A Marathon Reading of
James Joyce's ULYSSES
IS HISTRIONIC PERSONALITY DISORDER ABSOLUTELY NECESSARY?:
VALUING AND DEVALUING HISTRIONIC TRAITS
IN HETEROSEXUAL WOMEN
Copyright (c) 2009 Herb Guggenheim
Many individuals may display histrionic personality traits. Only when these traits are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress do they constitute Histrionic Personality Disorder.
—DSM-IV-TR (APA, 2000)
Tara is a sixty-two-year-old Caucasian female. But one might mistake her for someone in her mid-forties.
Tara came to the psychotherapist for assessment and possible treatment because she had "boyfriend problems." In brief, her boyfriend Bob, who was twelve years younger than she, was simultaneously dating a woman who he considered "more age appropriate."
"I can't get him to leave her!" Tara exclaimed. "I don't know what to do. We're totally in love but he's afraid to get that bitch [referring to Bob's other girlfriend] out of his life. I try so hard to make my relationships work but they never do," she told the therapist. "I've had a lifetime of failed relationships." She wept but sounded to the therapist more like a child pretending to cry than like someone who was genuinely in pain.
Tara worked for a law firm as a senior administrator and reported no difficulties on the job. After work, she'd either go swing dancing at one of the many local dance venues or else she'd work out at her gym. She was a strict vegetarian and was extremely careful about what she ate. She was 5'6'' and weighed exactly 115 pounds.
She told the therapist that she looked better than most people her age and was proud of it. She liked being prettier than her female friends. She didn't know anyone else her age who went swing dancing three nights a week. "I'm probably one of the best dancers and I get asked to dance all the time—even by kids thirty years younger than me," she told the therapist.
Tara put considerable effort into looking good. She'd had a breast lift ten years earlier but had just had the procedure done again. To save money, she'd gone ahead and gotten a facelift at the same time. Her boyfriend had advised her not to go through with either procedure since he felt she already looked great. She'd ignored his advice, cashed in a sizable amount of stock, and gone ahead with her plan.
Tara told the therapist that she liked dating "younger guys." "They're more exciting and they have more energy than guys my own age."
Prior to her present relationship with Bob, Lana had dated a man named Dave. This man had taken her to a number of sex parties and swinger's clubs . She'd loved attending and watching the other participants—especially the females—many of whom, she said, were morbidly obese. Since she was one of the best looking women, she got a lot of male attention.
Tara told the therapist she enjoyed watching pornography—especially two kinds: "medical [themed] porn" and "old gross men having sex with young 'virginal' women."
Tara didn't have anything bad to say about her many past boyfriends or two past husbands. "They were all really nice wonderful people. Things just never seemed to work out."
In the next breath, however, she told her therapist that her first husband had hit her and that he'd introduced her to IV heroin use forty years ago. She told the therapist she hadn't used since her twenties but also said that while using she'd acquired Hepatitis C (presumably contracted from shared needles). She denied current drug use.
Although she'd been divorced from her first husband for more than thirty years, she said she very much regretted not having seen him just prior to his death in 2003: "We were on good terms," she said. When the therapist remarked that he was surprised she was on good terms with someone who'd beaten her and introduced her to heroin, Tara replied, "Oh, we became friends over the years. He wasn't the same person."
Another story she told dated back to her college days. She said her college roommate was dating a guy who'd ride the train up and see her on weekends. When Tara found out that her roommate had to be out of town for a week to attend a wake and a funeral, Tara somehow forgot to tell the boyfriend when he'd called midweek. "So, when his train pulled into the station, my roommate wasn't there to meet him—but I was." Tara continued dating the man until they both graduated.
Tara went on to say she loved having sex with her present boyfriend Bob. She was on hormone replacement therapy (HRT): "It helps my skin stay young looking and I don't have any trouble with vaginal dryness." She said that she knew about—and was indifferent to—the finding that long-term HRT increases the risk of getting breast cancer. "I have to have a life," she said.
She told the therapist that she was with her boyfriend quite a bit (even though he spent a lot of time with his other girlfriend). "We're so in love," she said. "I just wish he'd leave her so we could be together all the time. He says I'm the perfect woman."
