The Evolutionary Neurodevelopmental Perspective

Although the preceding perspectives are valuable, they are only part of the whole story. In the evolutionary theory, the histrionic personality is referred to as the active and other-oriented, whereas the dependent personality is referred to as the passive and other-oriented. Both feel helpless and make others the center of their lives. Dependents seek an instrumental surrogate, someone to compensate for feelings of helplessness and inadequacy. To bind others to them, dependents create a sweet, innocent, passive, and childlike façade. By perfecting this image, they dare others to confront the guilt of abandoning them.

In contrast, the histrionic actively seeks to create an image so compelling it consumes the consciousness of others with one single-minded desire: Get closer to me! If the ideal relationship is symbiotic, the dependent is comparable to the functions of a parasite and the histrionic to that of a black widow spider. Whereas the dependent mates for life, the histrionic mates covertly and symbolically across every medium the senses offer, attracting as many potential suitors as possible. Whereas the dependent invests in a single relationship, the histrionic hedges bets by cultivating backup alternatives. Whereas the dependent fuses exclusively with a single all-powerful other, the histrionic projects the secret wish of an omnipotent lover so powerfully that others easily become caught up in the web of fantasy themselves. Table 9.1 summarizes the histrionic personality in eight clinical domains, abstracted in part from the preceding discussion of perspectives.

The overarching question is: How does such a personality, like that of the histrionic, evolve? In keeping with the evolutionary perspective, for a personality to ultimately become what it is, it must survive, adapt, and replicate. As scientists delved into the origins of man to discover the process of evolution, so, too, do we examine the origins of the histrionic personality.

In searching for the biological origins of the histrionic pattern, the role of neurodevelopment is our first source of explanation. The neural and chemical substrate for tendencies such as sensory alertness and autonomic or emotional reactivity may logically be traced to genetic influences. Evidence demonstrating a high degree of family correspondence in these traits is suggestive of physiological commonalities but can be explained also as a function of experience and learning. The need for research is obvious, not only in establishing factually the presence of family correspondence but also in tracing the manner in which such alleged genetic factors unfold and take shape as psychological traits.

However, equally important to genetic influences are the environmental experiences, which inevitably contribute to and mold a newly born personality. The constitutionally alert and responsive infant experiences greater and more diverse stimulation in the first months of life than the less aware or receptive infant. As a consequence of these early stimulus gratifications, the tendency to look outward to the external world for rewards is reinforced rather than looking inward. In a similar manner, normally alert infants may develop this exteroceptive attitude if their caretakers, by virtue of sensory indulgence and playfulness, expose them to excessive stimulation during early life stages.

Histrionics appear to have been exposed to a number of different sources that provided brief, highly charged, and irregular stimulus reinforcements. For example, the histrionic may have had many different caretakers in infancy (parents, siblings, grandparents, and

TABLE 9.1 The Histrionic Personality: Functional and Structural Domains

Functional Domains

Structural Domains

Dramatic

Gregarious

Expressive Behavior

Is overreactive, volatile, provocative, and engaging, as well as intolerant of inactivity, resulting in impulsive, highly emotional, and theatrical responsiveness; describes penchant for momentary excitements, fleeting adventures, and shortsighted hedonism.

Self-Image

Views self as sociable, stimulating, and charming; enjoys the image of attracting acquaintances by physical appearance and by pursuing a busy and pleasure-oriented life.

Attention Seeking

Shallow

Interpersonal Conduct

Actively solicits praise and manipulates others to gain needed reassurance, attention, and approval; is demanding, flirtatious, vain, and seductively exhibitionistic, especially when wishing to be the center of attention.

Object-

Representations

Internalized representations are composed largely of superficial memories of past relations, random collections of transient and segregated affects and conflicts, as well as insubstantial drives and mechanisms.

Flighty

Disjointed

Cognitive Style

Avoids introspective thought, is overly suggestible, attentive to fleeting external events, and speaks in impressionistic generalities; integrates experiences poorly, resulting in scattered learning and thoughtless judgments.

Morphologic Organization

There exists a loosely knit and carelessly united morphologic structure in which processes of internal regulation and control are scattered and unintegrated, with ad hoc methods for restraining impulses, coordinating defenses, and resolving conflicts, leading to mechanisms that must, of necessity, be broad and sweeping to maintain psychic cohesion and stability, and, when successful, only further isolate and disconnect thoughts, feelings, and actions.

