Antisocial Personality Disorder Resources

by Aunt Becky | May 14, 2019

What Is Personality?

Personality is a particular set of behaviors, traits, emotions, and patterns that make up a person, his character, and their individuality. Personality includes how we see the world, our thoughts, attitudes, and feelings. Personality is strongly influenced by our values, attitudes, perception of ourselves, and predicts our reactions to people, the world, stress, and problems.

While there are many different definitions of personality, most focus on the pattern of behaviors and characteristics that can help predict and explain a person’s behavior.

Explanations for personality can focus on a variety of influences, ranging from genetic explanations for personality traits to the role of the environment and experience in shaping an individual’s personality.

Environmental factors that can play a role in the development and expression of personality include such things as parenting and culture. How children are raised can depend on the individual personalities and parenting styles of caregivers as well as the norms and expectations of different cultures.

What Is A Personality Disorder?

A person’s personality may be influenced by experiences, environment (surroundings, life situations) and inherited – genetic – characteristics. A person’s personality typically stays the same over time.

While personality disorders differ from mental disorders, like schizophrenia and bipolar disorder, they do, by definition, lead to significant impairment. Personality disorders are estimated to affect about 10 percent of people, although this figure ultimately depends on where clinicians draw the line between a “normal” personality and one that leads to significant impairment.

A personality disorder is a way of thinking, feeling, and behaving that is different from the expectations of the culture, causes distress, problems functioning, and lasts over time. Personality disorders are almost always associated with marked social and personal disruption and are both pervasive and inflexible. While these behaviors can produce poor coping skills, leading to personal issues including anger, anxiety, depression, and distress, they are considered appropriate by the person with the disorder.

What is Antisocial Personality Disorder?

Some people have no regard for others and can cause harm to them without any regret or feelings of guilt. When this behavior is pervasive, a person may have a chronic mental health condition known as antisocial personality disorder. Sometimes people with antisocial personality disorder are called “sociopaths” or “psychopaths” depending upon the spectrum of severity of their disorder.

Antisocial Personality Disorder, often called sociopathy or psychopathy due to both being seen as subsets of Antisocial Personality Disorder (though which applies depends on the symptoms), is a mental health disorder in which a person has a long-standing pattern of exploiting, manipulating, or violating the rights of others. Antisocial Personality Disorder often begins in childhood or the teen years and pervades into adulthood.

What is a sociopath? People with antisocial personality disorder are willing to use deception or manipulation to get whatever they want, such as power or money. They may con people, use an alias; they may steal or use aggressive behavior to achieve their desires. Even when caught, they show no regret or guilt because they do not feel any remorse or guilt. These people are devoid a sense of empathy and do not consider the feelings of others without help. They also tend to act impulsively, which can lead to arrests and substantial time in prison.

There is a common myth in popular culture that people with ASD tend to be successful, charismatic people who hold positions of power, and while it’s true that there are high functioning sociopaths, they are not the norm. While sociopath path traits can include persuasiveness or charm, most people with the disorder will struggle with irresponsibility. They’re less likely to take advantage of employment opportunities, less likely to pay bills on time, and are at high risk of incarceration due to impulsive behaviors. They’re also likely to have a shorter life expectancy due to impulsive behaviors like substance abuse and criminal activity.

ASPD is associated with co-occurring mental health and addictive disorders and medical comorbidity. Rates of natural and unnatural death (suicide, homicide, and accidents) are excessive. ASPD is a predictor of poor treatment response. ASPD begins early in life, usually by age 8 years. Diagnosed as conduct disorder in childhood, the diagnosis converts to ASPD at age 18 if antisocial behaviors have persisted. While chronic and lifelong for most people with ASPD, the disorder tends to improve with advancing age. Earlier onset is associated with a poorer prognosis. Other moderating factors include marriage, employment, early incarceration (or adjudication during childhood), and degree of socialization.

Antisocial personality disorder is defined by a pattern of socially irresponsible, exploitative, and guiltless behavior. Symptoms include failure to conform to law, failure to sustain consistent employment, manipulation of others for personal gain, deception of others, and failure to develop stable interpersonal relationships.2 Lifetime prevalence for ASPD is reported to range from 2% to 4% in men and from 0.5% to 1% in women. Prevalence peaks in people age 24 to 44 years and drops off in people 45 to 64 years. The male-to-female ratio is estimated at between 2:1 and 6:1, depending on assessment method and sample characteristics. The prevalence of ASPD varies with the setting but can reach 80% in correctional settings.

ASPD is associated with co-occurring mental health and addictive disorders, including major depressive disorder, bipolar disorder, anxiety disorders, somatic symptom disorders, substance use disorders, gambling disorder, and sexual disorders.9,10 People with ASPD are at risk for traumatic injuries, accidents, suicide attempts, hepatitis C infections, and the human immunodeficiency virus. People with ASPD use a disproportionate share of medical and mental health services. ASPD has been identified as a predictor of poor treatment response in certain populations.

People with ASPD have high mortality rates owing to accidents, suicide, and homicide.One study showed elevated death rates from diabetes mellitus, suggesting that some people with ASPD may neglect their medical problems or fail to comply with medical regimens.People who have Antisocial Personality Disorder usually lack empathy (the ability to understand and appreciate the emotions of others), lean towards being cynical and callous, often scornful of the emotions, feelings, rights, and suffering of others. Those with Antisocial Personality Disorder may feel that they are above everyone else, that ordinary work is beneath them; they may have loudly-voiced opinions and come across as cocky or arrogant.

Even as they are contemptuous of the feelings of others, they may come across as charming, using expansive language to impress those around them, even as they exploit their personal and sexual relationships.

How Does Antisocial Personality Manifest In Early Life?

Antisocial behaviors typically have their onset before age 8 years. Nearly 80% of people with ASPD developed their first symptom by age 11 years. Boys develop symptoms earlier than girls, who may not develop symptoms until puberty. Robins has observed that a child who makes it to age 15 without exhibiting antisocial behaviors (that is, conduct disorder (CD)) will not develop ASPD. Other investigators have also reported that the presence of conduct disorders in childhood is a robust predictor of ASPD in adulthood

The DSM-5 definition of ASPD requires a history of childhood CD, the diagnosis used for persistent and serious childhood behavior problems. Once the child passes age 18 years, if the behavioral problems have persisted the diagnosis changes to ASPD. An estimated 25% of girls and 40% of boys with CD will later meet criteria for ASPD. A subset of antisocial adults have no history of childhood CD, but appear to meet adult criteria for ASPD; these people tend to have milder syndromes.

It should be noted that the making of a diagnosis of a conduct disorder only means that at the time, the child concerned has been behaving in a way that meets the specified criteria. It is purely a phenomenological description and carries no implications about the cause in any particular case. The child may spontaneously change over time and no longer meet criteria for a diagnosis. In some kids, the origins might be entirely outside the child, with the child reacting as any child might to a coercive, traumatic, or abusive upbringing. In others, it could be that the child had had a completely benign upbringing but was born with callous-unemotional traits that were displayed in all social encounters. The following are general characteristics of a child who has conduct disorder:

Younger children aged 3 to 7 years usually present with general defiance of adults’ wishes, disobedience of instructions, angry outbursts with temper tantrums, physical aggression to other people (especially siblings and peers), destruction of property, arguing, blaming others for things that have gone wrong, and a tendency to annoy and provoke others.

In middle childhood, from 8 to 11 years, the above features are often present, but as the child grows older and stronger, and spends more time outside the home, other behaviors are seen. They include: swearing, lying about what they have been doing, stealing others’ belongings outside the home, persistent breaking of rules, physical fights, bullying other children, being cruel to animals and setting fires.

In adolescence, from 12 to 17 years, more antisocial behaviors are often seen: being cruel to and hurting other people, assault, robbery using force, vandalism, breaking and entering houses, stealing from cars, driving and taking away cars without permission, running away from home, truanting from school, and abusing alcohol and drugs.

It must be noted that not all children who exhibit the types of behaviors listed in early childhood progress on to the later, more severe forms, such as antisocial personality disorder. In fact, only about half continue from those in early childhood to those in middle childhood; likewise, only about a further half of those with the behaviors in middle childhood progress to show the behaviors listed for adolescence.

However, the early onset group are important as they are far more likely to display the most severe symptoms in adolescence, and to persist in their antisocial tendencies into adulthood. The most antisocial 5% of children aged 7 years are 500 to 1000% more likely to display indices of serious life failure at 25 years, for example drug dependency, criminality, unwanted teenage pregnancy, leaving school with no qualifications, unemployment, and so on.

Longitudinal studies show that most children and young people with conduct disorders had prior oppositional defiant disorder and most (if not all) adults with antisocial personality disorder had prior conduct disorders.

Similarly, approximately 90% of severe, recurrent adolescent offenders showed marked antisocial behavior in early childhood. By contrast, there is a large group who only start to be antisocial in adolescence, but whose behaviors are less extreme and who tend to become less severe by the time they are adults.

What Causes Antisocial Personality Disorder?

The evidence below discusses many associations between antisocial behavior with a wide range of risk factors. The exact role in causation of most of these risk factors is unknown: while we know what, statistically, predicts conduct-problem outcomes, we do not know how or why. Establishing a risk factor is by no means straightforward, particularly as it is unethical to experimentally expose healthy children to risk factors to see whether those factors can cause new conduct problems. The use of genetically sensitive designs and the study of within-individual change in natural experiments and treatment studies have considerable methodological advantages for suggesting causal influences on conduct problems.

Genes:

Oddly, less than 10% of the families in any community account for more than 50% of that community’s criminal problems, which reflects a merge of genetic plus environmental risks for ASPD. Now, there is solid evidence from twin and adoption studies that conduct problems are substantially heritable.