At the end of the initial assessment, she told her therapist: "You really are a wonderful person. I feel like we really communicated today."
What are we to make of this person? To find the answer, we must start in a most unlikely place.
What could be more wholesome than a G-rated Disney film? Such films are a parent's best friend, right?—free of profanity, graphic violence, and explicit sexual content. And yet, even the world of children's films (films like Finding Nemo, The Little Mermaid, and The Princess Diaries) are helping children master the codes and conventions of contemporary society, including those governing sexuality.
In a recent study, Martin and Kazyak (2009), sociologists at the University of Michigan, examined the content of some recent top grossing G-rated films. Among their findings:
The primary account of heterosexuality in these films is one of heteroromantic
love and its exceptional, magical, transformative power. Secondarily,
there are some depictions of heterosexuality outside of this model. Outside
of hetero-romantic love, heterosexuality is constructed as men gazing
desirously at women’s bodies. (Martin & Kazyak, 2009, p. 323)
Martin and Kazyak go on to elaborate on their second point: "[G]endered bodies are portrayed quite differently, and we see much more of some bodies than others. Women throughout the animated features in our sample are drawn with cleavage, bare stomachs, and bare legs" (p. 329). These findings suggest that histrionic constructs permeate our culture and that even young children are taught that histrionic women are ideal women.
Depictions of Romantic Love
Continuing their discussion about the centrality of heterosexual romantic love in children's cinema, Martin and Kazyak describe the manner in which heterosexual love is depicted in the various films they examined:
[I]n Beauty and the Beast, the main characters fall in love frolicking in the snow; Aladdin and Jasmine fall in love as they fly through a starlit sky in Aladdin; Ariel falls in love as she discovers the beauty of earth in The Little Mermaid; Santa and his eventual bride ride in a sleigh on a sparkling snowy night with snow lightly falling over only their heads in Santa Claus 2; and Pocahontas is full of allusion to water, wind, and trees as a backdrop to the characters falling in love. The characters often say little in these scenes. Instead, the scenes are overlaid with music and song that tells the viewer more abstractly what the characters are feeling. These scenes depicting hetero-romantic love are also paced more slowly with longer shots and with slower and soaring music. (p. 325)
What can be gleaned from Martin & Kazyak's analysis?
With the advent of DVD players, movies on demand and TiVo, children's films can be—and often are—watched over and over. Thus, children can incorporate the messages they receive (in movies and elsewhere) into their own personal construction of social reality. Part of that understanding includes an understanding of the attraction between men and women and a vision of romantic love that is abstract, inarticulate, and wildly emotional. In a very real sense, histrionic traits are prized.
In this paper, I will discuss the history and development of the concept of histrionic personality disorder. I will argue that histrionic traits are, in many ways, prized, valued, and encouraged by our culture and that they may serve an evolutionary function. I will also argue that, in order to regulate and limit the effects of histrionic traits, societies have also chosen to stigmatize them, calling them either more failings or signs of a mental disorder.
The diagnosis histrionic personality disorder (HPD) has appeared in every edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders since 1980; however, the history of the disorder is far longer. In order to understand histrionic personality, we must first understand its historical antecedent—hysteria.
Histrionic personality disorder's historical precursor is hysteria. HPD is the end result of the long slow separation of the concept of hysteria into two fairly distinct disorders: conversion disorder and HPD.
Hysteria itself is a concept with a 4,000 year history (Beck, 2004). According to Beck, Freeman, & Associates (2004):
The concept of hysteria began with the Egyptian idea that if the uterus were unmoored, it would wander throughout the body, lodging in one place and producing hysterical symptoms there. Treatment consisted of luring the uterus back to its normal position by fumigating or anointing the vagina with sweet-smelling or precious substances, or by chasing the womb away from its new location by inhalation or application of foul-smelling, noxious substances at the distressed site. Hippocratic1 prescriptions often included marriage and childbirth, which physicians have recommended to their hysterical patients ever since. (p. 217)
Over the intervening 4,000 years, various accounts of hysteria have surfaced in religious, historical, and scientific literature (McHugh, 2008; Spanos & Gottlieb, 1979). The demonic possession of the girls of Salem, Massachusetts in the late seventeenth century, the patients "cured" by Anton Mesmer in eighteenth century Paris, and Jean-Martin Charcot's pseudoconvulsive pseudoepileptic patients at the Salpêtrière Hospital in late nineteenth century Paris are all now regarded as examples of hysteria.
