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Histrionic Personality Disorder

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H
Histrionic Personality Disorder
Katie C. Lewis1 and Elsa Rose Mastico3
1
Austen Riggs Center, Stockbridge, MA, USA
3
Massachusetts College of Liberal Arts, North
Adams, MA, USA
Synonyms
Hysteria; Hysterical personality disorder
Definition
Histrionic personality disorder is a psychiatric
condition listed in the current edition of the Diag-
nostic and Statistical Manual for Mental Disorders
(DSM-5; American Psychiatric Association
2013). Individuals with this disorder are charac-
terized by frequent engagement in dramatic,
seductive, or attention-seeking behavior, exagger-
ated emotional displays that carry a theatrical
quality, an impressionistic or reactionary
approach to understanding their environment,
and heightened suggestibility and openness to
influence by others.
Introduction
Compared to other contemporary character disor-
ders, histrionic personality disorder is notable for
# Springer International Publishing AG 2017
V. Zeigler-Hill, T.K. Shackelford (eds.), Encyclopedia of Personality and Individual Differences,
DOI 10.1007/978-3-319-28099-8_590-1
its extensive history of being studied in both
ancient and modern cultures. Authors have postu-
lated about the physiological and psychosocial
origins of histrionic symptoms over the course of
four millennia – from ancient Egypt, to the Salem
witch trials, to modern-day academic medical
institutions. Early descriptions of the illness
focused primarily on physical symptoms for
which there was no apparent medical cause; the
origins of contemporary disorders such as conver-
sion disorder, somatoform disorder, phobias, and
cultural terms such as “mass hysteria” can be
traced from these early symptom presentations
and clinical descriptions (Novais et al. 2015).
Other “hysterical” symptoms characterized by
emotionality and interpersonal disruptions were
understood to be a manifestation of pathological
personality functioning, with clinical researchers
focusing more on describing the underlying
impairments in emotion, cognition, internal con-
flict, developmental history, and experiences of
self and other that uniquely relate to hysterical
trait presentation. These latter investigations led
to the eventual development of “hysterical per-
sonality disorder” (later called “histrionic person-
ality disorder”) as a diagnosis, which was first
included in the second edition of the Diagnostic
and Statistical Manual of Mental Disorders
(DSM-II; American Psychiatric Association
1968). Throughout its long history, histrionic per-
sonality disorder has been described in different
ways and examined across different sociocultural
contexts; disagreements about the disorder have
2 Histrionic Personality Disorder
sparked many debates between academic
researchers and clinicians alike. The history of
histrionic personality disorder, a summary of
information about its clinical presentation and
course, and its associated controversies are
described below.
History of Hysteria and Histrionic
Personality Disorder
Early references to the constellation of symptoms
that we now call histrionic personality disorder
can be traced to the classical concept of Hysteria.
Stemming from the Greek term “hystera,” mean-
ing the womb or uterus, hysteria was studied for
nearly four millennia prior to the modern concept
of histrionic personality disorder. The term hyste-
ria was first used in the Kahun Papyrus, an ancient
Egyptian medical text, in an entry entitled “Exam-
ination of a woman who is ill from her womb
wandering” (Quirke 2002). References to “hyste-
ria” appeared in several texts written during the
time of the ancient Greeks and Romans, including
a text by Hippocrates (460  370 BC) who
described it as the “consequence of a dry womb
rising toward the throat searching for humidity”
(Novais et al. 2015). The disorder was historically
conceptualized as an aliment of a woman’s phys-
ical body, a formulation that changed only when
physicians of the mid-seventeenth century pro-
posed that hysteria was better characterized as a
disorder of the brain (Boss 1979). Thomas
Sydenham (1624–1689), a prominent clinician
working during this period of time, published a
treatise on hysteria entitled Epistolary Disserta-
tion on the Hysterical Affections in 1685 that
identified hysteria as a disease of the nervous
system which could affect men as well as
women and whose symptoms were most likely
triggered by intense internal emotional activation
(Boss 1979; Novais et al. 2015). Although
unexplained physical ailments remained an
important feature of the disorder, Sydenham’s
formulation of hysteria as a mental disorder that
involves both psychological and somatic pro-
cesses and exists as a “disease of the integral
person” (Boss 1979, p. 231) contributed to
significant advances in understanding, diagnos-
ing, and treating the disorder.
