A CASE OF Histrionic Personality Disorder
By: THEODORE MILLON
et al.
Notes:
(1) Numbers mark aspects of the case most consistent with DSM
criteria as follow, and
do not necessarily indicate that the
case “meets” diagnostic criteria in this respect.
(2) Patient's name has been changed in respect to
confidentiality, and names mentioned are not of a real existent person.
Case of Yvonne
Yvonne is a 23-year-old, single female referred for
psychological assessment by her gynecologist. She is outgoing and effusive, “dressed to kill,” and yet
coquettishly reluctant to disclose the nature of her difficulties.(4) When directly asked, she
avoids open discussion and seems to free associate to any number of topics,
some happy,
some sad, but all tangential to the clinical interview. (3) She talks a lot, but doesn’t
really say much. She states, for example, that she is on a first-name
with her physician, that she has been a dancer since she was a little girl, and that she is
“blessed” with countless
good friends. (5)
After a period of direct questioning, Yvonne reveals that she
has been
experiencing debilitating pain continually for over half a year. “I just lay in bed and feel
like I will absolutely expire!” she exclaims, closing her eyes and dropping her
head forward to feign death. Extensive medical testing reveals no sufficient
basis for her complaint.
(6)
During the clinical interview, Yvonne’s nonverbal affectations
are numerous. Her head is cocked slightly down, eyes wide with invitation. Her facial expressions,
intended to underscore the meaning of her words, are exaggerated far
beyond those of normal persons. (6) She skips quickly from one topic to another. Apparently
theatrical by nature, she measures the reaction of her audience and adjusts
her performance accordingly. She periodically throws out double entendres, but
retreats to the safer,
more demure meaning if others begin to act on her suggestions. (2) At times, she seems to parade
through a succession of persons to find the one that best fits the role of
therapy client.
Despite Yvonne’s interpersonal intensity, her history seems
mostly unremarkable.
She describes a happy and well-adjusted family, though she admits some
conflict with her mother. Her two brothers, much older than she, still
treat her like a baby. She remains very close to her parents, especially her father, and calls
home on a daily
basis. At present, she is not involved in a serious relationship,
but notes with a giggle
that “most boys find me very attractive.” Nevertheless, she feels that
she has been unlucky in love, and openly admits that most guys “just want me for my
body.” “I think I
find it easy to get to know others,” she says, “and that’s why I get
so bored with people so
fast.” (8) Instead, she prefers the
excitement of
new experiences, including occasional episodes of intoxication and substance abuse.
Currently, Yvonne works as a dancer at an adult club, but
asserts forcefully
that she is different from the other girls, an artist plying her trade. When asked what
drew her to this mode of expression, she says she likes the attention and the money, “two
things I can’t do without.” (4) She expresses
disgust with both the after-hours practices of the other dancers and with
the clientele. (1) Her family believes that she is teaching ballet. The
source of her pain remains uncertain.
DSM-IV Criteria
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:(1) is uncomfortable in situations in which he or she is not the center of attention
(2) interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
(3) displays rapidly shifting and shallow expression of emotions
(4) consistently uses physical appearance to draw attention to self
(5) has a style of speech that is excessively impressionistic and lacking in detail
(6) shows self-dramatization, theatricality, and exaggerated expression of emotion
(7) is suggestible, i.e., easily influenced by others or circumstances
(8) considers relationships to be more intimate than they actually are
References
(1) Personality Disorders in Modern Life, second edition,
2000, 2004 by John Wiley & Sons, Inc.
(2)Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition. Copyright
1994 American Psychiatric Association.
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