PSY4761: Personality disorders. Extensive elaboration of the learning objectives associated with task 4: Histrionic and narcissistic personality disorder. Includes citations and notes from the tutorial in orange. For all tasks, see the bundle.
Task 4. Histrionic and Narcissistic PD
Histrionic personality disorder
1. What is the clinical picture (phenomenology) of Histrionic PD?
DSM-V criteria histrionic personality disorder
Een diepgaand patroon van buitensporige emotionaliteit en aandacht vragen, beginnend in
de vroege volwassenheid en tot uiting komend in diverse situaties, beginnend in de vroege
volwassenheid en tot uiting komend in diversie situaties, zoals blijkt uit vijf (of meer) van de
volgende kenmerken:
1. voelt zich niet op zijn gemak in situaties waarin hij niet in het centrum van de
belangstelling staat.
2. de interactie met anderen wordt vaak gekenmerkt door onaangepast seksueel
verleidelijk of uitdagend gedrag.
3. toont snel wisselende en oppervlakkige emotionele uitingen.
4. maakt voortdurend gebruik van het eigen uiterlijk om de aandacht op zichzelf te
vestigen.
5. heeft een manier van spreken die uitermate impressionistisch is en waarbij details
ontbreken.
6. toont zelfdramatiserende, theatrale en overdreven uitingen van emoties.
7. is suggestibel, dat wil zeggen gemakkelijk beïnvloedbaar door anderen of de
omstandigheden.
8. beschouwt relaties als meer intiem dan deze in werkelijkheid zijn.
VIDEOS
Video Regina; je kan de histrionische persoonlijkheidsstoornis nog niet bij haar stellen omdat
ze geen volwassene is
2. What is the role of gender in Histrionic PD?
Sprock, J. (2000). Gender-typed behavior examples of Histrionic Personality Disorder. Journal
of Psychopathology and Behavioral Assessment, 22, 107-122.
Abstract
Findings that clinicians diagnose Histrionic Personality Disorder more frequently in women
may be due to the feminine gender weighting of the criteria or because the diagnostic label
elicits a feminine stereotype. Using a method derived from the act-frequency approach,
undergraduates generated behavioral examples of the DSM-IIIR and DSM-IV Histrionic
criteria without regard to sex or according to sex role instructions that elicited masculine or
feminine sex roles. A sample of psychologists and psychiatrists rated the representativeness
of the symptoms for the Histrionic criteria or for Histrionic Personality Disorder. Feminine
behaviors were rated more representative of Histrionic Personality Disorder and somewhat
more representative of the Histrionic criteria than masculine behaviors suggesting that the
feminine sex role is more strongly associated with the label than the criteria. Masculine
behaviors were also rated less representative than sex-unspecified examples. Results
,provide a possible explanation for the higher rates of diagnosis of Histrionic Personality
Disorder in women.
Introduction
Kaplan asserted there is sex bias in the DSM-III criteria for Histrionic Personality Disorder
(HPD) because HPD is diagnosed more often in women and the criteria are based on a
feminine stereotype. However, differential rate of diagnosis does not necessarily suggest
bias and may reflect actual differences in the prevalence of the disorder. In addition, even if
sex bias does exist, the source of bias may reside in the clinician’s assessment rather than
the diagnostic criteria. It is important to differentiate between potential sources of bias
which can occur independently, be confused with, or interact with each other.
Several studies have demonstrated clinician sex bias in the diagnosis of HPD by
manipulating the sex of a patient in a case history while holding the rest of the information
constant. Ford and Widiger found that clinicians were influenced by patient sex when rating
the applicability of Histrionic personality disorder to a case. However, they failed to find
evidence of sex bias when the clinicians were asked to make judgments about the presence
of individual Histrionic criteria. They concluded that sex bias was associated with the
diagnostic label (i.e., clinicians associate Histrionic Personality Disorder with being female)
rather than the diagnostic criteria. More recently, Funtowicz and Widiger found that the
threshold for diagnosing personality disorders more frequently diagnosed in women
(including HPD) was no lower than for personality disorders diagnosed more often in men,
providing little evidence for a bias against women in the diagnostic criteria.
However, there is considerable support for the contention that the construct of
Histrionic personality disorder is consistent with a feminine stereotype. Two studies
conducted with undergraduate participants found that a sex-unspecified case representing
HPD was predicted to be about a woman suggesting that it elicited a sex-specific stereotype.
Another study found that undergraduates who sorted the DSM-IIIR personality disorder
criteria on a continuum from masculine to feminine rated the HPD criteria as feminine.
