic devaluation, which often produces intense hostility and feelings of helplessness in the clinician. Awareness of these psychodynamics helps to maintain some intellectual comfort in the face of the open contempt expressed by the patient.

Minimizing the threat posed by the psychopath is both realistically and dynamically unwise: it may encourage the patient to demonstrate his destructive power.

The most important feature of therapy is the consistency and integrity of the therapist. The patient may perceive empathy as weakness. The feeling of reciprocal gratitude is alien to him. The therapist who "gives in" gives the psychopath a feeling of sadistic triumph. It is unrealistic to expect love from antisocial people, but you can earn their respect by persistently confronting and demanding of them. When I work with these patients, I insist on payment being made at the BEGINNING of each session.

Associated with integrity is uncompromising honesty and keeping promises. Honesty does not mean self-disclosure or moralizing.

It simply means that the therapist must come to terms with his own antisocial tendencies in order to have a basis for identification with the patient's psychology. For example, when discussing payment with such a patient, you need to be willing to openly admit your selfishness and greed.

Any instance in which the patient restrains his own impulses and takes pride in exercising self-control should be considered a major milestone in the treatment of antisocial personality.

Unlike therapy for patients with other diagnoses, the therapist of a psychopathic client must adopt an attitude of “bordering on indifference of independent power.” You should not emotionally “invest” in the patient. Once the patient perceives the therapist's hopes and needs, he will immediately begin to sabotage the psychotherapy in order to defeat him and feel superior. It is better to let the patient understand that it is up to him whether or not to benefit from psychotherapy.

Source: https://rorschach-club.livejournal.com

Symptoms

Manifestations of hysterical psychopathy are quite vivid and noticeable. A person constantly strives to be the center of attention. We can say that this is vital for him, and it doesn’t matter what the reaction of others is: approval, censure or bewilderment. The main thing for him: to provoke a response.

The behavior of patients is pretentious, demonstrative, feigned. If they have an ordinary appearance, they try to bring shockingness and expressiveness. Natural beauty is emphasized even more, honing the image to perfection. Typical is the use of seduction techniques that are inadequate and provocative in nature. They fall in love easily, taking their love to extreme measures. But their inconstancy also extends to love feelings: they quickly fade away. Multiple love affairs become commonplace.

Particular attention should be paid to the emotionality of a hysterical personality. Each of her emotions reaches excessive expression and is inappropriately exaggerated. If it is sadness, then with sobs, love - in a whirlwind, joy - enthusiastic, indescribable. Patients do not restrain themselves; they play out an ordinary, everyday situation with excessive dramatization.

From the outside it may seem that a person is experiencing an emotion with all his being. In fact, everything is feigned and deceitful. The essence of the process is to play the role well. These are demonstrative individuals who crave attention. Their attitude to the world is superficial. They do not delve into the depths of the situation, snatching only those facts on which they can “play”, and do not study the essence of the issue. Their goal: to attract attention, to produce an effect.

Mysterious illness

People suffering from hysterical disorder tend to invent and attribute to themselves the presence of unexplained diseases. They colorfully describe symptoms, go into detail, and show dramatic reenactments. Their condition is often accompanied by autonomic disorders that reach extreme levels of manifestation: fainting, attacks of suffocation, nausea, loss of voice, sensitivity, immobility of the limbs.

In search of sympathy and attention, they often visit hospitals, pretending to be sick and helpless. If little attention is paid to them, the attacks intensify. Seeing that they are being watched, patients with hysterical personality disorder perfectly play the role of the sick person. But when they are distracted and forgotten, their condition suddenly improves.

The patient consulted a doctor with complaints of constant weakness and fatigue. I was worried about insomnia, frequent dizziness, and trembling of the limbs. “There are times when my legs give out.” She claimed that she suffered complete paralysis of her arms and legs twice. However, in both cases everything was somehow restored mysteriously. She complained about being in a bad mood.

On examination: she is too cutesy, tries to imitate a staggering gait, loses consciousness. Expresses apathy, worry about the future, talks about his imminent death. Complains of memory loss. But when surrounded exclusively by patients, she transforms, becomes cheerful, sociable, and the lost memory suddenly returns. At a meeting with her husband she becomes a flirtatious, attractive young woman.

Treatment and therapy

Drug treatment is unproductive for personality disorders (although it helps, for example, with the symptoms of depression associated with hysterical disorder), so psychotherapy is mainly used.

