What Is Histrionic Personality Disorder?

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Since the start of Johnny Depp’s ongoing defamation trial against Amber Heard-which concerns a 2018 op-ed she wrote identifying herself as a survivor of sexual violence (and which did not name Depp)-the public has been made privy to a staggering amount of testimony regarding their prior relationship, including allegations of abuse (by both parties) and substance abuse.

This week, a psychologist hired by Depp’s team testified that Heard has both histrionic personality disorder (HPD) and borderline personality disorder (BPD). Though Heard has previously disclosed to the court a PTSD diagnosis made by a different psychologist, Depp’s team’s psychologist, Shannon Curry, alleged that Heard was “grossly exaggerating” her PTSD symptoms. Curry argued that as a result of the combination of HPD and BPD, Heard was prone to be “reactive” as well as “dramatic, erratic, and unpredictable.”

Heard’s attorney later attempted to cast doubt on these diagnoses, stating that Curry is not board certified. While BPD is a broadly accepted diagnosis, HPD is somewhat more controversial. Heard has not yet testified or publicly commented on Curry’s diagnoses.

Whereas mood disorders like depression or bipolar disorder are defined by traits and symptoms that tend to ebb and flow, personality disorders are “more state than trait,” says Thea Gallagher, a clinical psychologist at NYU Langone Health. While a person experiencing depression or anxiety can typically recognize their symptoms and differentiate between their “normal” self versus their depressed/anxious self, a person with a personality disorder only knows life through the lens of that disorder. “Their way of seeing themselves, of seeing the world, operating in the world, is very rigid, extreme to the point where it causes a great deal of trouble for them in many areas of life,” explains Francis Mondimore, director of the Mood Disorders Clinic at Johns Hopkins Bayview Medical Center and author of Borderline Personality Disorder: New Reasons for Hope.

Most personality disorders aren’t treated with medications; there are no FDA-approved medications for their use. Typically, the recommended treatment for people with personality disorders is psychotherapy. Cluster B personality disorders – which include BPD and HPD – are thought to affect between 1 to 6 percent of the general population. What causes personality disorders is a subject of ongoing research, but it’s been theorized that genetics, childhood trauma or abuse, and high reactivity (sensitivity to stimuli) may be factors.

Histrionic personality disorder is characterized by an extreme need to be the center of attention as well as a dramatic affect, says Mondimore.

Like borderline personality disorder, histrionic personality disorder falls under an umbrella known as “Cluster B” personality disorders, which also include antisocial personality disorder and narcissistic personality disorder. On the whole, Cluster B personality disorders are characterized by “intense, unstable emotions, distorted self-images, and difficulty in relationships,” says Gallagher.

By contrast, the DSM defines Cluster A personality disorders as characterized by “odd, eccentric thinking or behavior”; they include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.

Mondimore says that while three of four Cluster B personalities (antisocial, narcissistic, and borderline) share a common thread – a “somewhat damaged sense of self” – histrionic personality disorder doesn’t fit as well within the group. Whereas the better-understood Cluster B disorders have a clear, disruptive impact on people’s lives, it’s been harder for psychologists to agree if and how HPD uniquely disrupts the lives of people diagnosed with the disorder.

Psychologists may diagnose patients with a personality disorder through a series of clinical interviews and questionnaires, like the Structured Clinical Interview for DSM Disorders (SCID), says Gallagher. Typically, these questionnaires are designed to assess whether or not someone “endorses” or agrees with the point of view of a given personality disorder.

For his part, Mondimore is wary of diagnoses made through the DSM. “The DSM was developed as a research tool,” he says – the criteria for given diagnoses are helpful to researchers and practitioners who want to study a given disorder. “The DSM isn’t really meant as a clinical tool to help the clinician make a diagnosis and develop a treatment plan,” he adds. “If a particular diagnosis doesn’t point you in a particular direction as far as treatment, it’s not terribly useful.”

HPD is one such example, he says; though psychotherapy is the primary treatment model for Cluster B personality disorders, HPD is poorly understood, which means there aren’t necessarily specific types of therapy recommended. By contrast, says Mondimore, “for borderline personality disorder, there’s actually much more research, and a particular type of psychotherapy has been developed to treat that.” Another issue with diagnosing personality disorders is that, according to the DSM, several of them have overlapping criteria.

The word “histrionic” sounds like “hysterical” for a reason. “The older term for histrionic personality disorder was hysterical personality disorder, and that had a lot of connection with very outdated and misogynistic attitudes towards women,” says Mondimore. Though the disorder was given a new name in an attempt to move away from those connotations, Mondimore says the diagnosis’s sexist roots are still visible – not least of all because it’s primarily a diagnosis given to women.

“These people are said to have shallow emotions, to be often flirtatious,” he says. “Again, there is a sexist kind of a judgment there.” The symptoms typically associated with HPD “beg the question if there is a gendered interpretation of certain behaviors,” says Gallagher. That said, she adds, there are gendered differences in other disorders, too – women are more likely to be diagnosed with anxiety, and men are more likely to be diagnosed with narcissistic personality disorder, for instance.

Mondimore says HPD is a diagnosis that’s gone out of fashion for other reasons, as well. “The things that are said to characterize the disorder are very vague,” he explains. “They involve a tremendous amount of judgment. It’s just a diagnosis that people have shied away from, so I’m actually a little surprised that it shows up at all anymore. ”

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