UNIT 3 DEPENDENT AND HISTRIONIC

PERSONALITY DISORDER
Structure
3.0 Introduction
3.1 Objectives
3.2 Dependent Personality Disorder
3.2.1 Diagnostic Features
3.2.2 Causes
3.2.3 Treatment

3.3 Histrionic Personality Disorder

3.3.1 Diagnostic Features of Histrionic Personality Disorder
3.3.2 Causes of Histrionic Personality Disorder
3.3.3 Treatment of Histrionic Personality Disorder
3.3.3.1 Cognitive Behaviour Therapy
3.3.3.2 Group Therapy
3.3.3.3 Family Therapy
3.3.4 Prognosis

3.4 Let Us Sum Up

3.5 Unit End Questions
3.6 Glossary
3.7 Suggested Readings

3.0 INTRODUCTION
In your social interactions you might come across such persons who are extremely
dependent on other persons. They behave in extremely submissive way. They show
acute discomfort at the possibility of separation or sometimes of simply having to be
alone. They build their lives around other people and subordinate their own needs
or views for the sake of other persons, even when their needs are justified and their
views are right. The persons having these characteristics are labeled as suffering from
dependent personality disorder. On the other hand, you might come across to such
persons are typically concerned about their looks. They are inclined to express their
emotions in an exaggerated fashion; for example hugging someone they have just met
or crying uncontrollably during a sad movie. Their self-esteem depends on the approval
of others and does not arise from a true feeling of self-worth. These are the characteristic
features of histrionic personality disorder. In the present unit we will discuss the
nature and symptoms of dependent and histrionic personality disorders. We will also
attempt to understand the causes and treatment of dependent and histrionic personality
disorders.

3.1 OBJECTIVES
After completing this unit, you will be able to:
 Explain the meaning of dependent personality disorder;
34
 Describe the diagnostic features of dependent personality disorder; Dependent and Histrionic
Personality Disorder
 Distinguish dependent personality disorder from other forms of personality
disorders;
 Elucidate the causes of dependent personality disorder;
 Explain the treatment of dependent personality disorder;
 Define histrionic personality disorder and explain its symptoms;
 Delineate the diagnostic features of histrionic personality disorder;
 Distinguish histrionic personality disorder from borderline and dependent
personality disorders;
 Analyse the causes of histrionic personality disorder; and
 Describe the psychotherapies used for the treatment of histrionic personality
disorder.