Psychoanalytic

According to supporters of psychoanalysis, one of the most favorable prognoses is when using psychoanalytic therapy. The therapist should remember, however, that attempts at seduction are one of the main attention-getting techniques in the hysteric's arsenal, and will no doubt be used on the therapist as well; however, if seduction towards the therapist is successful, it can have the most destructive effect both on the course of therapy and on the internal state of the client. Another serious difficulty in treating hysterical clients is erotic countertransference, which often arises in therapy with this type of client.

During therapy with any therapist, a hysterical person very quickly develops a strong transference, the characteristics of which strongly depend on the gender of the therapist. With a therapist of the opposite sex, the hysterical client typically feels aroused, fearful, and defensively seductive. Feels hostility and competition towards a therapist of the same sex. In both cases, the transference most obviously replicates the client's child-parent conflict.

There are a number of other serious problems that arise in the therapy of such people, such as: countertransference to the client’s regression, the irritation that it can cause in the therapist, erroneous underestimation of overly theatrically described experiences, and others.

A look from the inside

Hysterical psychopaths are very trusting, suggestible, and are easily drawn into deception. Often they do not have their own opinion, giving in to someone else’s. They easily get involved in adventures. Endowed with a rich imagination, it is difficult for them to separate reality from fantasy, so they are often accused of lying.

People with hysterical disorder do not like to work, especially where high professionalism, refined skills and perseverance and effort are required.

The woman, in her words, developed a tremor (trembling) throughout her body, her legs gave way, her tongue fell out, she mumbled and growled, and there was a short-term loss of consciousness while working in the garden. The reason, in her opinion, was fatigue and overwork.

Such individuals choose easy, uncomplicated work. They love to attend social events and talk about beauty. They prefer a hedonistic lifestyle, seeking to gain benefits and pleasure.

There is an opinion about hysterical psychopaths as immature, frivolous, “empty” individuals.

The thinking of a patient with histrionic disorder is called “wishful thinking,” known as wishful thinking. His mental activity is driven by his own desires. They take over the mind so much that they can distort thoughts so that they do not correspond to reality. In other words, everything that goes against what he wants is ignored. Everything he wants is correct, the rest is complete delusion, incorrect, insignificant.

People with hysterical disorder love to extol themselves and exaggerate their merits. They try to appear super-erudite and gifted, using a few simple pieces of knowledge. They boast about meeting famous people.

The Russian poetess Zinaida Gippius, the decadent Madonna as her contemporaries called her, suffered from this disorder. “I love myself like God,” says Zinaida Nikolaevna in one of her poems called “Dedicated.”

The poetess expressed her desire to amaze and conquer in everything. She put on such bright, expressive makeup that her face looked like a mask. It looked very unnatural and atypical for the late 19th century. Gippius' movements were affected by mannerism and absurdity. She was ready to go to any lengths to attract attention and admiring glances.

Having been married for 10 years, Zinaida Nikolaevna remained a virgin, which she flaunted at every opportunity. She considered herself bisexual: “in my spirit I am more of a man, in my body I am more of a woman.” Some contemporaries considered her a hermaphrodite.

Hysterical individuals with pathological fantasies are dangerous to society. They make excellent swindlers, healers, and fortune tellers. At a young age, they are so immersed in their fantasies that they invent non-existent situations: how they developed secret weapons, carried out complex operations, are able to confess to a murder they did not commit.

Causes and symptoms of hysterical psychopathy

Experts consider heredity and childhood trauma to the nervous system to be one of the main and most common causes of this pathology. The acquired form of psychopathy always begins with a specific traumatic event in a person’s life. An example is the case when a long-awaited and only child is born to parents after the tragic death of another child. The fear of loss and the feeling of guilt in front of the departed older child provoke adults to broadcast the talent and exclusivity of their child into society, to overprotect the child, pamper him, indulge all his whims, overpraise him and never punish him for bad deeds.

Such children show signs of hysterical psychopathy from a very early age, thereby manipulating everyone. They are capricious, disobedient, uncompassionate, and demonstrative in their actions. Probably, each of us has seen in our lives a child stomping or falling to the floor, beating in a terrible hysterics. These children have their own bright talents: they read poetry with pleasure and emotion, sing in public, and take an active part in various children's events and concerts. To attract attention to themselves, they can go to extreme measures: lie, invent amazing stories about themselves, pass off their fantasies as reality. With age, these features intensify. This is especially pronounced in puberty girls and menopausal women.

One of the signs of such fantasies is the pedantic detail of invented events, down to unimportant details, excessive emotional coloring of what is happening, increased gestures and facial expressions. While telling a fictitious story, the patient may suddenly scream, burst into tears, laugh loudly, show excitement by breathing, etc.

Diagnosis and treatment

To make a diagnosis of “hysterical personality disorder,” a pathopsychological study is of great importance: anamnesis, conversation, experiment, observation of the patient during a conversation and without his knowledge.

