Histrionic Personality Disorder?

With the recent request to introduce histrionic personality disorder in the Sandusky trial, it occurred to me that many people may not be familiar with personality disorders in general, let alone histrionic personality disorder. Here’s a quick summary adapted from our book, Modern Psychopathologies: A Comprehensive Christian Appraisal (Yarhouse, Butman & McRay, InterVarsity Press, 2005).

Mental health professionals have identified a group of disorders that reflect persons who have enduring patterns of maladaptive behaviors that are not a response to crisis, stress, or trauma. They are a more consistent way of relating. These maladaptive ways of relating impair social functioning and cause others distress typically. We call them personality disorders, and they are not without controversy throughout the history of making diagnostic categories.

Today they are organized in the Diagnostic and Statistical Manual of Mental Disorders (DSM) into three major categories/clusters. There is the “odd or eccentric” cluster (Cluster A); the “dramatic, emotional or erratic” cluster (Cluster B); and the “anxious or fearful” cluster (Cluster C). The Cluster B group includes antisocial, borderline, narcissistic, and histrionic personality disorders.

It is the histrionic personality disorder that is becoming a point of controversy in the Sandusky trial. The public is likely more familiar with antisocial and borderline personality disorders from the portrayal of them in the media and entertainment. Histrionic personality disorder is typically characterized by a desire to be the center of social relationships. Often people diagnosed with histrionic personality disorder are described as self-centered and demanding, consistently looking for approval from others and focusing on their own accomplishments.

We seem to know a little more about the causes of antisocial and borderline personality disorders, and we have less clarity around histrionic personality disorder. Various psychosocial and interpersonal theories have been advanced.

The general themes for treating histrionic personality disorder include reducing demands, emotional ‘temper tantrums’ and seductiveness in relating to others. The person needs to learn to reduce their own need for attention for the wrong reasons. They learn how to develop more real and authentic relationships, which would be reciprocal and reflect a more consistent mood state and fewer dramatic displays of emotion.

It will be interesting to see where this development in the trial goes. Appealing to a personality disorder raises the question of what that means in the context of personal volition for behavior. It is apparently a novel and largely untested defense, as it is not the same as an insanity plea and it’s unclear exactly what will be claimed in light of a condition that is challenging to diagnose.