3.2 DEPENDENT PERSONALITY DISORDER

Dependent personality disorder, formerly known as asthenic personality disorder is
a personality disorder that is characterised by a pervasive psychological dependence
on other people. Persons affected by dependent personality disorder have a
disproportionately low level of confidence in their own intelligence and abilities and
have difficulty in making decisions and undertaking projects on their own. They rely
on others to make ordinary decisions as well as important ones. Their pervasive
reliance on others, even for minor tasks or decisions, makes them exaggeratedly
cooperative out of fear of alienating those who help their needs. Individuals with
dependent personality disorder sometimes agree to other people when their own
opinion differs, so as not to be rejected (Hirschfeld, Shea, & Weise, 1995). They
are reluctant to express disagreement with others and are often willing to go to
abnormal lengths to win the approval of those on whom they rely. Their desire to
obtain and maintain supportive and nurturant relationships may lead to lead to their
other behavioural characteristics (Bornstein, 1997), including submissiveness, timidity,
and passivity. Another common feature of the disorder is an exaggerated fear of
being left to fend for oneself. Adolescents with dependent personality disorder rely
on their parents to make even minor decisions for them, such as what they should
wear or how they should spend their free time, as well as major ones, such as what
college they should attend or which career they should choose.
In the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Text
Revision (DSM-IV-TR), the American Psychiatric Association states that five of the
following criteria should be present for a diagnosis of dependent personality disorder.
Has difficulty making everyday decisions without an excessive amount of advice and
reassurance from others;
Require others to take responsibility for major decisions and responsibilities beyond
what would be age-appropriate (e.g., letting a parent choose a college without
offering any input on the decision);
Has difficulty expressing disagreement with others because of fear of loss of support
or approval;
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Personality Disorders Has difficulty initiating projects or doing things on his or her own (because of a lack
of self-confidence in judgment or abilities rather than a lack of motivation or energy);
Goes to excessive lengths to obtain nurturance and support from others, to the point
of volunteering to do things that are unpleasant;
Feels uncomfortable or helpless when alone because of exaggerated fears of being
unable to care for himself or herself;
Urgently seeks another relationship as a source of care and support when a close
relationship ends;
Is unrealistically preoccupied with fears of being left to take care of himself or herself.
Dependent personality disorder is more common in those who have suffered from
chronic illness in childhood.
A child may also exhibit dependent behaviour in response to a specific stressful life
event (such as the death of a caregiver or divorce). However, it should not be
considered a potential symptom of dependent personality disorder unless the behaviour
becomes chronic and significantly interferes with day-to-day functioning and/or causes
the child significant distress.
The ICD- 10 of World Health Organisation lists dependent personality disorder as
F 60.7.
Dependent personality disorder is characterised by at least 3 of the following:
 encouraging or allowing others to make most of one’s important life decisions;
 subordination of one’s own needs to those of others on whom one is dependent,
and undue compliance with their wishes;
 unwillingness to make even reasonable demands on the people one depends on;
 feeling uncomfortable or helpless when alone, because of exaggerated fears of
inability to care for oneself;
 preoccupation with fears of being abandoned by a person with whom one has
a close relationship, and of being left to care for oneself;
 limited capacity to make everyday decisions without an excessive amount of
advice and reassurance from others.

3.2.1 Diagnostic Features

The essential feature of Dependent Personality Disorder is a pervasive and excessive
need to be taken care of. Individuals with Dependent Personality Disorder have
great difficulty making everyday decisions (e.g., what color shirt to wear to work or
whether to carry an umbrella) without an excessive amount of advice and reassurance
from others (Criterion 1).
These individuals tend to be passive and to allow other people to take the initiative
and assume responsibility for most major areas of their lives (Criterion 2).
Adults with this disorder typically depend on a parent or spouse to decide where
they should live, what kind of job they should have, and which neighbours to befriend.
Adolescents with this disorder may allow their parent(s) to decide what they should
36
wear, with whom they should associate, how they should spend their free time, and Dependent and Histrionic