Several studies have determined interactions between the families genetic history and the child’s environment while growing up can lead to an increase or decrease in a child’s potential to develop conduct disorders. The more stable and nurturing the environment, the less likely that the genetic predisposition will express itself in conduct disorder.

Both twin and adoption studies have found a link between antisocial behavior in the biological parent and adverse conditions in the adoptive home that predicted the adopted child’s antisocial outcome, which means that the genetic risk factors can modified by the rearing environment. One twin study found the experience of abuse was associated with an increase of 24% chance of developing conduct disorder for children at high genetic risk, but an increase of only 2% among children at low genetic risk. Such gene–environment interactions are being increasingly discovered. Awareness of a familial predisposition toward antisocial personality disorder actually increases the urgency to intervene and improve a the child’s environment.\

Pregnancy Complications And/Or Temperament:

Recent general population studies have found associations between life-long conduct problems and perinatal complications, minor physical anomalies, and low birth weight. Most studies support a bio-social model in which pregnancy complications might lead to vulnerability to other risks such as hostile or inconsistent parenting. Several prospective studies have shown associations between irritable temperament as an infant and conduct problems, but so far no consensus has been reached.

Cognitive Deficits:

Children with conduct problems have been shown to have increased rates of deficits in language-based verbal skills. Children who cannot reason or assert themselves with their words may attempt to gain control of social exchanges using aggression; which means that kids with low verbal IQ leads to to problems at school, which could mean that the child experience of school becomes unrewarding rather than a source of self-esteem and support.

Children and young people with conduct problems have been shown consistently to have poor tested executive functions. Executive functions are the abilities implicated in successfully achieving goals through appropriate and effective actions. Specific skills include learning and applying contingency rules, abstract reasoning, problem solving, self-monitoring, sustained attention and concentration, relating previous actions to future goals, and inhibiting inappropriate responses. These mental functions are largely, although not exclusively, associated with the frontal lobes.

Parenting Styles:

Studies have shown that parents of children with conduct problems tend to be less consistent in their use of rules, provide more vague commands, are more likely to react to their children based on how they felt (for example: bad mood) rather than based on what the child was actually doing, are less likely to check their children’s whereabouts, and were unresponsive to their children’s behaviors. Conduct problems are associated with hostile, critical, punitive and coercive parenting.

There is considerable evidence that children’s difficult behaviors do indeed evoke parental negativity. The fact that children’s behaviors can cause negative parenting does not mean that negative parenting has no impact on children’s behavior.

We now have the ability to intervene and change course of children’s antisocial behaviors by removing the harsh, cold, inconsistent parenting through parental education. Parenting classes can reverse poor patterns of parenting and promote positive encouragement of children with setting of clear, calmly enforced boundaries can lead to improvement of conduct problems.

Child/Parent Attachment:

The quality of the parent–child relationship is crucial to later social behavior, and if the child does not have the opportunity to make attachments with their parents, such as being put into foster care, typically leads to subsequent problems with antisocial behaviors. One study found that ambivalent and controlling attachment parenting predicted later conduct problems behaviors; disorganized child attachment patterns seem to be especially associated with conduct problems. While it seems obvious that poor parent–child relations in general predict conduct problems, it’s unknown if attachment difficulties have an independent causal role in the development of behavior problems. However, in adolescence there is evidence that attachment representations independently predict conduct symptoms over and above parenting quality.

Domestic Violence: 

Several researchers have found that children exposed to domestic violence between adults are subsequently more likely to themselves become antisocial. In one study, it was proposed that marital conflict influences children’s behavior because of its affect on emotional regulation; a child may respond to fear arising from marital conflict by controlling their reactions through denial of the situation. This can lead to developing the wrong appraisal of other social situations and poor problem-solving skills. Children’s antisocial behavior may be increased by domestic violence because children are likely to imitate aggressive behavior modeled by their parents. Through parental fights, children may learn that aggression is a normal part of relationships and that works to control others as well as aggression is okay, not punished.

Abuse

Many parents use physical punishment, and parents of children with antisocial behavior frequently resort to it out of desperation; associations between physical abuse and conduct problems are well-stablished. In a longitudinal study, child sexual abuse predicted conduct problem. However, sometimes some parents resort to severe and repeated beatings that are clearly abusive. This usually terrifies the child, causes great pain and overwhelms the ability of the child to stay calm, which leads the child to be less able to regulate their anger and teaches them a violent way of responding to stress. Unsurprisingly, it creates children who have more conduct problems.

Friendship groups

Children and young people with antisocial behavior have poorer peer relationships and associate with other children with similar antisocial behaviors. They have more aggressive and unhappy interactions with other children and they experience more rejection by children without conduct disorders.

What Are Some Symptoms of Antisocial Personality Disorder?

While antisocial personality disorder is a personality disorder diagnosed in adulthood, it has its precedent in childhood. The DSM-5’s criteria for ASPD require that the individual have conduct problems evident by the age of 15/Persistent antisocial behavior as well as a lack of regard for others in childhood and adolescence is known as conduct disorder and is the precursor of ASPD. About 25–40% of youths with conduct disorder will be diagnosed with ASPD in adulthood.

Conduct Disorder:

Conduct disorder (CD) is a disorder diagnosed in childhood that parallels the characteristics found in antisocial personality disorder. Conduct disorder is characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated. Children with this disorder often display impulsive and aggressive behavior, may be callous and deceitful, and may repeatedly engage in petty crime such as stealing or vandalism, and/or get into fights with other children and adults.These behaviors are typically persistent and may be difficult to deter with even with threats or punishment. Attention deficit hyperactivity disorder (ADHD) is common in this population; children with the disorder may also engage in substance abuse.

Conduct disorder is different from oppositional defiant disorder (ODD) as children with ODD do not commit aggressive or antisocial acts against other people, animals, and property; though it’s worth mentioning that many children diagnosed with ODD are subsequently re-diagnosed with conduct disorder.

Two developmental courses for CD have been identified based on the age at which the symptoms become present:

The first is known as the “childhood-onset type” and occurs when conduct disorder symptoms are present before the age of 10 years. This course is often linked to a more persistent life course and more pervasive behaviors, and children in this group express greater levels of ADHD symptoms, neuropsychological deficits, more academic problems, increased family dysfunction, and higher likelihood of displaying and engaging in aggression and violence

The second is called “adolescent-onset type” and occurs when conduct disorder develops after the age of 10 years. Compared to the childhood-onset type, less impairment in various cognitive and emotional functions are present, and the adolescent-onset variety may remit by adulthood.

In addition to this differentiation, the DSM-5 provides a specifier for a callous and unemotional interpersonal style, which reflects characteristics seen in psychopathy and are believed to be a childhood precursor to this disorder. Compared to the adolescent-onset subtype, the childhood onset subtype, especially if callous and unemotional traits are present, tends to have a worse treatment outcome.

Antisocial Personality Disorder:

Antisocial personality disorder is defined by a pervasive and persistent disregard for morals, social norms, and the rights and feelings of others. People who have this personality disorder typically have no problems exploiting others in harmful ways for their own gain or pleasure, and frequently manipulate and deceive other people, through wit and a façade of superficial charm or intimidation and violence. People who have ASPD are arrogant, think badly and negatively of others, and/or lack remorse for their harmful actions and have a callous attitude toward those they have harmed. Irresponsibility is a core characteristic of this disorder: people with antisocial personality disorder often have significant difficulties in maintaining stable employment as well as fulfilling their social and financial obligations; people with this disorder often lead exploitative, unlawful, or parasitic lifestyles.

Those with antisocial personality disorder are often impulsive and reckless, failing to consider or disregarding the consequences of their actions. They may repeatedly disregard and jeopardize their own safety and the safety of others and place themselves and others in danger. People who have ASPD are often aggressive and hostile, display a unregulated temper, and may lash out violently with provocation or frustration. People who have ASPD are prone to substance abuse and addiction as the abuse of various psychoactive substances is common in this population. These behaviors lead such people into frequent conflict with the law, and many people with ASPD have extensive histories of antisocial behavior and criminal infractions stemming back before adulthood.

Serious problems with interpersonal relationships are often seen in those with the disorder. Attachments and emotional bonds are weak, and interpersonal relationships often revolve around the manipulation, exploitation, and abuse of others. While they generally have no problems in establishing relationships, they may have difficulties in sustaining and maintaining them. Relationships with family members and relatives are often strained due to their behavior and the frequent problems that these people may get into.

A person cannot be diagnosed with antisocial personality disorder based on a single action. Behaviors that are explained by something else, such as addiction, trauma, or a cognitive disability, will also not be diagnosed as antisocial personality disorder. People with antisocial personality disorder struggle to follow or understand social rules about how to interact with others. They fail to see other people as beings worthy of consideration, kindness, or rights. They may not feel empathy or guilt.

However, not all people with antisocial personality disorder act on these emotions, nor do all people who violate the rights of others have a mental health condition. A person might be evaluated for antisocial personality disorder after interacting with police, seeking treatment for chronic relationship problems, or being involved in a negative experience with a child or partner.