Historians now view hysteria as playing a
potential role in several accusations of witchcraft
occurring in the seventeenth century. Boss (1979),
for example, describes the “woeful case” of Marie
Glover (p. 223), a 14-year-old girl who in 1602
began exhibiting “fits” after being spoken to
harshly by a female neighbor. Ms. Glover’s neigh-
bor was accused of being a witch and forced to
spend a year in jail for her crime. Although med-
ical texts at the time had started to identify emo-
tional and psychological factors as the underlying
cause of hysteria, these formulations were typi-
cally offered as tentative hypotheses, without sig-
nificant efforts to discount the possibility of a
supernatural origin of symptoms (Boss 1979).
Hysteria at both the individual level and “mass
hysteria” at the community level have been
blamed by historians for the events surrounding
the Salem Witch Trials in the late 1600s, during
which over 20 individuals, primarily women,
were accused of witchcraft and executed
(Starkey 1969).
During the late 1800s, hysteria became a major
topic of focus in medical schools, and physicians
and researchers began to speculate on the role of
personality functioning and unconscious pro-
cesses in the emergence and course of hysterical
symptoms. Jean-Martin Charcot (1825–1893)
was the first physician to propose that hysteria
was related specifically to unconscious mental
processes, and his use of hypnosis as a primary
therapeutic approach to working with hysterical
patients influenced several writers who went on to
develop expanded theories of the disorder (Novais
et al. 2015). William James (1842–1910)
described the work of Charcot, Pierre Janet
(1859–1947), and other early pioneers in the
study of hysteria in his seminal volume The Prin-
ciples of Psychology (1890), which detailed both
the therapeutic efforts and cognitive experiments
that were conducted on patients presenting with
hysterical symptoms at the Pitié-Salpêtrière Hos-
pital in Paris during the mid-nineteenth century.
Through multiple observations of patients
displaying a “split” in their conscious awareness
(e.g., finding that a patient with “glove paralysis”
Histrionic Personality Disorder
would make writing motions when an unseen
pencil was placed in their affected hand), James
(1890) concluded that in cases of hysteria:
We have to deal. . . neither with a blindness of the
eye itself, nor with a mere failure to notice, but with
something much more complex; namely, an active
counting out and positive exclusion of certain
objects. . . we see how deceptive are appearances,
and are forced to admit that a part of consciousness
may sever its connections with other parts and yet
continue to be. (pp. 212–213)
Sigmund Freud (1856–1939), the father of
psychoanalysis and an early student of Charcot’s
who was greatly influenced by his mentor’s work
with hysterical patients, published several papers
on hysteria in the late nineteenth and early twen-
tieth centuries. The development of his conceptu-
alization of hysteria, and repression as a hysterical
defense against psychic conflict, occurred in tan-
dem with the development of the early techniques
of classical psychoanalysis and Freud’s initial for-
mulations of the unconscious. His initial view of
hysteria was focused on the importance of trauma
and the repression of traumatic memories, often of
a sexual nature, in the development of
unexplained somatic symptoms. Later, Freud
incorporated a focus on the repression not only
of actual experienced events but also of conflic-
tual fantasies and internal desires as a source of
hysterical symptoms. With his colleague Josef
Breuer, Freud published Studies on Hysteria in
1895, describing hysteria as a disorder caused by
unconscious conflict and asserting that symptom
remission was possible only by bringing uncon-
scious experiences and memories into conscious
awareness (Breuer and Freud 1895). Freud
worked closely with many hysterical patients,
using talk therapy and free association to explore
somatic symptoms and repressed conflictual
desires (McWilliams 1994; Novais et al. 2015).
Freud’s work with hysterical patients played an
invaluable role not only in clinical understanding
of histrionic symptoms but also in the early over-
all development of psychoanalytic theory and
technique. His studies also provided a conceptual
framework and vocabulary for viewing the symp-
toms of hysteria as relating to personality, devel-
opmental history, and the internal world and
3
fantasies of individuals with hysterical symptoms,
creating a foundation from which modern formu-
lations of histrionic personality disorder eventu-
ally developed.
In terms of formal diagnosis, patients who
were evaluated during the late nineteenth and
early twentieth century were most frequently
assigned a diagnosis of hysteria when they
displayed fickleness and suggestibility, seductive-
ness or overtly sexualized behaviors, and theatri-
cality of mood and behavior (Novais et al. 2015).