Dissociation

Fickle

Regulatory Mechanism

Regularly alters and recomposes self-presentations to create a succession of socially attractive but changing facades; engages in self-distracting activities to avoid reflecting on and integrating unpleasant thoughts and emotions. Sexu-alization is used to influence relationships, projection to deny this influence. Both are examples of massive repression.

Mood/ Temperament

Displays rapidly shifting and shallow emotions; is vivacious, animated, impetuous, and exhibits tendencies to be easily enthused and as easily angered or bored.

Note: Shaded domains are the most salient for this personality prototype.

Note: Shaded domains are the most salient for this personality prototype.

foster parents), who supplied intense, short-lived stimulus gratifications that came at irregular or haphazard intervals. Such experiences may have not only built a high-level sensory capacity, which requires constant "feeding" to be sustained, but also conditioned the infant to expect stimulus reinforcements in short concentrated spurts from a mélange of different sources. (Irregular schedules of reinforcement establish deeply ingrained habits that are highly resistant to extinction.) Thus, the persistent yet erratic dependency behaviors of the histrionic personality may reflect a pathological form of intense stimulus seeking traceable to highly charged, varied, and irregular stimulus reinforcements associated with early attachment learning. As such, the shifting from one source of gratification to another, the search for new stimulus adventures, the penchant for creating excitement, and the inability to tolerate boredom and routine all may represent the repercussions of these unusual early experiences.

In other words, the parents of the future histrionic rarely punish their children and distribute rewards only for what they approve and admire, yet often fail to bestow these rewards even when the child behaves acceptably. Such behaviors have personality consequences: strategies designed to evoke rewards, a feeling of competence and acceptance only when others acknowledge their performances, and a habit of seeking approval for its own sake. All three of these traits are characteristic of the histrionic personality. We next detail their development.

Children who receive few punishments and many rewards develop a strong and inambivalent inclination to relate to others. If they learn that the achievement of rewards is dependent on fulfilling the expectations and desires of others, they will develop a set of instrumental behaviors designed to please others and thereby elicit these rewards. However, if these strategies succeed sometimes but not always—that is, if they are sporadically reinforced—these children will persist in using them or variations of them, well beyond all reason, until they do succeed, which eventually they will. As do most anything intermittently reinforced, these instrumental behaviors will not easily be extinguished, even if they fail much of the time.

As a consequence of this pattern of experiences, children become actively rather than passively oriented toward others. Furthermore, they learn to look to others rather than to themselves for rewards since their behavior is only preliminary and not a sufficient condition for achieving reinforcements; the same behavior on their part elicits a reward one time but fails on another. Despite the fact that they continuously aim to please and perform for others, it is always others who determine whether and when they will be rewarded. They await others' judgment as to whether their efforts will bring recognition and approval; as a consequence, it is others who define the adequacy of their behavior; that is, their competence is judged by the reaction of others, not by their own efforts or behaviors.

There is little question that children learn, unconsciously, to mimic that which they are exposed to. The prevailing attitudes and feelings and the incidental daily behaviors displayed by family members serve as models, which growing children imitate and take as their own long before they are able to recognize what they are doing or why. This process of vicarious learning is made especially easy if parental behaviors and feelings are unusually pronounced or dramatic. Under these circumstances, when parents call attention to themselves and elicit emotional reactions in their children, the children cannot help but learn clearly how people behave and feel. Thus, many female histrionics report that they are "just like" their mother, emotionally labile women "bored to tears with the routines of home life," flirtatious with men, and "clever and facile in their dealings with people." The presence of a histrionic parent, who exhibits feelings and attitudes rather dramatically, provides a sharply defined model for vicarious and imitative learning.

Children who struggled long and hard to capture the attention and affection of their parents under conditions of sibling rivalry often continue to use the devices that led to their periodic successes long after the rivalry ceased to continue. Not only are these behaviors reactivated when they seek attention in the future, but they often misperceive innocuous situations (perceptive distortion) and recreate competitive situations (repetition compulsion) in such ways as to bring forth the strategies they learned in the past. If the child learned to employ cuteness, attractiveness, and seduction as a strategy to secure parental attention, these interpersonal behaviors may persist and take the form of a lifelong histrionic pattern.

Aesthetically appealing girls and likable or athletic boys need expend little effort to draw attention and approval to themselves; their mere being is sufficient to attract others. As rewarding as these experiences may be in building up a high sense of self-esteem, they do have their negative consequences. These persons become excessively dependent on others because they are accustomed to approval and have learned to expect attention at all times. They experience considerable discomfort, then, when attention fails to materialize. To ensure the continuation of these rewards and thereby avoid discomfort, they learn to play up their attractiveness. For example, the formerly pretty young girl, to elicit the attention and approval that came so readily in youth, goes to great pains as she matures to remain a pretty woman; similarly, the formerly successful young athlete struggles to keep his muscular and trim figure as he progresses into middle life. Both of these attractive individuals may have failed to acquire more substantial talents in their youth because they needed none to elicit social rewards. What we observe in their later life, then, is a childish exhibitionism and an adolescent, flirtatious, and seductive style of relating, all of which characterize the histrionic personality.