Those affected by Antisocial Personality Disorder may exhibit the following signs and symptoms:

• Making decisions based on one’s own needs and desires, without considering the needs of others
• Lacking concern for the needs, feelings, or pain of others, and lacking remorse after hurting others
• Exploiting others in relationships, making it difficult to have relationships
• Using lies, domination, or intimidation to control others
• Exhibiting manipulative behavior, including using charm or ingratiation for one’s own benefit
• Exhibiting dishonest or fraudulent behavior
• Not being concerned about how others feel; some people with antisocial personality disorder enjoy sadistic behavior, such as hurting others
• Feeling hostility, anger, or aggression, particularly in response to relatively small problems
• Lacking inhibitions, which may cause a person to disobey rules, abandon their commitments, or take unnecessary risks
• Sense of right and wrong is skewed or ignored
• Prone to lying and deception
• Shows a lack of remorse about harming others
• Violates the rights of others
• Frequent agitation
• Episodes of aggressive or violent behavior
• Tendency toward child abuse or neglect
• Tendency toward partner abuse or difficult relationships
• Chronic legal problems
• Uses charm or wit to manipulate others
• Intimidates people
• Difficulties holding down a job or acting responsibly at work

Millon’s Subtypes Of Antisocial Personality Disorder:

Theodore Milton identified five subtypes for antisocial behavior; however, someone with Antisocial Personality Disorder may experience none or many of these subtypes:

Malevolent Antisocial:

These people are a mixture of antisocial and paranoid or sadistic personalities, and are often considered to be the worst types of antisocial personality disorder. Malevolent antisocial people are belligerent, rancorous, vicious, malignant, brutal, callous, vengeful, and vindictive. Their actions are hateful and destructive as completed with a defiance of conventional life. Like the someone with paranoid personality disorder, malevolent antisocial personalities anticipate both betrayal and punishment. Instead of using verbal threats, however, these people secure their boundaries with cold-blooded ruthlessness that will avenge every mistreatment they believe others have done to them.

For malevolent antisocial personalities, feeling tender emotions are a sign of major weakness, and they interpret goodwill and kindness of others as hiding a deceptive ploy – so they are always on guard. Where sadistic traits are most prominent, they may display a chip-on-the-shoulder attitude and a willingness to confirm their strong self-image by victimizing those too weak to fight back or those whose fear may prove particularly entertaining. When confronted with displays of strength, malevolent antisocial personalities love posturing and pressuring their “opponents” until they feel they have “won.” Few make concession. rather they escalate confrontations as far as necessary, backing down only when clearly outgunned.

Covetous Antisocial:

These people feel that life has been excessively unfair to them. These people feel that life has not given them “their due;” that they have been deprived of their rightful amount of love, support, or material reward; while everyone else has received more than their share. Highly jealous of others who have received the bounty of a good life, covetous antisocial personalities are driven by an greedy desire for payback – to take what destiny refused them. Through deceit or destruction, their goal is compensation for the emptiness of life, rationalized by the belief that they alone can restore the imbalance in their lives. They seethe with anger and resentment, their greatest pleasure lies in taking control of the property and possessions of others. Some are overtly criminal. With a gigantic drive for revenge, these people are used to manipulating other people like pawns in a power game.

Regardless of their success, however, covetous antisocial personalities usually are insecure about their power and status, never quite feeling that they’ve been compensated for life’s “unfairness.” Ever jealous and envious, pushy and greedy, they often make ostentatious and wasteful displays of materialism and conspicuous consumption – buying exotic cars, huge homes, and/or elaborate jewelry as a way of boasting of their power and achievements to others. Most people who have covetous antisocial personalities feel a gaping sense of emptiness, juxtaposed with vague images of how different life should have been, if opportunity had blessed them, as it has so many others.

Some covetous antisocial personalities are simple thieves, and others become manipulative entrepreneurs who exploit people as objects to satisfy their desires. While they have little compassion for or guilt about the effects of their behavior, they never feel that they have acquired quite enough, never achieve a sense of contentment, and feel unfulfilled regardless of their successes, remaining forever dissatisfied yet insatiable.

Risk-Taking Antisocial:

Minor risk taking within a controlled environment allows us all a normal outlet for excitement and sensation-seeking, such as sky-diving. However, there are people for whom taking risks is intended to impress others around them with their behavior of courageous indifference to potentially deadly consequences. Risk-taking antisocial personalities, who combine antisocial and histrionic traits, deeply desire other people to see them as unaffected by what almost anyone else would surely experience as dangerous or frightening. While others shrink in fear, they are unfazed by the possibility of gambling with death or serious injury. Risk is sought as its own reward, a means of feeling stimulated and alive, not a means of material gain. While their pretense is being dauntless, intrepid, and bold, their hyperactive search for hazardous challenges is seen as foolhardy, if not stupid.

Risk-taking antisocial personalities are thrill seekers that want to to test their strength by performing for the attention, applause, and amazement of an audience. Otherwise, they would simply feel trapped by the responsibility and boredom of everyday life. The most important factors making them antisocial is the irresponsibility of their actions and their failure to consider the consequences for their own life, or the lives of others, as they pursue ever more daring challenges.

Reputation-Defending Antisocial:

Not all people who have antisocial personality disorder desire material possessions or power; some are motivated by the desire to extend, then defend, their reputation of bravery and toughness. Their antisocial acts are used to ensure that others notice them and provide them the respect that they deserve. This means that they’re always on guard against the possibility of belittlement. Society should know that the reputation-defending antisocial personality is someone significant, not to be easily dismissed, treated with indifference, taken lightly, or pushed around. Whenever their status or ability is slighted, they may erupt with ferocious intensity, posturing, and threatening until their rivals back down. Some reputation-defending antisocial personalities are loners, some are involved in gang activities, and others seek to impress peers with aggressive acts of leadership and/or violence that secures their status as the alpha male, the dominant member of the pack. Being tough and assertive is a defensive act intended to prove their strength and guarantee a reputation of major courage.

Nomadic Antisocial:

As the most widely held impression is that those who have antisocial personality disorder are incorrigible criminals who undermine the values of culture, some seek simply to run away from a society in which they feel unwanted, cast aside, or abandoned. Although most people who have antisocial personality disorder react antagonistically to social rejection, nomadic antisocial personalities tend to drift along at the margins of society, scavenging whatever resources they come across. The nomadic variant combines antisocial with schizoid and/or avoidant characteristics. Those with nomadic antisocial tendencies see themselves as doomed and only want to exist at the edge of the world that would almost certainly reject them. Mired in self-pity, they drop out of society to become gypsy-like roamers, vagabonds, or wanderers. With little regard for their personal safety or comfort, they may drift from one setting to another as homeless people involved in prostitution and substance abuse.

Adopted children who feel uneasy about their place in the world sometimes follow the path of the nomadic antisocial, wandering from place to place in a search for their true home or natural parents. Their sense of “being from nowhere” signifies alienation from self and others. This is why nomadic antisocial personalities often appear disconnected from reality and lack any clear sense of self-identity. Compared to other types, nomadic antisocial personalities often seem harmless because of their attitude of indifference and disengagement. Some are indeed vacant and fearful, but others are deeply angry and resentful. As a consequence of alcohol or substance abuse, they may act out impulsively, discharging their frustrations in brutal assaults or sexual attacks on those weaker than themselves.

How Is Antisocial Personality Disorder Diagnosed?

A person must be at least 18 years old to receive a diagnosis of antisocial personality disorder or any other personality disorders. To receive a diagnosis of ASPD, it must also be evidence that they qualified for a diagnosis of conduct disorder before the age of 15, as many of the symptoms of the two disorders are similar. A diagnosis of antisocial personality disorder will also not be given if the behaviors occur due to the symptoms of schizophrenia or bipolar disorder .Antisocial personality disorder falls under the dramatic/erratic cluster of personality disorders, “Cluster B.” and is one of the most well-known of the personality disorders as it is frequently associated with violence and crime.

Personality disorders, like Antisocial Personality Disorder, are not usually diagnosed by a general family practitioner. Instead, personality disorders should be diagnosed by a mental health professional like a psychologist or psychiatrist.

However, many people with Antisocial Personality Disorder do not seek out medical treatment or a diagnosis unless the disorder begins to significantly impact their lives.

General Diagnostic Guidelines For The ICD-10 And DSM-5 For Personality Disorders:

Conditions not directly attributable to gross brain damage or disease, or to another psychiatric disorder, meeting the following criteria:

1. markedly disharmonious attitudes and behavior, involving usually several areas of functioning, e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;
2. the abnormal behavior pattern is enduring, of long standing, and not limited to episodes of mental illness;
3. the abnormal behavior pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
4. the above manifestations always appear during childhood or adolescence and continue into adulthood;
5. the disorder leads to considerable personal distress but this may only become apparent late in its course;
6. the disorder is usually, but not invariably, associated with significant problems in occupational and social performance.

For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations. For diagnosing the subtypes of personality disorders, clear evidence is usually required of the presence of at least three of the traits or behaviors given in the clinical description.

Diagnosis of Antisocial Personality Disorder From The DSM-5:

The essential features of a personality disorder are impairments in personality (self and interpersonal), functioning, and the presence of pathological personality traits. To diagnose antisocial personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning (a or b):

a. Identity: Ego-centrism; self-esteem derived from personal gain, power, or pleasure.

b. Self-direction: Goal-setting based on personal gratification; absence of prosocial internal standards associated with failure to conform to lawful or culturally normative ethical behavior.

AND

2. Impairments in interpersonal functioning (a or b):

a. Empathy: Lack of concern for feelings, needs, or suffering of others; lack of remorse after hurting or mistreating another.

b. Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to control others.

B. Pathological personality traits in the following domains:

1. Antagonism, characterized by:

a. Manipulativeness: Frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one’s ends.

b. Deceitfulness: Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events.

c. Callousness: Lack of concern for feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one’s actions on others; aggression; sadism.

d. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior.

2. Disinhibition, characterized by:

a. Irresponsibility: Disregard for – and failure to honor – financial and other obligations or commitments; lack of respect for – and lack of follow-through on – agreements and promises.

b. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing and following plans.

c. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; boredom proneness and thoughtless initiation of activities to counter boredom; lack of concern for one’s limitations and denial of the reality of personal danger.

C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or sociocultural environment.

E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

F. The individual is at least age 18 years.

Diagnosis of Antisocial Personality Disorder From ICD-10:

The WHO’s International Statistical Classification of Diseases and Related Health Problems, tenth edition (ICD-10), has a diagnosis called dissocial personality disorder (F60.2)

It is characterized by at least 3 of the following:

1. Callous unconcern for the feelings of others;
2. Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations;
3. Incapacity to maintain enduring relationships, though having no difficulty in establishing them;
4. Very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
5. Incapacity to experience guilt or to profit from experience, particularly punishment;
6. Marked readiness to blame others or to offer plausible rationalizations for the behavior that has brought the person into conflict with society.

