The norm is to receive more than one personality disorder diagnosis. Combinations with secondary patterns lead to colorations of the primary pattern, though occasionally subtypes appear merely as a combination of the major traits. Frequently seen subtypes of the histrionic personality are described in the following sections and summarized in Figure 9.1. Actual cases may or may not fall into one of these combinations.
Especially dramatic, romantic, and attention seeking, the theatrical histrionic is the epitome of the basic histrionic pattern. Described by Fromm's "marketing orientation," such individuals essentially live as commodities, marketing themselves as chameleons on social demand, and changing the characteristics they display depending on audience and circumstance. For them, nothing is intrinsic. Instead, the self is subordinated to the requirements of the social economy—transformed, synthesized, fabricated, and packaged to optimize their appeal to the given market niche. Style is not only valued over substance but also valued to the exclusion of substance. As a result, the theatrical histrionic exists largely without depth, as having inner identity limits potential maneuvering. Rather, reading the motives of others and reflecting back to them what is attractive, pleasing, and seductive is their prominent endeavor.
Within the theatrical subtype lie several subvarieties. Among women, such histrionics personify the female gender by adorning themselves with bright, sexy clothes and jewelry. Some create a good composition and resemble fashion plates; others, however, look gaudy, accessorizing beyond all sensibility, as if level of attractiveness were directly proportional to the number of earrings and bracelets. Among men, theatrical histrionics include some bodybuilders and many "pretty boys," who embody the male sex role by creating a look that suggests superpotency. Somewhat less obvious, but still within the theatrical subtype, are those who dramatically exhibit their intellectual achievements or financial success, perhaps through ostentatious displays of consumer goods. Whether male or female, theatrical histrionics are always mating, at least symbolically. Yvonne is probably not exaggerated enough to qualify for this subtype.
The infantile histrionic, similar to Kernberg's (1967) infantile personality, represents a blend of the histrionic and borderline personalities. As indicated previously, many histrionics possess strong dependency issues. By sexualizing relationships prematurely and pulling powerful others into their orbit, histrionics experience more indulgences and fewer frustrations. Therefore, they have no need to develop the solid sense of identity that begins its formation with what analysts call the reality principle, the realization that life is so intrinsically frustrating that some generalized psychic apparatus, the ego, will be required to deal with it. As such, the life of the histrionic continues to be dominated by a need to be the center of attention, by persistent sensation seeking, and by primitive regressions into fantasy, all of which serve the pleasure principle.
In the more primitively organized infantile histrionic, the expression of these characteristics is even more severe. Given their lack of identity formation, their attachment to significant others is highly dependent and demanding. Most constantly seek reassurance to maintain their stability and vacillate between overcompliance and profound depression when approval is not forthcoming. With no sense of self to buffer or modulate their basic drives, their emotions change quickly, easily, and unpredictably, running the gamut from intense love to intense rage to intense guilt, all of which may be expressed simultaneously. In more pleasant moments, they may behave with a childlike agreeableness or fascination but become sullen or pouty the next. Many complain that they are either unloved or treated unfairly, attitudes that quickly escalate into tantrums when anyone disagrees.
The vivacious histrionic synthesizes the seductiveness of the histrionic with the energy level typical of hypomania. The result radiates attractiveness, charm, playfulness, verve, and intensity. More than just bubbly or perky, vivacious histrionics are interpersonally cheerful, optimistic, spontaneous, and impulsively expressionistic, often without regard to future consequences. Driven by a need for excitement and stimulation, many are easily infatuated, attaching themselves to one person after another in quick succession. Be-haviorally, their movements are quick and animated. They both enter and leave with a flourish. Even though they are only superficial thinkers, their ideas often flow so quickly and easily that others become infected by their excitement. Those who are more normal race around, get things done, start projects, and persuade others to join them with an energy and friendliness that make for a natural salesperson. Others, however, pursue momentary whims without completing much of anything—leaving broken promises, empty wallets, and distraught associates. Not surprisingly, many vivacious histrionics also possess narcissistic traits.