Contrast with Related Personalities

Given their drama and theatrics, the histrionic is one of the most reliably identifiable personality disorders. In addition to similarities with the dependent, the histrionic shares important traits with several other disorders as well. In general, personalities that are self-oriented, such as the narcissist and antisocial, tend to develop paranoid traits under conditions of intense or prolonged stress, whereas personalities that are other-oriented, such as the dependent and histrionic, develop traits that are more borderline. Accordingly, both dependent and histrionic personalities, for whom fantasies of fusion with caretakers are an important feature, tend to develop symptoms related to identity diffusion or dissociation, though borderlines are usually more severe. Likewise, both borderlines and histrionics exhibit rapidly shifting emotions, and both experience feelings of profound emptiness. Both may attempt to manipulate others with suicidal gestures. However, actual self-destructive behaviors, such as cutting, are more frequently seen in borderlines. Despite their contrasts, the two disorders do shade into each, as histrionics may develop borderline traits. Developmentally, histrionics enjoy a special relationship with their opposite-sex parent that stops short of actual incest and develop repression as a means of keeping such forbidden desires out of consciousness. In contrast, for borderlines, incest or other sexual abuse is often a reality.

Both histrionics and narcissists are exhibitionists, sharing a desire to be the absolute center of attention, though for different reasons. As noted, histrionics exhibit their wares and read the desires of others to create intense interest and attraction. Narcissists are aloof from such concerns and feel that they should be desired just as they are; tailoring their image betrays too much vulnerability. Histrionics believe the world is dominated by the sexual instinct and specialize in creating such wishes in others, though not necessarily in fulfilling them. Narcissists, in contrast, believe the world is dominated by their own self. They seek the realization of grandiose wishes for infinite power, success, and superiority. Histrionics exhibit themselves to others to create desire. In contrast, narcissists exhibit themselves to elicit admiration; they enjoy the worship they give themselves as much as the attention they receive from others. Histrionics follow popular fads and conventions and feign fragility and neediness as necessary to pull others back to them. Narcissists, in contrast, disdain dependency, viewing themselves as being above activities that subordinate their personal charisma to mundane group norms. For this reason, the narcissist remains above it all, calm and insouciant, whereas the histrionic is given to emotional displays that seem shallow, labile, and often desperate.

Finally, we revisit the antisocial and histrionic personalities. They both are impulsive, manipulative, stimulus-bound, and unable to anticipate the consequences of their behavior. Histrionics, however, often seem impulsive because of their dramatic, hyperemotional behavior, which is used to secure attention and nurturance. Alternatively, they may seem impulsive because of their cognitive style. Because histrionics are both hyperemotional and easily distracted, their attention may seem to move impulsively from one stimulus to the next, each receiving its own affective exclamations. Consequently, histrionics are less often engaged in blatant criminal behavior, with the exception of drug abuse. In contrast, antisocial impulsivity stems from an inability to delay gratification, especially where the release of aggressive impulses is concerned. Antiso-cials are bound by their drives; they fail to think ahead because their consciousness is absorbed by the possibility of immediate reward. In contrast, histrionics fail to think ahead because they want to minimize cognitive effort; awareness of the future invites the responsibility of choice, and histrionics repress that burden. Their distractible and impressionistic style is constructed to prevent deliberate consideration and cautious evaluation of a variety of alternatives.

Pathways to Symptom Expression

Each personality style finds a path to dysfunction in its own particular way. In each case, a logic can be constructed that links expressed symptoms directly to the personality, development, and circumstances of the individual concerned. In general, the degree of symptom expression is associated both with the severity of the disorder and with the intensity of current life stressors. Thus, an individual who might be diagnosed as disordered, whose life is currently without stressful concerns, might easily be symptom-free, whereas a normally high-functioning individual encountering severe stress might develop an Axis I disorder. As you read the following paragraphs, try to identify the connection between personality and symptom.

