1. Fallon Comrack
November 18, 2014
http://diaryofahistrionic.blogspot.com.au/
I. Thumbnail summary of Internet case history
The Internet case that I selected is called "Diary of a Histrionic Personality"; it is a self-
report written in blog form, by an anonymous 21 year old woman from the United Kingdom (2010).
This young woman describes and reflects upon her experience of symptoms of the psychological
disorder known as Histrionic Personality Disorder (HPD).
II. Symptom picture as reported in the case history
In her blog posts, the author of this case study lists one of the DSM IV-TR's defining
symptoms of Histrionic Personality Disorder, and states, "I am not uncomfortable not being the
centre of attention but I prefer when the focus is on myself and I tend to have to remind myself to
include the people around me" ("Diary of a Histrionic Personality", 2010). This statement is
contradictory because she begins by denying that she is uncomfortable when she is not the center of
attention, and then continues to describe actions that she takes (or tries to resist) that would direct
the focus of the situation towards herself. Therefore, she is, as defined by the DSM-IV,
"uncomfortable in situations in which he or she is not the center of attention" (4th ed., text rev.;
DSM–IV–TR; American Psychiatric Association, 2000).
The blogger explains another symptom as listed by the DSM-IV when she writes about her
sexual relationships, considering that her "interaction with others is often characterized by
inappropriate sexually seductive or provocative behavior" (4th ed., text rev.; DSM–IV–TR;
American Psychiatric Association, 2000). She explains that at the beginning of her relationships she
tends to "perform" and "act perfect" ("Diary of a Histrionic Personality", 2010). She says that every
guy she has dated has "showered [her] with compliments in the beginning because [she] is
everything they want [her] to be" ("Diary of a Histrionic Personality", 2010). The author of the case
goes onto say that this act eventually fades and her fragile relationships usually end as a result. This
is an inappropriate pattern seen in her relationships that involves sexually seductive behavior.
Sexually provocative behavior is described by the author when she talks about the changes
that happen over the course of her usually short-lived, fragile relationships with men. She says
about her lovers: "they will most likely hate the fact that I'm flirting with their friends and rolling
around in compliments since I will happily listen to anyone who is wanting to give me praise or
attention," and "I am very male attention focused and thus even how I get ready each morning is a
performance" ("Diary of a Histrionic Personality", 2010). This sexually provocative behavior
proves the existence of two other symptoms listed by the DSM-IV, including her "rapidly shifting
and shallow expression of emotions" as well as her "suggestibility" or how easily she is influenced
(4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000). The male who is giving
her the most attention at the time enables and perpetuates her histrionic behavior -- whether she is in
a relationship or not -- thus, proving her superficiality within relationships.
Additionally, the author of this case study "consistently uses physical appearance to draw
attention to [her]self" (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000).
She straight out says, "I have to look attractive at all times because I want to be desirable at all
times even if I have absolutely no interest in 95% of the men looking at me" ("Diary of a Histrionic
Personality", 2010). She also is aware of her tendency to show "self-dramatization, theatricality,
and exaggerated expression of emotion" (4th ed., text rev.; DSM–IV–TR; American Psychiatric
Association, 2000), claiming that her ex-boyfriend used to describe her as a "little ball of self praise
that walks around talking to herself and building up her own ego" ("Diary of a Histrionic
Personality", 2010).
In one of her posts, she describes an interaction between her and one of her "close friends"
who she "cares about deeply" and is a male ("Diary of a Histrionic Personality", 2010). Although it
is hard to determine from the given information, this could potentially be an example of her
considering "her relationships to be more intimate than they actually are" (4th ed., text rev.; DSM–

2. IV–TR; American Psychiatric Association, 2000). She said when she was talking to her friend about
"being down", she said to him "I'm so depressed" ("Diary of a Histrionic Personality", 2010). She is
seemingly aware of her "style of speech that is excessively impressionistic and lacking in detail"
(4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000). She is able to analyze
her own histrionic tendencies to identify her symptoms, using her blog as an outlet and attempt to
control her disorder.
III. Symptom picture as reported from objective data
According to the textbook, "Abnormal Psychology: Current Perspectives", "the essential
feature of histrionic personality disorder is self-dramatization -- the exaggerated display of
emotion" (2005, p. 296). Most of the people with this disorder tend to be manipulative and their
behavior is usually "aimed at attracting attention and sympathy" (Alloy, Riskind & Manos, p. 296).