The ICD states that this diagnosis includes “amoral, antisocial, asocial, psychopathic, and sociopathic personality/” Although the disorder is not synonymous with conduct disorder, presence of conduct disorder during childhood or adolescence may further support the diagnosis of dissocial personality disorder. There may also be persistent irritability as an associated feature

It is a requirement of the ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

How Is Antisocial Personality Disorder Treated?

It’s unfortunate that Antisocial Personality Disorder is often grossly misunderstood by the public as well as mental health professionals. The stigma of labels like “sociopath” and “psychopath” means that those with Antisocial Personality Disorder often are discriminated against in the mental health community, especially since the pervasive lack of remorse may come across as not having any feelings whatsoever. This can greatly hinder diagnosis and treatment.Individuals with Antisocial Personality Disorder are not easily motivated to change their patterns of behaviors, but it can be done. Threats are almost never a good motivator for those with Antisocial Personality Disorder, but intensive approaches to draw connections between a person’s actions and their feelings may help. Emotions are a key aspect of treatment, as those with antisocial personality disorder have very few emotionally-rewarding relationships. Reinforcing any emotions – aside from anger – is important, as expressing emotions is a sign of progress that the therapy may be working.

The treatment of choice for antisocial personality disorder is psychotherapy, coupled with treatment of other co-morbid diagnoses with medication. The recommended treatment for someone with antisocial personality disorder will also depend on their circumstances, taking into account factors such as age, offending history and whether there are any associated problems, such as alcohol or drug abuse and addiction.The person’s family and friends will often play an active role in making decisions about their treatment and care.

Treatment should address any co-occurring disorders, which often include attention-deficit/hyperactivity disorder, borderline personality disorder, and impulse control disorders such as gambling disorder or sexual disorders. Because a majority of people with antisocial personality disorder will also have a substance abuse disorder, a person may need to complete detoxification as the first step of treatment, with the substance abuse and personality disorder then treated simultaneously. Medications may be used to treat co-morbid conditions, but there are no indications that medications will help to treat antisocial personality disorder.

Self-help groups designed specifically for those with Antisocial Personality Disorder may be very helpful, as those with antisocial personality disorder often feel more at ease discussing feelings and behaviors with their peers in a supported environment. However, it must be made clear that the group therapy is not a place to brag about exploits and bad behaviors.

Psychotherapy, or talk therapy, is usually the treatment recommended for antisocial personality disorder. A therapist can help a person manage negative behaviors and build interpersonal skills they may lack. Often the first goal is simply to reduce impulsive behaviors that can lead to arrest or physical harm. Family therapy might be a useful option to educate family members and improve communication, and group therapy may also help when limited to people with the disorder. Often, the most effective way for a person with antisocial personality disorder to learn better coping skills is to face up to the consequences of their behavior.

Democratic Therapeutic Communities (DTC)

Evidence suggests community-based programs can be an effective long-term treatment method for people with antisocial personality disorder, and is becoming increasingly popular in prisons. DTC is a type of social therapy that aims to address the person’s risk of offending or re-offending, as well as their emotional and psychological needs. It’s based around large and small therapy groups and focuses on community issues, creating an environment where both staff and prisoners contribute to the decisions of the community.There may also be opportunities for educational and vocational work.

The recommended length of treatment is 18 months, as there needs to be enough time for a person to make changes and put new skills into practice.

Relationships With Someone Who Has Antisocial Personality Disorder:

A healthy intimate relationship is extremely difficult to establish with an adult who, at their very core, seeks to control and demean another person. Their lack of care or concern regarding the impact of their actions can further exacerbate the pain for their mates. It can be difficult for loved ones to move past their flippant manner of inflicting harm: “He hurt me and he didn’t seem to care.”

Aside from problems such as minimal empathy, antagonism, manipulation, and anger, 6 additional things that hinder safe relationships with a psychopath include:

No Capacity To Bond:

At the beginning of intimate relationships, people who have ASPD are often typically excited and stimulated by their new partner; while it may feel good, this state can easily be mistaken as bonding and deep caring for their mate. Unfortunately, this tends to be the dopamine-driven stage of romantic love that can feel like addictive attraction. Once that fades, so does their interest in their partner, and typically at this stage they begin to show display disdain for their partner.

Dysfunctional Cycles:

People who have ASPD often demonstrate a predictable cyclical style of romantic relationships common for those with cluster B personality disorders. They idealize, devalue, and then discard their partners, with no concern for the pain they cause. Given that they never had an actual bond with their mate in the first place, walking away from the relationship causes them little to no discomfort. Many are happy to move along to the next target, particularly if they left their former mate in the “loser” position.

Cycle of Dysfunctional Relationships with Cluster B Personality Disorders:

Idealization -> Devalue -> Disregard -> Repeat

They Can’t And Won’t Apologize:

ASPD is a disorder that hinders the ability of a person to feel natural guilt and remorse for the hurts they cause others; they also here is a tendency to engage in immoral behavior. When they do hurt someone or cause damage, these people usually will not apologize. If what appears to be an apology is offered, it is rarely beyond words and tends to include an element of distancing and minimizing (“I made a mistake”). They feel no guilt and remorse because these emotional states are not within their capacity, therefore, the typical apology that naturally follows when one has caused harm will be absent. Their stance is typically, “Move on,” “Let it go,” “You’re too sensitive,” or, “Why are you still talking about that—it’s in the past!”

High Levels of Narcissism: 

People who have ASPD  have an incredibly inflated, grandiose sense of themselves. They do not need or care about the approval of others. Any desire they have for control or worship is associated with feelings of superiority, not insecurity. Unfortunately, for the person with psychopathy, there tends to be no genuine interest in friendships.

People As “Objects:”

People who have ASPD have a strong need for power and control and often place others in the role of “loser,” even those who demonstrate loyalty, trust and love toward them. Psychopathic individuals usually have a “use” for those they keep close. They consider some people puppets, who will defend them, agree with them, or sacrifice their reputation to protect them. They choose to have numerous puppets. For many with psychopathy, this role is also assigned to their intimate partner.

Immorality:

ASPD is a disorder that has immorality as a core feature. When there is immorality, harm to others tends to follow. It would not be uncommon for someone with this condition to have secret/dual lives, pervasive hateful thoughts, or a consistent pattern of violating behaviors, including Internet trolling, using children as pawns, abusing/bullying others, or forcing a partner to have sex.

Coping When a Loved One Has Antisocial Personality Disorder:

If you have a loved one with antisocial personality, it’s common to feel discouraged and upset. Try to remember that lack of remorse or empathy is a symptom of their personality disorder may assist as you set realistic expectations for how your loved one can improve. With treatment, some people with antisocial personality disorder do learn to form positive relationships, be more responsible, and respect the boundaries of others. Others simply cannot not, and family members will have to consider how they want to respond to this challenge. One interesting fact is that people with antisocial personality disorder who are married tend to improve over time compared to single people.

Caring for a person with antisocial personality disorder can be difficult and challenging. Depending on the circumstances, families can play an important part in supporting a person with antisocial personality disorder, but they may also need help and support themselves. Get support. Join a group. Find a knowledgeable therapist. There are plenty of people who can help you in your journey. Take advantage of them all.

Get support. Join a group. Find a knowledgeable therapist. There are plenty of people who can help you in your journey. Take advantage of them all.

Be informed. Learn the symptoms. Recognize the course of the illness. Understanding what you’re dealing with is half the battle.

Don’t argue. People with ASPD love to bicker. They’re quick to point out where you and others are wrong. Refuse to take part in the discussion. If they don’t stop debating, you can always walk away.

Don’t believe lies. If you think they’re lying, they probably are. That’s what folks with ASPD do. Don’t point out the flaws in their logic. Don’t try to sway them to your point of view. State your case, then remain silent. You’ll feel and appear stronger if you do.

Set firm guidelines. Decide how you’ll handle particular issues. For instance, you may decide not to bail them out of jail or hang up if they become verbally abusive on the telephone. You can’t change their behavior, but you can change how you respond.

Let go of guilt. You didn’t cause your loved ones’ problems. And there’s little you can do to fix them. Feeling bad only wastes precious emotional resources. Save your energy for something useful.

Take care of yourself. Dealing with another’s ASPD can be exhausting. Make sure your personal needs are met before dealing with theirs.

Be informed. Learn the symptoms. Recognize the course of the illness. Understanding what you’re dealing with is half the battle.

Don’t argue. People with ASPD love to bicker. They’re quick to point out where you and others are wrong. Refuse to take part in the discussion. If they don’t stop debating, you can always walk away.

Don’t believe lies. If you think they’re lying, they probably are. That’s what folks with ASPD do. Don’t point out the flaws in their logic. Don’t try to sway them to your point of view. State your case, then remain silent. You’ll feel and appear stronger if you do.

Set firm guidelines. Decide how you’ll handle particular issues. For instance, you may decide not to bail them out of jail or hang up if they become verbally abusive on the telephone. You can’t change their behavior, but you can change how you respond.

Let go of guilt. You didn’t cause your loved ones’ problems. And there’s little you can do to fix them. Feeling bad only wastes precious emotional resources. Save your energy for something useful.

Take care of yourself. Dealing with another’s ASPD can be exhausting. Make sure your personal needs are met before dealing with theirs.

Know yourself – what you are willing to tolerate and what you refuse to tolerate. Once you know your own boundaries, explain those boundaries to the antisocial person. Explain what actions you will take if and when those boundaries are violated.

Follow through with your plan each and every time.

Expect deception, manipulation, and betrayal.