Personality Disorder
what school or college they should attend.
This need for others to assume responsibility goes beyond age appropriate and
situation appropriate. Because they fear losing support or approval, individuals
with dependent personality disorder often have difficulty expressing disagreement with
other people, especially those on whom they are dependent (Criterion 3).
These individuals feel so unable to function alone that they will agree with things that
they feel are wrong rather than risk losing the help of those to whom they look for
guidance.
They do not get appropriately angry at others whose support and nurturance they
need for fear of alienating them. Individuals with this disorder have difficulty initiating
projects or doing things independently (Criterion 4).
They lack self-confidence and believe that they need help to begin and carry through
tasks. They will wait for others to start things because they believe that as a rule
others can do them better.
These individuals are convinced that they are incapable of functioning independently
and present themselves as inept and requiring constant assistance.
They are, however, likely to function adequately if given the assurance that someone
else is supervising and approving.
There may be a fear of becoming or appearing to be more competent, because they
may believe that this will lead to abandonment.
Because they rely on others to handle their problems, they often do not learn the
skills of independent living, thus perpetuating dependency.
Individuals with Dependent Personality Disorder may go to excessive lengths to obtain
nurturance and support from others, even to the point of volunteering for unpleasant
tasks if such behaviour will bring the care they need (Criterion 5).
They are willing to submit to what others want, even if the demands are unreasonable.
Their need to maintain an important bond will often result in imbalanced or distorted
relationships.
They may make extraordinary self-sacrifices or tolerate verbal, physical, or sexual
abuse.
Individuals with this disorder feel uncomfortable or helpless when alone, because of
their exaggerated fears of being unable to care for themselves (Criterion 6).
They will “tag along” with important others just to avoid being alone, even if they are
not interested or involved in what is happening.
When a close relationship ends (e.g., a breakup with a lover; the death of a caregiver),
individuals with dependent personality disorder may urgently seek another relationship
to provide the care and support they need (Criterion 7).
Their belief that they are unable to function in the absence of a close relationship
motivates these individuals to become quickly and indiscriminately attached to another
person. Individuals with this disorder are often preoccupied with fears of being left
to care for themselves (Criterion 8).
37
Personality Disorders They see themselves as so totally dependent on the advice and help of an important
other person that they worry about being abandoned by that person when there are
no grounds to justify such fears. To be considered as evidence of this criterion, the
fears must be excessive and unrealistic.
Dependent Personality Disorder must be distinguished from other personality disorders,
especially from borderline personality disorder, histrionic personality disorder, and
avoidant personality disorder, because they have certain features in common. It is,
therefore, important to distinguish among these disorders based on differences in
their characteristic features.
Similarities and differences
Both dependent personality disorder and borderline personality disorder are
characterised by fear of abandonment.
However, the individual with borderline personality disorder reacts to abandonment
with feelings of emotional emptiness, rage, and demands.
The individual with dependent personality disorder reacts with increasing appeasement
and submissiveness and urgently seeks a replacement relationship to provide caregiving
and support.
Borderline personality disorder patients show a typical pattern of unstable and intense
relationships.
Individuals with histrionic personality disorder, like those with dependent personality
disorder, have a strong need for reassurance and approval and may appear childlike
and clinging.
However, unlike dependent personality disorder, which is characterised by self-effacing
and docile behaviour, histrionic personality disorder is characterised by gregarious
flamboyance with active demands for attention.
Both dependent personality disorder and avoidant personality disorder are
characterised by feelings of inadequacy, hypersensitivity to criticism, and a need for
reassurance.
However, individuals with avoidant personality disorder have such a strong fear of
humiliation and rejection that they withdraw until they are certain they will be accepted.
In contrast, individuals with dependent personality disorder have a pattern of seeking
and maintaining connections to important others, rather than avoiding and withdrawing
from relationships.

