Histrionic personality disorder: essence, causes, symptoms and correction

People who strive to constantly be the center of attention, childishly reacting with tears and hysterics to the prohibitions and busyness of other people, are also childishly self-centered. Creative personalities with a fragile inner world and a vulnerable soul? Or people with hysterical disorder?

The essence of the disorder

People with hysterical disorder (hysterical disorder) look unusual, bright, theatrical. Their behavior and appearance are provocative and seductive. They are asking for compliments. They want to be the center of attention at any cost. They say about them “negative PR is also PR.” For inattention to their own person, hysterical individuals punish others with irritation, aggression and resentment.

At the same time, hysterical individuals suffer from unstable self-esteem. They strive to please and please everyone. They take all relationships too closely, and react to all events very emotionally. This makes them easily disappointed in people and suffer over little things.

Others see them as insincere. First of all, precisely because of the intensity of emotions and violent reactions to trivial things.

Hysterical individuals are characterized by repression. They choose from life and events what they like and benefit from, which will create drama. Very often important details are left out. In relationships, such omissions provoke conflicts.

Some scientific sources classify histrionic disorder as a borderline disorder. Indeed, in both cases, individuals are distinguished by emotional instability and a pronounced dependence of the individual’s state on the opinions and assessments of the environment. And also in both cases, the person is only capable of unstable and superficial relationships.

Symptoms of Histrionic Personality Disorder

This disease in the scientific literature is also called histrionic or hysterical personality disorder . You can also find a name such as demonstrative personality syndrome . Hysterical personality disorder refers to psychopathic diseases characterized by the individual’s need for attention, pretentious behavior, and unstable self-esteem. People suffering from hysteria are divided into hysterical and histrionic personalities. Both personality types strive to always be in the center, their behavior in society is provocative and deliberately attracts attention.

A distinctive feature of people with histrionic personality disorder is their speech style . Their speech is impressionistic, theatrical, with an emphasis on their own vivid emotions. The behavior of hysteroids is sexually provocative. Also, such people can attract attention to themselves by any available means, and also unconsciously overestimate the level at which their relationships with other people are. For example, they may consider people they barely know their close friends.

According to the theory put forward by psychodynamic scientists, people with histrionic personality disorder experienced unhealthy family relationships . In such a family, where there were distant and domineering parents, the children did not feel loved and were afraid of being rejected. It was because of this, afraid of being rejected, and because of the fear of loss, that such people began to dramatize every situation, inventing problems and crises for themselves so that adults would take care of them.

Cognitive theorists argue that as people become more emotional, they lose opportunities to acquire new knowledge about the world around them. To understand what is happening in the world, they are forced to rely on the knowledge of other people. It is believed that hysterical people adhere to the attitude that they are unable to take care of themselves on their own, and are in search of people who can satisfy their needs. Sociocultural theorists believe that the causes of hysterical personality disorder lie in the norms of society, in its requirements and expectations. In modern life, you often have to gain attention and admiration from others through theatrical behavior. It is precisely these values that can be the causes of a person’s hysterical personality disorder.

Causes of the disorder

The roots of the disorder go back to childhood:

Probably, the parents did not notice the child, were busy with work, and paid attention only when the child was ill. The feeling of uselessness and loneliness, unsatisfied desires and needs of the child are prerequisites for the development of hysterical disorder.
Demanding parents who force the child to deserve love is another possible reason.
Another unfavorable family upbringing style that can lead to hysterical disorder is “family idol” upbringing. Indulging in the whims of a child and elevating his personality to a cult is also not beneficial.

Origins of the disease

The specific causes of the development of hysterical personality disorder have not been established. Psychiatrists believe that the occurrence of the disease is associated with three factors: genetic characteristics, the family upbringing system and organic brain damage in childhood.

Inherited character traits are different, but with hysterical psychopathy, transmission from parents of increased impressionability, emotionality and inability to notice small details is often detected. Damage to brain structures may be associated with pregnancy, childbirth, or early childhood.

In psychoanalysis, it is believed that a hysterical personality is often formed when parents transmit to their children attitudes that people initially have different power depending on their gender. status, social position. This occurs in a child’s childhood, including when adults refuse to accept his emerging sexuality. Not all psychiatrists agree with the opinion of psychoanalysts.