Prior to the twentieth century, hysteria was almost always diagnosed in women. Patients generally suffered pseudoconvulsions, pseudoseizures, and/or pseudoneuropathy but hysteria of this type had a wide variety of other physical manifestations. Though these "illnesses" had physical signs, those signs could not be traced to any organic source. In the three cases cited above, the women involved were also able to express some wild emotions and act out in ways which defied the conventions of their respective societies (McHugh, 2008; Spanos & Gottlieb, 1979). McHugh (2008) makes the point that hysterics aren't faking their illnesses and afflictions; they actually believe they are afflicted. This has to do, in part, with their extreme suggestibility.
The modern understanding of hysteria began in the late nineteenth century with the work of five physicians: Freud, Breuer, Charcot, Kraepelin, and Babinski (McHugh, 2008, Silverstein, 2007, Spanos & Gottlieb, 1979). Silverstein (2007) points out: "Histrionic personality was the prototypical psychoneurosis in classical psychoanalysis. The fundamental concepts of psychoanalytic theory were formulated with histrionic (hysterical) patients in mind" (p. 151).
Freud and his colleague Breuer felt that traumatic memories haunted their hysterical patients and that a cure could be effected by having the patient recall events from her childhood (McHugh, 2008). Freud also saw hysterical symptoms as emanating from pent up or repressed sexual energy (Silverstein, 2007).
Kraepelin and Charcot—both contemporaries of Freud—championed descriptive psychiatry and neurology. Unlike Freud who sought out deep-seated causes of mental illness, Kraepelin and Charcot described what they saw through observation and autopsy. Silverstein notes:
Kraepelin's influence established the descriptive characteristics of the disorder, drawing attention to such patients' excitability, lability of mood, and erotic or romantic preoccupations, among other features. (p. 151)
Other psychiatric thinkers added to Kraepelin's description "emphasizing ingenuousness of perceived experience and an exaggerated or self-aggrandizing manner to draw attention to themselves" (Silverstein, 2007, p. 152).
Later thinkers noted more characteristics: seductive actions and appearance, compliant suggestibility, sensitivity to disappointment accompanied by devaluation (Silverstein, 2007). Some suggested that hysterical patients are inhibited, frigid, or asexual. Others noted that hysterics can be dramatic, emotional, and labile but that this behavior conceals a need to be taken care of (Silverstein, 2007). One theoretician called attention to forgetting as the main cognitive manifestation of hysteria; hysterical individuals understand reality in an impressionistic way because they don't pay attention to, and therefore forget, details (Silverstein, 2007).
Gradually, psychiatrists began to separate hysterical patients into two subgroups. In 1951, DSM-1 drew a distinction between the "conversion reaction"-type of hysteria and the "emotionally unstable personality"-type of hysteria (Beck, 2004). In 1968, DSM-II drew a distinction between hysterical neuroses and hysterical personality (Beck, 2004). Group one (conversion reaction/hysterical neuroses) consisted of patients who reported a lot of physical symptoms—numbness of an arm, convulsions, paralysis, etc. These symptoms did not have an organic cause. Group two (emotionally unstable personality/hysterical personality) exhibited many of the same personality traits as those in group one but claimed no physical symptoms. The common characteristics of the two groups seem to be attention seeking, suggestibility, and emotionality (to better understand how the two groups are related, see Lidz, T., 1963).
When DSM-III was created in 1980, the term hysteria and its adjectival form hysterical were discarded (Ford & Widiger, 1989). Instead, patients of the group one (physical symptom) type were said to have conversion disorder and patients of the group two (purely emotional and attention seeking) type were now said to have histrionic personality disorder.
DSM-III-R, DSM-IV, and DSM-IV-TR have all retained histrionic personality disorder as a diagnostic category.