3.2.2 Causes
Although the exact cause of dependent personality disorder is not known, it most
likely involves both biological and developmental factors.
Some researchers believe an authoritarian or over-protective parenting style can lead
to the development of dependent personality traits in people who are susceptible to
the disorder.
It is commonly thought that the development of dependence in these individuals is a
result of over-involvement and intrusive behaviour by their primary caretakers.

38
Caretakers may foster dependence in the child to meet their own dependency needs, Dependent and Histrionic
Personality Disorder
and may reward extreme loyalty but reject attempts the child makes towards
independence.
Families of those with dependent personality disorder often do not express their
emotions and are controlling.
They demonstrate poorly defined relational roles within the family unit.
Some other researchers suggest that dependent children are insecurely attached to
their mothers or other caregivers and may not have had close and trusting relationships
with others during childhood.
Individuals with dependent personality disorder often have been socially humiliated
by others in their developmental years. Hence they may carry significant doubts
about their abilities to perform tasks, take on new responsibilities, and generally fear
to function independently of others. This reinforces their suspicions that they are
incapable of living autonomously.
In response to these feelings, they portray a helplessness that elicits care giving
behaviour from some people in their lives.

3.2.3 Treatment
The primary treatment for dependent personality disorder is psychotherapy with an
emphasis on learning to cope with anxiety, developing assertiveness, and improving
decision-making skills. The most effective psychotherapeutic approach is one which
focuses on solutions to specific life problems the patient is presently experiencing.
Long term therapy, while ideal for many personality disorders, is contra indicated in
this instance since it reinforces a dependent relationship upon the therapist. While
some form of dependency will exist, no matter of the length of therapy, the shorter
the better in this case. Examining the client’s faulty cognitions and related emotions
(of lack of self-confidence, autonomy versus dependency, etc.) can be an important
component of therapy.
Assertiveness training and other behavioural approaches have been shown to be
most effective in helping treat individuals with this disorder.
Group therapy can also be helpful, although care should be utilised to ensure that the
patient doesn’t use groups to enhance existing or new dependent relationships.
Challenging dependent relationships the client has with others that may be unhealthy
for the client should generally be avoided at the onset of therapy.
As therapy progresses, these challenges can occur but must be done carefully;
restraint must be used if the individual is not ready to give up these unhealthy
relationships.
Termination issues will likely be of extreme importance and will virtually be a litmus
test of how effective the therapy has been.
If the individual cannot end therapy successfully and move on to become more self-
reliant, it should not be seen as a therapeutic failure. Rather, the individual was not
likely seeking life-changing therapy in the first instance but instead solution-focused
therapy.

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Personality Disorders
Self Assessment Questions
1) What do you mean by dependent personality disorder?
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2) Discuss the diagnostic features of dependent personality disorder.
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3) How does dependent personality disorder differ from other personality disorder?
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4) Explain the causes of dependent personality disorder.
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5) How can dependent personality disorder be treated? Discuss the methods of
treatment.
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3.3 HISTRIONIC PERSONALITY DISORDER