While they did not conclude that their results demonstrated sex bias in the criteria, they
suggested that the HPD criteria had a feminine gender weighting.
Further, men and women may manifest symptoms of HPD differently. These
differences would affect the likelihood of HPD being assigned if the symptom presentations
differ in representativeness for the diagnostic criteria or for the diagnosis. For example, the
expression of Histrionic tendencies in men may be more indirect, manifested through
antisocial behaviors, and therefore less representative. If so, more women may be diagnosed
with HPD because their symptom presentations are more prototypic. Moreover, behaviors
consistent with a feminine sex role may be more likely to invoke the sex-typed stereotype
associated with the diagnostic label.
The purpose of this study was to examine the representativeness of sex-typed
behavioral examples of HPD symptoms at the criterion level and at the diagnostic level in
order to better understand how sex bias associated with Histrionic Personality Disorder
might occur. The methodology was derived from Buss and Craik’s act-frequency approach in
which specific behavioral descriptions (acts) are used to exemplify personality traits or
dispositions. Personality disorders are viewed as syndromes of dispositions, which are
categories of acts, and are related to everyday dispositions and behaviors. The act-frequency
approach starts with the nomination of acts for a set of dispositions associated with a
construct or set of constructs; typically, undergraduates are asked to list specific acts
, (behavioral examples) that exemplify the dispositions. The resulting lists of acts are then
evaluated by panels of experts for their prototypicality for the dispositions and/or the
constructs. Buss and Craik suggested the act-frequency approach as a systematic way to
investigate the conceptual basis of personality disorders; acts could be nominated for the
traits or the diagnostic criteria associated with the disorders followed by prototypicality
ratings to identify representative acts and the structure of the concepts.
In the present study, specific behavioral examples were generated for the criteria for
HPD but sex-role instructions were used to elicit sex-typed behavioral examples of how they
might be manifested by men and women in everyday behaviors. Undergraduates in separate
instruction conditions were asked to list masculine, feminine or sex-unspecified behavioral
examples for the DSM-IIIR and DSM-IV criteria for HPD. Then, a national sample of clinical
psychologists and psychiatrists rated the prototypicality of the behaviors; half rated the
representativeness of the behaviors for the specific Histrionic criterion for which they were
listed and half rated the representativeness of the behaviors for the construct of Histrionic
Personality Disorder overall. It was expected that feminine behaviors would be rated as
better examples of the criteria than masculine behavioral examples due to the feminine
gender weighting of the criteria, and much better examples of the construct of HPD since the
diagnostic label may more strongly invoke a feminine sex role stereotype.
Discussion
Feminine behavioral examples of Histrionic Personality Disorder were rated as somewhat
better examples of the HPD criteria and as more representative of the construct of HPD
overall than masculine behavioral examples. These (small) differences were statistically
significant and may be due to the feminine gender weighting of the HPD criteria. Results
support Ford and Widiger’s contention that the feminine sex role stereotype is more
strongly associated with the diagnostic label than the criteria. If feminine behaviors are seen
as better examples of the HPD criteria and the construct of HPD, there is an increased
likelihood of the diagnosis being assigned to women. It is important to point out that
behaviors that were not sex-typed (i.e., listed in the sex-unspecified, both masculine and
feminine, or all three instruction conditions) were rated as highly as feminine behaviors. A
more accurate interpretation may be that masculine behaviors are seen as less
representative of the HPD criteria and particularly of the construct of Histrionic Personality
Disorder.
The pattern of ratings also may provide some insight into how clinicians view
Histrionic Personality Disorder. Based on the high frequency of the behaviors in the
prototypes, some of the criteria (i.e., 6: dramatization, theatricality, exaggerated emotion; 1:
is uncomfortable unless the center of attention; 8: considers relationships more intimate)
appear to reflect core symptoms of the disorder. Interestingly, several behaviors
representing the DSM-IIIR criterion, is self-centered, which is no longer part of the DSM-IV
criteria for HPD were rated as very representative of the diagnosis. The deletion of this
criterion does not mean that self-centered behaviors are not seen with HPD. Few behavioral
examples for criterion 3 (rapidly shifting and shallow affect) or criterion 7 (is suggestible),
and none for criterion 4 (uses physical appearance), were rated as prototypic of HPD.
Conclusions regarding the prototypicality of specific criteria should be viewed with caution,
however, due to the considerable overlap of behaviors listed for different criteria. This
overlap may have occurred because the criteria consist of a combination of trait and
behaviorally based descriptions reflecting features that are not necessarily independent
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