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Author Topic: DIFFERENCES|COMORBIDITY: Borderline and Histrionic Personality Disorder  (Read 9571 times)
phoenixgirl
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« on: August 09, 2007, 11:58:37 AM »

I've just read about histrionic personality disorder.  I'd never heard of it before, but I've definitely refered to MIL's behavior as "histrionics."  Interesting . . .

http://www.psychologytoday.com/conditions/histrionic.html

Symptoms
Constantly seeking reassurance or approval
Excessive dramatics with exaggerated displays of emotion
Excessive sensitivity to criticism or disapproval
Inappropriately seductive appearance or behavior
Overly concerned with physical appearance
Tendency to believe that relationships are more intimate than they actually are
Self-centeredness, uncomfortable when not the center of attention
Low tolerance for frustration or delayed gratification
Rapidly shifting emotional states that appear shallow to others
Opinions are easily influenced by other people, but difficult to back up with details

I see here that borderline and histrionic personality disorders are placed in the same category:
http://www.mayoclinic.com/health/personality-disorders/DS00562

Things that jumped out at me that we talk about regularly as behaviors our BPD have but which are not stated directly in the criteria for diagnosing BPD are:

Self-centeredness, low tolerance for frustration, excessive sensitivity to criticism (which I guess could fall under the BPD's fear of rejection)

My MIL's behavior with her sons is not what I'd call overtly sexual, but she has always behaved in a, "Look at how silly I am and giggle at me" kind of way, like she is a flirty school girl.  She definitely has "excessive dramatics with exaggerated displays of emotion."  I wouldn't say she is overly concerned with her physical appearance.  

Some of the descriptions I've read fit my BIL more than my MIL, and I would say he is definitely concerned with his physical appearance.  When his brother was describing a nearly-fatal surgery gone wrong, BIL interrupted to change the subject back to his newly acquired job.  BIL also suffers from undiagnosed physical symptoms, and from what I've read, somatoform disorders are linked with histrionic personality disorder.

I haven't read anything mentioning that personality disorders can coexist.  

Here's another interesting website I found:

http://www.merck.com/mmpe/print/sec15/ch201/ch201a.html

From the site:

Borderline personality is marked by unstable self-image, mood, behavior, and relationships.  (MIL + BIL)

Affected people tend to believe they were deprived of adequate care during childhood and consequently feel empty, angry, and entitled to nurturance. As a result, they relentlessly seek care and are sensitive to its perceived absence. (MIL + BIL)

Their relationships tend to be intense and dramatic. When feeling cared for, they appear like lonely waifs who seek help for depression, substance abuse, eating disorders, and past mistreatments. (MIL)

When they fear the loss of the caring person, they frequently express inappropriate and intense anger.
These mood shifts are typically accompanied by extreme changes in their view of the world, themselves, and others—eg, from bad to good, from hated to loved. When they feel abandoned, they dissociate or become desperately impulsive. (MIL)

Their concept of reality is sometimes so poor that they have brief episodes of psychotic thinking, such as paranoid delusions and hallucinations. (MIL)

They often become self-destructive and may self-mutilate or attempt suicide.

They initially tend to evoke intense, nurturing responses in caretakers, but after repeated crises, vague unfounded complaints, and failures to comply with therapeutic recommendations, are viewed as help-rejecting complainers.  (MIL)

Borderline personality tends to become milder or to stabilize with age.  (Really?)

(See also the American Psychiatric Association's Guideline Watch: Practice Guideline for the Treatment of Patients With Borderline Personality Disorder.)

--------------------------

Histrionic personality involves conspicuous attention seeking. (MIL + BIL)

Affected people are also overly conscious of appearance and are dramatic. (MIL + BIL)

Their expression of emotions often seems exaggerated, childish, and superficial.  (MIL + BIL)

Still, they frequently evoke sympathetic or erotic attention from others.  (MIL + BIL)

Relationships are often easily established and overly sexualized but tend to be superficial and transient.  
 
Behind their seductive behaviors and their tendency to exaggerate somatic problems (ie, hypochondriasis [see Table 1: Personality Disorders: Coping Mechanisms]) often lie more basic wishes for dependency and protection.  (BIL)

---------------

It's all interesting.  I know I am not fit to diagnose anyone, but does anyone know if these disorders can coexist?  BIL definitely has somatic problems (remember his "bruised rib" that made him lie on the couch moaning), including some with physical manifestations.  His opinions are easily influenced by others, whereas MIL's opinions warp reality to suit her needs and cannot be changed with reason.