Histrionic personality disorder is a type of personality disorder in which the affected
individual displays an enduring pattern of attention-seeking and excessively dramatic
behaviours beginning in early adulthood and present across a broad range of situations.
Individuals with histrionic personality disorder are highly emotional, charming, energetic,
manipulative, seductive, impulsive, erratic, and demanding. Individuals with histrionic
personality disorder tend to be so overly dramatic that they often seem almost to be
40 acting which is why, the term histrionic, which means theatrical in manner, is used.
The Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition- Text Dependent and Histrionic
Personality Disorder
Revised (the DSM-IV- TR) classifies histrionic personality disorder as a personality
disorder. More specifically, histrionic personality disorder is classified by DSM-IV-
TR as a Cluster B (dramatic, emotional, or erratic) personality disorder. The personality
disorders which comprise Cluster B include histrionic, antisocial, borderline, and
narcissistic. Histrionic personality disorder is defined as a personality
disorder characterised by a pattern of excessive emotionality and attention seeking
including an excessive need for approval and inappropriate seductiveness usually
beginning in early adulthood. These individuals are lively, dramatic, enthusiastic, and
flirtatious.
DSM-IV-TR lists eight symptoms that form the diagnostic criteria for histrionic
personality disorder. An individual having at least five of the below characteristics
might be considered to have a histrionic personality disorder:
 Center of attention: Patients with histrionic personality disorder experience
discomfort when they are not the center of attention.
 Sexually seductive: Patients with histrionic personality disorder displays
inappropriate sexually seductive or provocative behaviours towards others.
 Shifting emotions: The expression of emotions of patients with histrionic personality
disorder tends to be shallow and to shift rapidly.
 Physical appearance: Individuals with histrionic personality disorder consistently
employ physical appearance to gain attention for themselves.
 Speech style: The speech style of patients with histrionic personality disorder
lacks detail. Individuals with histrionic personality disorder tend to generalise,
and when these individuals speak, they aim to please and impress.
 Dramatic behaviours: Patients with histrionic personality disorder display self-
dramatisation and exaggerate their emotions.
 Suggestibility: Other individuals or circumstances can easily influence patients
with histrionic personality disorder.
 Overestimation of intimacy: Patients with histrionic personality disorder
overestimate the level of intimacy in a relationship.
The ICD-10 of World Health Organisation lists histrionic personality disorder
as (F60.4) Histrionic personality disorder is characterised by at least 3 of the following:
 self-dramatisation, theatricality, exaggerated expression of emotions;
 suggestibility, easily influenced by others or by circumstances;
 shallow and labile affectivity;
 continual seeking for excitement and activities in which the patient is the center
of attention;
 inappropriate seductiveness in appearance or behaviour; and
 over-concern with physical attractiveness.
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder
also satisfies a set of general personality disorder criteria.
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Personality Disorders 3.3.1 Diagnostic Features of Histrionic Personality
Disorder
Excessive attention-seeking behaviour and emotionality is the essential feature
of histrionic personality disorder. Individuals with histrionic personality disorder tend
to feel unappreciated if not the center of attention, and their lively, dramatic, and
excessively extraverted styles often ensure that they can charm others into attending
to them.
In seeking attention, their appearance and behaviour are often quite theatrical and
emotional, as well as sexually provocative and seductive. They are inclined to express
their emotions in exaggerated fashion; for example hugging someone they have just
met are crying uncontrollably during a sad movie (Pfohl, 1995).
They are often seductive in appearance and behaviour, and typically concerned
about their looks; for example they may spend a great deal of money on unusual
jewelry. Their style of speech may also be dramatic but is quite impressionistic but
often vague, lacking in detail, and characterised by hyperbole.
The cognitive style associated with histrionic personality disorder is impressionistic
(Shapiro, 1965) characterised by a tendency to view situations in very global, black-
and-white terms. Individuals with this disorder are usually able to function at a high
level and can be successful socially and professionally.
People with histrionic personality disorder usually have good social skills but they
tend to use these skills to manipulate other people and become the center of attention.
Furthermore, histrionic personality disorder may affect a person’s social
or romantic relationships or their ability to cope with losses or failures.
Their sexual adjustment is usually poor (Apt and Hurlbert, 1994) and their interpersonal
relationships are stormy because they may attempt to control their partner through
seductive behaviour and emotional manipulation, but they also show a good deal of
dependence.
Usually they are considered to be self-centered, vain, and over-concerned about the
approval of others. People with these disorders have also distorted self-images.
For people with histrionic personality disorder, their self-esteem depends on the
approval of others and does not arise from a true feeling of self-worth.
They have an overwhelming desire to be noticed, and often behave dramatically or
inappropriately to get attention.
Prevalence rate
The prevalence of histrionic personality disorder in the general population is estimated
to be approximately 2%-3% (and 10%-15% of psychiatric outpatients). Individuals
who have experienced pervasive trauma during childhood have been shown to be at
a greater risk for developing histrionic personality disorder as well as for developing
other personality disorders.
Clinicians tend to diagnose histrionic personality disorder more frequently in females;
however, when structured assessments are used to diagnose histrionic personality
disorder, clinicians report approximately equal prevalence rates for males and females.
In considering the prevalence of histrionic personality disorder it is important to
42
recognise that gender role stereotypes may influence the behavioural display of histrionic
personality disorder and that woman and men may display histrionic personality Dependent and Histrionic
Personality Disorder
disorder symptoms differently.
Similarities and differences
Histrionic Personality Disorder must be distinguished from other personality disorders,
especially from dependent and borderline personality disorders because they have
certain features in common.
It is, therefore, important to distinguish among these disorders based on differences
in their characteristic features.
Both histrionic personality disorder and borderline personality disorder are
characterised by manipulative, projection sensitive, and attention seeking behaviours.
However histrionic personality disorder and borderline personality disorder have
different emphasis.
Borderline personality disorder is characterised by intense clinging dependency, whereas
for the persons with histrionic personality disorder getting the attention of others is
a high priority.
Histrionic personality disorder can further be distinguished from dependent personality
disorder.
Patients with histrionic personality disorder and dependent personality disorder share
high dependency needs, but only dependent personality disorder is linked to high
levels of self-attributed dependency needs.
Moreover, persons with histrionic personality disorder tend to be more active and
seductive as compared to those persons with dependent personality disorder.

