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Histrionic Personality Disorder

Histrionic personality disorder is often difficult to treat because those affected often do not see their behavior as problematic and can only change it slowly and with difficulty. Further difficulties in therapy are that the patients often have excessive demands, dramatize their problems, tend to sudden emotional outbursts or only initiate superficial changes - for example to please the therapist.

It is therefore important to carefully make them aware of the psychological backgrounds of their various problems. Because of the manipulative behavior (for example, dramatizing one's own problems in order to achieve a certain purpose) the therapist should set clear rules and limits. A structured approach that gives the patient orientation is also seen as useful.

Another problem is that a dilemma can easily arise in therapy: If the therapist gives a lot of help or makes decisions for the patient, he indirectly promotes the need for constant attention and support. If, on the other hand, he is reluctant to provide assistance, this can lead to the therapy being discontinued. It is therefore important to find a middle ground in therapy that supports both the need for support and attachment and the need for self-control and autonomy.

Psychoanalytic and deep psychology-based therapy

It is usually assumed that long-term therapy is necessary. The therapist should be supportive and appreciative and give the patient a feeling of security. In this way, he gives him a positive model for interpersonal relationships. This can help reduce the tendency to overly emotional behavior.

Over time, the therapist should carefully educate the patient about the condition. It also works to challenge the constant need for attention and immediate needs. Patients should learn to differentiate between real, achievable and socially non-achievable needs and develop behavior that is more adapted to reality.

Cognitive behavioral therapy

Long-term therapy is also seen as useful in cognitive behavioral therapy. In therapy, patients should gradually become aware of their tendency to only satisfy their needs through others. Then they can learn to meet them themselves and to reduce their needs towards others to a level that can be fulfilled.

Exercises to perceive feelings are an important aspect of therapy. In the process, patients gradually learn to distinguish their “real” feelings from those they are merely staging. In addition, unfavorable beliefs can be worked out, questioned and gradually changed - for example the belief that one is helpless and always dependent on others. In order to change difficulties in interpersonal relationships, specific situations can be practiced in role play. In addition, patients can practice problem-solving strategies that enable them to assess problems more realistically and systematically search for solutions.

In order to create more structure in patients' lives and to strengthen their independence and self-control, tasks for self-observation and homework, in which they are supposed to take on tasks independently, are often used. In addition, those affected can practice doing something on their own or completing a task they have started on their own in order to reduce their emotional volatility.

In order for the changes to be maintained in the long term, the therapy should be continued for a while when the symptoms have improved significantly and the patients have become more self-confident. In this phase of therapy you can be stimulated to think about the meaning and the most important contents of your life and about future goals.

Group therapy

In group therapy, the patients receive feedback from the other group members. This can help them to better recognize their behavior problems and so gradually change them.

Therapy with psychotropic drugs

Psychiatric drugs are usually not considered useful for treating histrionic personality disorder. They are usually only used if another mental disorder is present at the same time, such as depression or an anxiety disorder.