Rogers and communication theory

Histrionic Personality Disorder (HPD) is one of the least seen personality disorders in the United States, and one of the least researched in psychology today. In 2004, only two to three percent of the population treated in clinical environments had been diagnosed with the disorder (Britton, 2004). As a result, while researchers have studied possible causes for the disorder, the research on such causes is scarce, and no single cause has been determined. Clearly, more research in this area is needed, particularly due to the detrimental effects of the disorder on the families and friends of those affected by the problem.

To understand the issue of possible causation, it is important to first understand the disorder itself. The American Psychological Association describes HPD as one of ten personality disorders. This particular disease is located in the second of three clusters, that of the B. cluster, or the dramatic or emotional personality disorders. Those with histrionic disorder are excessively emotional, and constantly seek attention, finding themselves uncomfortable in situations where they are not the center. These behaviors begin in early adulthood, and continue throughout the patient's life. These individuals' interpersonal interactions are often inappropriate, including seductive, sexual, or provocative behaviors, and these individuals often see their relationships as intimate than they are. Histrionic patients often show rapid changes in emotional states as well as exaggerated emotions, but these emotions appear shallow due to a lack of detail in speech, and a style of conversation that is impressionistic. Histrionic individuals also use their appearance to draw attention to themselves, and are highly suggestible (APA, 2000).

While the symptoms of the disorder are clearly defined, the causes for it are much less understood. This paper will focus on the causal factors presented within current research for histrionic personality disorder, and will discuss the current theories associated with each possible cause. This paper will review causes stemming from biological, developmental, cognitive, and social factors, and aims to show clear links between specific histrionic personality disorder symptoms, specific causes, either internal or external, and personality theories associated with each finding. In this way, we hope to study histrionic disorder in terms of personality theories related to possible causes.

Research regarding the causes of histrionic disorder focuses primarily on biological, developmental, cognitive, and social factors (Kraus, 2001). The first area we will examine is that of the neurochemical physiological, or biological, causes. Preclinical studies have shown the noradrenergic system, which houses nerve cell bodies within the locus coeruleus, plays a vital role in the regulation of arousal, as well as impulsivity (Aston-Jones, 2002). Those with HPD have been shown to have highly responsive noradrenergic systems, as well as a malfunction of catecholamines, which are responsible for emotional reactions (Trestman, et al., 1992). Biological theorist Hans Eysenck's personality theory of the Factor Analysis, which separates people into two categories, those of extrovert/introvert and neurotic, would explain such a biological reaction as a biological patterned response to external stimuli (Heffner, 2002). In light of the Factor Analysis, and using the research studies on HPD and the noradrenergic system, one can see clearly a possible link between the high levels of sexual and seductive interpersonal relationships of the person with HPD and highly responsive noradrenergic systems.

In addition to biological causes of HPD, other researchers have concluded there are developmental causes associated. A study by Lee in 2006 showed a clear link between traumatic childhood experiences and the later development of HPD. These experiences included sexual abuse, rejection of a mother or father figure, or a failure to achieve age-specific goals at appropriate times. Furthermore, Lee (2006) also found that those with HPD often use defense mechanisms such as repression, denial, and disassociation.

These findings suggest at least marginal support for a link between HPD and developmental issues, and are supported by the psychoanalytical theory. Psychoanalytic theory, developed by Sigmund Freud, describes the psychosexual stages of development, and outlines possible problems if those developmental stages are interrupted. According to Freud, interruption of the phallic stage can cause individuals to indulge in sexual deviance, and to develop maladaptive interpersonal relationships. Further, Freud also noted the use of similar defense mechanisms used by those with HPD in those who are unable to please the id, or the impulsive part of human kind, and the superego, or the angelic portion of the human personality (Heffner, 2002). By examining Lee's research supporting a link of causation between development and HPD, one can clearly see additional support for psychoanalytical theories of personality.

A third area of research is that of social learning causes for HPD. Research by Leising (2006) showed a link between inconsistent interpersonal reinforcement by parents and later development of HPD. Further, the study suggested that those with HPD have learned to "get what they want" from others by drawing attention to themselves through seduction, overreaction to situations, and high emotional states (Leising, 2006).

Social learning theorist Julilan Rotter, and his theory of "behavior potential," would support such a research finding. Rotter noted a belief that people engage in inappropriate behavior only if expectations of rewards for the behavior are high, and if those rewards are valuable to the individual (Heffner, 2002). Using this theory in combination with Leising's findings, one could suggest that those suffering from HPD behave in highly emotional, seductive, overpowering ways to achieve the reward of being the center of attention.

Yet another area of research is the sociocultural causes of HPD. In a study by Skodol and Bender (2003), there were high levels of gender bias found in the diagnosis of women with HPD. The researchers noted that the cultures of countries with high levels of HPD in women, such as in the United States, associate exaggerated emotion and personal suggestibility with women more than men. In doing so, the culture of the area causes a gender bias in practitioners that can potentially cause a different diagnosis between men and women for the same behaviors. The researchers concluded it is possible that HPD is found equally among males and females, but diagnosed more often in females due to societal and cultural bias (Skodol and Bender, 2003).

Gordon Allport and other trait theorists believe as Skodal and Bender suspected. According to Allport's trait theory, all individuals have a number of specific traits, called central traits. The cardinal trait, however, is the trait that becomes a dominant force. Allport himself noted that women's traits were generally emotion based, making women more likely to overreact to emotional situations (Heffner, 2002). Using this theory in combination with Skodol and Bender's findings, it is possible that the traits of women lead to a cultural bias in the diagnosis of HPD in women.

Still another area of research in the causation of HPD is that of personal variables. Seidlitz (2001) found, for example, that individuals with HPD had long lasting symptoms, but that those symptoms changed with age. In particular, younger individuals with HPD were found to use seduction and sexual attitudes to create attention, while older individuals used more maternal or paternal behaviors (Seidlitz, 2001). While both sets of behaviors serve to make the individual the center of attention, those behaviors differ as personalities change.

Carl Jung and other analytic psychologists would agree with this theory of causation. According to Jung's theory of archetypes, all individuals have traits that are primordial images inherited from ancestors. Within this structure is the self archetype, which according to Jung is the unifying portion of the personality that finds balance, and helps us to feel complete (Heffner, 2002). Using this concept in combination with Seidlitz's research, it is possible that the self archetype will change over time as an individual seeks to find balance in new circumstances such as within a career, after childbirth, or during marriage. As this self archetype changes, then, so do the personal variables that can cause a variety of symptoms to emerge in those with HPD.