The Interpersonal Perspective

Although Sullivan is usually regarded as the father of the interpersonal perspective, later interpersonal thinkers have been much more systematic. Leary (1957), for example, was the first to actualize the potential of the interpersonal circle. His cooperative-overconventional personality comes closest to the contemporary histrionic. Such individuals are characterized by extroverted friendliness and sociability and a striving to be liked and accepted. On the positive side, Leary noted that they are ever optimistic, if somewhat bland, and "continually strive to please, to be accepted, to establish positive relations with others" (p. 304). On the negative side, however, he also noted that they are intolerant of criticism, seek to void themselves of all guilt, and refuse to see their own behavior as hostile or power mongering.

Researchers following Leary have further refined the geometry of the original interpersonal circle through more sophisticated statistical methods. In a particularly finegrained analysis, Kiesler (1983, 1996) divides the circle into 16 segments described at two levels of functioning, normal and pathological. Although many personality disorders possess characteristics that do not map neatly onto the interpersonal model, the histrionic can be described succinctly in terms of two main segments. In the normal range, Kiesler (1996, pp. 14-15) uses the descriptors uninhibited, dramatic, perky, neighborly, approachable, and interested. At the pathological extreme, these become unbridled, melodramatic, flamboyant, always available, and intrusive.

Histrionics have many distinctive interpersonal qualities, most notably their self-image and the immediate impression they make on others. At least at a conscious level, they usually see themselves as attractive, friendly, and fun to be around. In the beginning, they can seem most charming. The ease with which they open up and relate their feelings seems to establish a quick intimacy that is both alive and refreshing, qualities that alone are often very attractive. More severe histrionics, however, inevitably become volatile, provocative, theatrical, and capacious. Their one-on-one charm becomes a talent for grabbing the headlines, marketed to entire social groups. If not the life of the party, the histrionic at least has a retinue of smiling followers eager for eye contact. To make themselves more appealing, they may alternate playing the naive, innocent waif and the worldly sophisticate, tailoring their display as the audience desires. Attentiveness to such signals allows them to quickly maneuver their interpersonal impression to minimize any possibility of rejection or indifference, while maximizing ongoing attention and attracting numerous potential suitors, their resources, and their helpfulness. Dramatic gestures, attractive coiffures, frivolous comments, and shocking clothes—all are designed to stimulate interest and draw attention, as Case 9.3 demonstrates.

Although histrionics are often experienced as being attractive at first, their intimate relationships usually have a superficial quality. Because most require constant attention and stimulation, their partners may eventually feel enslaved by their neediness, tire of the burden, and simply withdraw emotionally, leaving the histrionic terminally bored and actively looking for alternatives. More pathological individuals may move quickly through friendships and companions, who become burned out by their intensity and mood swings. By contrast, the less pathological individuals maintain relationships by using their good looks and charm, for example, the illustrious trophy wives, whose mission is to look good and ornament their husbands' achievements. Not surprisingly, many histrionics find the self-confidence of the narcissistic style to be very attractive. One is as empty as the other is full. Although hardly satisfying, such relationships may endure as long as each member keeps up his or her end of the bargain. The male must continue his ascent up the ladder of social status; the female must appear as attractive as possible and combat the process of aging with grace. The unfortunate reality for these women relying on their appearance to gauge success is the Darwinian effect of survival of the fittest or, in this case, prettiest. Inevitably, younger and prettier competition surfaces and creates insurmountable stress for the aged vixen.

An example of superficial interpersonal relationships is the case of Sheila. When she presents for evaluation and therapy, she exhibits many of the classic features of the histrionic personality, with characteristics of the infantile subtype. In the message left at the counseling center, Sheila threatens suicide but apparently feels that she will not be taken seriously. She seeks to guarantee a response by following up her threat with, "I'm not kidding." In the interview, she readily admits using such suicidal gestures manipula-tively, noting that it gets attention and "always works on the parents." Although she is probably being truthful, it is also possible that Sheila fears that she has underestimated the impact of her message and wants to head off interventions she most definitely would not enjoy, perhaps hospitalization, by suggesting that she was being deliberately manipulative. Moreover, her behavior with the male interviewer is suggestive and inappropriate, and there is a curious discrepancy between the depression she acknowledges and her animated style. Her responses to questions seem overemotionalized and poorly detailed, often with no real segue between succeeding emotional states.