Keep your finances separate. Do not loan money that you expect to be repaid.

If in a romantic relationship, do not trust the antisocial person to be alone with your friends and family, as cheating is highly likely, and a betrayal of this type is often very damaging.

Have backup plans for child-care, dates, etc. as the antisocial person is not likely to be dependable.

Maintain personal safety at all times. Keep a cell phone charged and on your person, keep enough gas in the car to get away, and, if necessary, inform a friend that you may need to stay with him/her sometimes. Know where shelters are in your area. Call 9-1-1 if the person becomes violent.

It is not recommended to have a romantic relationship with a person with antisocial personality disorder due to the emotional and/or physical damages that may be inflicted. However, if, for some reason, you feel you cannot end the relationship, keep yourself safe at all times.

Additional Resources for Antisocial Personality Disorder:

Aftermath: Surviving Psychopathy – dedicated to educating the public regarding the nature of psychopathy and its cost to individuals and society. We seek to support the families and victims of those with psychopathy.

Out of the Fog provides information and support for those with a loved one who has a personality disorder.

Histrionic Personality Disorder

by Aunt Becky | May 7, 2019

What Is Personality?

Personality is a particular set of behaviors, traits, emotions, and patterns that make up a person, his character, and their individuality. Personality includes how we see the world, our thoughts, attitudes, and feelings. Personality is strongly influenced by our values, attitudes, perception of ourselves, and predicts our reactions to people, the world, stress, and problems.

While there are many different definitions of personality, most focus on the pattern of behaviors and characteristics that can help predict and explain a person’s behaviors.

What Is A Personality Disorder?

A person’s personality may be influenced by experiences, environment (surroundings, life situations) and inherited – genetic – characteristics. A person’s personality typically stays the same over time.

While personality disorders differ from mental disorders, like schizophrenia and bipolar disorder, they do, by definition, lead to significant impairment. Personality disorders are estimated to affect about 10 percent of people, although this figure ultimately depends on where clinicians draw the line between a “normal” personality and one that leads to significant impairment.

A personality disorder is a way of thinking, feeling, and behaving that is different from the expectations of the culture, causes distress, problems functioning, and lasts over time. Personality disorders are almost always associated with marked social and personal disruption and are both pervasive and inflexible. While these behaviors can produce poor coping skills, leading to personal issues including anger, anxiety, depression, and distress, they are considered appropriate by the person with the disorder.

There are 10 specific types of personality disorders. Personality disorders are long-term patterns of behavior and inner experiences that differs significantly from what is expected. The pattern of experience and behavior begins by late adolescence or early adulthood and causes distress or problems in functioning.

Without treatment, personality disorders can be long-lasting. Personality disorders must affect at least two of the following areas:

• Way of thinking about oneself and others
• Way of responding emotionally
• Way of relating to other people
• Way of controlling one’s behavior

What is Histrionic Personality Disorder?

Histrionic Personality Disorder (HPD) is a personality disorder characterized by a pattern of extreme, intense emotions as well as attention-seeking behavior. A person who has histrionic personality disorder needs to be the center of attention in a group – any group – and when they are not, they become upset and uncomfortable. Histrionic personality disorder (HPD) also majorly interferes with emotional stability, and are prone to emotional overreaction in a wide variety of situations, and from the viewpoint of others, they may seem constantly on edge. When they do react, it is usually from a self-centered perspective, and the needs of others are seldom their priority.

In addition to the extremes of their emotional sensitivity and reactivity, people with histrionic personality disorder have a strong need to be the center of attention and frequently exhibit a range of attention-seeking behavior. They also want instant satisfaction and are easily frustrated or overwhelmed by obstacles or criticism. People with HPD usually have good communication skills and are often quite charismatic, projecting a “life of the party” or “larger than life” image. But beyond good initial first impressions they have a difficult time establishing and maintaining close and satisfying relationships.

Despite their self-absorption, people with HPD are subsumed by insecurity, which usually leaves them frustrated and miserable and seeking answers for their feelings of inadequacy.

HPD is classified as a Cluster B personality disorder, along with borderline personality disorder, narcissistic personality disorder, and antisocial personality disorder. People with Cluster B conditions are known to be highly emotional, erratic in their feelings and behavior, and self-centered in their approach to socializing and building relationships.

Nearly 15 percent of the American population meet the diagnostic criteria for one or more of 10 recognized personality disorders. Histrionic personality disorder is one of the least common of these personality disorders, affecting about 1.8 percent of the population – which still represents about four million people. Histrionic personality disorder is diagnosed more frequently among women, who comprise about two-thirds of the known cases. This may not reflect the true incidence of the disorder, but could relate to the willingness of women (or unwillingness of men) to seek assistance for the symptom of HPD when they manifest.

The seeds of histrionic personality disorder are likely sown in childhood, but its symptoms don’t normally become apparent until late adolescence. The severity of the condition may then escalate during early adulthood and become a dominant factor from that point on.

Those with histrionic personality disorder need novelty and thrills, which may lead them to become bored with the usual routines. This may lead to frustration when gratification is delayed, as they want immediate satisfaction. Interest in jobs, friendships, and relationships may quickly dwindle in favor of the shiny newness of other relationships.

Someone with histrionic personality disorder often appears as effervescent, lively, and interesting (sometimes shallow), and cannot handle it when the attention is not focused entirely upon them. In order to direct attention back to themselves, they may begin sexually suggestive or seductive behavior. Despite being highly sexual, people with histrionic personality disorder often have problems with emotional intimacy in sexual or romantic relationships.

Whether or not they are aware, they often choose a role (victim, princess) within their relationships. People with histrionic personality disorder may try to control their partner through seductiveness or emotional manipulation while displaying a strong dependency on their partners on another level. Because people with histrionic personality disorder crave excitement and newness, longer-term relationships are difficult for them to maintain.

It’s hard for those with histrionic personality disorder to maintain same-sex friendships because their sexually-charged style may come across as a threat to their friends’ romantic relationships. In addition, people with histrionic personality disorder can alienate friends through their demands for constant attention, and their depression when that attention is not provided.

What Are The Core Features of Personality Disorders?

The general requirements for the diagnosis of a personality disorder are:

• a pervasive pattern of maladaptive traits and behavior
• beginning in early adult life
• it usually has its first manifestations in childhood and is clearly evident in adolescence
• it is not diagnosed before early adult life because these maladaptive traits are very common in childhood and adolescence, but most individuals age-out of these traits before early adulthood
• leading to substantial personal distress and/or social dysfunction, and disruption to others
• is of long duration, typically lasting at least several years
• Severity Rating Scale For Personality Disorders:

Severity rating scale for personality disorders in the International Classification of Diseases (ICD)-11:

Mild Personality Disorder: notable problems in many interpersonal relationships and the performance of expected work and social etiquette, but some relationships are maintained and/or some roles carried out. Mild personality disorder is typically not associated with substantial harm to self or others.

Moderate Personality Disorder: marked problems in most interpersonal relationships and in the performance of expected occupational and social roles across a wide range of situations that are sufficiently extensive that most are compromised to some degree. Moderate personality disorder often is associated with a past history and future expectation of harm to self or others, but not to a degree that causes long-term damage or has endangered life.

Severe Personality Disorder: There are severe problems in interpersonal functioning affecting all areas of life. The person’s general social dysfunction is profound and the ability and/or willingness to perform expected occupational and social roles is absent or severely compromised. Severe personality disorder usually is associated with a past history and future expectation of severe harm to self or others that has caused long-term damage or has endangered life.

HPD is a serious condition that isolates those who surround the people who have the disorder.

A mnemonic that has sometimes been used to describe 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 liability, shallowness

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

However, people who suffer from HPD are often just as interested in attracting negative attention, including shock, anger, outrage, shame, guilt and remorse.

What Causes Histrionic Personality Disorder?

What Are Symptoms of Histrionic Personality Disorder? 

While people with Histrionic Personality Disorder are able to function at a high-level and be socially successful, they often use these skills to manipulate others and become the center of attention.

Personality disorders generally are marked by an obsessive concern for the self, rigid and uncompromising attitudes, and an inability or unwillingness to adapt to the needs and desires of others. These disorders function as a cover for deep-seated self-esteem issues, representing a form of overcompensation for feelings of insecurity and inferiority.

An accurate histrionic definition focuses on the distinctive symptoms HPD produces, which include:

• Strong and volatile emotions, both negative and positive
• Rapid shifts in mood, often triggered by seemingly benign events
• Self-centeredness, in conversation and behavior
• Exaggerated gestures or words designed to draw attention
• Expressions of sentiments toward others that seem shallow or insincere, as if meant to manipulate or create a certain impression
• Grossly exaggerated emotional displays
• Believe that their relationships are fa more intimate than they are
• A lack of patience, often accompanied by childish reactions
• Tendency to become flustered or frustrated when things go wrong
• Extreme sensitivity to criticism or perceived rejection
• Constant approval-seeking behavior
• Constant reassurance-seeking behaviors
• Flirtatious or sexually suggestive behavior that may violate interpersonal boundaries
• Exhibition-type behaviors
• Unwillingness to change; suggestions of change are viewed as threats
• Obsessive concern with physical appearance
• A tendency to become bored or distracted, making it difficult to finish tasks or projects
• Lack of empathy, no capacity to read the emotions of others or correctly interpret their words and actions
• Inability to maintain satisfying relationships due to self-centered tendencies and emotional outbursts

Many of these symptoms are common to other personality disorders, which inevitably interfere with personal, social, and professional functioning.

What Are Some Of The Traits Of Those Who Have HPD?

The following list is a collection of some of the more commonly observed behaviors and traits of those who suffer from HPD. Note that these traits are given as a guideline only and are not intended for diagnosis. People who suffer from HPD are all unique and so each person will display a different subset of traits. Also, note that everyone displays “borderline” behaviors from time to time. Therefore, if a person exhibits one or some of these traits, that does not necessarily qualify them for a diagnosis of HPD. See the DSM Criteria on this page for diagnostic criteria.