Since that time contemporary writers have empha-
sized other elements of histrionic symptom pre-
sentations, with cognitive-behavioral clinicians
focusing on pathological underlying beliefs (e.g.,
that caregivers are untrustworthy and must be
manipulated through the use of provocative
behaviors and seduction) or poor cognitive pro-
cessing capacities that lead to an overly impres-
sionistic understanding of self and environment
(Shapiro 1965).
The first edition of the Diagnostic and Statisti-
cal Manual (DSM-I; APA 1952) included features
of hysterical personality organization under the
general category of “emotionally unstable person-
ality,” but an official diagnostic category for hys-
teria did not exist until the second DSM edition
was published in 1968 (DSM-II; APA 1968). The
DSM-II included a reference to the “hysterical
neuroses,” with dissociative and conversion sub-
types, that described sudden loss of physical func-
tioning in a specific part of the body without
medical explanation – a diagnosis that remained
clearly connected to older conceptualizations of
hysteria. “Hysterical personality” was listed sep-
arately as a personality disorder in the DSM-II,
describing patients whose:
. . .behavior patterns are characterized by excitabil-
ity, emotional instability, over-reactivity, and self-
dramatization. This self-dramatization is always
attention-seeking and often seductive, whether or
not the patient is aware of its purpose. These per-
sonalities are also immature, self-centered, often
vain, and usually dependent on others. (APA
1968, p. 42)
The term hysterical personality disorder was
later changed to histrionic personality disorder in
the publication of the DSM-III (APA 1980), an
4 Histrionic Personality Disorder
adjustment that has been attributed by some to the
growth in number of female mental health practi-
tioners in the 1970s. For many women in the field,
the word hysterical remained too closely
connected to the perception that hysteria was a
disorder that only women could develop (Decker
2013). Because of this, arguments were made that
changing the diagnostic label to a less historically
entrenched term would contribute to a less biased
approach to diagnosing, understanding, and
treating the disorder. Although the official diag-
nosis was changed to “histrionic personality dis-
order,” the DSM-III retained the term “hysterical
personality disorder” in the first paragraph of the
new description, leading many psychiatrists to
feel that the intention of this name change had
been entirely missed (Decker 2013). The defini-
tion was edited accordingly in order to address
this concern for the publication of the DSM-IV
(American Psychiatric Association 1994).
Clinical Presentation and Treatment of
Histrionic Personality Disorder
The most recent edition of the Diagnostic and
Statistical Manual of Mental Disorders (5th ed.;
DSM-5; American Psychiatric Association [APA]
2013) outlines eight diagnostic criteria for histri-
onic personality disorder, including (1) discomfort
in not being the center of attention; (2) inappropri-
ately seductive, flirtatious, or provocative behav-
ior; (3) displays of shallow or rapidly shifting
emotions; (4) use of physical appearance to draw
attention to the self; (5) style of speech that is
impressionistic or lacking in specific detail;
(6) engagement in self-dramatization or exagger-
ated expression of emotions; (7) being easily
influenced by circumstances or others; and
(8) considering relationships to be more intimate
than they actually are. To receive a DSM-5 diag-
nosis, individuals must meet at least five of these
criteria, with features typically emerging in early
adulthood and persisting over time.
Other diagnostic approaches include additional
specific subtypes or variants of the disorder, such
as an “inhibited” subtype that is characterized
primarily by emotional reservedness, naivety,
and a higher prevalence of somatic symptoms
(PDM Task Force 2006). Theodore Millon iden-
tified a total of six subtypes of histrionic person-
ality disorder (2004, pp. 297–300), each featuring
different constellations of symptoms that may
result in varied clinical presentations and primary
interpersonal concerns. These subtypes include
the “appeasing histrionic,” who focuses on placat-
ing others and smoothing over differences, possi-
bly to the point of self-sacrifice; the “vivacious
histrionic,” who is charming, energetic, and
impulsive; the “tempestuous histrionic,” who
may display more negativistic features such as
moodiness or interpersonal turbulence; the “dis-
ingenuous histrionic,” who displays more antiso-
cial features such as intentional manipulation and
deceit; the “theatrical histrionic,” who may be
focused primarily on outer physical appearance;
and finally, the “infantile histrionic,” who engages
in childlike behaviors such as sulking or making
unreasonable demands and who is more emotion-
ally labile.