The author of the given case recalls being manipulative and self-dramatized under the circumstance
that she is in a group of friends:
"Now particularly with friend groups, myself will know how to get the attention back to
myself in a very subtle way and also I am thinking about how to keep it subtle at all times
because if done in an obvious way, people start to ignore you. The most intelligent way to do it, is
not to get the attention back to you by yourself but by getting other people to draw the
attention back to you" ("Diary of a Histrionic Personality", 2010).
She goes on to say that she can also redirect the attention of conversation to herself by
responding to a friend by saying "Oh I know how you feel. I went through a similar thing…" and
then telling her own experience ("Diary of a Histrionic Personality", 2010). She is consciously and
actively coming up with strategies to steer the direction of conversation the way she wants it to go,
which is toward herself.
To her, she seems sensitive, but to others, histrionic people usually come off as shallow and
insincere (Alloy Riskind, & Manos, p. 296). Initially, someone with histrionic personality disorder
may come off as warm and affectionate, but they eventually lose the "perfect act" as described by
the author in the case study, and become "oppressively demanding," and "generally taking without
giving", as stated in the textbook (296). The author of the case comes outright with this
characteristic, acknowledging her "need for a lot of attention without giving much back" ("Diary of
a Histrionic Personality", 2010).
The author also notes that she has been called self-absorbed by numerous people, preventing
her from establishing any lasting sexual bonds (Alloy, Riskind, & Manos, p. 296). She describes the
fragility of her interpersonal relationships, claiming that she often moves quickly from partner to
partner depending on whether or not they were giving her the attention she was seeking ("Diary of a
Histrionic Personality", 2010) (Alloy, Riskind, & Manos, p. 296). An example that the textbook
gives of a person with Histrionic Personality Disorder, is spoiling their companion's evening
because they are "so 'overcome' with emotion during a sad movie that they have to be taken home
immediately" (Alloy, Riskind, & Manos, p. 296). This is similar to the case study, in which the
author talks about previously demanding to go home or storming off "if feeling ignored by a
boyfriend" ("Diary of a Histrionic Personality", 2010).
The textbook also gives credit to Bornstein's study in 1999, on the associations between
histrionic personality disorder and physical attractiveness in those who are diagnosed (Alloy,
Riskind, & Manos, p. 296). This study found that women displaying histrionic symptoms were "on
average more physically attractive than other women, both those with other PD's and without"
(296). These women were found to exhibit "more negative behaviors in important relationships", as
the author of our case study does as well (296). In describing her seduction of men, she puts on her
perfect act and often gets asked why she is single, noting, "I'm a very attractive young lady" ("Diary
of a Histrionic Personality", 2010). Another similarity between Bornstein's findings and the case
study was the tendency for women with Histrionic Personality Disorder to use "less mature defense
mechanisms" (Alloy, Riskind, & Manos, p. 296). About arguing with her significant other toward
the end of a relationship, she says, "I will keep arguing until that person either admits they are
wrong or I back them into a corner" ("Diary of a Histrionic Personality", 2010).

3. IV. Diagnosis
According to the comparison of sources about the case, with information being given to me
by the author in the "Diary of a Histrionic Personalty" as well as the textbook, "Abnormal
Psychology: Current Perspectives", I would diagnose this person with Histrionic Personality
Disorder. Clearly, the author of this case study is intellectually and emotionally intelligent. She
seems to have significant knowledge about her personality disorder as well as the symptoms that
she exhibits. She says that "a lot of people paint Histrionics as these selfish individuals who are
only out for themselves when actually its human closeness that they really crave and are actually
just going about it the wrong way" ("Diary of a Histrionic Personality", 2010). She perceives her
actions as caring, despite her constant need for attention in social contexts. She also seems willing
(although maybe not through the use of treatment) to try to change and decrease the intensity of
symptoms in her everyday life. Overall, she meets many, if not all of the symptoms listed in the
DSM-IV for diagnosing Histrionic Personality Disorder (4th ed., text rev.; DSM–IV–TR; American
Psychiatric Association, 2000).
