10. Dependent vs. Histrionic PDO - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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The Sun, the Moon, and the Stars, Dependency and Histrionics in Couples and Couple Therapy
Chapter 10: DEPENDENT VS. HISTRIONIC PERSONALITY DISORDER


The behavior and strategies for dependent personality disorder and histrionic personality disorder are quite distinct- virtually opposite in many ways.  They appear to be on opposing sides of the sun, the moon, and the stars.  The dependent person is submissive and willing to submerge him or herself to the partner, making him or her the center of the universe.  On the other hand, the histrionic person demands to be the center of the universe and tends to dominate interpersonal and social space while shoving the partner into the shadows.  However, the two personality disorders share common emotional or psychological roots.  Behavior and strategy differences arise from other important traits that vary between the two disorders.  “…although DPD and HPD are both linked with high levels of underlying dependency needs, DPD- and HPD-diagnosed persons differ with respect to the degree of insight they have in this domain (Kantor, 1992; Millon, 1996).  Typically, the individual with DPD has at least some awareness of the ways that underlying dependency needs affect his or her behavior, whereas the person with HPD has little insight in this area… Consistent with the assertions of the DSM-IV, a number of researchers have argued that DPD is associated with high levels of ‘self-attributed’ (i.e., conscious) dependency needs, as well as high levels of ‘implicit’ (i.e., unconscious) dependency needs (Bornstein, 1993; Oveholser, 1996, Pincus & Gurtman, 1995).  In contrast, HPD appears to be associated with high levels of implicit dependency needs but low levels of self-attributed dependency needs (Horowitz, 1991; Millon, 1996; Pfohl, 1991)” (Bornstein, 1998, page 1-2).

Minnie, with dependent issues shamefully, but readily self-identified as depending on Johann’s opinions and direction.  She professed not to know what to do without his guidance and “strength.”  Her internal vulnerability or dependency rose compulsively to the surface and she knows it.  Hunter on the other hand had unconsciously suppressed her vulnerability or quickly distracts herself from despair with her histrionic behaviors.  If confronted with her insecure attachment style, Hunter vehemently denies that she has any anxiety about betrayal, abandonment, or rejection.  Despite other complications, getting Minnie to acknowledge her dependency needs was not a barrier to therapy. Hunter’s unwillingness to acknowledge dependency needs made couple therapy that much more difficult.  “… the HPD person typically denies any overt dependency-related needs or motivations, thereby maintaining a façade of independence (Berman & McCann, 1995).  Repression is used by the HPD individual to cope with unpleasant affect and anxiety-producing emotional responses (e.g., feelings of neediness and vulnerability; Horowitz, 1991).  These findings help explain the contrasting dependency-related behaviors exhibited by DPD and HPD individuals in real-world situations and settings.  DPD is generally associated with an overtly dependent (i.e., passive and submissive) coping style, whereas HPD is associated with an active, manipulative orientation that functions in part to mask a pervasive underlying dependency… Millon (1996)… went on to note that HPD person’s ‘sociable and capricious behaviors give the appearance of considerable independence of others, but beneath this guise lies a fear of autonomy and an intense need for signs of social approval and attention’ (p.68).  The suggestibility and somatizing tendencies of the HPD person may also represent subtle, indirect manifestations of unacknowledged dependency needs (Bornstein, 1995a; Bornstein, Krukonis, Manning, Mastrosimone, & Rossner, 1993)” (Bornstein, 1998, page 10-11).  Hunter dances away and around any therapist intrusions beneath her protective histrionic shell.  The therapist is vulnerable to chasing Hunter figuratively around the therapy room if unaware of the histrionic defensive style.

Therapeutic attention on the behaviors of the dependent individual focuses on how they create problems in the relationship with the partner.  The origins, the emotional and psychological process, problematic behaviors, and the interpersonal affects can be simultaneously addressed since the dependent individual and partner can be led to understand their linkage.  At least, the dependent individual is not predisposed against considering the relationships among personal needs and subsequent actions.  And, the dependent individual also freely admits that he or she makes it entirely about the partner.  Individuals with histrionic personality disorder do not focus on his or her partner.  “In contrast to individuals with DPD, persons with HPD appear to use a combination of displacement, denial, and repression to keep underlying dependency needs outside awareness.  Thus, whereas the DPD individual actively seeks intimacy with a significant other, the HPD person displaces his or her needs for support and reassurance from a valued other to the world at large, behaving ins such a way as to call attention to himself or herself and to ensure that others are focusing on his or her needs (Bornstein, 1998)” (Bornstein, 1998, page 10).  Minnie is deeply invested in Johann.  He is the partner that she has attached to.  Johann and Minnie have a lot in common and a lot invested in each other.  Unlike some couples with a dependent partner, Johann does not enjoy, want, or need a dependent partner.  Other than her annoying dependent behaviors, Johann and Minnie’s relationship works well for each other.  Minnie has powerful dependency instincts that amplify her attraction to Johann that are intricately intertwined with her respect and love for him.  Minnie however is arguably truthful when she asserts that Johann is the “one.”  To Hunter, however Brandon is the one… now.  Hunter does not have more than a superficial attachment to him.  Or, if there is some attachment, it is very secondary to her primary need to avoid feeling despair.  Brandon is part of the more expansive world at large.  He is one candidate- the latest candidate among thousands of potential recruits.

Hunter does not consider Brandon inadequate as much as she feels true intimacy with anyone is impossible.  “The maladaptive worldview of the histrionic person is that life is unpredictable, controlling, and demanding, but that she, nevertheless, is entitled to love and special care and consideration.  Her self-view is that she is deserving of love and attention, and she needs others to love and admire her in order to be happy (Sperry, 1995).  Furthermore, she views others favorably only as long as she can elicit their attention and affection.  She uses deception, charm, flirtation, and manipulation to achieve and then reduce the unpredictability of life, especially regarding loss of love and attention.  Finally, she believes that despite her incessant craving for love, real love is never possible.  Despite her notorious craving for love, the histrionic person believes that her behavior is the result of coercion and thus cannot believe that real love is possible” (Sperry and Maniacci, 1998, page 197).  Hunter can possibly admit that she uses Brandon or can replace him- that is, she can own some aspects of her manipulation.  However, she is less likely to reveal or confront her vulnerability and despair about never finding real love.  She may be able to quickly delve into her hopelessness, but she cannot truly contemplate and endure any exploration of her deepest needs.  It would be too terrifying.  This is not to say that this particular personality disorder is impossible to treat.  Personality disorders are by definition, pervasive deeply ingrained patterns of dysfunctional behavior.  And, as such are extremely difficult to treat.  Recognition that histrionic personality disorder has similar roots to those of dependent personality disorder may foster greater compassion for the histrionics existential terror, rather than continued critical focus on his or her self-aggrandizing behavior.  However, histrionic personalities and the couple with a histrionic partner may especially be very difficult to treat if the client is too immersed and too fragile in the disorder.  In this particular case with Hunter and Brandon, this was true.  It is also possible (perhaps, probable) that this couple broke up eventually, when either Brandon decided he was worthy of more and wanted more in a relationship.  Or they broke up when Hunter subsequently found him insufficiently attentive and needed a new fresh audience.  Or, more unlikely, that Hunter recognized her histrionic behaviors and began working on her growth to stay in a more genuine mutually fulfilling different relationship.

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Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
(510) 614-5641 or (510) 582-5788
fax: (510) 889-6553
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