Across diagnostic approaches, commonalities
that emerge in descriptions of histrionic personal-
ity disorder include the features of self-
dramatization, engagement in seductive interper-
sonal behaviors, exaggerated emotional displays,
and chronic attention-seeking behaviors. Histri-
onic individuals respond to people and events in
an impressionistic, sometimes impulsive, manner
that prioritizes immediate reward over long-term
goals. A core organizing theme for individuals
with this personality style is an emphasis on the
use of gender and sexuality as a means of securing
influence and control over perceived powerful
“others,” typically of the opposite sex. In modern
Western cultures, this may manifest in the form of
provocative and flirtatious behavioral displays; in
more conservative societies or in cultures that
adopt a more repressive stance toward sexuality,
a histrionic character style may take on a more
inhibited, reserved form. In its more severe path-
ological form, individuals with histrionic person-
ality disorder often experience difficulty in
forming and maintaining their interpersonal rela-
tionships and struggle to develop a cohesive,
defined sense of self (Horowitz 2004; Blagov
et al. 2007). Many of these individuals are referred
Histrionic Personality Disorder
to psychotherapists by a physician after consistent
complaining of unexplained health or medical
symptoms. Other issues that may lead them to
seek psychotherapy include relational disruptions
or symptoms of anxiety and depression
(McWilliams 1994; Millon et al. 2004).
Individuals with histrionic features often expe-
rience chronic issues with managing their emo-
tions and effectively using their capacity for
concentration, problem-solving, and
logic. Although they may outwardly appear to
experience intense feelings of joy, anger, or
despair, there is often a performative or theatrical
quality and a sense of transience to these displays
(McWilliams 1994; Millon et al. 2004). This dra-
matization has been hypothesized to operate as an
unconscious defense against deeply rooted anxi-
ety and conflict. Histrionic individuals are highly
susceptible to influence, often adopting the
thoughts or suggestions of others as “truth” with-
out a clear subjective sense of their own opinions
or values (Horowitz 2004; Shapiro 1965). They
notoriously demonstrate impairments in certain
cognitive abilities, often basing their decision-
making on hunches or impressions without fully
considering their options or the possible conse-
quences of their actions (Shapiro 1965). Millon
et al. (2004) highlighted the defensive function
that the histrionic cognitive style serves, recogniz-
ing that such an approach:
. . . actively protects them from anything too pre-
cise, factual, concrete, abstract, reasoned, logical,
systematic, philosophical, or existential. The factual
or concrete is too boring. The abstract or reasoned is
too tedious. The philosophical is too long and tire-
some. The existential is too deep and too threaten-
ing. (p. 315)
While there have been no systematic studies of
the effectiveness of psychotherapy for the treat-
ment of histrionic personality disorder, there is
general agreement that patients typically benefit
from long-term psychotherapy treatment
(McWilliams 1994; Blagov et al. 2007). Although
clinicians have noted that premature termination
is often a concern with more impulsive, emotion-
ally avoidant histrionic patients, research has
actually shown that there is no significant rela-
tionship between the presence of histrionic traits
5
and number of psychotherapy sessions attended
(Hilsenroth et al. 1998). As histrionic individuals
tend to be interpersonally oriented, a treatment
approach that focuses on creating a positive ther-
apeutic alliance, while at the same time
establishing clear boundaries, is often
recommended (McWilliams 1994). Therapists
are cautioned against adopting an overly nurturing
or accommodating therapeutic style in order to
avoid reinforcement of the patient’s more child-
like, dependent behaviors. Patients typically ben-
efit from the opportunity to focus on better
integration of their emotional experiences, the
cognitive understanding of their environment
and sense of self while in treatment, and the
exploration of potentially painful emotions in a
space that is consistent, supportive, and safe
(McWilliams 1994). Developing areas of interest
and activities that may support the growth of
positive self-esteem and a more differentiated
sense of self and identity is encouraged. Psycho-
analytic psychotherapy is often viewed as the
treatment of choice for histrionic personality dis-
order, though cognitive therapy is also used either
as a primary treatment modality or in conjunction
with psychodynamic techniques (McWilliams
1994; Millon et al. 2004; Blagov et al. 2007).
Research on Histrionic Personality
Disorder: Current and Future Directions
Despite histrionic personality disorder’s long his-
tory, there have been relatively few empirical
studies focused specifically on the features, etiol-
ogy, or course of the disorder. Most often, histri-
onic personality disorder is investigated in larger
studies that evaluate a range of personality disor-
ders or traits as they naturalistically occur in clin-
ical and community populations (Lenzenweger
2006; Samuel and Widiger 2004). Individuals
with histrionic personality styles are typically
compared to those experiencing other character
disorders, such as obsessive-compulsive person-
ality disorder (often described as the antithesis of
histrionic personality disorder), borderline per-
sonality disorder, dependent personality disorder,
and/or antisocial personality disorder (ASPD).
