Histrionic Personality Disorder, Case vignette (2)

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 Monique

Monique, an attractive and vivacious woman, sought therapy hoping to prevent the disintegration of her third marriage. As she describes her problem, her emotions run the gamut from laughter to sadness. (3) Whenever in a relationship, she would eventually become “bored,” (laughter) start showing interest in “more exciting males,” (1)  and eventually return to partying and drinking. “Can you imagine me in a s-e-x-u-a-l affair?” she asks the interviewer playfully with a feigned innocence. (2)  As a recovering alcoholic, Monique thought she might be “on the brink,” but wanted to take a good look at herself before ruining her marriage to the loving husband who had bonded so well with Jacqueline, her daughter from her first marriage.

Monique’s history foreshadows her current situation. She is four years older than her sister, her only sibling. Her father, a wealthy businessman and gifted salesman, regarded the girls as “display pieces,” trotting them out at social gatherings so that others could admire the successful family man. Her mother was an emotional but charming woman who took great pains that the children grew up “beautiful and talented.” Both entered childhood pageants and talent shows. Monique’s most precious memory is running into her father’s arms after winning one such contest at age 8.

During the teen years, Monique was very popular, a social butterfly who dated often and never wanted for attention from the opposite sex. She busied herself with a variety of extracurricular activities, including the high school choir and artwork for the school paper. In her junior and senior years, she made the varsity cheerleading team. (6)  She describes these years with a flourish as “just the most wonderful and exciting and stimulating time that a person could ever, ever have.” (5)  She does, however, recount becoming depressed and lying in bed for days when her best girlfriend was voted homecoming queen. “She wasn’t nearly as cute as me,” Monique states solidly. (1)

After high school, Monique decided on art school instead of a traditional college. As a freshman, she married a fellow student, a handsome boy three years older with good grades but a reputation for causing trouble. Though they had known each other for only three weeks, “It was like we’d known each other all our lives . . . I could tell we were meant!” she states. She recounts the course of subsequent events as if building up the plot of a soap opera, introducing dramatic pauses at just the right points. Both craved excitement and eventually decided on an open marriage. She is still not certain her first husband is Jacqueline’s real father. Seven months later, they were divorced. Three years later, she married an older man in his forties who gave both mother and daughter a “comfortable home and lots of love and attention.” Again, however, she eventually became bored and started several affairs, but broke off each one for fear her husband would find out. Eventually he did, and they were divorced. (8) For the next four years, she was on her own, partying, using drugs, and drinking heavily. Her mother and sister took care of Jacqueline.

Her wild days came to an end, however, when she met her present husband, a talented writer. But now that she has settled down, Monique again feels herself at the threshold of destroying the relationship, either by her own potential infidelity or by the distraction of alcohol abuse.

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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Histrionic Personality Disorder, Case vignette (1)
Histrionic Personality Disorder, Case vignette (3)

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