3.3.2 Causes of Histrionic Personality Disorder

The exact cause of histrionic personality disorder is not known, but many mental
health professionals believe that both learned and inherited factors play a role in its
development. For example, the tendency for histrionic personality disorder to run in
families suggests that a genetic susceptibility for the disorder might be inherited.
However, the child of a parent with this disorder might simply be repeating learned
behaviour.
Other environmental factors that might be involved include a lack of criticism or
punishment as a child, positive reinforcement that is given only when a child completes
certain approved behaviours, and unpredictable attention given to a child by his or
her parent(s), all leading to confusion about what types of behaviour earn parental
approval.
Psychosexual stages of development through which each individual passes determine
an individual’s later psychological development as an adult.
Early psychoanalysts proposed that the genital phase is a determinant of histrionic
personality disorder. Later psychoanalysts considered the oral phase, Freud’s first
stage of psychosexual development, to be a more important determinant of histrionic
personality disorder.
Most psychoanalysts agree that a traumatic childhood contributes towards the
development of histrionic personality disorder.
43
Personality Disorders Some theorists suggest that the more severe forms of histrionic personality disorder
derive from disapproval in the early mother-child relationship.
Anthony Storr, a psychoanalyst, (1980) has interpreted histrionic behaviour as a
pattern that is often adopted by individuals who do not feel able to compete with
others on equal terms and believe that no one is paying attention to them.
According to Storr such people may have been disregarded by their parents as
children. Although the child repeatedly tried to get the parents to think of him or her
as an individual, those attempts failed.
The child then becomes demanding and resorted to all kinds of dramatic behaviour
in order to be noticed. The less attention the parents paid to the child, the more the
child has to shout or dramatise to get their attention.
Another component of Freud’s theory is the defense mechanism. Defense mechanisms
are sets of systematic, unconscious methods that people develop to cope with conflict
and to reduce anxiety. According to Freud’s theory, all people use defense mechanisms,
but different people use different types of defense mechanisms. Individuals with
histrionic personality disorder differ in the severity of the maladaptive defense
mechanisms they use. Patients with more severe cases of histrionic personality disorder
may utilise the defense mechanisms of repression, denial, and dissociation.

3.3.3 Treatment of Histrionic Personality Disorder

Histrionic personality disorder, like other personality disorders, may require several
years of therapy and may affect individuals throughout their lives. Some professionals
believe that psychoanalytic therapy is a treatment of choice for histrionic personality
disorder because it assists patients to become aware of their own feelings. Long term
psychodynamic therapy needs to target the underlying conflicts of individuals with
histrionic personality disorder and to assist patients in decreasing their emotional
reactivity. Cognitive behaviour therapy, group therapy, and family therapy have been
used for treating histrionic personality disorder.
3.3.3.1 Cognitive Behavioural Therapy
Cognitive therapy is a treatment directed at reducing the dysfunctional thoughts of
individuals with histrionic personality disorder. Such thoughts include themes about
not being able to take care of oneself. Cognitive therapy for histrionic personality
disorder focuses on a shift from global, suggestible thinking to a more methodical,
systematic, and structured focus on problems. Cognitive behavioural training in
relaxation for an individual with histrionic personality disorder emphasises challenging
automatic thoughts about inferiority and not being able to handle one’s life. Cognitive
behavioural therapy teaches individuals with histrionic personality disorder to identify
automatic thoughts, to work on impulsive behaviour, and to develop better problem-
solving skills.
3.3.3.2 Group Therapy
Group therapy is suggested to assist individuals with histrionic personality disorder to
work on interpersonal relationships. Psychodrama techniques or group role play can
assist individuals with histrionic personality disorder to practice problems at work
and to learn to decrease the display of excessively dramatic behaviours. Using role-
playing, individuals with histrionic personality disorder can explore interpersonal
relationships and outcomes to understand better the process associated with different
44
scenarios. Group therapists need to monitor the group because individuals with Dependent and Histrionic
Personality Disorder
histrionic personality disorder tend to take over and dominate others.
3.3.3.3 Family Therapy
To teach assertion rather than avoidance of conflict, family therapists need to direct
individuals with histrionic personality disorder to speak directly to other family
members. Family therapy can support family members to meet their own needs without
supporting the histrionic behaviour of the individual with histrionic personality disorder
who uses dramatic crises to keep the family closely connected. Family therapists
employ behavioural contracts to support assertive behaviours rather than temper
tantrums.

