Formerly called hysteria, histrionism is now defined as a very expansive personality disorder that aims to fill or maintain a permanent need for attention. It is the improvement in self-image that in most cases enables the patient to come out of this disorder.

Definition of histrionics

Histrionism is a personality disorder marked by a constant quest for attention, by all means: seduction, manipulation, exaggerated emotional demonstrations, dramatization or theatricalism.

Histrionism is a disease classified in the International Classification of Diseases (ICD) and in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) as a histrionic personality disorder.

Egyptian medical papyri show that histrionism was already present in humans 4 years ago. Until a few centuries ago, we spoke more of hysteria. Only the women were diagnosed with hysteria. Indeed, it was believed the hysteria relating to the improper placement of the uterus in the human body. Then, in the 000th-XNUMXth century, hysteria fell into the realm of beliefs. She was a symbol of evil, of a demonization of sexuality. A real witch hunt was taking place against people suffering from hysteria.

It was at the end of the 1895th century that Freud, notably with his book Studien über Hysterie published in XNUMX, brought up the new idea that hysteria is a serious personality disorder and that it is not reserved that Women’s.

Types of histrionics

Most studies of histrionism show only one type of histrionism.

However, comorbidities – associations of two or more diseases in a person – including histrionism are frequent, hence the potential variations of histrionism according to a pathological duo formed with other diseases, in particular personality disorders – antisocial, narcissistic, etc.– or depressive disorders such as dysthymia – chronic mood disorder.

Theodore Millon, American psychologist, went further on the subject by declining subtypes of histrionism, such characteristics of the disease attributed to each type of patient behavior:

• Soothing: the patient focuses on others and smooths out differences, possibly to the point of sacrificing himself;
• Vivacious: the patient is charming, energetic and impulsive;
• Tempestuous: the patient displays mood swings;
• Hypocrisy: the patient exhibits marked social characteristics such as intentional manipulation and deception;
• Theatrical: the patient plays with his outward physical appearance;
• Infantile: the patient adopts childish behaviors such as sulking or demanding unreasonable things.

Causes of histrionics

The causes of histrionism are still uncertain. However, several avenues exist:

• An education too centered on the child: education would play a significant role in the development of the disease. A profusion of attention paid to the child can forge the habit in him of being the center of attention and trigger the disorder, like the child who has laughed at the habit of lying, or even manipulating for achieve their goals or maintain parental attention;
• A problem in the development of sexuality: according to Freud, a lack of libidinal evolution is at the base of histrionism, that is to say a lack of development of the patient’s sexual function. It is not a question of the development of the sexual organs as such but of a lack in the level of the development of sexuality, of the establishment of the libido throughout the life of the child;
• A 2018 thesis demonstrated that castration anxiety and the non-resolution of the famous Oedipal conflict were found among all people suffering from histrionism, as proposed by the Austro-British psychoanalyst Melanie Klein.

Diagnosis of histrionics

Histrionism is often revealed in early adulthood.

Histrionism manifests itself through obvious signs such as the loss of control over one’s behavior, social and emotional relationships. The detailed diagnosis is based on the criteria listed in the International Classification of Diseases (ICD) and in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5).

Histrionism is expressed primarily through behavior. At least five of the following eight symptoms are present in a histrionic person:

• Dramatic, theatrical, exaggerated behaviors;
• Misperception of relationships: relationships seem more intimate than they are;
• Use their physical appearance to attract attention;
• Seductive or even provocative attitude;
• Fickle mood and temperament, which changes very quickly;
• Superficial, poor and very subjective speeches;
• Suggestibility (easily influenced by others or by circumstances);
• Subject uncomfortable if he is not the heart of the situation, the attention.

Different personality tests can be used to establish or guide the diagnosis:

• The Minnesota Multiphase Personality Inventory (MMPI);
• The Rorschach test – famous test for analyzing ink stains on plates.

People affected by histrionism

The prevalence of histrionism is around 2% in the general population.

Histrionism affects both men and women, contrary to what was thought in previous centuries. Some researchers, like the French psychoanalyst Gérard Pommier, decline the symptoms of histrionism differently depending on whether the patient is a woman or a man. For him, male hysteria is a repression of femininity. It is therefore expressed as violence against the feminine, a resistance to feminine hysteria, a psychopathic tendency, a recourse to warlike ideals in order to fight against the feminine. A 2018 thesis confronted patients suffering from female and male histrionism. The conclusion of this is that no major difference remains between hysterical women and hysterical men.

Factors favoring histrionism

The factors favoring histrionism join the causes.

Dramatic behaviors

Histrionism is expressed above all through dramatic, theatrical, exaggerated behavior.

Misperception of relationships

The person suffering from histrionism perceives relationships more intimately than they actually are. She is also easily influenced by others or by circumstances.

Need to attract attention

The histrionic patient uses their physical appearance to attract attention and may display seductive, even provocative, attitudes to achieve this. The subject is uncomfortable if he is not the center of attention. The person suffering from histrionism may also inflict self-harm, resort to suicide threats or use aggressive gestures to attract attention.

Other symptoms

• Fickle mood and temperament, which changes very quickly;
• Superficial, poor and very subjective speeches;
• Problems with concentration, problem solving and logic;
• Chronic problems managing their emotions;
• Aggressiveness;
• Attempted suicide.

According to Freud, going beyond the symptoms is only possible through awareness of unconscious experiences and memories. Understanding and / or eliminating the origin of the personality disorder can relieve the patient:

• Psychotherapy, to help the patient better integrate his emotional experiences, better understand his environment, improve his feelings towards him and reduce the need to be at the center of attention;
• Hypnosis.

If the histrionism tends towards neurosis – the patient becomes aware of his disorder, his suffering and complains about it – these therapies can be accompanied by the taking of antidepressants. Note that any drug treatment based on benzodiazepines is ineffective and should be avoided: the risk of drug dependence is considerable.

Preventing histrionism consists of trying to reduce the expansive nature of one’s behavior:

• Develop areas and centers of interest that are not self-centered;
• To listen to others.