But, now that histrionic personality disorder is its own condition, we are still left with two questions: Is histrionic personality disorder really a disorder? and If it is a disorder, what sort of disorder is it? In order to find out, we must directly question the DSM criteria for the histrionic diagnosis.
Questioning the Histrionic Diagnosis
Histrionic personality disorder (HPD) presents the clinician with many challenges. Chief among them is determining why histrionic personality disorder is a disorder in the first place. What is it about these signs and symptoms that make them harmful to oneself, harmful to others, or significantly more maladaptive than the signs and symptoms of a normal personality? Beck, Freeman, Davis, and Associates (2004) allude to this problem when they state:
Although patients with any personality disorder showed more functional impairment on the Global Assessment of Functioning Scale (Nakao et. al., 1992) than did patients without personality disorders, HPD was one of the personality disorders with the least functional impairment. (p. 219)
The DSM-IV-TR constellation of symptoms is considerably different than that for any of the other nine personality disorders.
Diagnostic criteria for 301.50 Histrionic Personality Disorder
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:
Psychiatric Association, 2000, p. 714)
As expressed above, these symptoms seem more like the value judgments of critical others than they do the symptoms of a disorder.
Criterion 1: Don't many people want to be the center of attention? What makes wanting to be the center of attention maladaptive? Those who are the center of attention can be quite entertaining and people often look forward to spending time with them.
Criterion 2: Don't most people want to be attractive? What makes "sexually seductive" or "provocative" behavior inappropriate anyway? Isn't being sexually seductive in the best interest of the person wanting a partner or mate?
Criterion 3: What makes an expression of emotion shallow? Who judges this? Who has a right to judge? Do all emotions have to be deep? Why is the rate of shift in and of itself the sign of a disorder (provided the person is not psychotic)?
Criterion 4: Don't many people want to define themselves and draw attention to themselves through their dress and appearance? What makes one's choice of how to look significant? Moreover, how is this "sign" substantially different from criteria one and two?
Criterion 5: Who determines whether a person's speech is "excessively impressionistic"? Are not people allowed to express themselves however they want? Who makes the decision that one form of speech is to be privileged while another form of speech is to be labeled pathological?
Criterion 6: What is wrong with self-dramatization? Why is such a manner of expressing oneself a symptom of a disorder? How is theatricality different from self-dramatization? How are both different from exaggerated expression of emotion? Why must everyone express themselves in the same way? Do we not want there to be difference in the world?
Criterion 7: Can one be suggestible and not have histrionic personality disorder? Don't we want people in the world who are receptive to our influence? As long as people aren't following suggestions that cause them to endanger themselves or others, can they really be said to be unhealthy in this respect?
Criterion 8: Hasn't everyone made a mistake about the quality and degree of intimacy in a relationship?
Maybe psychiatrists and psychologists are talking about a kind of woman they just don't happen to like.
Yet, even if clinicians ignore these moral and philosophical problems with each of the individual criteria and accept the entire DSM "package" as is, they still run into problems. Some contemporary researchers have questioned the coherence of the histrionic personality disorder as a distinct diagnosis (Blagov, 2008; Cale, 2002; Shahar, Scotti, Rudd, & Joiner, 2008). For example, Blagov (2008) conducted studies in which he saw many mixed presentations with some features of both the borderline personality disorder and histrionic personality disorder. He asserts that the HPD diagnosis may be neither coherent nor valid (Blagov, 2008).
Additionally, Shahar, Scotti, Rudd, & Joiner (2008) conducted research that suggests that hypomania may predict or exacerbate certain Cluster B personality disorders, including HPD. If this is indeed the case, histrionic traits might simply be signs of hypomania.
Cale (2002) suggests that histrionic personality disorder in women and antisocial personality disorder in men may be expressions of the same underlying psychopathy. If this finding turns out to be correct, it certainly blurs the distinction between the two disorders. At the very least it sheds additional light on Ford and Widiger's (1989) research which suggests that clinicians are more inclined to make certain kinds of diagnoses not according to DSM criteria but rather because of the sex of the patient they're diagnosing.
What if the gender of a patient is the sole determining factor in the kind of diagnosis he or she receives?
