Cognitive therapy in histrionic personality disorder

We present cognitive therapy for histrionic personality disorder as a different approach in addressing this problem that is so difficult to treat in therapy.

Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking, that begins in the early stages of adulthood and is present in various contexts, according to the fifth edition of the Diagnostic Manual of Mental Disorders (DSM -5).

Furthermore, this personality disorder has as diagnostic criteria the presence of five or more of the following facts:

Person she feels uncomfortable in situations where she is not the center of attention.Interaction with others is frequently characterized by inappropriate sexually seductive or provocative behavior.Rapid changes and flat expression of emotions.Use of physical appearance to attract attention. Style of speaking based excessively on impressions and lacking details. Self-dramatization, theatricality and exaggerated expression of emotion, The person is suggestible (that is, easily influenced by others or by circumstances) and considers the relationships to be closer than they really are.

As can be seen, the histrionic personality is that person that we conceive as childish, with little tolerance for frustration, like a boy or girl with tantrums. They are excessively dependent on others, with a lack of empathy and do not tolerate being contradicted or not having their way.

So, The profile of a histrionic person is characterized by the need to attract the attention of everyone around them, above all, through superficial behaviors, with appearance. For example, they choose clothes in bright colors that attract attention or unique prints.

Additional characteristics

In addition to the diagnostic criteria themselves, there are some other interesting characteristics. Although it is more common in women, there are also men with a histrionic personality pattern.

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Women often wear a lot of makeup, heels, and engage in seductive behavior. to gain the affection and attention of others.

For its part, men, also tries to demonstrate his virility or behavior of “Don Juanism” in an exacerbated way. For both, the ultimate goal is conquest, thereby reinforcing their self-esteem.

Once they have cheated on the other, they do not know how to manage the relationship and feel the need to escape from it to embark on another one. They are not gratified by the relationship itself, but by the give and take of “fooling” or seduction.

Cognitive therapy for histrionic disorder is proposed as a method to modify automatic thoughts. of these people, conduct behavioral experiments and modify the course of interpersonal relationships.

More characteristics of histrionic personality disorder

The fundamental characteristic from which histrionic personality disorder is based is the terror of possible rejection.. The self-esteem of these people is extremely low, but instead of giving in to it, as, for example, dependents can do, they overcompensate. This overcompensation comes hand in hand with maximizing their superficial or banal qualities, such as physical appearance or a frivolous and empty charm.

So, The histrionic patient harbors thoughts in his mind such as “I am inadequate and incapable of managing life on my own.”. Having come to the conclusion that they are incapable of taking care of themselves, they need to find a way for others to take care of them. In this way, they actively seek attention and approval, to ensure that others meet their needs.

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Carried away by theatrics and the desire to attract attention, they lose sight of the real goal and come to pursue stimulation and drama for themselves. And once their relationships take a step further or a certain depth, they have no idea how to cope. Therefore, relationships are almost always superficial, flat and based on the representation of an insubstantial role.

Cognitive therapy in histrionic personality disorder

Cognitive therapy in histrionic disorder is not an easy task. This condition is one of those with the least awareness of its own problems, so most of the time they do not even believe they have a problem. They usually come for consultation when they have hit rock bottom in their life and don’t know where to go or how to handle it.

The first step is that the cognitive therapist does not become the “savior” that the histrionic patient is accustomed to having at his side. You must be careful not to be seduced into this tempting role.. If the therapist falls into this trap, it is difficult for the therapy to move forward.

On the other hand, it is very important reinforce the histrionic patient for his ability to attend to details in the session, as well as practicing assertiveness. They are patients who ramble, get lost in their stories, are too global. Therefore, they need to focus on details and learn to be more precise.

Cognitive therapy in histrionic personality disorder assumes that one of the objectives is for the patient to learn to focus attention on a specific problem. Establishing an agenda of topics allows you to begin teaching him to focus his attention.

It is advisable to set authentic goals that are important to him and allow immediate benefits. This is because, as often happens in their other relationships, they abandon therapy before changes occur. Therefore, They usually need constant reinforcements, without losing sight of what we establish in the long term.

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One of the techniques used in cognitive therapy for histrionic personality disorder is to fantasize about what his life would be like if he changed the way he behaves in relationships. It’s about organizing your ideas around who you would like to be.

Another technique used in therapy is externalization of voices, in which the therapist states the patient’s automatic thoughts and the patient gives more adaptive responses.

The patient sees that Socratic questioning is easier for him if his own words are used in therapy.. For example, use “today I have a meeting with the cockroach”, instead of “I have a meeting with my boss”.

Finally, emphasize that training in problem solving, particularly in So-called means-ends thinking is essential. The objective is for the patient to stop using manipulation as a problem-solving strategy and consider applying other alternatives that would bring greater benefits.