Symptoms

The main symptoms of hysterical disorder include:

regularly seeking the attention of others;
inconsistency in affections, interests and relationships;
whims;
an irresistible and uncontrollable desire to be in the center of being taken out due to admiration, surprise or pity (it doesn’t matter).

For people with hysterical disorder, there is nothing worse than indifference, so even the image of a negative hero will do. In order to attract attention, it is often used:

extravagant and defiant appearance;
boasting;
lie;
fantasies;
inventing diseases with very real (psychosomatic) demonstration of symptoms (spasms, nausea, suffocation, numbness or iciness of the limbs).

Knowledge and thoughts are often superficial, but at the same time a person strives to look better and knowledgeable in everything. Because of this, it often looks ridiculous and stupid. And if he manages to interest someone in the primary “top of the sciences,” then this will not last long. Upon closer acquaintance, the inner emptiness makes itself felt and the interlocutor’s interest disappears. It should be noted that the desire to be noticed in a hysterical person is still stronger than the desire to be the best.

Hysterical personalities are suggestible and very susceptible to the influence of others. Their whole life is a theater; for every action they need spectators. Each of their actions is endowed with elements of drama.

Defending, especially sensitive hysteroids are classified into a special group. They are anxious and shy, infantile. Their inner world is complex, the individuals themselves suffer from feelings of inferiority and increased reflection. Infantility and fragility manifest themselves at the level of not only the psyche, but also physiology. However, naivety and frankness are often feigned. Inside there are individuals with an iron grip and resourcefulness in life. They manipulate people with their weakness and whims.

Behavior is often theatrical in nature, gender affiliation is cultivated. Probably the phrase “I am a woman, I need to be pursued. I need attention. I can be moody” often refers to a personality disorder. After all, this pathology is more common in women.

The likelihood of developing hysterical disorder in women is higher provided that at a young age the girl managed to overcome problems in interpersonal relationships through theatrical behavior. Then such behavior could become entrenched as a stereotype.

This type is described in many monographs and manuals and is included in a wide variety of taxonomies of psychopathy. Its main feature is boundless egocentrism, an insatiable thirst for constant attention to one’s own person, admiration, surprise, veneration, and sympathy. At worst, even indignation or hatred of others towards oneself is preferred, but not indifference and indifference - just not the prospect of remaining unnoticed (“thirst for increased evaluation” according to K-Schneider, 1923). All other qualities of the hysteroid are fueled by this trait. Suggestibility, which is often brought to the fore, is distinguished by selectivity: nothing remains of it if the situation of suggestion or the suggestion itself does not “give grist to the mill of egocentrism.” Deceit and fantasy are entirely aimed at embellishing one’s personality. Apparent emotionality actually turns into a lack of deep, sincere feelings with great expression of emotions, theatricality, and a tendency to show off and pose.

Hysterical traits often appear from an early age. Such children cannot stand it when others praise them in front of them, when others are given more attention. They quickly get bored with toys. The desire to attract attention, to listen to admiration and praise becomes an urgent need. They willingly read poetry in front of the audience, dance, sing, and many of them really show good artistic abilities. Academic success in the early grades is largely determined by whether they are held up as an example to others.

With the onset of puberty, a sharpening of hysteroid features is usually observed. As is known, in recent decades the picture of hysteria in adults has changed significantly. Hysterical fits, paralysis, etc. have almost disappeared. They have been replaced by less severe neurasthenic-like symptoms [Karvasarsky B.D., Tupitsyn Yu.Ya., 1974; Karvasarsky B.D., 1980]. This also applies entirely to adolescence. However, during this period, hysterical character traits manifest themselves primarily in behavioral characteristics, in adolescent behavioral reactions. In addition, the acceleration of physical development has significantly changed the previous idea of the infantile grace, fragility, and childishness of hysterical adolescents. Only with one of the options we described (“labile hysteroids” - see page 113) is it often possible to encounter a graceful appearance. In other cases, there may not be a trace left of it.