Somatoform Disorders

Historically, the psychodynamic perspective has always considered illness-related symptoms, especially conversion symptoms, to be part of the hysterical personality. Today, such symptoms have been separated from their associated personality traits and classified as part of the Axis I disorders, irrespective of their association to the hysterical personality. Therefore, we see many other personalities exhibit somatic symptoms, notably, the dependent personality. Hueston, Mainous, and Schilling (1996) found that medical care use was highest for subjects at risk for histrionic and dependent personality disorders as opposed to all other personality disorders, a finding in keeping with our dancer, Yvonne, who suffered from pain for months with no apparent cause.

For histrionics, hypochondriacal concerns—the fear that you have some serious disease—and somatization disorder—physical complaints lacking a substantial basis—are used instrumentally to draw attention, comfort, and nurturance from others. Whenever the histrionic feels empty, isolated, or bored, the secondary gains become more tempting, so the disorder seems to be exacerbated. Finally, as noted by Benjamin (1996), frequent complaints of illness have often been associated with the female gender role, as it was with the patients Freud studied in his seminal investigations. For Benjamin, these somatic aspects are considered so important that they form a distinct subtype of the histrionic personality.

Dissociative Disorders

As with somatic symptoms, dissociation also has a historical association with the hysterical personality as viewed through the psychodynamic perspective. The hysterical phenomenon of forgetting what you know to be true, a motivated amnesia, was the original conundrum that led Freud to the discovery of the unconscious. Breuer and Freud, for example, noted two distinct states of consciousness in their famous patient, Anna O. For the histrionic, dissociation is simultaneously both a defense and a symptom. Because histrionics make extensive use of repression, they fail to integrate their various experiences into a single integrated conception of the self. As such, their mental architecture creates an enduring vulnerability to identity diffusion and other forms of dissociation during stressful periods.

However, dissociation also serves a protective purpose. By disconnecting their true selves from the theatrical poise they present to the world, histrionics prevent painful experiences from being processed to any depth. In effect, the existence of an integrated self is temporarily suspended until the storm blows over, preventing anguish, despair, or anxiety from surging into full conscious awareness. Note that because dissociative symptoms are so frequently associated with a history of childhood abuse, their presence should motivate clinicians to inquire about such a possibility.

Anxiety Disorders

Both dependents and histrionics are vulnerable to separation anxieties, though for different reasons. Histrionics increase their potential for anxiety through their tendency to seek diverse sources of support and stimulation. Because they quickly get bored with old attachments and excitements, their relationships are never truly solidified. Consequently, they often set themselves up to feel isolated and alone. Like borderline subjects, they may find themselves frantically searching for attention and approval until some new romance or excitement captures their interest. Subjectively, their discomforts are real but again tend to be overdramatized as a means of soliciting attention and support. Agoraphobia is probably more rare among histrionics than dependents, for histrionics naturally love to take center stage and become the center of attention in a social gathering. Likewise, phobias are probably rare, except where they constitute an image the histrionic wants to present.

Mood Disorders

In the histrionic personality, major depression usually stems from feelings of emptiness, boredom, or loss of dependent security, probably related to relationship problems; recall the case of Sheila, the semisuicidal sophomore. Given histrionics' characteristic tendency toward sensationalism, agitated symptoms are most common, accompanied by dramatic verbalizations of abandonment and helplessness. Their agitation, however, does not reflect the internal struggle that can occur with the negativist and obsessive-compulsive, but instead represents the direct expression of their feelings, though probably in an exaggerated form. Because histrionics think globally, they may simply report that they feel "incredibly awful" or "bad," emphasizing the intensity of their feelings without much further qualification. Consistent with their socially exuberant style, histrionics may also be susceptible to the development of manic or hypomanic disorders. Confronted with severe separation anxieties or anticipating loss of social approval, some histrionics intensify their habitual behaviors, becoming frantically congenial and hyperactive. Sheila may fall into this category.

Substance Abuse

Histrionics sometimes become involved in substance abuse. Alcohol, for example, liberates their already dramatic tendencies, while further deadening the self-insight that histrionics characteristically repress. The function of the abuse varies among these individuals. For Yvonne, substance abuse is consistent with a partying lifestyle, where it enhances stimulation and excitement. For Monique, substance abuse may have started the same way; after her second divorce, however, alcohol seemed to become important in distracting her from larger life problems. Stimulants may also be used to escape feelings of emptiness, helping the subject feel alive and energetic while supporting a natural tendency toward sensation seeking. Because histrionics are usually concerned about physical appearance, stimulants also provide a faster means of becoming slim and attractive. Those with an abundance of neurotic anxiety may use heroin or methadone as a means of self-medication. Given their lack of solid internal controls, the prognosis for histrionic substance abusers is probably poor.

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