That histrionic personality disorder is a creation of the male mind is undeniable. Until fairly recently, most psychiatrists and psychologists were male, most doctors were male, and most members of the clergy were male. As McMullen (1991) warns:
[W]e must continue to think carefully about how we come to label some behaviours as healthy and as normal and others as unhealthy and as abnormal, and we must be particularly cognizant of the powerful role that sex and gender play in these social judgments. (p. 141)
Although one might be tempted to think that sexism has decreased over the last half century, it still manifests itself in some very public ways. The tendency of male therapists to diagnose histrionic personality disorder in female patients was demonstrated in an interesting study conducted by Ford and Widiger (1989). The results of this study are summarized by McMullen (1991):
In the case of Histrionic Personality Disorder (HPD) and Antisocial Personality Disorder (APD), there is some evidence to suggest that although the individual criteria themselves may not be sex-biased, clinicians' use of these diagnostic labels is affected by the sex of the patient. Ford and Widiger (1989) found that there was a clear tendency for clinicians to diagnose women with HPD and not with APD, even when cases were more antisocial than histrionic, and not to diagnose men with HPD. (p. 140)
Ford and Widiger (1989) suggest that when male clinicians are given case histories with a mixture of antisocial and histrionic traits in which the patient is identified as female, they are more likely to diagnose histrionic personality even if there is a preponderance of antisocial symptoms in the case history.
Another curious (perhaps inadvertent?) example of sex bias is contained in the Handbook of Diagnosis and Treatment of DSM-IV-TR Personality Disorders (Sperry, 2003). Sperry draws a distinction between histrionic personality disorder (maladaptive) and histrionic personality style (adaptive). I'm going to quote his examples of both in their entirety because I want to take a look at some of the underlying assumptions Sperry makes. The first is the description of a woman with histrionic personality disorder (I've italicized words that I think are important for the reader to take note of):
Ms. P. is a 20-year-old female undergraduate student who requested psychological counseling at the college health services for "boyfriend problems." Actually, she had taken a non-lethal overdose of minor tranquilizers the day before coming to health services. She said she took the overdose in an attempt to kill herself because "life wasn't worth living" after her boyfriend had left the afternoon before. She is an attractive well-dressed woman adorned with makeup and nail polish which contrasts sharply with the very casual fashion of most coeds on campus. During the initial interview she was warm and charming, maintained good eye contact, yet was mildly seductive. At two points in the interview she was emotionally labile, shifting from smiling elation to tearful sadness. Her boyfriend had accompanied her to the evaluation session and asked to talk to the clinician. He stated that the reason he had left the patient was because she made demands on him that he could not meet and that he "hadn't been able to satisfy her emotionally or sexually." Also, he noted that he could not afford to "take her out every night and party." (p. 134) (italics added)
Let me now compare the above description with Sperry's description of the histrionic personality style. Again, I have italicized words that I think the reader should take note of:
Mr. M. is a 41-year-old literary agent who spent the early years of his career representing non-fiction writers to major publishing houses. He was quite successful for several years but also became somewhat disenchanted with his behind-the-scene efforts. Although he has made several of his clients extraordinarily wealthy and famous, he dreamed of the time when he too would be financially independent and in the limelight. When cable TV licenses became available, he sensed the opportunity to fulfill his dream. He would become president of his own station and host his own talk show. After all, he had several high-visibility clients who he could get to be guests on his show. He set out to garner financing for his plan. With his charming manner and alluring vision, he quickly intrigued several backers and got the station launched. The only problem was he had not thought much about the production side of the enterprise. He quickly arranged for interviews for an executive producer. William T. was the fourth person he interviewed. Mr. M. knew as soon as William walked in that he was right for the job. After a 10-minute interview, William was hired. Mr. M's hunch about both William and the success of the talk show proved to be right. (Sperry, 2003, pp. 134-35)
Throughout his book, Sperry draws a distinction between the pathological and non-pathological versions of various personality types. In the above two cases, he "just happens" to assign all that is pathological to the female case and all that is (in his view) non-pathological to the male one. The 20-year-old female college student is juxtaposed to the 41-year-old male already well into his career. The reader can infer that the female might meet criteria for an Axis I diagnosis of major depressive disorder. She has boyfriend problems; the male's relationship is not discussed. She is "adorned with" makeup and nail polish; whereas, the male's physical appearance is not discussed. The female's dress is described as being in sharp contrast to other coeds on campus. The male's dress is not discussed. The woman is described as "mildly seductive." The man's sexual aura is not discussed. The woman's boyfriend describes her as "demanding"; the man's expectations of others are not discussed. The woman's boyfriend states that he cannot satisfy her emotionally or sexually. The man's relationship status is not discussed nor is his partner's ability to satisfy him. She is said to want to "party" every night; the man's preference regarding how he spends his leisure time is not discussed. Sperry is not viewing the two cases through the same lens.
