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The relationship of histrionic personality disorder to antisocial personality and somatization disorders.

The authors examined the association of antisocial personality disorder, somatization disorder, and histrionic personality disorder, both within individuals and within families, in 250 patients. All three disorders overlapped considerably within individuals; the strongest relationship was between antisocial personality and histrionic personality. A high prevalence of antisocial personality was reported in the families of patients with somatization disorder but not in the families of patients with histrionic personality. The authors suggest that histrionic individuals develop antisocial personality if they are male and somatization disorder if female; moreover, all three conditions may represent alternative manifestations or different stages of the same underlying diathesis.

Antisocial Personality Disorder

Histrionic personality disorder in women with somatization disorder.

The clinical distinctions between histrionic personality disorder and somatization disorder have frequently been blurred. In this study, 60 women with somatization disorder were found to have histrionic personality disorder. A DSM-III diagnosis of histrionic personality disorder did not significantly help to improve the diagnosis of somatization disorder. A diagnosis of histrionic personality disorder should stimulate a search for better-validated Axis I diagnoses.

Adult

Treatment outlines for borderline, narcissistic and histrionic personality disorders. The Quality Assurance Project.

Treatment outlines for Axis I disorders were published during 1982-1985. Treatment outlines for the DSM-III personality disorders are being published. This guide to the treatment of borderline, histrionic and narcissistic disorders was developed from the literature, from the opinions of practising psychiatrists and from the experience of nominated experts. Even though the treatment of patients who suffer from these disorders is very difficult, the surveys of outcome in the literature suggest that a majority of patients improve significantly with long term psychotherapy. In the present outline the expert committee describe a hypothetical model for the genesis of these disorders and outline the steps to be followed if therapy is to be optimal. The experts stress that therapy is often prolonged and difficult but can be rewarding. They caution that therapists are likely to require considerable special training and it is recommended that they seek supervision throughout the process of therapy.

Australia

Gender stereotypes for paranoid, antisocial, compulsive, dependent, and histrionic personality disorders.

To assess similarity between gender-role stereotypes and the personality disorder prototypes, university students (31 women and 13 men) were asked to assign gender to six descriptions of DSM-III--R personality disorders. Significant agreement was found in gender assignment for five of the six descriptions. Descriptions of the paranoid, antisocial, and compulsive personality disorders were viewed as male, and descriptions of the dependent and histrionic personality disorders were viewed as female. The description of schizoid personality disorder was not significantly gender-typed.

Adult

Percept-genetic signs of repression in histrionic personality disorder.

Several types of perceptual distortions of two anxiety-arousing visual stimuli are coded as repression in the Defense Mechanism Test, a tachistoscopic, percept-genetic technique. Given the well-established correspondence between hysteria and repression, the study included a clinical validation of these variants of repression against the diagnosis of histrionic personality disorder. 41 subjects with evidence of this disorder on the Millon Clinical Multiaxial Inventory-II were compared with 41 nonhistrionic controls. Significantly more histrionics were coded for the type of repression in which the threatening figure is transformed into a harmless object (code 1:42), while animal- and statue-repressions, when combined (codes 1:1 and 1:2), were significantly more characteristic of the nonhistrionic group. As an unpredicted finding, significantly more histrionic subjects employed defensive strategies, currently coded as reaction formations (code 4:). Histrionic subjects without concomitant compulsive features were coded more frequently for introaggression (code 6:) compared both with nonhistrionic controls and with histrionic-compulsive subjects. The findings are discussed within the context of the available percept-genetic literature. It is suggested that the Defense Mechanism Test may be further employed to objectify and investigate the defense mechanisms of the DSM-III-R disorders.

Adult

An epidemiological study of histrionic personality disorder.

In conjunction with the Epidemiological Catchment Area (ECA) survey conducted in Baltimore, MD, a two-stage probability sample of community subjects was developed with a full psychiatric examination employing DSM-III criteria. This report details the observations on those subjects diagnosed with the DSM-III diagnosis Histrionic Personality Disorder. The results indicate that this condition can be diagnosed reliably and that it is a valid construct. It has a prevalence of 2.1% in a general population. Males and females are equally affected, suggesting that prior reports of an increased prevalence in females was an expression of ascertainment bias found in hospital-based studies. The diagnosis is associated with clear evidence of disturbance in the emotional, behavioural, and social realms. Individuals with this disorder tend to use health care facilities more frequently than others.