Among the behavioral manifestations of hysteria in adolescents, which serve as the reason for contacting a psychiatrist, suicidal demonstrations should be put in first place - they were the reason for referral to a teenage psychiatric clinic in 80% of cases of hysteroidal psychopathy and character accentuations. According to our observations, the first suicidal demonstrations in accelerated adolescents often occur at the age of 15-16 years. In this case, methods of “suicide” are chosen only those that are safe (cutting the veins on the forearm, medicines from a home medicine cabinet) or designed to ensure that a serious attempt will be warned by others (preparing for hanging, depicting an attempt to jump out of a window or throw yourself under a vehicle in front of those present and etc.). Abundant suicidal “alarming” often precedes or accompanies a demonstration: farewell notes are written, “secret” confessions are made to friends, “last words” are recorded on a tape recorder, etc.

The reason that pushed the hysterical teenager to “suicide” is most often cited by him as “unsuccessful love.” However, it is usually possible to find out that this is just a romantic veil or simply an invention aimed at “ennobling” one’s personality and creating an aura of exclusivity around oneself. The real reason is usually wounded pride, loss of valuable attention for a given teenager, fear of falling in the eyes of others, especially peers, and losing the halo of a “chosen one.” Of course, rejected love, a breakup, and especially the appearance of a rival or rival deals a sensitive blow to the egocentrism of a hysterical teenager, if, moreover, all events unfold in front of the eyes of friends and girlfriends (see Mikhail B., p. 18).

Another reason for a suicidal demonstration may be the need to get out of a dangerous situation, to avoid serious punishment, evoking sympathy, pity, and compassion.

The suicidal demonstration itself, with the worries of others, the bustle, the ambulance, the curiosity of random witnesses, gives considerable satisfaction to hysterical egocentrism.

In search of the real reasons for a suicidal demonstration, it is important to note where it is committed, to whom it is addressed, whom it should pity, whose lost attention it should regain, who it should be forced to make concessions or denigrate in the eyes of others. If, for example, the reason is declared to be a discord with her beloved, and the demonstration is carried out in such a way that she cannot not only see, but also cannot find out about it, but her mother becomes its first witness (Nikita B., p. 17), there is no doubt that that it is in the relationship with the mother that the conflict lies. If the reason given is the rejected love of a girl who lives in another city and no one knows her here, and a demonstration (an attempt to throw herself from the embankment into a canal in front of passers-by) takes place in front of the doors of her educational institution, a very prestigious one, then the inevitable threat soon becomes clear exception for poor academic performance. Parents, however, often play the role of a “scapegoat” among hysterical teenagers for the “disappointments” that befall them among their peers. In cases of hysterical psychopathy, suicidal demonstrations can be carried out repeatedly, especially if the previous ones were successful, and can turn into a kind of behavioral cliche, which is resorted to in various kinds of conflicts [Alexandrov A. A., 1973]. Suicidal demonstrations are accompanied by bravado of “playing with death” with a claim to gain a reputation as an exceptional person.

In addition to suicidal demonstrations, with the hysteroid type of psychopathy and accentuations one also encounters acute affective suicidal reactions, which are more frequent in labile hysteroids. Such affective reactions are also most often caused by blows to self-esteem, humiliation in the eyes of others, loss of hopes for a special role, or the prospect of rising in someone else's eyes. Affective suicide attempts are usually filled with elements of demonstrativeness and are aimed at attracting everyone's attention. However, they are not just a performance - against the backdrop of strong affect, at some point a true suicidal goal or a desire to entrust one’s fate to chance (“come what may”) may flash through. Against the background of affect, even in the absence of a true intention to die, the line of what is safe in actions can easily be crossed, and an action that is demonstrative in plan can end in complete suicide - such power of affects is especially inherent in the mixed hysterical-epileptoid type.

The “flight into illness” characteristic of hysterical natures in difficult situations, the depiction of mysterious unknown diseases sometimes takes on a new form among some teenage groups, for example those imitating Western “hippies,” expressed by the desire to end up in a psychiatric hospital and thereby gain a reputation for unusualness in such an environment. To achieve this goal, not only suicidal threats are used, but also playing the role of a drug addict and, finally, complaints drawn from books on psychiatry, and various kinds of depersonalization-derealization symptoms, ideas of influence and cyclical mood swings are especially popular.