The man is at a different stage of life. His case history only focuses on his career. He is described as being "quite successful"; the woman's abilities vis-à-vis school and work are not discussed. He wants to be financially "independent" and "in the limelight." These desires are seen as positive; whereas, the woman's mild seductiveness is seen as negative. The man has "vision," secures "backers," and plays a "hunch." The woman is probably too young to have "backers." Whether or not people support her academic efforts is not discussed. Although, being depressed, she might not have a vision of what her future should be like, she may have had some vision of it prior to her breakup. Sperry does not include her ideas of what her career might look like.
Although Sperry may not have realized what he was doing when he prepared the two above-quoted examples, it is easy for the careful reader to see that the male and the female are not being assessed in the same way. The man who is said to have "histrionic personality style" may very well meet criteria for narcissistic personality disorder yet he is seen as non-pathological in Sperry's presentation.
Why are Sperry's two case examples so strikingly different?
In this essay, I've attempted to demonstrate that histrionic traits in women have been—and still are—simultaneously prized and disparaged. Why might this be the case?
Evolutionary psychology may offer a possible explanation.
Histrionic traits, especially seductiveness, revealing dress, and attention seeking, encourage sexual relationships. Sexual relationships, in turn, make procreation possible. In the early days of the human species, these kinds of histrionic behaviors may have out competed other kinds of behavior in certain situations. Histrionic traits could have been a minority survival strategy for certain females. Females who wanted to ally themselves with or seek protection from stronger more powerful males may have gotten more attention from those males by distinguishing themselves from the rest of the women in the group. The histrionic trait of rapidly shifting emotionality may have served to encourage males to focus more attention on care giving and nurturance. Certainly, infants get more attention when they cry. Why not adults? The trait of overvaluing relationships may have enabled histrionic females to stay with a powerful male who might be gone for long periods of time or who might want to seek out another mate.
An additional possibility is that females with histrionic traits may have helped evoke a general sexual response from all heterosexual males in the group. Once aroused in this way, males might have felt motivated to compete for the histrionic female. Upon learning that they were neither the strongest nor the most powerful males of the group, these males would turn their attention to more attainable non-histrionic females.
Male criticism of histrionic behavior (including characterizing such behavior as a disorder) may have historically served the twin purposes of limiting sexual contact and turning attention away from direct care giving and toward acquisition of food and shelter.
Female criticism of histrionic behavior (including characterizing it as a disorder and as a way of pandering to males) may promote diversity by enabling females who are not histrionic to successfully compete for male attention.
Of course, these speculations may not be true.
And yet, the existence of the fashion, beauty, and pornography industries leads me to think that histrionic behavior is prized and will continue to be prized in our culture for quite some time. That some males and females characterize histrionic behavior as maladaptive suggests to me that this behavior must be limited so that other pursuits such as providing food and shelter—and scholarship—can be undertaken.
Setting evolutionary biology aside for the time being, I want to turn my attention to three other points. First, the fact that traits travel in clusters does not automatically make those traits a disorder.