If I had to pick, I'd say MIL has BPD and BIL has HPD, although he does have the problems with substance abuse and intense anger that are characteristic of BPD.  I believe that he does overly sexualize things and place too much importance on physical appearance.  He has always made me uncomfortable in the way that he praises my appearance with too much familiarity and too much enthusiasm.  It's as though he doesn't know how to interact with a female other than being charming (in his mind).  This seems to have lessened in recent years, either because his girlfriend has been present and he knows on some level he shouldn't check out his brothers' wives, or maybe because he's grown up some.  As a teacher of teenaged boys and as a stoic, no-frills woman, I know I exude a certain anti-femininity that usually keeps me safe from uncomfortable situations with or unwanted attentions from chauvinistic students, so the fact that BIL doesn't pick up on what is obvious to 99% of my students is interesting.  I even had a suave male student offer to extract a favor from a teacher "if it's a female, because all the female teachers like me.  Well . . . except for you."   wink
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« Reply #1 on: August 09, 2007, 12:02:56 PM »

Yes, these disorders can coexist, as can many of the Cluster B disorders.  Borderline, histrionic, antisocial, and narcissistic p.d's are all members of the Cluster B personality disorders...   many overlapping characteristics.

Please understand that the description of the various p.d's does change and is usually in a state of flux.  Right now, DSM-IV is used to diagnose and discern various mental illnesses, but, if I'm not mistaken, a DSM 5.0 is just around the corner, and there will be changes.

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« Reply #2 on: August 09, 2007, 12:13:02 PM »

When asking differential questions about multiple personality disorders, it is important to understand why you are asking the question and how you intend to use the information. Without this perspective and focus, the data may be overwhelming, confusing and misleading.  For example...

~ if your child is not responding to therapy, it makes sense to look more carefully into the possibility that the wrong personality disorder was diagnosed or whether there are comorbid (multiple) personality disorders at play.

~ If you are trying to get along better with your wife, it's not as important to pinpoint the specific disorder or analyze the comorbidity as it is to recognize and fully understand the problem behaviors and how to constructively deal with them.  

~ If you are recovering from a failed relationship, the important thing is often to understand which behaviors were pathologic (mental illness) and which were just the normal run of the mill problems common to failing/failed relationships - there is often a bias to assign too much to the "pathology" and not enough to common relationship problems, or the issues we created by our own behaviors.

It's important to know that the distinctions are not all that neat and tidy. In a 2008 study, comorbidity with another personality disorder was very high at 74% (77% for men, 72% for women).  This is one reason why there is controversy around the DSM classifications of Personality Disorders - there is so much overlap it is confusing even to professionals - personality disorders are real, but they are not easily or neatly defined.

It is also worth noting that this personality disorder is scheduled to be dropped from the DSM 5.0 manual when it is published in 2013.

Comorbid w/BPD--------------
Paranoid
Schizoid
Schizotypal
Antisocial
Histrionic
Narcissistic
Avoidant
Dependent
OCD
More info
Men-----------
17%
11%
39%
19%
10%
47%
11%
2%
22%
Women-------
25%
14%
35%
9%
10%
32%
16%
4%
24%


Some helpful hints for sorting through this.

  • General and Specific There are definitions for "personality disorder" as a category and then there are definitions for the subcategories (i.e., borderline, narcissistic, antisocial, etc.).  Start with the broader definition first.  Keep in mind that to be a personality disorder, symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder - - the history of symptoms can be traced back to adolescence or at least early adulthood - - the symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life. Symptoms are seen in at least two of the following areas: thoughts (ways of looking at the world, thinking about self or others, and interacting), emotions (appropriateness, intensity, and range of emotional functioning), interpersonal functioning (relationships and interpersonal skills), or impulse control

  • Spectrum Disorders  An extremely important aspect of understanding mental disorders is understanding that there is a spectrum of severity. A spectrum is comprised of relatively "severe" mental disorders as well as relatively "mild and nonclinical deficits".  Some people with BPD traits cannot work, are hospitalized or incarcerated, and even kill themselves.  On the other hand, some fall below the threshold for clinical diagnosis and are simply very immature and self centered and difficult in intimate relationships.

  • Comorbidity Borderline patients often present for evaluation or treatment with one or more comorbid axis I disorders (e.g.,depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa). It is not unusual for symptoms of these other disorders to mask the underlying borderline psychopathology, impeding accurate diagnosis and making treatment planning difficult. In some cases, it isn’t until treatment for other disorders fails that BPD is diagnosed.  Complicating this, additional axis I disorders may also develop over time.  Because of the frequency with which these clinically difficult situations occur, a substantial amount of research concerning the axis I comorbidity of borderline personality disorder has been conducted. A lot is based on small sample sizes so the numbers vary.  Be careful to look at the sample in any study -- comorbidity rates can differ significantly depending on whether the study population is treatment seeking individuals or random individuals in the community.  Also be aware that comorbidity rates  are generally lower in less severe cases of borderline personality disorder.