Alcoholization can also be purely demonstrative. Full-blown alcoholism in hysterical adolescents is quite rare, and usually in these situations there is a combination of hysterical behavior with traits of another type. As a rule, hysterical teenagers drink a little, prefer mild degrees of intoxication, but are not averse to boasting about the huge amount they drink, their ability to drink without getting drunk, or an exquisite selection of alcoholic beverages (“I only drink cognac and champagne,” said a 14-year-old hysterical teenager) . However, according to our employee Yu. A. Strogonov, in asocial companies, where the ability to drink a lot causes “respect,” hysterical teenagers, wanting to give the impression that they can “outdrink everyone,” become victims of their pretensions and can actually become addicted to alcohol. However, they are not inclined to portray an alcoholic, since this role does not promise them either an aura of unusualness or greedily curious glances.

The delinquency of hysterical teenagers is usually not serious. We are talking about absenteeism, reluctance to study and work, since the “dull life” does not satisfy them, and they lack neither the ability nor perseverance to take a prominent place in study or work, which would please their pride. Clashes also occur over defiant behavior in public places, harassment of foreign tourists, and noisy scandals. In more serious cases, one has to deal with fraud, forgery of checks or documents, deception and theft of persons in whom confidence has been gained. Hysteroids avoid everything associated with gross violence, robbery, burglary, risk, and, apparently, are relatively rare among criminal teenagers [Ozeretsky N. I., 1932; Mikhailova L. O., 1976]

Running away from home can begin from the first grades of school and even in preschool age. They are usually caused by punishments that have taken place or expected, or due to one of the children's behavioral reactions - the reaction of opposition. This reaction in children and adolescents is more often associated with the loss of former attention from loved ones. Having run away from home, they try to stay where they will be looked for, or to attract the attention of the police so that they are brought home or their parents are called, or, finally, in some indirect way they signal their parents about their whereabouts. With age, shoots can become longer and acquire a romantic overtones. Their reasons are often the same as those that push them to a suicidal demonstration - loss of attention, collapse of hopes for an exalted position, the need to extricate themselves from history, which inevitably threatens to be ridiculed and cast down from an honorable pedestal. For example, having assured his acquaintances that his parents occupied a high position and talked about the “luxurious” lifestyle of their family, a 16-year-old boy ran away to distant lands when the demands of his friends to invite him to his home became too insistent.

Hysterical teenagers retain the features of childhood reactions of opposition, imitation, etc. Most often we see the reaction of the opposition to the loss or decrease in the usual attention from relatives, to the loss of the role of the family idol. Manifestations of the reaction of opposition may be the same as in childhood - “flight into illness” or attempts to get rid of the one to whom attention has switched (for example, forcing a mother to break up with her stepfather), but more often this childish reaction of opposition is manifested by behavioral disorders - sudden drinking, theft, absenteeism, and antisocial company are intended to signal to loved ones: “Give me back my former attention and care, otherwise I will disappear!”

Read also: Frontal epilepsy in children

The imitation reaction can determine a lot in the behavior of a teenager of the hysterical type. Hysteroids are generally unoriginal, and their entire life path is an imitation of someone, although this is done as unnoticed as possible and is always presented as “their own.” The model chosen to be imitated by a hysterical teenager should not, first of all, overshadow the imitating person. Therefore, for imitation, an abstract image or (more often) a person who is popular among teenagers, but does not have direct contact with this teenage group (“fashion idol”) is chosen. Sometimes imitation is based on a collective image: in efforts to achieve originality, the stunning statements of some, the unusual clothes of others, the provocative manner of behavior of others, etc. are reproduced.

The reaction of overcompensation is less characteristic of hysteroids, since it is associated with perseverance and tenacity in achieving the goal, which the hysterical nature lacks. But the compensation reaction can be quite pronounced. One might think that it is precisely this reaction that plays a significant role in the “cosmetic lies” characteristic of hysterics, in the fantasies that they force others to believe and, if they do not believe themselves, then at least enjoy them.

The fantasies of hysterical teenagers differ sharply from the fantasies of schizoids. Hysterical fantasies are always intended for certain listeners and viewers, so they are changeable, taking into account their interests, tastes, and situation. Hysterical teenagers easily get used to a fictitious role and behave accordingly. Gennady U. (p. 13) was taken to a teenage psychiatric clinic after he came to the state security authorities with a statement that he had been recruited by foreign intelligence, was instructing him to carry out an explosion at a factory, pointed to certain individuals as agents of this intelligence, etc. ... which, of course, was pure fiction.