6 Histrionic Personality Disorder
Researchers have consistently noted an overlap in
histrionic symptoms with other character diagno-
ses, leading to considerations over the past decade
of removing histrionic personality disorder as a
diagnosis from the DSM-5 (for a discussion of this
and other debated DSM revisions, see Section III
of the DSM-5 (APA 2013)).
Samuel and Widiger (2004) conducted a study
of clinician ratings of fictionalized “prototypical”
patients with different personality disorders and
collected trait ratings for each prototype using the
five-factor model of personality (Costa and
McCrae 1990). Prototypical histrionic patients
were uniquely rated as having higher levels of
gregariousness (on the extraversion factor) and
experience of feelings (on the openness factor)
compared to prototypes of other personality dis-
order patients. As expected, there were multiple
areas of overlap between histrionic personality
disorder traits and other personality diagnoses,
including high levels of anxiety and impulsivity
(on the neuroticism factor) which were shared
with prototypical patients diagnosed with border-
line and antisocial personality disorder.
There has been interest specifically in the many
areas of overlap and divergence between histri-
onic personality disorder and antisocial personal-
ity disorder (ASPD), both in terms of their shared
features (such as impulsivity, manipulative ten-
dencies, and novelty seeking) as well as the some-
what stereotypically “gendered” quality of each
disorder. Many writers have described, for exam-
ple, how the diagnostic criteria for each disorder
bring to mind a caricature-like image of the risk-
taking, suave, and dominating antisocial male,
contrasted with the naïve, flirtatious, and
attention-seeking histrionic female (see Millon
et al. 2004 for a review). Researchers have pro-
posed that the two disorders may share an under-
lying biogenetic etiology, specifically in regard to
impulsivity and stimulus-seeking traits (Cale and
Lilienfeld 2002). Alternatively, many others have
questioned the potential impact of implicit clini-
cian stereotype and bias in the more frequent
assignment of histrionic personality disorder as a
diagnosis to women versus ASPD to men. Actual
research findings on this topic have been mixed,
with some studies finding that there indeed appear
to be discrepancies in the rate of occurrence of
histrionic personality disorder in men versus
women (American Psychiatric Association 1994;
Warner 1978), and others indicating that when a
structured assessment tool is used, there are no
differences in the rate of histrionic personality
disorder occurrence between men and women
(Nestadt et al. 1990). Widiger and Spitzer (1991)
noted that even when gender differences in rate of
occurrence for different personality disorders are
found, these may be due to underlying biological
influences of the expression of shared genetic
traits, rather than reflecting a specific socialized
bias in the diagnostic process.
The relationship between histrionic personality
disorder and ASPD remains an ongoing area of
controversy, and much work remains to be done in
clarifying the relationship between the two disor-
ders. There is an ongoing need to better under-
stand histrionic personality disorder across
several domains, including the biological, devel-
opmental, and sociocultural factors affecting the
development and course of the disorder. Given the
particular importance of gender identity and sex-
uality as core organizing themes of the disorder,
the diagnosis and clinical understanding of histri-
onic personality disorder is likely ready to
undergo significant alterations as Western psychi-
atry increasingly moves away from a binary gen-
der system to a more fluid conceptualization of
gender and sexual identity and as further changes
develop in societal power differentials between
individuals based on gender constructs. More
research is needed that aims at achieving a better
understanding of histrionic traits along the dimen-
sions of healthy/adaptive functioning to more
pathological impairment, understanding the rela-
tionship between histrionic personality organiza-
tion and other psychological disorders and
medical conditions, and understanding both the
effectiveness of different treatment approaches
and the prognostic indicators of improved func-
tioning in histrionic individuals over time.
Histrionic Personality Disorder
Tensions and Controversies with
Histrionic Personality Disorder
There have been many debates surrounding mod-
ern classification systems for personality disor-
ders. One source of tension concerns how
personality and personality disorders are specifi-
cally defined – whether pathological character
functioning is separate from normal personality
or whether personality traits exist along a contin-
uum from adaptive to maladaptive levels of func-
tioning. Zetzel (1968) recognized this dilemma as
it applies to histrionic personality disorder several
decades ago, asserting that individuals with hys-
terical personality styles may be categorized as
being either “good hysterics” who function well
interpersonally and have a warm, vivacious
demeanor or “bad” hysterics who have poor inter-
personal relationships and a limited capacity to
effectively deal with stress.