Second, males and females define each other in a variety of ways. The fact that some males have defined females who display histrionic traits as sick may cause women with these traits to regard themselves that way. In her 1983 article "A Woman's View of DSM-III," Kaplan speaks to this issue:
That Dependent and Histrionic Personality Disorders, Agoraphobia, and Anorexia are more commonly diagnosed in females has been explained as follows: These disorders represent caricatures of the traditional female role. In other words, as Chesler (1972) claimed, women's high treatment rates for mental illness reflect partially a labeling of women who overconform to sex role stereotypes as pathological. Thus, the individual with Dependent Personality Disorder is passive and subordinate; the individual with Histrionic Personality Disorder is vain, dependent, and given to exaggerated expression of emotions; the agoraphobic may fear entering and coping with a man's world (Chambless & Goldstein, 1980); and the anorexic may have faithfully followed her model—the fashion model—to a society-condoned anorexic weight level. (Kaplan, 1983, p. 787)
Later, Kaplan states:
It appears then that via assumptions about sex roles made by clinicians, a healthy woman automatically earns the diagnosis of Histrionic Personality Disorder or, to help female clients, clinicians encourage them to get sick. (Kaplan, 1983, p. 789)
Third and finally, human beings have a tendency to "self-hug" (Reiss, 2008). This means we have a tendency to take our own values and impose them on the world. This means, for example, that if we like art galleries, everyone should like art galleries; if we like exercise, everyone should like exercise. Such self-hugging can blind us to the fact that other people may have preferences and motivations other than our own. As Reiss (2008) puts it:
We have a natural tendency to assume that our values are best, not just for us, but potentially for everyone. Such "self-hugging" motivates (1) personal blind spots; (2) intolerance of people with different values; and (3) a tendency to confuse individuality with abnormality. (p. 151)
Histrionic personality traits in women are both prized and disparaged. From an evolutionary psychology standpoint, having histrionic personality traits may confer competitive advantages on the women who have them or serve to motivate sexual and nurturing behavior in males. The disparaging of histrionic personality traits may serve to limit sexual behavior in males and confer competitive advantages on females who do not possess histrionic personality traits.
American Psychological Association. (2000). Diagnostic and statistical manual of mental disorders. (4th ed. text revision). Washington, DC: Author.
Beck, A. T., Freeman, A., Davis, D. D., & Associates. Cognitive therapy of personality disorders. (2nd ed.). New York: Guilford.
Blagov, P. S. (2008). Questioning the coherence of histrionic personality disorder: Borderline and hysterical subtypes in adults and adolescents. Journal of Nervous and Mental Disease, 196, 785-797.
Cale, E. M. (2002). Histrionic personality disorder and antisocial personality disorder: Sex-differentiated manifestations of psychopathy? Journal of Personality Disorders. 16(1), 52-72.
Ford, M. R., & Widiger, T. A. (1989). Sex bias in the diagnosis of histrionic and antisocial personality disorders. Journal of Consulting and Clinical Psychology, 57, 301-305.
Kaplan, M. (1983). A woman's view of DSM0-III. American Psychologist. 38, 786-792.
Lidz, T. (1963). Hysteria. In The encyclopedia of mental health. (Vol. 3, pp. 818-826). New York: Franklin Watts.
Martin, K. A., & Kazyak, E. (2009). Hetero-romantic love and heterosexiness in children’s G-rated films. Gender & Society, 23, 315-336.
McHugh, P. R. (2008). Try to remember: Psychiatry's clash over meaning, memory, and mind. New York: Dana.
McMullen, L. M. (1991). DDPD: Will the authors' goals be achieved? Canadian Psychology, 32(2), 139-141.
Reiss, S. (2008). The normal personality: A new way of thinking about people. New York: Cambridge University Press.
Shahar, G., Scotti, M. A., Rudd, M. D., & Joiner, T. E. (2008). Hypomanic symptoms predict an increase in narcissistic and histrionic personality disorder features in suicidal young adults. Depression and Anxiety, 25, 892-898.
Silverstein, M. L. (2007). Disorders of the self: A personality-guided approach. (pp. 145-170). Washington, DC: American Psychological Association.
Spanos, N. P., & Gottlieb, J. (1979). Demonic possession, mesmerism, and hysteria: A social psychological perspective on their historical interrelations. Journal of Abnormal Psychology, 88(5), S27-S46.
Sperry, L. (2003). Handbook of diagnosis and treatment of DSM-IV-TR personality disorders (2nd ed.). New York: Brunner-Routledge.
1Refers to the "father of medicine" Hippocrates who lived in ancient Greece from c.460-c.370 BCE and the school of Greek physicians who followed in his tradition.