Although probably exaggerated, the impression we get from Sheila's message is that she sometimes feels alienated from almost everyone. She has been arguing with her roommates since the beginning of the semester because she borrows their things without permission, parties too late, and brings intoxicated visitors back to the apartment she shares. Her boyfriend is "extremely and unreasonably jealous," probably in part because she denies the role of her seductive style in actively soliciting male attention. "I can't help it if they find me attractive," we can imagine her saying. Despite their problems, her boyfriend is nevertheless described as "the closest person in the world to me," an exaggeration consistent with the tendency of histrionic individuals to assume that their relationships are more intimate than they are. The fact that he has "turned on" her only makes matters worse, and that is what prompted her call to the counseling center. Almost every relationship has problems, but we can imagine that Sheila's are probably more chronic than most, with themes of crisis and betrayal that are repeated again and again. Indeed, this is one of the defining characteristics of personality disorder.

Sheila called the university counseling center just after midnight. She spoke softly into the answering machine and seemed to be fighting back tears. "Uh, I feel really shitty and I'm mad at everyone I know and I need to talk with someone who cares or I'm going to kill myself right now and I'm not kidding either!"1 Although she left her phone number at her dorm room, attempts to reach her by the on-call therapist were unsuccessful. According to her roommate, Sheila was out "making the rounds." After a second call the next morning, she agreed to come in for evaluation.

Sheila arrived 30 minutes late, chewing bubble gum and dressed scantily in a shocking black outfit. When her male interviewer paused immediately upon seeing her, she stated simply, "It symbolizes the way I'm feeling right now. Do you like it?" A turban covered her hair, and dark stones adorned her fingers, ears, and neck. The whole getup seemed chosen for its obvious shock value. An assessment of suicidal potential was the first objective, but Sheila denied that she was really serious. "If I was serious," she quipped dramatically, "I wouldn't be here, now would I?" "It's a good way of getting attention ... I don't like to be ignored . . . always works on the parents. You'd be surprised what you can get if you try hard enough." At that moment, she blew a big bubble, and then suddenly sucked the air out of it, all without losing eye contact with the interviewer.

Sheila reports problems in many areas of life. First, she is doing poorly in school and fears she may be thrown out if her grades do not improve. She is already on academic probation. When asked about her attendance, she admits that she rarely makes it to classes, because most of them are in the morning, and her social activities get started after midnight. However, "a lot of the guys in class have volunteered to take notes for me." Second, Sheila and her roommates have had problems getting along since the beginning of the semester. They object to her "borrowing" their things, her late nights, and her frequent male visitors, who often stay overnight in various states of intoxication. Finally, her boyfriend, whom she regards as extremely and unreasonably jealous, wants to break up, objecting to her flirtatious behavior, even though she swears she has been completely faithful to him over the month they have been together. Sheila states that she is overwhelmed that "the closest person in the world to me would turn on me all of a sudden like that." And that, she notes, is what prompted her call to the counseling center.

Although Sheila speaks of her great distress and depression, her demeanor belies her words. She is animated and demonstrative, perhaps even slightly manic. She flits from topic to topic and from emotion to emotion with only minimal insight and no real transition in between. No follow-up appointment could be made, because Sheila is "too busy." She denies continued feelings of suicidality. When asked if she wants to continue next week, she remarks teas-ingly "I'll get back to you," blowing another bubble and then pressing the gum under her seat on the way out.

Histrionic Personality Disorder DSM-IV Criteria

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:

(1) is uncomfortable in situations in which he or she is not the center of attention

(2) interaction with others is often characterized by inappropriate sexually seductive or provocative behavior

(3) displays rapidly shifting and shallow expression of emotions

(4) consistently uses physical appearance to draw attention to self

(5) has a style of speech that is excessively impressionistic and lacking in detail

(6) shows self-dramatization, theatricality, and exaggerated expression of emotion

(7) is suggestible, i.e., easily influenced by others or circumstances

(8) considers relationships to be more intimate than they actually are

Reproduced with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association.

1 Numbers mark aspects of the case most consistent with DSM criteria, and do not necessarily indicate that the case "meets" diagnostic criteria in this respect.

The development of the histrionic's interpersonal style can be understood from a social learning perspective (Millon, 1969, 1981), without invoking the somewhat obscure jargon of psychoanalysis and its associated psychosexual assumptions. Here, the parents of future histrionics rarely criticize or punish but instead reinforce only behaviors that are parentally approved, but on a variable schedule. Sometimes a behavior is rewarded, and sometimes it is not. Because nothing they do works consistently, such children experience frustration in getting their parents' attention and exaggerate behaviors basic to their gender stereotype to secure compliments and affection. Otherwise, they are ignored. For example, dressing up to look cute and pretty might produce a positive comment one day but not another. Eventually, only caricatured behaviors cross the threshold beyond which parents notice them and comment approvingly. Competent behaviors or achievement strivings inconsistent with the gender stereotype go unnoticed.

