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.As we first discussed in thebeginning of this chapter, there is some thought that the features of histrionicpersonality disorder, such as overdramatization, vanity, seductiveness, andoverconcern with physical appearance, are characteristic of the Western stereotypicalfemale and may lead to an overdiagnosis among women.Sprock (2000) examined thisimportant question and found some evidence for a bias among psychologists andpsychiatrists to associate the diagnosis with women rather than men.CausesDespite its long history, little research has been done on the causes or treatment ofhistrionic personality disorder.One hypothesis involves a possible relationship withantisocial personality disorder.Evidence suggests that histrionic personality andantisocial personality co-occur much more often than chance would account for.Lilienfeld and his colleagues (1986), for example, found that roughly two-thirds ofpeople with histrionic personality also met criteria for antisocial personality disorder.The evidence for this association has led to the suggestion (e.g., Cloninger, 1978;Lilienfeld, 1992) that histrionic personality and antisocial personality may be sex-typed alternative expressions of the same unidentified underlying condition.Femaleswith the underlying condition may be predisposed to exhibit a predominantlyhistrionic pattern, whereas males with the underlying condition may be predisposed toexhibit a predominantly antisocial pattern.TreatmentDurand 11-76Although a great deal has been written about ways of helping people with thisdisorder, little research demonstrates success (Dulit et al., 1993; Horowitz, 2001).Some therapists have tried to modify theattention-getting behavior.Kass, Silvers, andAbrams (1972) worked with five women, four of whom had been hospitalized forsuicide attempts and all of whom were later diagnosed with histrionic personalitydisorder.The women were rewarded for appropriate interactions and fined forattention-getting behavior.The therapists noted improvement after an 18-monthfollow-up, but they did not collect scientific data to confirm their observation.A large part of therapy for these individuals usually focuses on the problematicinterpersonal relationships.They often manipulate others through emotional crises,using charm, sex, seductiveness, or complaining (Beck & Freeman, 1990).Peoplewith histrionic personality disorder often need to be shown how the short-term gainsderived from this interactional style result in long-term costs, and they need to betaught more appropriate ways of negotiating their wants and needs.Narcissistic Personality DisorderWe all know people who think highly of themselves perhaps exaggerating their realabilities.They consider themselves somehow different from others and deserving ofspecial treatment.In narcissistic personality disorder, this tendency is taken to itsextreme.In Greek mythology, Narcissus was a youth who spurned the love of Echo,so enamored was he of his own beauty.He spent his days admiring his own imagereflected in a pool of water.Psychoanalysts, including Freud, used the termnarcissistic to describe people who show an exaggerated sense of self-importance andare preoccupied with receiving attention (Cooper & Ronningstam, 1992).Considerthe case of Willie.Durand 11-77WillieIt s All About MeWillie was an office assistant in a small attorney s office.Now in his early 30s,Willie had an extremely poor job history.He never stayed employed at the sameplace for more than 2 years, and spent considerable time working throughtemporary employment agencies.Your first encounter, though, would make youbelieve that he was extremely competent and that he ran the office.If you enteredthe waiting room you were greeted by Willie, even though he wasn t thereceptionist.He would be extremely solicitous, asking how he could be ofassistance, offer you coffee, and ask you to make yourself comfortable in hisreception area.Willie liked to talk, and any conversation was quickly redirected ina way that kept him the center of attention.This type of ingratiating manner was welcomed at first but soon annoyed otherstaff.This was especially true when he referred to the other workers in the officeas his staff, even though he was not responsible for supervising any of them.Theconversations with visitors and staff often consumed a great deal of his time andthe time of other staff, and this was becoming a problem.He quickly became controlling in his job a pattern that was revealed in hisother positions eagerly taking charge of duties that were assigned to others.Unfortunately, he did not complete these tasks well, and this created a great dealof friction.When confronted with any of these difficulties, Willie would first blameothers.Ultimately, though, it would become clear that Willie s self-centerednessand controlling nature were at the root of many of the office inefficiencies.Duringa disciplinary meeting with all of the law firm s partners, an unusual step, WillieDurand 11-78became explosively abusive and blamed them for being out to get him.He insistedthat his performance was exceptional at all of his previous positions somethingthat was contradicted by his previous employers and that they were at fault.After calming down, he revealed a previous drinking problem, a history ofdepression, and multiple family problems, all of which he believed contributed toany difficulties he experienced
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