Catastrophizing – The habit of automatically assuming a “worst case scenario” and inappropriately characterizing minor or moderate problems or issues as catastrophic events.

Chaos Manufacture – Unnecessarily creating or maintaining an environment of risk, destruction, confusion or mess.

Baiting – A provocative act used to solicit an angry, aggressive or emotional response from another individual.

Acting Out – Acting Out behavior refers to a subset of personality disorder traits that are more outwardly-destructive than self-destructive.

“Always” and “Never” Statements – “Always” and “Never” Statements are declarations containing the words “always” or “never.” They are commonly used by most people but arerarely true.

Anger – People who suffer from personality disorders often feel a sense of unresolved anger and a heightened or exaggerated perception that they have been wronged, invalidated, neglected or abused.

Belittling, Condescending, and Patronizing – This kind of speech is a passive-aggressive approach to giving someone a verbal put-down while maintaining a facade of reasonableness or friendliness.

Blaming – The practice of identifying a person or people responsible for creating a problem, rather than identifying ways of dealing with the problem.

Cheating – Sharing a romantic or intimate relationship with somebody when you are already committed to a monogamous relationship with someone else.

Circular Conversations – Arguments which go on almost endlessly, repeating the same patterns with no resolution.

Confirmation Bias – The tendency to pay more attention to things which reinforce your beliefs than to things which contradict them.

Denial – Believing or imagining that some painful or traumatic circumstance, event or memory does not exist or did not happen.

Dependency – An inappropriate and chronic reliance by an adult individual on another individual for their health, subsistence, decision making or personal and emotional well-being.

Depression – People who suffer from personality disorders are often also diagnosed with symptoms of depression.

Dissociation– A psychological term used to describe a mental departure from reality.

Emotional Abuse – Any pattern of behavior directed at one individual by another which promotes in them a destructive sense of Fear, Obligation or Guilt (FOG).

Emotional Blackmail – A system of threats and punishments used in an attempt to control someone’s behaviors.

Engulfment – An unhealthy and overwhelming level of attention and dependency on another person, which comes from imagining or believing one exists only within the context of that relationship.

Escape To Fantasy – Taking an imaginary excursion to a happier, more hopeful place.

False Accusations – Patterns of unwarranted or exaggerated criticism directed towards someone else.

Favoritism and Scapegoating – Systematically giving a dysfunctional amount of preferential positive or negative treatment to one individual among a family group of peers.

Fear of Abandonment – An irrational belief that one is imminent danger of being personally rejected, discarded or replaced.

Feelings of Emptiness – An acute, chronic sense that daily life has little worth or significance, leading to an impulsive appetite for strong physical sensations and dramatic relationship experiences.

Frivolous Litigation – The use of unmerited legal proceedings to hurt, harass or gain an economic advantage over an individual or organization.

Harassment – Any sustained or chronic pattern of unwelcome behavior by one individual towards another.

Holiday Triggers – Mood Swings in Personality-Disordered individuals are often triggered or amplified by emotional events such as family holidays, significant anniversaries and events which trigger emotional memories.

Hoovers & Hoovering – A Hoover is a metaphor taken from the popular brand of vacuum cleaners, to describe how an abuse victim trying to assert their own rights by leaving or limiting contact in a dysfunctional relationship, gets “sucked back in” when the perpetrator temporarily exhibits improved or desirable behavior.

Hysteria – An inappropriate over-reaction to bad news or disappointments, which diverts attention away from the real problem and towards the person who is having the reaction.

Identity Disturbance – A psychological term used to describe a distorted or inconsistent self-view

Impulsiveness – The tendency to act or speak based on current feelings rather than logical reasoning.

Invalidation – The creation or promotion of an environment which encourages an individual to believe that their thoughts, beliefs, values or physical presence are inferior, flawed, problematic or worthless.

Lack of Conscience – Individuals who suffer from Personality Disorders are often preoccupied with their own agendas, sometimes to the exclusion of the needs and concerns of others. This is sometimes interpreted by others as a lack of moral conscience.

Lack of Object Constancy – An inability to remember that people or objects are consistent, trustworthy and reliable, especially when they are out of your immediate field of vision.

Low Self-Esteem – A common name for a negatively-distorted self-view which is inconsistent with reality.

Manipulation – The practice of steering an individual into a desired behavior for the purpose of achieving a hidden personal goal.

Masking – Covering up one’s own natural outward appearance, mannerisms and speech in dramatic and inconsistent ways depending on the situation.

Mood Swings – Unpredictable, rapid, dramatic emotional cycles which cannot be readily explained by changes in external circumstances.

“Not My Fault” Syndrome – The practice of avoiding personal responsibility for one’s own words and actions.

No-Win Scenarios – When you are manipulated into choosing between two bad options

Panic Attacks – Short intense episodes of fear or anxiety, often accompanied by physical symptoms, such as hyperventilating, shaking, sweating and chills.

Push-Pull – A chronic pattern of sabotaging and re-establishing closeness in a relationship without appropriate cause or reason.

Raging, Violence and Impulsive Aggression – Explosive verbal, physical or emotional elevations of a dispute. Rages threaten the security or safety of another individual and violate their personal boundaries.

Relationship Hyper Vigilance – Maintaining an unhealthy level of interest in the behaviors, comments, thoughts and interests of others.

Riding the Emotional Elevator – Taking a fast track to different levels of emotional maturity.

Sabotage – The spontaneous disruption of calm or status quo in order to serve a personal interest, provoke a conflict or draw attention.

Selective Memory and Selective Amnesia – The use of memory, or a lack of memory, which is selective to the point of reinforcing a bias, belief or desired outcome.

Selective Competence – Demonstrating different levels of intelligence, memory, resourcefulness, strength or competence depending on the situation or environment.

Self-Aggrandizement – A pattern of pompous behavior, boasting, narcissism or competitiveness designed to create an appearance of superiority.

Self-Harm – Any form of deliberate, premeditated injury, such as cutting, poisoning or overdosing, inflicted on oneself.

Self-Loathing – An extreme hatred of one’s own self, actions or one’s ethnic or demographic background.

Self-Victimization – Casting oneself in the role of a victim.

Sense of Entitlement – An unrealistic, unmerited or inappropriate expectation of favorable living conditions and favorable treatment at the hands of others.

Silent Treatment – A passive-aggressive form of emotional abuse in which displeasure, disapproval and contempt is exhibited through nonverbal gestures while maintaining verbal silence.

Situational Ethics – A philosophy which promotes the idea that, when dealing with a crisis, the end justifies the means and that a rigid interpretation of rules and laws can be set aside if a greater good or lesser evil is served by doing so.

Splitting – The practice of regarding people and situations as either completely “good” or completely “bad.”

Stunted Emotional Growth – A difficulty, reluctance or inability to learn from mistakes, work on self-improvement or develop more effective coping strategies.

Testing – Repeatedly forcing another individual to demonstrate or prove their love or commitment to a relationship.

Thought Policing – Any process of trying to question, control, or unduly influence another person’s thoughts or feelings.

Threats – Inappropriate, intentional warnings of destructive actions or consequences.

Triggering -Small, insignificant or minor actions, statements or events that produce a dramatic or inappropriate response.

Tunnel Vision – The habit or tendency to only see or focus on a single priority while neglecting or ignoring other important priorities.

What Other Mental Health Disorders Occur In People Who Have HPD?

It is possible for a person to have the symptoms of more than one personality disorder as these disorders often blend into one another.

Among people diagnosed with HPD, borderline personality disorder, dependent personality disorder, and narcissistic personality disorder are also frequently diagnosed. Borderline personality disorder is the most commonly detected of these conditions, and some mental health professionals actually classify HPD as a borderline personality disorder subtype.

Some of the other mental and behavioral health disorders routinely diagnosed in people with histrionic personality disorder include:

• Depression. HPD creates strong emotional responses, and when rejection or disappointment is experienced people with histrionic personalities can easily slip into clinical depression.
• Anxiety disorders, including panic disorder. In one study, between 35 and 52 percent of those with various anxiety disorders also met the diagnostic criteria for a personality disorder, usually of a type that affects emotion and stress responses (such as HPD)
• Somatoform Disorders
• Attachment Disorders, such as reactive attachment disorder
• Eating disorders. About one-third of eating disorder sufferers also have one or more co-occurring personality disorders, often including HPD.
• Substance use disorders. While different studies have produced varying results, most research has shown as least some relationship between histrionic personality disorder and addiction. However, the association is not as strong as with several other types of personality disorder.

When an additional mental or behavioral health condition is diagnosed in people with HPD, treatment plans must be developed that focus equally on each disorder.

How is Histrionic Personality Disorder Diagnosed?

HPD is not a devastating psychological disorder, which means that people with this disorder rarely seek treatment as most people with HPD function successfully in society and at work. In fact, people with HPD usually have great people skills. unfortunately, however, they often use these skills to manipulate others.

According to the Diagnostic and Statistical Manual of Mental Disorders (5^th edition), people with histrionic personality disorder must have at least five (or more) of the following symptoms:

• Is uncomfortable in situations in which they are not the center of attention
• Has interactions with others characterized by inappropriate sexually seductive or provocative behavior
• Displays rapidly shifting and shallow expression of emotions
• Consistently uses their physical attention to draw attention to self
• Has a style of speech that is excessively impressionistic and lacking in detail
• Shows self-dramatization, theatricality, and exaggerated expression of emotion
• Is suggestible (that is, they are easily influenced by others or circumstances)
• Considers relationships to be more intimate than they actually are

If you have HPD, you might also be easily frustrated or bored with routines, make rash decisions before thinking, or threaten to commit suicide in order to get attention.