Adolescent

[Histrionic personality disorder in a psychiatry department at a general hospital].

The personality disturbances imply problem within the psychiatric assistance, both for its difficult delimitation and classification and for the limited results and bad use obtained from therapeutic resources. We studied 402 patients psychiatric service of a general hospital over a period approximately 2 years, 70 (17.5%) were diagnosed DSM-III with Personality disturbances: 44 females (62.9%) and 26 males (37.1%), of an age group between 18 and 67 years old. The most frequent diagnosis was of histrionic of the personality followed by unspecific and border-line. Within the histrionic disturbance of the personality there was a clear predominance of women, whereas in the others types, no significant differences were observed.

Adolescent

Neuroticism and personality disorder in depression.

Neuroticism and DSM-III personality disorder were studied in 39 depressed inpatients. Interrelationships between these variables and their relationship to depressive typology were compared. The relationship of neuroticism, DSM-III personality type and adequacy of personality to MAOI treatment are also examined. Neuroticism scores were unaffected by short-term treatment, and no differences in neuroticism were observed between melancholics and nonmelancholics, or between endogenous and nonendogenous depressives. Higher neuroticism scores were associated with DSM-III personality disorder. Personality disorder occurred significantly more often in nonmelancholia; borderline, antisocial and histrionic personality disorders occurred exclusively in nonmelancholia, while passive-aggressive, dependent and avoidant disorders occurred in both kinds of depression. Response to MAO inhibitor treatment was similar in patients with high and low neuroticism, adequate and inadequate personality, DSM-III personality disorder and no DSM-III personality disorder. Ambiguities of Eysenck's neuroticism scale are discussed in relationship to depression.

Antisocial Personality Disorder

Neurocognitive impairment in dramatic personalities: histrionic, narcissistic, borderline, and antisocial disorders.

Thirty-seven patients with personalities in the dramatic cluster (DSM-III-R histrionic, narcissistic, borderline, and antisocial) and 40 controls matched for age and gender were evaluated on 16 neurocognitive variables. The evaluation screened for deficits in functions of attention, memory, language, abstraction, and behavior planning/sequencing. Analysis of variance revealed significant deficits in neurocognitive performance among patients with dramatic personalities, particularly in subtests requiring multi-step, multi-element associative operations.

Adult

Histrionic disorder among Iranian high school and college students.

This study was designed to explore the sex and group differences in histrionic personalities of high school and university students, and also to explore the results of this study with those of Crown and Crisp from 1966 in England. A sample of 160 high school students (80 girls and 80 boys) were selected randomly from four high schools in Shiraz and Shiraz University. The mean ages for high school girls and boys were 15.3 and 17.3 yr., for university women and men were 20.6 and 23.2 yr., respectively. The hysteria (H) scale of the Middlesex Hospital Questionnaire was used. The questions of this scale refer to histrionic personality according to DSM-III and DSM-III--R. Analysis showed significant effects of group (high school, college) for histrionic personality disorder. It was concluded that more histrionic personality disorders were reported among British college students than among their Iranian peers.

Adolescent

Sex bias in the diagnosis of histrionic and antisocial personality disorders.

The differential prevalence of the histrionic and antisocial personality disorders among men and women has been attributed both to sex biases and to actual variation in disorder base rates. The present study assessed the bias and base rate explanations and examined whether sex biases are minimized by the relatively explicit diagnostic criteria in the DSM-III. Psychologists (N = 354) either diagnosed 9 DSM-III disorders from case histories that varied in the ambiguity of the antisocial and histrionic personality disorder diagnoses or rated the degree to which specific features extracted from the case histories met 10 histrionic and antisocial diagnostic criteria. The sex of the patient was either male, female, or unspecified. Sex biases were evident for the diagnoses but not for the diagnostic criteria. The results are discussed with respect to base rate effects, sex biases, and the construction of diagnostic criteria.

Adult

MCMI-II personality disorders in recent-onset bipolar disorders.