When parents fail to identify this dynamic, they instead set into motion a vicious circle in which more and more desperate and exaggerated efforts are required to sustain the same level of nurturance. Such children enter adolescence with a nearly insatiable thirst for attention and love. Naturally, they find that by exploiting their own growing sexuality, they quickly become a magnet for sustained sexual interest, whereas before, they could sustain nothing. While being Daddy's cute little girl worked some of the time, this strategy works all of the time, and it works well. When preadolescent tactics designed to get the opposite-sex parent's attention combine with the biologically motivated attraction of a developing libido, deprived histrionics are catapulted from the agony of being perpetually ignored to the ecstasy of social center stage, a role they will not soon relinquish. This developmental one-two punch is not unlike the emphasis on oral and oedipal concerns voiced by the psychodynamic perspective, though the language is different.

Such early interpersonal dynamics have further psychological consequences. First, they shuttle the histrionic down the pathway toward poor identity development. Social interactionists anticipated later developments in the interpersonal school, asserting that the self develops through the appraisals of others, a position not too different from that of contemporary object relations. Essentially, we learn who we are, consciously and unconsciously, from the reflections of others. As these reflections are internalized, they give the self content. Because histrionics are often ignored by parental figures, they simply have fewer reflections to internalize, and those they do have are centered on the exaggeration of stereotypic gender roles. Monique's case provides a prime example. Her father was interested in advertising himself as the successful family man with two beautiful daughters, and her mother took great pains to ensure that the girls grew up to be talented pageant winners. Neither parent seems to have been interested in nurturing Monique's unique potential as a person.

Given such a history, histrionics develop only a thin margin of self to cover basic emotions and contain or transform their drives, a fact that makes them vulnerable to dissociation and fragmentation of the self under conditions of intense anxiety or stress, Sheila being the example here. Histrionics don't just sometimes feel empty; they are empty, at least relative to the average person. The interpersonal message that histrionics internalize results in a crushingly low self-esteem. Essentially, their developmental mantra is, "You are ignored because you deserve to be ignored, because you do not merit more, and to merit more, you will have to try very, very hard." Because the very actions that produce validation on one occasion do not on the next, histrionics never feel that their self-worth is secure. In this sense, their sexualization represents a compensation that functions to control those on whom they depend, making nurturant resources more dependable and less variable. All the cases in this chapter seem to have followed this pathway.

Working from her SASB model, Benjamin (1996) paints a similar picture. Like most accounts, Benjamin emphasizes the classic father-daughter dynamic, noting that value within the family system depends on "good looks and entertainment value" (p. 168). The mother is symbolically dismissed from the marital relationship as the little girl becomes Daddy's new sweetheart. Although the father dotes on her, meeting all her needs, it is a pseudonurturance that rewards appearance and cuteness, not behaviors appropriate to the full female role. In turn, she learns that looking good and being charming and entertaining provide the keys to the castle, as Benjamin notes, and can be used coer-cively for control. The future histrionic is thus led into an active dependency on others (Millon, 1969), for knowing how to care for herself is not required. Surface behaviors map into what the SASB would call "friendly trust," but underneath, the agenda is to use sex-role exaggeration to milk others for attention, nurturance, and love.

In addition, Benjamin draws out other distinctive nuances of family dynamics. Echoing W. Reich (1933), she notes that the seductive charm of the future histrionic often provides power over a violent, and perhaps alcoholic, father who threatens the mother or other siblings. Here, the agenda is to protect the family and defuse a precarious situation by offering innocent dependency and other tender emotions directly in the face of potential violence. Such dynamics tend to be self-perpetuating, with both positive and negative effects. The safety of the family depends on her success, although there is no knowing whether the explosive caregiver can be successfully calmed. As a result, cues that signal impending violent episodes, Benjamin states, become associated with anxiety and panic. Gradually, they may become generalized to any flaw in future care-givers, so that anxiety and panic ensue whenever attention and approval fall below some almost unsustainable level. Finally, Benjamin notes the existence of a sickly, coquettish subtype of the histrionic personality, who coerces attention and exploits dependency through apparent disability.

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