Narcissistic and histrionic personality disorders, along with antisocial and borderline personality disorders, are part of what the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) organizes into a “cluster” of dramatic personality disorders.
What is Narcissistic Personality Disorder?
There is nothing wrong with a small and reasonable degree of narcissism; it allows you to feel self-confident, take pride in your accomplishments and protect yourself from unhealthy relationships. Narcissism (egocentrism) is an inborn characteristic in which children believe that the universe revolves around them. As you grow and develop, you learn that other people matter and that you cannot always be the center of attention. Ultimately you learn how to cope with disappointments and set-backs, while not losing your sense of self-worth. If you have a narcissistic personality disorder, you fail to grow out of your narcissistic ways and you never quite develop the coping skills that you need to successfully move past the challenges of life.
Symptoms commonly associated with a narcissistic personality disorder include: grandiosity or an enormous sense of self-importance, which is not supported by any actual accomplishments or talents, entitlement or beliefs that you are special (without having to do anything at all) and that you should limit your associations to equally special people, manipulation or the desire to take advantage of other people, indifference or the lack of empathy or concern for those around you and delusions or the belief that everyone is envious of you. Ironically, it is often the narcissistic person who is envious of other people’s status, possessions and/or accomplishments. If you have this personality disorder, you may appear self-important and conceited to others.
How Common is Narcissistic Personality Disorder?
Less than 1% of the general population suffers from this disorder. Approximately 50 to 75% of people diagnosed with narcissistic personality disorder are men. However, narcissistic individuals rarely feel the need to seek treatment so the actual number of those displaying these traits may be much higher.
What Causes Narcissistic Personality Disorder?
Opinions concerning the cause of this disorder vary, although most experts believe that the origin lies in the behavior and attitudes of your parents. Some experts believe that if you grew up with parents who neglected, abused and/or rejected you, you are more likely to develop this disorder, while others believe that if you grew up in a distant and cold home, your coping skills may not have been fully developed. These experts also believe that parents that treat their children too positively can predispose them to this disorder by giving them an exaggerated sense of self-worth.
How is Narcissistic Personality Disorder Treated?
People with this disorder rarely seek treatment because they do not believe that they have a problem. If you do seek therapy, your therapist will attempt to uncover and address your insecurities and remove defenses that cause you to isolate yourself from the world. Therapists will help you recognize faulty thinking and teach you how to focus on other people’s needs. Unfortunately, treatment is largely ineffective.
What is Histrionic Personality Disorder?
Histrionic personality disorder is defined by the DSM-IV as a chronic pattern of extreme emotionality and attention-seeking behaviors. The onset of histrionic personality disorder is adolescence.
According to the DSM-IV, you must meet five of these seven characteristics to be diagnosed with histrionic personality disorder:
- You are uncomfortable in a situation where you are not the focus on attention.
- Your interactions with other people are marked by overt sexuality, seductiveness and/or other provocative behaviors.
- You experience shallow and rapidly fluctuating emotions.
- Your speech is vague and opinions are given without any supporting details.
- Your emotions and behaviors are theatrical and exaggerated.
- You experience changes in your behavior and speech based on the situation and people involved.
- You believe that your relationships are more involved than they really are.
If you have this disorder, you may describe every minor detail of your life as if it were a grand and significant event. You may seem incapable of subtlety in your dress and your gestures and/or speech may appear theatrical.
You may also lack a true sense of your own identity and revise your statements and the manner in which you speak and behave in an effort to impress whoever happens to be in your presence. You may actively seek an audience because of your constant craving for approval, praise and validation.
More than likely you exaggerate physical injuries, illnesses and/or weakness in an attempt to elicit attention from others. You may even falsely threaten to commit suicide to gain concern and sympathy from others. You may wear sexually provocative clothes and/or exhibit sexually-charged behaviors in order to get attention from the opposite sex. In addition, you may believe that a causal relationship is an intense affair or an extremely intimate friendship. If you have this disorder, you may engage in risky behaviors such promiscuity, criminal activities and drugs and/or alcohol abuse.
Despite what you may regard as a wide circle of admiring friends, this disorder is marked by an inability to forge deep, lasting relationships. The film Austin Powers offers quite an accurate portrayal of histrionic personality disorder.
How Common is Histrionic Personality Disorder?
Approximately 2 to 3% of the general population suffers from this disorder, although much higher rates of 10 to 15% have been reported in both inpatient and outpatient settings.
What Causes Histrionic Personality Disorder?
In the past, histrionic personality disorder was known as hysterical personality disorder. The term hysteria was broad and referred to emotional overreactions believed to originate in a malfunction of the “female organs.” Now, experts realize that this is incorrect, but have not yet pinpointed any specific causes of the disorder.
Some experts believe that this disorder occur when overly controlling parents make you feel unloved and unappreciated, while others believe that extreme parental involvement reduces your ability to care about anyone or anything else. In addition, some experts believe societal pressure to keep girls and young women “dependent” and “girlish” predisposes them to this disorder.
What Treatments are Available for Histrionic Personality Disorder?
People with histrionic personality disorder often do not need to be encouraged to seek treatment as they enjoy the attention of therapy. However, once they arrive at a session, it can be difficult for the therapist to bypass their flamboyant and seductive behaviors and reach the root of the disorder.
Medical treatment is indicated when depression, anxiety, pain and/or illness occurs, but otherwise not medication is prescribed. In cases where medication is needed, anti-depressants, anti-anxiety or antipsychotic medications are cautiously prescribed.
American Psychiatric Association. (2001). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C.
Comer, R. J. (1996). Fundamentals of abnormal psychology. New York: W.H. Freeman and Company.
Kaplan, H. I., & Sadoc, B. J. (1996). Concise textbook of clinical psychiatry. Baltimore, MD: Williams & Wilkins.