Since the time of E. Kraepelin (1915), hysterics prone to such myth-making have often been classified as a special group of psychopathic pseudologists or mythomaniacs. From our point of view, for adolescence it is hardly justified to single out this special group, since fantasies and lies that decorate one’s own personality are characteristic of almost all hysterical teenagers. And even when inventions constitute the main thing in behavior, seemingly overshadowing all other hysterical traits, all these tales are always fueled by the basis of the hysterical character - insatiable egocentrism.

Teenage behavioral reactions are also colored by this main hysterical trait. The emancipation reaction can have violent external manifestations - running away from home, conflicts with relatives and elders, loud demands for freedom and independence, etc. It can clearly manifest itself when examined with the help of PDO. It may also be responsible for demonstrative nonconformism—a ostentatiously displayed denial of generally accepted norms of behavior, widespread ideals, views, and tastes. However, in essence, the real need for freedom and independence is not at all characteristic of teenagers of this type - they do not at all want to get rid of the attention and worries of loved ones. As a result, emancipatory aspirations often slide onto the rails of the childish reaction of the opposition.

The reaction of grouping with peers is always associated with claims to leadership or, in any case, to an exceptional position in the group. Possessing neither sufficient sternness nor a fearless readiness at any moment to forcefully assert his command role and subjugate others, the hysterical teenager strives for leadership in ways accessible to him. Possessing a good intuitive sense of the mood of the group, the still brewing and sometimes still unconscious desires and aspirations in it, hysterics can be their first spokesmen, act as instigators and incendiaries. In an impulse, in ecstasy, inspired by the glances turned to them, they can lead others, even show reckless courage. But they always turn out to be leaders for an hour - they give in to unexpected difficulties, easily betray their friends, are deprived of admiring glances, and immediately lose all their enthusiasm. The main thing is that friends will soon recognize their inner emptiness behind the external effects. This happens especially quickly when a leadership position is achieved in a different and more accessible way for a hysterical teenager - by throwing dust in the eyes with stories about his past successes and adventures. All this leads to the fact that hysterical teenagers are not inclined to stay too long in the same teenage group and willingly rush to another to start all over again. If you hear from a hysterical teenager that he is disappointed in his friends, there is no doubt that they are the ones who have already figured him out.

In conditions of closed teenage groups, for example, in closed teenage institutions with a regulated regime, where an arbitrary change of company is difficult, in order to occupy an exceptional position, a different path is sometimes chosen. Hysterical teenagers willingly accept leadership functions from adults - positions of elders, organizers of all kinds of events - in order to take the position of mediator between elders and other teenagers and thereby strengthen their special position.

Hobbies are almost entirely concentrated in the area of the egocentric type of hobby. Only something that gives you the opportunity to show off in front of others can captivate you. If you have the ability, then amateur artistic activity opens up the greatest opportunities here. Preference is always given to those types of art that are currently the most fashionable among teenagers in their circle (in our period - pop ensembles) or can amaze with their unusualness (for example, mime theater). It was impossible not to notice among teenagers in the 60s and 70s the low popularity of drama clubs and the declining popularity of dance ensembles. Sometimes the chosen hobbies, at first glance, do not belong to egocentric hobbies. However, in fact, it turns out that enthusiastic study of a foreign language, which usually comes down to mastering the most popular dialogues, is undertaken in order to show off in front of friends by talking with foreign tourists, and passion for philosophy is limited to the most superficial acquaintance with fashionable philosophical movements and is again intended to make an impression on the relevant environment with your knowledge. Imitating yogis and hippies provides particularly fertile ground in this regard. Even collected collections can serve the same purpose - to show off them (and yourself!) in front of your friends (Alexander F., p. 16). Sports and other manual-bodily hobbies are chosen much less frequently, as they require great perseverance to achieve a prestigious position. In contrast, leadership hobbies (the role of various types of organizers and managers) are more preferable, as they allow you to always be in sight. However, they soon begin to become burdensome with the formal responsibilities associated with them.

The sexual desire of hysteroids is neither strong nor intense. There is a lot of theatrical play in their sexual behavior. Male teenagers prefer to hide their sexual experiences and avoid conversations on this topic, because they feel that there is nothing to amaze them with here, they are afraid of being “not up to par.” Girls, on the contrary, tend to advertise their real connections and invent non-existent ones, are capable of slander and self-incrimination, and can play the role of sluts, enjoying the stunning impression on the interlocutor.