The World Health Organization’s ICD-10 lists histrionic personality disorder as:

A personality disorder characterized by:

• shallow and labile affectivity,
• self-dramatization,
• theatricality,
• exaggerated expression of emotions,
• suggestibility,
• egocentricity,
• self-indulgence,
• lack of consideration for others,
• easily hurt feelings, and
• continuous seeking for appreciation, excitement and attention.

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

A diagnosis of histrionic personality disorder occurs through a thorough examination by a psychiatrist or psychologist by reviewing symptoms and taking a detailed health history. If the symptoms meet the diagnostic criteria, a diagnosis of histrionic personality disorder is made.

What Are The Subtypes for Histrionic Personality Disorder?

Histrionic Personality Disorder Subtypes (As Suggested by Million)

Subtypes of HPD	Description	Personality Qualities
Infantile HPD	includes borderline PD symptoms	Labile, high-strung, volatile emotions; childlike hysteria and nascent pouting; demanding, overwrought; fastens and clutches to another; is excessively attached, hangs on, stays fused to and clinging.
Vivacious Histrionic	The seductiveness of the histrionic mixed with the energy typical of hypomania. Some narcissistic features may also be present	Vigorous, charming, bubbly, brisk, spirited, flippant, impulsive; seeks momentary cheerfulness and playful adventures; animated, energetic, ebullient.
Tempestuous histrionic	Includes passive aggressive PD	Impulsive, out of control; moody complaints, sulking; precipitous emotion, stormy, impassioned, easily wrought-up, periodically inflamed, turbulent.
Appeasing histrionic	Includes compulsive and depended PD	Seeks to placate, mend, patch up, smooth over troubles; knack for settling differences, moderating tempers by yielding, compromising, conceding; sacrifices self for commendation; fruitlessly placates the unplacatable.
Disingenuous histrionic	HPD and antisocial PD	Underhanded, double-dealing, scheming, contriving, plotting, crafty, false-hearted; egocentric, insincere, deceitful, calculating, guileful.
Theatrical histrionic	Variant of “pure” pattern	Affected, mannered, put-on; postures are striking, eyecatching, graphic; markets self-appearance; is synthesized, stagy; simulates desirable/dramatic poses.

How Is Histrionic Personality Disorder Treated?

Those who suffer Histrionic Personality Disorder are generally hard to treat for many reasons. People with HPD often only seek treatment when their symptoms have become too much for them to handle. Once in treatment, however, these people often exaggerate their symptoms and lack of ability to function. They also have a hard time, as they are emotionally needy, terminating therapy may become a problem.

If people who have HPD are truly determined to change their emotional and psychological reactions, HPD can be amenable to treatment.

Inpatient or intensive outpatient treatment programs in mental health treatment facilities are ideal for people diagnosed with HPD, who require peace, quiet, and ample social and psychological support in the early stages of recovery.

Psychotherapy is the preferred method of intervention for histrionic personality disorder. Some of the therapies that have proven effective for this condition include:

• Cognitive behavioral therapy (CBT). Through CBT people with histrionic personalities can begin to think and act more calmly and with more deliberation and contemplation. CBT is also effective against depression and anxiety disorders, which can co-occur with HPD.
• Interviews and self-report methods generally, in clinical practice with assessment of personality disorders, one form of interview is the most popular; an unstructured interview. The actual preferred method is a semi-structured interview. The reason that a semi-structured interview is preferred over an unstructured one is that semi-structured interviews tend to be more objective, systematic, replicable, and comprehensive. Unstructured interviews, despite popularity, tend to have problems with unreliability and are susceptible to errors leading to false assumptions of the client. One of the single most successful methods for assessing personality disorders by researchers of normal personality functioning is the self-report inventory following up with a semi-structured interview. There are some disadvantages with the self-report inventory method that with histrionic personality disorder there is a distortion in character, self-presentation, and self-image. This cannot be assessed simply by asking most clients if they have the criteria for the disorder.
• Psychodynamic therapy. The goal in psychodynamic therapy is to decrease emotional reactivity by identifying and demystifying the underlying reasons for the development of HPD.
• Family and couples therapy. Family therapy should be explored only after the person with HPD has done some hard work on him or herself; otherwise, the person with HPD is apt to dominate all conversations
• Holistic mind-body practices. Mindfulness techniques acquired through meditation, yoga, Tai Chi, biofeedback, and other holistic therapies have much to offer people with HPD, who need to reprogram their minds to more effectively control their hair-trigger emotional reflexes.
• Medications are not indicated for treatment of histrionic personality disorder, though they may be used to treat some of the symptoms and/or other, co-morbid, disorders.
• Self-help groups and/or group therapy is not effective for those who have HPD as they are prone to hysterics and outbursts

With careful and compassionate intervention that extends from initial treatment through aftercare, people with histrionic personality disorder can learn to minimize the condition’s influence on their lives. HPD cannot be cured, but over time its capacity to control emotional reactions can be reduced to a manageable level.

Coping With Histrionic Personality Disorder:

Lots of people with HPD lead normal lives and are able to work and be a part of society. In fact, many people with HPD do very well in casual settings. Many of them only encounter problems in more intimate relationships. Depending on your case, your HPD may affect your ability to hold a job, maintain a relationship, or stay focused on life goals. It may also cause you to constantly seek adventure, putting you into risky situations.

You are also at a higher risk for depression if you have HPD. The disorder can affect how you handle failure and loss. It can also leave you feeling more frustrated when you don’t get what you want. You should talk to your primary care provider if you have symptoms of HPD, especially if they are interfering with your everyday life and work or your ability to lead a happy, fulfilling life.

Loving Someone With Histrionic Personality Disorder:

It is exhausting to deal with a person who has this personality disorder as they are particularly demanding – which is part of the disorder. Sometimes, it may be possible to stop being around such a person and extricate oneself from the situation, in other cases, especially where family members are concerned, that is never a choice. Then what is one to do and how is one to keep the relation going?

Sometimes, people with HPD may be abusive. You are not obligated to spend time with an abusive person, and you have the right to distance yourself or cut contact altogether. Do what’s right for you.

Here are some ideas for dealing with a person who has histrionic personality disorder:

Establish And Maintain Boundaries:

Create realistic goals. Histrionic personality disorder is a complicated disorder, and there may be limited things that you can do to help your loved one. Therefore, realistic goals are incredibly important when you decide to help them.You must understand that you may never be able to help them with their condition.  Create some safe space between you for your own self care. You must take care of your self.

• Help your loved one set their own goals. For example, you may want to help them set goals related to the way they dress, the types of sexual relationships they have, or the amount of times they act out in a dramatic or theatrical way.

Set limits and stick to them. When your loved one has Histrionic Personality Disorder, you need to establish strict boundaries for your relationship. Your loved one may engage in attention-seeking, manipulative, or embarrassing behavior at any time, which does directly affect you. Try to have an open, honest discussion with them about your personal limits.

• For example, tell your loved one, “If you start manipulating me, I will leave” or “If you start acting out or embarrassing yourself to get attention, I will leave” and stick with this plan.

Make sure they know that you still love them. A relationship with a loved one with HPD can be complicated and tense as this personality disorder can cause major problems that cause hurt feelings and complicated, strained relationships. You should try to your loved one know that you still love them, even though you have limits and may sometimes leave, you still love and care for them.

• You can tell them, “I love you and want you in my life. However, there are times I cannot be around you because of your behavior.”

Know how and when to distance yourself. You may find yourself in a situation where your loved one is being manipulative, cruel, hurtful, embarrassing, or harmful which can be overwhelming to you. People with HPD often do anything to be the center of attention; including manipulation, acting dramatically, and love to play the victim. They may act in an overly provocative way, or act out in a hateful or angry way to gain attention. As you know, all of this can negatively affect you. Be aware that you may have to distance yourself from your loved one to protect yourself and your own well-being.

• Some people just aren’t equipped to help a person with HPD. Be aware that as a last resort, you may have to completely remove yourself from the situation and sever all ties.

Taking Care of Yourself:

Consider seeing a therapist. Talking with a therapist about your challenges and feelings regarding your loved one’s histrionic personality disorder is a good way to care for yourself. A therapist can help you to develop healthy coping mechanisms, learn how to communicate with your loved one more effectively, and work through your emotions. Consider talking to a therapist as part of your self-care strategy.

Seek help from your friends and family. Dealing with a loved one with HPD can be an emotionally exhausting rollercoaster and you may feel helpless, trapped, and/or confused. Find support from your loved ones when you need it, and ensure that you make time to be away from your loved one, and instead, visit and interact with others. This can help you feel supported.

• Talk to your friends and family about your difficulties. You can even ask them for advice if things get too much to bear.

Don’t let your loved one to dictate your other relationships. Because people with HPD often feel inadequate or inferior, they may throw fits or act in an over-dramatic way when you form relationships and spend time with other people. You cannot let the person with HPD dictate your other relationships.

• Your loved one may see another friend, partner, or even child as a threat. Discourage this behavior. Don’t give into any behavior in which your loved one tries to discourage the relationship.
• For instance, you can say, “I have friends and invite them over once in a while. This does not affect my love for you.”
• Your loved one may get jealous or threatened by you participating in activities that don’t include them. Refrain from giving up activities because of your loved one’s HPD.

Come to terms with the idea that your loved one may never understand your needs. People with HPD appear to be self-centered, which means that they may not understand or respect your needs, even if you have clearly outlined them. People who hav do not realize their actions are wrong, or how their actions affect other people.

• You may need to accept that your loved one will never treat you how you deserve to be treated. This is why setting boundaries and limits in the relationship is so important.

How To Cope With HPD:

Don’t make excuses. If your loved one has HPD, you may find yourself wanting to make excuses for their behavior, cover up their behavior, or clean up any messes they have made. This is not your job, and can take a toll on you. Try not to make excuses or mediate any messes your loved one has made. This may just enable your loved one’s behavior.

