Histrionic Personality Disorder - A Psychodynamic Perspective

The root of histrionic personality disorder involves viewing their own gender as inferior, weak, insignificant, and powerless, while viewing the opposite gender as strong, powerful, and exciting^{1 2}. All genders can have a histrionic character, but it is mostly diagnosed in females due to the societal stance that men are more powerful, and perhaps because fathers are more idealized, as they are less involved in primary caregiving for infants². So I will address information in this blog from the example of a female to keep it simple.

Childhood Dynamics of Histrionic Personality²

As babies, histrionic personalities tend to be intense, sensitive, and right-brained, tending to seek out stimulation. However, they are easily overwhelmed by too much internal stimulation, including emotions such as anxiety, shame, and guilt¹. Histrionic individuals are sociophilic, meaning they’re super duper social and other-oriented, craving attention, love, and closeness. They are fixated at the oral stage of psychosexual development, needing extreme responsiveness and nurturance from mom (or a mother figure), but they never find satiation. There is also a second fixation at the phallic stage involving the oedipus complex. This is the conflict where a child turns toward the powerful, exciting father while simultaneously needing to remain connected to and identify with the mother, creating a tension between rivalry and identification.

To concisely sum this up, we can use Freud’s concept of penis envy in which powerlessness was learned to be equated with not being male, and thus penislessness. Basically, males have power, and females desire that power while splitting their own masculinity and femininity. McWilliam’s² example perfectly captures this: “When I feel strong, I feel like a man, not a strong woman” (p. 321).

Relational Dynamics in Histrionic Personality²

According to the PDM-22, a histrionic’s unhealthy belief about the self is, “There is something problematic with my gender and its meaning,” and their unhealthy belief about others is, “The world is best understood in terms of gender binaries and gender conflicts.” There seems to be two conflicts in relation to one’s gender and the opposite gender. For example, a little girl learns that femininity is weak and inferior, but yet finds some power in seductiveness. She also learns that masculinity is powerful but dangerous, resulting in an approach–avoidance conflict. Think about the little girl who gets excited when her daddy comes home…but sometimes there is dread in delayed punishment when her mother says, “Wait until your dad gets home!” Later, her father may seem uncomfortable and detached when she starts to physically develop, reinforcing her view that femininity is rejected. She feels she can attain power by attaching to a male. These conflicts lead to distress or anxiety that needs to be defended against.

Common Defense Mechanisms in Histrionic Personality²

We all use defense mechanisms to cope with life. For histrionic personalities, they devalue their own gender while fearing and envying the opposite gender they see as powerful. They tend to utilize defenses to handle this conflict such as repression, conversion, sexualization, acting out, regression, and dissociation^{1 2}.

→Repression
Repression involves unconsciously blocking ideas or impulses that one finds unacceptable- often painful desires, fears, and emotions. For histrionic personalities, traumatic memories and sexual desires can be repressed, but because sexual desires are normal and build up, repression doesn’t hold up long term. It will eventually leak out in other ways.

→Conversion
One way that repressed urges can “leak out” is through conversion. Conversion involves having physical symptoms with no medical basis (because it stems from psychological anxiety). While not currently as common, in the Victorian era when women were supposed to be “asexual,” there was the common conversion symptom of glove paralysis. This was an inability to move or feel the hand, but the arm was unaffected, a medical improbability. The paralysis seemingly helped deal with the conflict between a desire to masturbate and being raised to believe masturbation was prohibited. You can’t do it if your hand doesn’t work, and so that solves the conflict…and it also gains attention and nonerotic care from others. Nowadays, conversion is captured under the DSM-5-TR as functional neurological symptom disorder³.

→Sexualization
Sexualization involves placing libidinal urges onto extreme needs for love and closeness. Thus, the act of sex itself is a defense, not an expression or necessarily even enjoyable. Histrionic personalities can be very seductive, but unaware that their behaviors invite sexual connection. Sexualization often goes hand in hand with the defense mechanism of acting out.

→Acting Out
Histrionic personalities act out in a counterphobic manner, meaning they go against their fears. They approach and move toward what they are frightened of, though the fear is usually unconscious (remember they fear the danger and power of the opposite gender). Here are some examples:

• Feeling inferior, they seek to be the center of attention.
• Feeling ashamed of their gendered body, they are exhibitionistic.
• Feeling scared of a powerful other, they provoke them.

→Regression
Regression is a return to an earlier level of development under stress, fear, or insecurity. Histrionic personalities can regress to a more childlike state where they are suggestible and helpless. Think of the historical “swoon” where women would gush over big strong men, while giggling like a little girl. At healthy levels, regression can be charming, but at unhealthy levels, there can be whining, clinginess, demandingness, physical illness, and/or addiction to crisis.

→Dissociation
Dissociation involves keeping conflicting urges or unacceptable, distressing emotions and feelings separated in the psyche. For those with histrionic personalities, this may look like keeping different pieces of the self or experience compartmentalized, like having different roles in a play. Dissociative symptoms may include binge eating, fugue states, and hysterical rages. There’s a few interesting historical examples as well, including La belle indifference (inappropriate minimization of symptoms); Pseudologia fantastica (pathological lying, but also lying to the self in the moment); and Fausse reconnaissance (remembering something that didn’t occur).

The Self in Histrionic Personality²

Remember, for the histrionic personality there is preoccupation with gender, sexuality, and their relation to power. Their sense of self involves feeling fearful, small, inferior, and defective, like a child trying to survive and make it in a realm filled with others who are powerful. For example, in early childhood, a little girl learns to scream to get what she wants due to inconsistent responses from parents. If successful, she might learn that attention will always be there if she acts out. Perhaps this explains the DSM³ criteria involving shallow affect, but also theatrical, exaggerated emotions. However, it’s not the full picture.

When histrionic personalities express feelings, they can seem theatrical, exaggerated, and inauthentic, BUT it doesn’t mean they don’t actually have the feelings. They do! They just also have high anxiety regarding expressing themselves to powerful others, always expecting to be devalued and treated like a child. They expect their emotions to be disrespected. But by expressing feelings in a way that could be taken back as not serious, they can reserve the option to minimize or retract what they say…so playacting or superficiality is protective. Their emotion is absolutely there; it is just riddled with conflict. They stroll through life pretending to be themselves.

Do you relate to any of these conflicts or dynamics? It’s hard to parse all this out! If you want to better understand these dynamics in yourself or others, therapy and/or psychological testing can help! If you’re in Virginia (or a PsyPact state), check out Quest Psychological and Counseling Services for available services. If you’re a provider stuck on a case, we also offer consultations for mental health professionals!

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