It should be emphasized that the weak link of the hysteroid type, a blow to which can reveal hysterical traits with hidden accentuation or cause a bright hysterical reaction with obvious accentuation, most often are injured pride, loss of attention from those around them or especially significant people, collapse of hopes for a prestigious position, debunked exclusivity .

The self-esteem of hysterical teenagers is far from objective. Those character traits that can make an impression at the moment are exposed.

In hysterical psychopathy, the aggravation of character traits occurs both along the path of intensification and frequency of acute affective reactions of a demonstrative type with repeated performances depicting the desire to commit suicide, and along the path of other demonstrative behavioral disorders.

In severe hysterical psychopathies, under the influence of mental trauma, reactive hysterical psychoses can develop - hysterical twilight states, pseudodementia, etc. However, in our time, hysterical psychoses in adolescents are rarely encountered and mainly in the situation of a forensic psychiatric examination.

Hysterical psychopathy can be either constitutional or a consequence of psychopathic development, more often on the basis of hysteroid, as well as labile or hyperthymic accentuations of character when raised in conditions of indulgent hyperprotection.

In the teenage population, hysterical accentuation is found in 2-3% of male adolescents and somewhat more often in female adolescents [Ivanov N. Ya., 1976].

Three variants of the hysteroid type are most common in adolescence. The “pure” asteroid type does not require any special description; examples of various degrees of psychopathy and character accentuation of this type are given in Chapter. I. Labile hysteroid is presented in the section on the labile type (p. 113). The hysteroid-unstable type is quite common, although it has not yet been sufficiently studied [Alexandrov A. A., 1978].

Hysteroidal-unstable type. This type is common among adolescent males. Most of them lack the infantility and gracefulness of physique characteristic of classical descriptions of hysteroids. On the contrary, the acceleration of physical development is usually quite pronounced. Outwardly, when they first meet, such teenagers may seem unstable. Antisocial company of peers, drinking, idleness and craving for a “fun life”, neglect of one’s responsibilities, avoidance of study and work - all this really occurs. However, behind all this is not thoughtlessness, not an almost instinctive craving for constant entertainment and pleasure, but the same egocentrism. All manifestations of antisocial behavior: alcoholism, delinquency, etc. - serve for bravado in front of elders and peers, in order to at least in this way earn a reputation for exclusivity. In asocial companies themselves, a claim to leadership and unusualness is revealed. Idleness and dependency are associated with high, virtually impossible demands regarding a future profession. Falsehood is not only defensive, as with unstable people, but it almost always serves the purpose of embellishing oneself. In delinquent behavior, artistic abilities are skillfully used (the ability to gain trust, skillful deception, etc.).

Alexey D., 17 years old. Father and mother have been divorced for many years, although they live in the same apartment. Doesn't communicate with father. He developed normally, studied satisfactorily until the age of 13, and had no behavioral disorders. In the 6th grade, studying seemed difficult, I abandoned classes, and got involved with an antisocial group of teenagers. He began to engage in “farming” - he bought and resold the things of foreign tourists. He earned a lot of money from this - he began to dress in the latest fashion. He announced to his mother that he had a sailor friend who brought everything from abroad. At the age of 14, I went to Tallinn and Kyiv with two friends - I called my mother from the station so that “not to worry.” He stated that he wanted to see beautiful cities, but was detained by the police there due to speculation.

I barely finished 8th grade. At the insistence of his mother, he entered a vocational school, but there he constantly skipped classes. At the age of 16, he was convicted of participating in a gang fight. He claims that he got into this company by accident and was “slandered.” He was soon released from the colony due to an amnesty. There, according to him, he easily established contact with his comrades, but was oppressed by the harsh regime. After his release, he first returned to vocational school, but soon dropped out of classes. I spent all my days in some company. According to his mother, a nurse, he began to return home in an unusual state, somehow excited. The mother suspected the use of intoxicants. He was sent for examination to a teenage psychiatric clinic.