When working with such patients, it is important to evaluate their behavior not only from the patient’s words, but also by observing them from the outside, since they tend to exaggerate their condition. Relatives provide invaluable assistance in making a diagnosis.

There are special tests to determine histrionic personality disorder, which can even be taken online. But they cannot be the only diagnostic criterion.

Pharmacotherapy for histrionic disorder is ineffective. Pathology is treated with psychotherapy. However, one should take into account the inclusion of protective mechanisms of the patient’s psyche when working with a psychotherapist, such as transference and countertransference, which complicate therapy.

Story

The concept of hysteria began with the ancient Egyptian idea that if the uterus is not anchored, it will wander throughout the body and stop at a certain place, causing hysterical symptoms there. Treatment consisted of returning the uterus to its normal position by fumigating or smearing the vagina with incense, or driving the uterus from a new location by inhalation or application of foul-smelling poisonous substances to the affected area. Hippocrates' prescriptions often included marriage and childbearing—recommendations doctors still give to their hysterical patients today.

Millon (1981) gives an excellent overview of early German descriptions of the hysterical character, briefly describing the long-standing controversy over the use of the term. For example, according to Millon, as early as 1923 Schneider used the label "attention-seeking" as a substitute for "hysterical", arguing that the latter term implied a moral judgment and had too broad and vague a meaning.

Although psychoanalytic theory derives from Freud's explanation of the symptoms of hysteria, his primary interest focused on conversion hysteria rather than hysterical personality traits. Early psychodynamic accounts emphasize unresolved oedipal conflicts as the primary determinant of the disorder, and repression is seen as the most characteristic type of defense. Abraham (1927/1948), Fenichel (1945) and Reich (1945) emphasized the significant role of the Oedipus complex, as well as castration anxiety and penis envy, in the development of the hysterical personality. They viewed oral fantasies as a defensive regression against the dominant features of the Oedipus complex. Based on the belief that the release of repressed sexual emotions would lead to a cure, psychoanalytic treatment of hysteria initially consisted of suggestive influences and hypnosis to facilitate abreaction. Freud later modified his method to include the use of free association and the interpretation of resistance and transference to facilitate the achievement of insight and abreaction. Although the treatment of hysteria has been considered the basis of the psychoanalytic method, few empirical, controlled studies have been published.

Marmor (1953) challenged the classical psychoanalytic view by raising the question of whether the fixation of the hysterical personality is primarily oral rather than phallic in nature, suggesting a deeper and more primitive disorder. Several psychoanalytic theorists have reached a compromise between these two views, proposing differentiations within the spectrum of histrionic personality (Easser & Lesser, 1965; Kernberg, 1975; Zetzel, 1968). Not long ago, Baumbacher & Amini (1980-1981) identified three subgroups of disorders in GPD: 1) neurosis of a hysterical nature, associated with the classic triadic Oedipus complex; 2) hysterical personality disorder, which occurs at the initial phallic stage and is thus associated with dyadic (mother-child) problems; 3) borderline personality organization with hysterical characteristics, characterized by more primitive types of defenses of the pre-Oedipal stages.

In factor analytic studies, Lazare, Klerman, and Armor (1966, 1970) found that four of the seven traits traditionally associated with histrionic personality clustered together as expected. The traits of emotionality, exhibitionism, egocentrism, and sexual provocation were grouped together, while the traits of suggestibility and fearful sexuality did not form a group. Dependency was in the middle position. It was surprising that the hysterical traits group included traits such as aggression, oral expression, stubbornness, and rejection of others. Based on these results, Lazar and his colleagues concluded that their sample of hysterical patients probably corresponded to a more primitive, pregenital variant of hysteria.

Already in the DSM-I (APA, 1952), a distinction was made between what was considered the neurotic aspects of hysteria (the conversion reaction) and the personality aspects (then called the “emotionally unstable personality”). The DSM-II (APA, 1968) distinguished hysterical neurosis (including conversion reaction and dissociative reaction) and hysterical personality. Although psychoanalytic theories of the hysterical personality were better known than any other concept, they apparently did not have much influence on official classifications. For example, the diagnosis of histrionic personality in the DSM-II was based on groups of traits and behaviors, and histrionic personality was defined as a pattern of behavior “characterized by excitability, emotional instability, excessive reactivity, and demonstrativeness... These individuals are also immature, self-focused, often vain and highly dependent on others” (p. 43). As noted earlier, the DSM-III (APA, 1980) did not use the term “hysteria” at all, but instead described a separate category of histrionic personality disorder.