• Your loved one’s behavior may be humiliating for you. However, learning to walk away or detach yourself may be the best way to take care of yourself.

Avoid trying to teach your loved one a lesson. Sometimes, loved ones of those with HPD abandon the person to teach them some sort of lesson. This can arise when the person with HPD manipulates you too much or you feel nothing that you do is working. This kind of punitive behavior does not work with people with HPD, so you should avoid the temptation.

• • If you do this, your loved one may feel abandoned and throw a dramatic fit since you abandoned them.
  • You may end up feeling helpless and manipulated if you try to use this kind of manipulation on your loved one. Avoid using games with your loved one. Stay direct and open with them instead.

Don’t reward attention-seeking behavior. Your loved one may engage in dramatic, attention-seeking behavior regularly, and one of the best ways to deal with this is to ignore it. Don’t engage with them when they are acting like this, it will further reinforce the negative behavior with attention.

• Your loved one likely has a chemical imbalance, which means they may not be able to help their behavior. Instead of getting into an argument or encouraging behavior, just ignore it and let it pass.

Remain calm. One of the best things you can do to help your loved one is to stay calm. A person with Histrionic Personality Disorder thrives on chaos and drama, if/when they get dramatic or have a fit, reacting to them in a negative way will play into what they want and encourage the behavior. Instead, remain calm during these fits.

• You may need to engage in deep breathing exercises or step away from your loved one for a few moments to collect yourself.

Put physical distance between you and your loved one. People with HPD form intimate attachments very easily, which means they may cross physical boundaries. They may not be able to understand or respect the boundaries you have set for yourself. You may find your loved one hugs you, touches you, or invades your space more than you wish. Your loved one may interpret your actions as threatening or inappropriate. To help with this, keep physical distance between you and them.

• For example, you may want to sit in a chair if your loved one is on the couch, or sit on the other end of the couch. When standing, keep a few feet between you and your loved ones.
• Be mindful not to do anything that might be suggestive or interpreted as inappropriate. You don’t want your loved one to misinterpret what you are doing. Always be mindful of your boundaries.

Encourage your loved one to evaluate and think about what other people say. Some people who have HPD are highly suggestible and will go along with what other people say without enforcing their own boundaries and desires. If you notice that your loved one is blindly agreeing with people or doing what other people tell them to do, try to encourage your loved one to think for him or herself.

• If you notice that your loved one is agreeing with someone without evaluating the statement, you could try asking some questions to help you loved one evaluate what the person said.
  • For example, your loved one might repeat a political opinion as a fact because they heard someone else say it. You could then ask your loved one questions like, what is the evidence for that? How did they come to that conclusion? Why do you agree with them?
• If your loved one is doing something because someone has suggested it, then you can also use questioning to help.
  • For example, your loved one might start dressing differently because someone suggested it. You might ask your loved one questions like, do you really want to do that? Would you be doing that if he or she had not suggested it? What might you be doing if he or she had not suggested that?

Suggest different clothing for your loved one. One of the main symptoms of HPD is wearing provocative clothing to garner attention. This type of attire is not suitable for all situations, such as work. You can help your loved one by suggesting they dress differently for certain situations.

• Make sure to start any suggestion with a compliment. Those with HPD respond extremely negatively to any criticism. By complimenting them, you can help yourself get a positive response.
• For example, you may say, “I really love that outfit. You should wear that tomorrow night when you go out with your friends! Why don’t you wear this to work instead today? It looks great on you, and everyone will think you look classy.”

Ask for support when your loved one states their opinion. Often, people with HPD will just talk or argue because they like the attention and drama. They may offer strong opinions while offering no support. When this happens, ask your loved one to back up their opinion.

• For example, you may say, “What are you basing that opinion on?” or “Do you have any examples to support your opinion?” You may also say, “That doesn’t sound like a correct statement. Can you give me some evidence to support your position?”
• If your loved one cannot support their opinion, explain that they need to only provide opinions based on facts or details. Encourage research issues so they can make informed opinion

Help your loved one come up with solutions. Often, people with HPD ignore solutions in favor of focusing on the drama of the problem. One way you can try to help your loved one is by encouraging them to come up with solutions and focus on problem-solving techniques instead of the problem.

• For example, when your loved one gets dramatic about a problem, listen to what they say about the problem. Then say, “I understand you have a problem, but dwelling on it will not help you or anyone else. Let’s work together to find a solution.”

Explore other things. To help keep your loved one’s attention-seeking or manipulative behavior to a minimum, you should talk about or do other things with them. Don’t let your loved one dwell on problems or dominate the spotlight. Talk about yourself or suggest that the two of you do an activity together.

• • For example, you may want to say, “We have been talking about you for a long time now. I would like to share with you things about my life.”
  • You can try to distract your loved one if they are in a middle of an attention-seeking or manipulative episode. You can change the subject, start watching television, or suggest that you go for a walk or to a movie.

Communication With Your Loved One:

Try empathizing with them, then set a limit. People with HPD may feel sensitive to rejection, because they’re deeply insecure. Helping them label their feelings allows them to better understand how they’re feeling, and know that you aren’t rejecting them (just asking them to stop doing something).

• • • “I get that you’re feeling lonely. But faking an injury isn’t a healthy way to get attention. If you want, we could do something simple together, like taking a walk or playing a board game.”
    • “I know you’re excited to be with friends. Please remember to let Jamal talk, too.”
    • “I can tell that you’re upset. I’m exhausted, though, and I don’t have the energy to talk about it. Could you call your sister, or talk to me in the morning?”

Try labeling their behaviors. People with HPD report being somewhat oblivious to their destructive habits, meaning that they may not realize when they are out of line. Make an observation or question about what they’re doing. This encourages them to step back and re-evaluate what they’re doing.

• • • “You’re spiraling.”
    • “Are you trying to manipulate me?”
    • “It looks like you’re starting something self destructive.”
    • “Honey, you’re making it about you again.”

Remind them of the consequences of what they’re doing. People with HPD may not think things through, or realize that their actions could have destructive consequences. Calmly remind them of what could happen if they act, or keep acting, a certain way.

• • • “You’re making me uncomfortable. If you keep doing this, I will leave.”
    • “This is John’s special day. If you do that at his party, he’ll feel really hurt and upset.”
    • “You could get seriously hurt if you do that.”
    • “When you do this, it makes me not want to spend time with you.”

Express feelings and boundaries clearly and calmly. People with HPD can benefit from explicit boundaries and reminders. Try using “I” language to explain how their behavior makes you feel. This can serve as a warning so that they can slow down and think.

• • • “When you ______, I feel ______. Because of this, _________.”
    • “Please, stop interrupting me. I’m getting frustrated.”
    • “That really hurt my feelings.”
    • “You’re embarrassing me. It makes me want to leave.”

Follow through with consequences if your loved one doesn’t heed your warning. They need to know that when you set boundaries, you mean what you say.

• • • For example, if you say that you’re going to leave if they keep doing something, and they keep doing it, then leave.

Talk about inappropriate behavior, without criticizing them personally. People with HPD act out because they feel insecure, and you don’t want to be cruel or make things even worse. Talk about their behavior, and the consequences of their behavior, without labeling them as selfish or bad. This helps them re-examine their actions and learn from them.

• • • Unhelpful: “You’re such a drama queen! I can’t deal with you anymore! I’m never taking you anywhere again.”
    • Helpful: “I’m disappointed and embarrassed that you flirted with my boss, even after I asked you to stop. It makes me not want to take you to work parties anymore, because I don’t know how to deal with this.”
    • Unhelpful: “You’re so embarrassing! If you don’t stop being like this, you’ll end up sad and alone.”
    • Helpful: “You really embarrassed me in the grocery store today. Now I feel bad, and I don’t know what I’ll do next time I see Mrs. Martinez in public.”

Helping Your Loved One Get Treatment for HPD:

Encourage treatment. The best way a person with HPD can get better is through treatment. However, most people with HPD either don’t seek treatment or they only stay in treatment for a short period of time. You should encourage your loved one to get treatment. If they are already seeking treatment, help encourage them to continue treatment, even when they get bored or want to quit.

• • • “I love you, and your behavior is hurting yourself and me. Would you be willing to get treatment?”
    • “I know you feel that treatment is no longer exciting or that you are better, but this is a major condition that cannot be fixed quickly. Will you please reconsider going back to treatment?”

Help them get psychotherapy. Psychotherapy is the most effective treatment for HPD. This includes talking with a therapist who can use different therapeutic approaches to help your loved one, such as cognitive behavioral therapy. Most people with HPD don’t continue with their therapy after beginning because they lose interest, think they are better, or are too impulsive to follow through with their treatment.

• Cognitive behavioral therapy can address problematic behaviors, such as impulsive actions, manipulative behaviors, and theatrics.

Seek treatment for underlying conditions. Often, people with HPD also have other, co-occurring disorders, such as depression. Because of their feelings of insecurity, inadequacy, and abandonment, they may feel depressed and need to be treated for this.

• If this is the case, your loved one can take selective serotonin reuptake inhibitors (SSRIs) to treat the depression, which may help their overall mood. SSRIs are common in the treatment of depression, and include medications such as Zoloft, Celexa, and Prozac.

Keep watch for destructive behavior. Histrionic personality disorder may lead to self-destructive behavior. People with HPD often exhibit suicidal behavior or behavior leading to self-harm. The person may just be threatening these behaviors to gain attention, so you need to make a decision about the seriousness of the threat.

• Some people with HPD will harm themselves or try to commit suicide to gain attention. Try to notice when your loved one is getting to this destructive stage.
• People with HPD may also exhibit dangerous behavior towards others. Watch your loved one to see if they exhibit any tendencies to hurt those around them