The appeasing subtype combines histrionic, dependent, and compulsive features. Approval is their one mission in life: You must like them; you must become their friend. To achieve this goal, they continually compliment, praise, flatter, commend, and make you feel that they would do anything for you: "You are so ingenious! You have done a perfect job! You look so beautiful! How can I help you?" Whenever they sense indifference, they immediately step up their activities, positioning their appraisal back toward the positive. In effect, they present the image of absolute goodwill, someone for whom appreciation becomes a moral imperative. When disagreements do occur, they immediately begin smoothing things over, even when they must sacrifice ground, compromise their own desires, or concede important points. Rather than retaliate against those who cannot be placated, they choose simply to suffer injuries, painting themselves as innocent victims caught in a cruel world, martyrs who suffer the slings and arrows of outrageous fortune, ever deserving of sympathy and pity.
The implication of such a conciliatory lifestyle is the compensation for a substantial void. Beneath their friendly smiles lie the emptiness of the histrionic, the guilt of the compulsive, and the inferiority and helplessness of the dependent. Most feel that they are problem persons who are unloved and inadequate. As such, they become super-pleasers, ever alert to any subtle means whereby appreciation and approval might be secured. More developmentally advanced than the basic histrionic, these individuals have internalized condemning parental voices that rain down from on high with criticism and admonishment. Whereas compulsives hyperconform, these individuals appease their tormentors, conscientiously anticipate their needs, and offer only goodwill and kind gestures in return for anger and hostility. Essentially, they become so nice and good and sweet they could make even a sadistic superego feel guilty.
The tempestuous variant combines features of the histrionic and negativistic personality. Such individuals are best described as intensely moody and emotionally variable.
During better periods, they enact mainly histrionic features, presenting an attractive front, being superficially friendly and sociable, engaging others in conversation, and adding their own free emotional expression in return. Like the theatrical histrionic, they are easily bored, overly dramatic, hyperreactive to external stimulation, and impulsively sensation-seeking. When combined with borderline features, the result is emotional overdrive. Like the borderline, tempestuous histrionics are hypersensitive to criticism, intolerant of frustration, and socially immature—characteristics that almost ensure that the good times won't last. Most alternate between periods of extreme emotional excitement and impulsive acting-out, followed by fits of anger that transition to depressive-like symptoms of fatigue and sleep and eating pattern changes.
Whereas normal persons develop a strong sense of self-identity that wraps and conceals basic drives and moderates emotions, tempestuous histrionics are not only more thinly veneered than the basic histrionic pattern but also somewhat fragmented like the borderline. Consequently, they are much more vulnerable to unmoderated displays of raw and rapidly changing emotions. When tweaked, they lose control, reacting with storm and turbulence to even minor provocations. Deprived of attention, they may search frantically for approval, becoming contentious, dejected, or hopeless when it is not readily forthcoming. Over time, these individuals may become less and less histrionic and more and more disgruntled and critical of others, begrudging others' good fortune. They may also develop preoccupations with body functioning and health, and dramatically exhibit their illnesses or complain endlessly about ailments to recapture lost attention and support.
The disingenuous subtype synthesizes histrionic and antisocial features. A somewhat different picture is created, depending on the relative influence of histrionic and antisocial traits. In the beginning, they make a good first impression and seem sociable and sincere, exhibiting such spontaneity and charm that others quickly lower their defenses. The combination of histrionic and antisocial features, however, makes the disingenuous subtype more manipulative than the basic histrionic pattern and for ends other than simple attention and approval. For some, their histrionic traits serve simply as a convenient method of making contacts and opening doors but overlay and temporarily conceal characteristics fundamental to the antisocial, including a willingness to violate social conventions, break promises and shatter loyalties, behave irresponsibly, and sometimes erupt with anger and physical confrontation. For some, the antisocial influence stops here with traits attributable to simple delinquency.
Others, however, combine histrionic and more psychopathic characteristics. These individuals synergize the histrionic's more adaptive social skills, charm, and ability to read the motives and desires of others with a rather calculated malevolence. Obviously, this variant is more egocentric, more willingly insincere, and probably more conscious of their manipulations than is the basic histrionic pattern. They often seem to enjoy conflict, gaining a degree of gratification or amusement from the excitement and tension thereby produced. Because antisocials usually interpret kindness as weakness, their friendly histrionic traits sometimes make them afraid that others will come to view them in exactly that same way. If they sense this is true, they may avenge this wrong impression by becoming particularly predatory.
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