The clinic behaves pretentiously. Proud that he has a “foreign surname.” During a conversation, he shows off and rolls his eyes flirtatiously. He said that he avoids booze, doesn’t drink vodka at all, and in groups he tries to drink no more than one glass of weak wine. At the age of 13, I sniffed stain remover with my friends, but soon gave it up - “I got tired of it.” According to him, after leaving the colony, he willingly used various pills (Seduxen, Pentalgin, etc.) in his company, wanting to cause a “high.” Upon admission to the clinic, I did not detect any withdrawal symptoms.

Among teenagers, he claims to be a leader and tries to impress with stories about his asocial past. He refuses to study at a vocational school. He said that he would agree to take a “cook course for overseas voyages,” but then pointedly declared that the “stain of the colony” had ruined his life—they wouldn’t take him anywhere to a “decent place.” He considers studying radio engineering at a vocational school unworthy. He says that he is interested in modern pop music, quickly names several fashionable things and ensembles, but his knowledge here is superficial: apparently, he was more busy speculating on tape recordings than the music itself.

Upon examination, there is a pronounced acceleration of physical development. Height 184 cm with body weight 64 kg. Sexual development is complete. On the body there is a tattoo with criminal symbols (signs of a criminal record, being in prison, a symbol of the desire for “freedom”).

Neurological and somatic examination showed no abnormalities.

Survey using PDO. According to the objective assessment scale, despite the established tendency to character dissimulation, a pronounced hysteroid type was diagnosed. Apparently, due to dissimulation, the traits of the unstable type were not diagnosed. Signs indicating the development of psychopathy have not been established. Due to dissimulation, the determination of other indicators may be incorrect (conformity is average; the emancipation reaction is not expressed, no tendency towards delinquency has been identified). There is a negative attitude towards alcoholism. According to the subjective assessment scale, self-esteem reflects dissimulation and attitudinal behavior: features of the conformal and paranoid type appear, only sensitive traits are reliably rejected (i.e., a desire to show oneself as “correct” and a “strong personality” is revealed).

Diagnosis. Mentally healthy. Behavioral disorders against the background of accentuation of the hysteroid-unstable type.

Diagnostics

Hysterical disorder is diagnosed if at least 4 of the following symptoms are present:

ostentatious and theatrical behavior, exaggerated expression of feelings (for example, sobbing excitedly, wide hugs, bows);
suggestibility and ease of being influenced from outside (people or situations);
frequent changes between pessimistic and optimistic states;
regularly seeking out exciting experiences and activities that will allow you to be the center of attention;
inadequate demonstration and emphasis of sexuality (gender) in appearance and behavior;
expressed concern about external attractiveness.

Treatment

In the correction of self-disorder, the method of assertive behavior (independence of the state from the assessments and opinions of others, focus on oneself), cognitive restructuring (changing negative and destructive thinking that leads to dangerous behavior to positive and productive thinking), development of social skills, training in methods of problem solving (getting out of difficult life situations). Sometimes drug therapy is used, but for the correction of related diseases and consequences, for example, depression.

Psychological help consists of supporting a hysterical personality. But only socially acceptable forms of behavior should be encouraged. It is necessary to maintain the artistry of the individual, but at the same time gradually rid him of the god complex. Attention, understanding and regular evaluation (praise) are important for a hysterical personality.

You need to understand that people with hysterical disorder do not respond to requests and advice, so you need to carefully switch their attention to something else, thereby distracting them from negative experiences.

People with histrionic disorder avoid situations of failure and frustration. But it is on mistakes that life experience is built. Therefore, it is important to teach how to accept defeats and overcome difficulties. It is important for loved ones to provide support and attention, including in situations of failure, so that gradually they are perceived normally by the patient.

Afterword

A hysterical personality will always have little attention; she always needs proof of love. But the paradox is that saturation will never come. Gradually, discontent will accumulate, and threats and aggression will rain down on loved ones. To avoid this, you need to help the individual learn to express their needs and desires, dissatisfaction and disagreement immediately, speak directly about them, and not throw tantrums and guessing games.

Depending on the interests of the individual, you need to find a hobby that will satisfy the need for attention. For example, in many sports, the desire to be the best and be in the spotlight will be beneficial. Of course, the egocentrism of a hysterical person and the very essence of teamwork will often come into conflict, but it is hysterical people who can stir up a team.

Hysterical disorder can be expressed to varying degrees. In some cases it remains at the level of accentuation. A loving, patient, and most importantly psychologically literate person who knows the characteristics of hysterical manifestations can help a hysterical person.