This study investigated the personality disorders of 21 recent-onset Bipolar Disorder patients using the revised Million Clinical Multiaxial Inventory (MCMI-II; Millon, 1987). Personality disorder assessments, conducted after patients' clinical symptoms had settled, indicated that 17 patients received at least one MCMI-II personality disorder diagnosis with a trend toward multiple diagnoses. Narcissistic, Antisocial, and Histrionic personality disorders were diagnosed most frequently and were the scales most elevated. Schizoid and Compulsive personality disorders were the scales least elevated. Diagnostic concordance between the MCMI-II and the Structured Interview for DSM-III Personality (SIDP; Pfohl, Stangl, & Zimmerman, 1983) was poor; the MCMI-II made more multiple diagnoses. Implications of the discrepancies between these instruments and suggestions for future research are discussed.

Adult

Standardized assessment of personality disorders in obsessive-compulsive disorder.

We assessed 96 patients with obsessive-compulsive disorder for DSM-III personality disorder diagnoses with a standardized interview instrument (Structured Interview for the DSM-III Personality Disorders). Fifty patients (52%) met criteria for at least one personality disorder, with mixed, dependent, and histrionic personality disorders most frequently diagnosed. Compulsive personality disorder was diagnosed in only 6 patients (6%), 5 of whom had had onset of obsessive-compulsive symptoms before the age of 10 years, indicating that DSM-III compulsive personality disorder is not invariably a premorbid condition for the development of obsessive-compulsive disorder. Schizotypal personality disorder, at 5%, was found to be less common than in past samples, reflecting differences in either assessment methods or sampling.

Adolescent

Perceptual strategies of isolation in obsessive-compulsive personality disorder.

Recent findings have shown that the Defense Mechanism Test, a serial tachistoscopic technique developed inside the percept-genetic frame of reference, discriminates neurotics from normals, neurotics from schizophrenic outpatients, and subjects with histrionic personality disorder from controls. The present research addresses another major class of Axis II pathology, comparing on the Defense Mechanism Test a group with a psychometric diagnosis of obsessive-compulsive personality disorder (n = 26) with a matched sample of noncompulsive controls. As predicted, several variants of isolation were significantly more characteristic of the compulsive group. Intellectualization, disappearance of the whole structure, whitening of the hero, and lack of recognition of the threat were the variants of isolation with the best discriminative properties. Codings of reaction formation were not linked with compulsive personality, which is congruent with the recent observation of their correspondence to the histrionic personality disorder. The findings are presented in the context of the percept-genetic literature on obsessive-compulsive defensive strategies.

Adult

The relationship between early life events and DSM III personality disorders.

The relationship between early childhood events and DSM III personality disorders was examined in 82 non-psychotic psychiatric outpatients. Early loss of a parent or living in a family where there was overt marital discord was associated with having a greater chance of developing DSM III Cluster B personality disorders (narcissistic, antisocial, borderline, histrionic) as adults. It was also related to an increased number suicide attempts as adults. Those patients who suffered an early loss of a parent through death had a significantly higher percentage of antisocial personality and suicide attempts as adults. Patients who as adults had a DSM III Cluster B personality disorder were significantly less likely than comparison patients to have had an early loss of a parent. This finding of a lower chance of a personality disorder if there were a loss of a parent was also significant for histrionic personality disorder when it was analyzed separately. Some theoretical implications of these findings are discussed.

Adult

Diagnosing dissociative disorders in The Netherlands: a pilot study with the Structured Clinical Interview for DSM-III-R Dissociative Disorders.

OBJECTIVE: To improve the ability to diagnose dissociative disorders in The Netherlands, the authors conducted a study using a Dutch version of the Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D) with additional questions on childhood trauma and symptoms of borderline and histrionic personality disorders. METHOD: All interviews were audiotaped or videotaped and rated by two investigators separately. Forty-four patients (42 women and two men) participated in the study. Most of the patients had been referred for evaluation of dissociative symptoms; five had participated in a nationwide survey on incest. None of the patients had ever received a diagnosis of a dissociative disorder, and none had evidence of organic brain syndrome or mental retardation. All patients were in active treatment; 23 were being treated in an outpatient psychiatric service, 13 in an inpatient psychiatric service, and eight in private practice. Thirty-two patients had been psychiatric inpatients at least once. RESULTS: Four diagnostic groups of patients were identified: two with dissociative disorders (12 patients with multiple personality disorder and 11 with dissociative disorder not otherwise specified), one with DSM-III-R personality disorders (11 patients), and one without dissociative or personality disorders (10 patients). CONCLUSIONS: Dissociative disorders are clearly not only an American phenomenon. The diagnosis can be made outside of the United States if the symptoms are sought. The SCID-D proved to be a promising instrument.

Adolescent