Histrionic personality disorder remains some-
what difficult to diagnose and treat given the
substantial overlap of symptoms with other per-
sonality disorders that carry more obvious and
dramatic symptoms (e.g., borderline personality
disorder). As noted previously, some critics con-
tinue to claim that the diagnostic criteria are too
heavily focused on stereotypically feminine traits.
Traits such as shallowness and sexually provoca-
tive behaviors are entities that Western societies
often attribute to women, and when men are diag-
nosed with histrionic personality disorder, there is
often a tendency for them to be described in ste-
reotypically gendered terms such as dramatic and
feminine (PDM Task Force 2006). With the ongo-
ing association of histrionic traits to femininity,
the problem and potential stigma in assigning this
disorder to male patients may continue.
Lay descriptions of individuals who display
histrionic traits or behaviors can be experienced
as “othering” to women. Many people continue to
use the term “hysterical” when describing women
who appear overly effusive in their emotional
displays, which may be invalidating to the histri-
onic individual and lead others to trivialize and
dismiss that individual’s subjective experiences
and struggles. Rather than viewing histrionic fea-
tures as carrying both positive (warmth,
7
liveliness) and pathological (emotional reactivity,
manipulativeness) relevance for daily
functioning – regardless of whether the traits are
diagnosed in men or women – the colloquial use
of the term “hysterical” as a pejorative term con-
tinues to contribute to stigma and misunderstand-
ing of histrionic personality disorder as a
diagnosis.
Conclusion
Beginning with its appearance in the earliest
recorded medical text, the ancient Egyptian
Kahun Papyrus, over 4000 years ago (Boss
1979; Quirke 2002), histrionic personality disor-
der has served the role of sparking debate and
interest into how our unconscious experiences
and emotions influence our behaviors, relation-
ships, and physical health. As noted, early formu-
lations asserted that hysteria was caused by
wandering parts of the female anatomy (Quirke
2002). This led to later formulations that attrib-
uted symptoms to supernatural phenomena such
as witchcraft (Starkey 1969) and eventually to a
recognition of the role of unconscious emotional
experiences and mental conflict in histrionic per-
sonality functioning (Breuer and Freud 1895). In
modern culture, the somatic symptoms that fig-
ured so prominently in the earliest descriptions of
the disorder have been re-categorized under dif-
ferent diagnostic labels that now describe psycho-
somatic disorders, thus leaving the more
emotional and behavioral features of the disorder
to assume a primary role in the diagnostic criteria
for the condition.
An association between histrionic tendencies
and stereotypical femininity has existed since
ancient times, and modern formulations of the
disorder have not been entirely successful in elim-
inating the subtle negative bias or pejorative tone
connected to the term “hysterical” as it is used in
everyday speech and language. Formal diagnostic
techniques have improved the ability of clinicians
to accurately diagnose the disorder without risk of
being unduly influenced by sociocultural bias, and
the continued expansion of available research and
literature on histrionic personality disorder will
8 Histrionic Personality Disorder
undoubtedly aid in improving knowledge and
understanding of the disorder in both male and
female patients. While gender identity undoubt-
edly plays a role in the central themes and con-
cerns that characterize the disorder, research is
needed to understand how modern formulations
of gender as a dimensional construct may influ-
ence the experiences and manifestation of histri-
onic symptoms.
As personality disorders and character psycho-
pathology in general continue to be examined
from a dimensional rather than categorical per-
spective, it will be important for future genera-
tions of clinicians and researchers to evaluate and
consider the potentially positive influence that
histrionic traits carry on interpersonal functioning
(e.g., see Zetzel’s (1968) “good hysteric”) and to
determine clinically how to best identify and
address symptoms that become upsetting or dis-
ruptive to the histrionic individual. Continued
psychiatric inquiry into the effectiveness of dif-
ferent treatment approaches and study of histri-
onic personality organization as it relates to other
character disorders will contribute more broadly
to a greater understanding of dimensions of health
and pathology, especially as they compare to the
domains of interpersonal warmth and relatedness,
the experience and regulation of emotion, and the
cognitive capacities for understanding social envi-
ronments and interpersonal relationships.
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