3.3.4 Prognosis
The personality characteristics of individuals with histrionic personality disorder are
long-lasting. Individuals with histrionic personality disorder utilise medical services
frequently, but they usually do not stay in psychotherapeutic treatment long enough
to make changes. They tend to set vague goals and to move toward something more
exciting. Treatment for histrionic personality disorder can take a minimum of one to
three years and tends to take longer than treatment for disorders that are not personality
disorders, such as anxiety disorders or mood disorders.
Research indicates that a relationship exists between poor treatment outcomes and
premature termination from treatment for individuals with Cluster B personality
disorders.
Self Assessment Questions
1) Define histrionic personality disorder and describe its symptoms.
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2) Discuss the diagnostic features of histrionic personality disorder.
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3) Distinguish histrionic personality disorder from dependent personality disorder.
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45
Personality Disorders
4) Explain the causes of histrionic personality disorder.
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5) Discuss the psychotherapies used for the treatment of histrionic personality
disorder.
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3.4 LET US SUM UP

Dependent personality disorder is characterised by a pervasive psychological
dependence on other people. Persons affected by dependent personality disorder
have a disproportionately low level of confidence in their own intelligence and abilities
and have difficulty in making decisions and undertaking projects on their own. They
rely on other to make ordinary decisions as well as important ones. The essential
feature of Dependent Personality Disorder is a pervasive and excessive need to be
taken care of.
The cause of dependent personality disorder is not known, it most likely involves
both biological and developmental factors. It is believed that an authoritarian or over-
protective parenting style can lead to the development of dependent personality traits
in people who are susceptible to the disorder. It is commonly thought that the
development of dependence in these individuals is a result of over-involvement and
intrusive behaviour by their primary caretakers other caregivers or did not have close
and trusting relationships with others during childhood.
The primary treatment for dependent personality disorder is psychotherapy with an
emphasis on learning to cope with anxiety, developing assertiveness, and improving
decision-making skills. The most effective psychotherapeutic approach is one which
focuses on solutions to specific life problems the patient is presently experiencing.
Long-term therapy, while ideal for many personality disorders, is contra-indicated in
this instance since it reinforces a dependent relationship upon the therapist.
Histrionic personality disorder is classified by DSM-IV-TR as a Cluster B (dramatic,
emotional, or erratic) personality disorder. Histrionic personality disorder is a type of
personality disorder in which the affected individual displays an enduring pattern of
attention-seeking and excessively dramatic behaviours beginning in early adulthood
and present across a broad range of situations.
Excessive attention seeking behaviour and emotionality is the essential feature
of Histrionic Personality Disorder. Individuals with histrionic personality disorder tend
to feel unappreciated if not the center of attention, and their lively, dramatic, and
excessively extraverted styles often ensure that they can charm others into attending
46 to them. In seeking attention, their appearance and behaviour are often quite theatrical
and emotional, as well as sexually provocative and seductive. The prevalence of
histrionic personality disorder in the general population is estimated to be approximately Dependent and Histrionic
Personality Disorder
2%-3% (and 10%-15% of psychiatric outpatients
The exact cause of histrionic personality disorder is not known, but many mental
health professionals believe that both learned and inherited factors play a role in its
development. Early psychoanalysts viewed the genital stage of psychosexual
development is a determinant of histrionic personality disorder. Later psychoanalysts
considered the oral phase to be a more important determinant of histrionic personality
disorder. Most psychoanalysts agree that a traumatic childhood contributes towards
the development of histrionic personality disorder.
Some theorists suggest that the more severe forms of histrionic personality disorder
derive from disapproval in the early mother-child relationship.
Psychoanalytic therapy is a treatment of choice for histrionic personality disorder
because it assists patients to become aware of their own feelings. Long-term
psychodynamic therapy needs to target the underlying conflicts of individuals with
histrionic personality disorder and to assist patients in decreasing their emotional
reactivity. Cognitive behaviour therapy, group therapy, and family therapy have been
used for treating histrionic personality disorder.

