Wednesday, October 24, 2007

Antisocial & Histrionic

Antisocial personality disorder

Antisocial personality disorder (APD) is a psychiatric condition characterized by an individual's common disregard for social rules, norms, and cultural codes, as well as impulsive behavior, and indifference to the rights and feelings of others. Antisocial personality disorder is terminology used by the American Psychiatric Association's Diagnostic and Statistical Manual, while the World Health Organization's ICD-10 refers to Dissocial personality disorder.

Diagnostic criteria (DSM-IV-TR)

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, currently DSM-IV-TR), a widely used manual for diagnosing mental and behavioral disorders, defines antisocial personality disorder as a pervasive pattern of disregard for and violation of the rights of others occurring since age 15vc, as indicated by three (or more) of the following:

1.failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest

2.deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure

3.impulsivity or failure to plan ahead

4.irritability and aggressiveness, as indicated by repeated physical fights or assaults

5.reckless disregard for safety of self or others

6.consistent irresponsibility, as indicated by repeated failure to sustain steady work or honor financial obligations

7.lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

Diagnostic criteria (ICD-10)

Chapter V of the tenth revision of the International Classification of Diseases offers a set of criteria for diagnosing the related construct of dissocial personality disorder.

Dissocial Personality Disorder (F60.2), usually coming to attf a gross disparity between behavior and the prevailing social norms, and characterized by:

callous unconcern for the feelings of others;

gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations;

incapacity to maintain enduring relationships, though having no difficulty in establishing them;

very low tolerance to frustration and a low threshold for discharge of aggression, including violence;

incapacity to experience guilt or to profit from experience, particularly punishment;

marked proneness to blame others, or to offer plausible rationalizations, for the behavior that has brought the patient into conflict with society.

There may also be persistent irritability as an associated feature. Conduct disorder during childhood and adolescence, though not invariably present, may further support the diagnosis.


Common characteristics of people with antisocial personality disorder include:

Persistent lying or stealing

Recurring difficulties with the law

Tendency to violate the rights of others (property, physical, sexual, emotional, legal)

Substance abuse

Aggressive, often violent behavior; prone to getting involved in fights

A persistent agitated or depressed feeling (dysphoria)

Inability to tolerate boredom

Disregard for the safety of self or others

A childhood diagnosis of conduct disorders

Lack of remorse for hurting others

Superficial charm


A sense of extreme entitlement

Inability to make or keep friends

Lack of guilt

Recklessness, impulsivity

People who have antisocial personality disorder often experience difficulties with authority figures.


Histrionic personality disorder

Histrionic personality disorder (HPD) is a personality disorder characterized by a pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriate seductiveness, usually beginning in early adulthood.

The essential feature of the histrionic personality disorder is a pervasive and excessive pattern of emotionality and attention-seeking behavior. These individuals are lively, dramatic, enthusiastic, and flirtatious. They may be inappropriately sexually provocative, express strong emotions with an impressionistic style, and be easily influenced by others.

The literature differentiates HPD according to gender. Women with HPD are described as self-centered, self-indulgent, and intensely dependent on others. They are emotionally labile and cling to others in the context of immature relationships. Females with HPD over identify with others; they project their own unrealistic, fantasied intentions onto people with whom they are involved. They are emotionally shallow and have difficulty understanding others or themselves in any depth. Selection of marital or sexual partners is often highly inappropriate. Pathology increases with the level of intimacy in relationships. Women with HPD may show inappropriate and intense anger. They may engage in manipulative suicide threats as one aspect of general manipulative interpersonal behavior.

Males with HPD usually present with identity diffusion, disturbed relationships, and lack of impulse control. They have antisocial tendencies and are inclined to exploit physical symptoms. These men are emotionally immature, dramatic, and shallow. Both men and women with HPD engage in disinhibited behavior.

People with this disorder are usually able to function at a high level and can be successful socially and at work. However, histrionic personality disorder may affect a person's social or romantic relationships or their ability to cope with losses or failures. People with this disorder may seek treatment for depression when romantic relationships end, although this is by no means a feature exclusive to this disorder. They often fail to see their own situation realistically, instead tending to dramatize and exaggerate. Responsibility for failure or disappointment is usually blamed on others. They may go through frequent job changes, as they become easily bored and have trouble dealing with frustration. Because they tend to crave novelty and excitement, they may place themselves in risky situations. All of these factors may lead to greater risk of developing depression.


The cause of this disorder is unknown, but childhood events and genetics may both be involved. It occurs more frequently in women than in men. Histrionic Personality Disorder is only rarely found in men; men with similar symptoms are often diagnosed with antisocial personality disorder.

Little research has been conducted to determine the biologic sources of this disorder. Psychoanalytic theories incriminate seductive and authoritarian attitudes by fathers of these patients.


The symptoms include:

Constant seeking of reassurance or approval.

Excessive dramatics with exaggerated displays of emotions.

Excessive sensitivity to criticism or disapproval.

Inappropriately seductive appearance or behavior.

Excessive concern with physical appearance.

A need to be the center of attention (self-centeredness).

Low tolerance for frustration or delayed gratification.

Rapidly shifting emotional states that may appear shallow to others.

Opinions are easily influenced by other people, but difficult to back up with details.

Tendency to believe that relationships are more intimate than they actually are.

Make rash decisions

Threaten or attempt suicide to get attention

Diagnostic criteria (DSM-IV-TR)

The Diagnostic and Statistical Manual of Mental Disorders, a widely used manual for diagnosing mental disorders, defines histrionic personality disorder as 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: 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 suggestible, i.e., easily influenced by others or circumstances

8.considers relationships to be more intimate than they actually are.


A mnemonic that can be used to remember the criteria for histrionic personality disorder is PRAISE ME:

P - provocative (or seductive) behavior
R - relationships, considered more intimate than they are
A - attention, must be at center of
I - influenced easily
S - speech (style) - wants to impress, lacks detail
E - emotional lability, shallowness

M - make-up - physical appearance used to draw attention to self
E - exaggerated emotions - theatrical

Diagnostic criteria (ICD-10)

The International Statistical Classification of Diseases defines histrionic personality disorder as characterized by:

self-dramatization, theatricality, exaggerated expression of emotions;

suggestibility, easily influenced by others or by circumstances;

shallow and labile affectivity;

continual seeking for excitement and activities in which the patient is the centre of attention;

inappropriate seductiveness in appearance or behaviour;

over-concern with physical attractiveness.

Associated features may include egocentricity, self-indulgence, continuous longing for appreciation, feelings that are easily hurt, and persistent manipulative behaviour to achieve own needs.


Because of the lack of research support for work on personality disorders and long-term treatment with psychotherapy, the empirical findings on the treatment of these disorders remain based on the case report method and not on clinical trials. On the basis of case presentations, the treatment of choice is psychotherapy aimed at self-development through resolution of conflict and advancement of inhibited developmental lines. Group therapy is not recommended for those with HPD because it often perpetuates histrionic behavior because the person then has an audience to play off of.

Family therapy
Alternative therapies

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