V. Etiology
According to the article, "A time series evaluation of the treatment of histrionic personality
disorder with cognitive analytic therapy", by Stephen Kellett, there has been "much debate and
disagreement concerning the etiology of HPD" (2007) (p. 389). On the other hand, there "is
consistency across clinicians, researchers and theoreticians regarding the typical cognitive,
affective, and interpersonal symptoms of HPD" (Kellet, p. 389). HPD has been defined by behavior
driven by "excessive attention-seeking and unwarranted/disproportionate emotionality" (Kellet, p.
389). Previously, HPD has been "primarily regarded as a female disorder" (Kellet, p. 390). Despite
this sexist idea being challenged in time, the fact remains that at least two thirds of those diagnosed
with HPD are women (Alloy, Riskind, and Manos, p. 296). Otherwise, symptoms of HPD are said
to "vary markedly from case to case, regardless of the gender of the client" (Kellet, p. 390). After
undergoing many changes as society advances, this particular personality disorder is now
considered Hysteria in the DSM-V.
VI. Treatment
The treatment for people who have Histrionic Personality Disorder is psychotherapy, as well
as a combination of behavioral and cognitive techniques. Due to the tendency of people with
personality disorders to avoid treatment, therapists must take a more directive, and parental
approach with these patients (Alloy, Riskind, & Manos, p. 304). It is thought that the more actively
engaged the therapist is with their clients, the more likely it is for the client to block "acting-out
behavior", to be "more focused on the present than on the past," and "more concerned with
connecting feelings and actions" (304). The therapist also attempts to determine "what, in [the
client's] childhood experience, might have created such a need for admiration" (304). In the case
study, the author mentions her horrible childhood and how she likes to tell people about it, and
often this is the root of the problems for people diagnosed with HPD. Finding out the potential
causes of the disorder is a slow process, so I would recommend at least a year of therapy for the
author of this case study as well as six months of follow-up treatment.
According to the textbook, personality disorders may be "usefully addressed by behaviorists
if the diagnostic terms are understood as 'descriptors of classes of behavior that have been learned
and can be changed'" (Alloy, Riskind, & Manos, p. 304). Behavioral techniques "have operated on
the assumption that, because most of these disorders can be seen as inappropriate social behavior,
what the patient needs is social-skill training" (305-306). In patients for HPD specifically,
behavioral techniques that teach empathetic behavior and effective interaction with the other sex
could be very useful. For treatment, I would definitely recommend behavioral strategies as such to
the author of the case that has been examined.
Finally, I would recommend treatment that involves some aspects of cognitive therapy for
this particular case of HPD. In cognitive therapy, the therapist could set realistic goals of getting the
patient to modify, reinterpret and camouflage any distortions or exaggerations in her schemas
(Alloy, Riskind, & Manos, p. 306). By reinterpreting her schemas, which have been woven into her

4. normal cognitive processes early on, they can be put to more functional use (306). This process is
also referred to as "schematic camouflage, [which] involves teaching patients socially acceptable
behaviors that they can use to simply ease their way in situations in which their habitual rigidity is
likely to cause them difficulties" (307).
VII. Applications
Suffering with HPD or another similar personality disorder would drastically affect my day
to day life. If I felt that I was a genuinely caring and giving person, but my interpersonal
experiences suggested otherwise, I would probably be extremely hard on myself. This pressure to
prove to others that I am a person with good intentions could then further intensify the symptoms of
my PD, causing me to get stuck in a similar cycle as the one seen in this case study. I imagine it
being difficult to distinguish self-care from the care that you have for others'. Unintentionally being
overly dependent on and demanding of my loved ones would hurt their feelings and make them
dread having to deal with my constant need for approval. By hurting their feelings, my feelings
would also be hurt -- even further perpetuating my symptoms of disordered thinking patterns and
resulting behaviors. As mentioned, it is a cycle that is difficult to break due to the deep
internalization of self-schemas and the lack of insight about the disorder.
References
Alloy, L., Riskind, J., & Manos, M. (2005). Personality Disorders. In Abnormal Psychology:
Current
Perspectives (9th ed., pp. 296-307). New York, NY 10020: McGraw Hill.
American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders (4th ed., text rev.).
Imissyourkiss. (2010, June). Diary of a histrionic personality [Web log comment]. Retrieved from
http://diaryofahistrionic.blogspot.com/.
Kellett, S. (2007). A time series evaluation of the treatment of histrionic personality disorder with
cognitive
analytic therapy. Psychology & Psychotherapy: Theory, Research & Practice, 80(3), 389-
405.
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