3.5 UNIT END QUESTIONS

1) Define dependent personality disorder and explain its symptoms.
2) Discuss the diagnostic features of dependent personality disorder.
3) In what respect does dependent personality disorder differ from other forms of
personality disorder?
4) Explain the causes of dependent personality disorder.
5) How can dependent personality disorder be treated? Discuss the methods of
treatment.
6) Explain the nature and symptoms of histrionic personality disorder.
7) Explain the diagnostic features of histrionic personality disorder.
8) In what respect histrionic personality disorder is different from dependent
personality disorder?
9) Discuss the causes of histrionic personality disorder.
10) Discuss psychotherapies used for treating the individuals with histrionic personality
disorder.

3.6 GLOSSARY
Borderline personality disorder : Personality disorder involving extreme “black
and white” thinking, instability in relationships,
self-image, identity and behaviour. Borderline
personality disorder occurs in 3 times as many
females than males.
Cognitive-behavioural therapy : Group of treatment procedures aimed at
identifying and modifying faulty thought
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Personality Disorders processes, attitudes and attributions, and
problem behaviours.
Dependent personality disorder : Personality disorder characterised by pervasive
psychological dependence on other people.
Histrionic personality disorder: Personality disorder characterised by
pervasive attention-seeking behaviour including
inappropriate sexual seductiveness and shallow
or exaggerated emotions.
Family therapy : Specialised type of group therapy in which the
members of the family of the client all participate
in group-treatment session.
Group therapy : Psychotherapy of several persons at the same
time in small groups.
Narcissistic personality disorder : personality disorder involving a pervasive
pattern of grandiosity need for admiration, and
a lack of empathy.
Oral stage : First stage of psychosexual development, during
which pleasure is derived from lip and mouth
contact from need-fulfilling objects.
Personality disorders : Characterised by enduring maladaptive patterns
for relating to the environment and oneself,
exhibited in a wide range of contexts that cause
significant functional impairment or subjective
distress.
Phallic stage : Stage of psychosexual development during
which a childbegins to perceive his or her own
body as a source of gratification. Feelings of
narcissism are heightened during this period.
Psychoanalysis : Method used by Freud to study and treat
patients.
Psychotherapy : Treatment of mental disorders by psychological
methods.

3.7 SUGGESTED READINGS

Carson, R., Butcher, J.N., & Mineka, S. (2005). Abnormal Psychology and Modern
Life (3rd Indian reprint). Pearson Education (Singapoer).
Durand, V. K. & Barlow, D. H. (2000). Abnormal Psychology: An Introduction.
Stamford: Thomson Learning.
Sarason, I.G. Sarason, B.R. (1996). Abnormal Psychology: The Problem of
Maladaptive Behaviour. New Jersey: Prentice Hall Inc.
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental
48
Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, Dependent and Histrionic
Personality Disorder
2000.
Apt, C. & Farley Hurlbert, D. (1994). The sexual attitude, behaviour, and relationships
of women with histrionic personality disorder. Journal of Sexual and Marital Therapy,
20, 125-133.
Bornstein, R. E. (1997). Dependent personality disorder in the DSM-IV and beyond.
Clinical Psychology: Science and Practice, 4, 175-187.
Dependent personality disorder- Diagnostic and Statistical Manual of Mental
Disorder-Fourth Edition- Text Revised (DSM-IV- TR) American Psychiatric
Association (2000).
Dependent personality disorder – International Statistical Classification of Diseases
and Related Health Problems 10th Revision (ICD- 10).
Hirshfeld, R. M. A., Shea, M. T., & Weise, R. (1995). Dependent personality
disorder. In W. J. Livesley (Ed.), The DSM-IV personality disorders. New York:
Guilford.
Histrionic personality disorder – International Statistical Classification of Diseases
and Related Health Problems, 10th revision (ICD-10).
Shapiro, D. (1965). Neurotic styles. New York: Basic Books.
Storr, A. (1980). The art of psychotherapy. New York: Methuen

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