  • Multi-axial Diagnosis  In the DSM-IV-TR system, technically, an individual should be diagnosed on all five different domains, or "axes." The clinician looks across a large number of afflictions and tries to find the best fit.  Using a single axis approach, which we often do as laymen, can be misleading -- looking at 1 or 2 metal illness and saying "that's it" -- if you look at 20 of these things, you may find yourself saying "thats it" a lot.   smiley  A note in the DSM-IV-TR states that appropriate use of the diagnostic criteria is said to require extensive clinical training, and its contents “cannot simply be applied in a cookbook fashion”.

  • Don't become an Amateur Psychologist or Neurosurgeon  While awareness is a very good thing, if one suspects a mental disorder in the family it is best to see a mental health professional for an informed opinion and for some direction - even more so if you are emotionally distressed yourself and not at the top of your game. 

I hope this helps keep it in perspective.   smiley

Skippy



DIFFERENCES|COMORBIDITY: Overview of Comorbidity

Additional discussions...

Personality Disorders
Borderline and Paranoid Personality Disorder
Borderline and Schzoid/Schizotypal Personality Disorder
Borderline and Antisocial Personality Disorder
Borderline and Histrionic Personality Disorder
Borderline and Narcissistic Personality Disorder
Borderline and Avoidant Personality Disorder
Borderline and Dependent Personality Disorder
Borderline and Obsessive Compulsive Personality Disorder
Borderline and Depressive Personality Disorder
Borderline and Passive Aggressive Personality Disorder
Borderline and Sadistic Personality Disorder
Borderline and Self Defeating Personality Disorder

Other
Borderline PD and Alcohol Dependence
Borderline PD and Aspergers
Borderline PD and Attention Deficit Hyperactivity Disorder
Borderline PD and BiPolar Disorder
Borderline PD and Dissociative Identity Disorder
Borderline PD and P.T.S.D.
Borderline PD and Reactive Attachment Disorder (RAD)
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« Reply #3 on: August 14, 2007, 10:56:04 AM »

Yes, definately. I believe my ex was BPD comorbid with HPD as he displayed some BPD traits but not others, and some HPD traits and not others. In short:  He did not show the overt rage of most BPDs but everything else.  He was not overly concerned with his appearance nor especially interested in sex, but all other traits of HDP.
I even read somewhere that HDP, NPD and Antisocial could be grouped under Borderline as the base motivation is basically the same... abandonment depression.
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« Reply #4 on: February 28, 2011, 12:02:21 PM »

http://BPD.about.com/od/relatedconditions/a/Histronic-Personality-Disorder.htm?nl=1

this article states that HPD and BPD are almost non distinguishable...
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« Reply #5 on: March 10, 2011, 11:08:58 PM »

http://BPD.about.com/od/relatedconditions/a/Histronic-Personality-Disorder.htm?nl=1

this article states that HPD and BPD are almost non distinguishable...

Lots of people call themselves experts on BPD who really have no clue.

They are both cluster B PDs, so they have certain things in common. Someone can have both at the same time.

The DSM 5.0 planning task force wants to eliminate HPD as well as NPD. Who knows what will happen.
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« Reply #6 on: March 11, 2011, 07:41:15 AM »

this confuses me:

•Rapidly shifting and shallow expression of emotion

•Shows self-dramatization, theatricality, and exaggerated expression of emotion

aren't exaggerated expression of emotion and shallow expression of emotion somewhat opposites?

can you help me  understand?

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« Reply #7 on: March 11, 2011, 09:13:50 AM »

this confuses me:

•Rapidly shifting and shallow expression of emotion
Answer: Retention of emotion - Control Mechanism, withdrawl safety in your shell.
This is why they appear shy and aloof until they are comfortable enough or relaxed enough to use the next.


•Shows self-dramatization, theatricality, and exaggerated expression of emotion
Answer: Control Mechanism - By being front and center once they feel safe they control themselves and the situation by giving you the safest script they can.
aren't exaggerated expression of emotion and shallow expression of emotion somewhat opposites?

can you help me  understand?
Answer: It's related to the "fight or flight" response.  Withdrawing  is a "flight" response. The Later is the "fight" response, the aggressive and controlling side.  At least that's my take on it.
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« Reply #8 on: March 13, 2011, 12:44:56 AM »

My uBPDh wanted to be a standup comedian so that he could control his audience's reactions and emotions.  Totally a controlling person who had to be the center of attention.
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« Reply #9 on: November 22, 2013, 07:27:48 AM »

We think that our D17 suffers more from HPD. Is that a form of BPD?
What are specific signs?
More importantly HOW SHOULD WE RESPOND to those rather histrionic behavior patterns?

Thanks so much for your help.
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