Histrionic Personality Disorder - Choice of Treatment

Because of the lack of research support for work on personality disorders and long-term treatment with psychotherapy, the empirical findings on the treatment of these disorders remain based on the case report method and not on clinical trials. On the basis of case presentations, the treatment of choice is psychotherapy aimed at self-development through resolution of conflict and advancement of inhibited developmental lines. The reason for this choice is that good results have been frequently reported, whereas there are few case reports of success with other approaches.

Despite the fact that most successful treatment reports have been from psychoanalytic psychotherapy perspectives, more recent efforts that have involved the use of cognitive-behavioral approaches have also reported the utility of these perspectives on formulation and technique. For this reason, an integrative approach is useful. By integration, I mean the putting together of a reasoned plan that includes selections from all options.

As recommended by Horowitz, one can use in this integrative therapy the basic ground rules from psychodynamic approaches for how to establish a therapeutic alliance, understand and handle various motivational levels of transference, and counteract resistances to change. Cognitive-behavioral means can be employed for identifying irrational cognitions, disruptions of clear conscious representation and expression, and techniques that reinforce the repetition of more adaptive actions. It is important to repeat interpersonal behavioral changes, because repetition in action may be required in order for the patient to change internal schematizations. When this has been accomplished, the patient becomes less consciously attentive to new behaviors and is then more poised and automatic in the use of less maladaptive practices. The patient is also able to deal more effectively with others in rapidly moving social and work situations and becomes capable of both more realistic and more dignified self-appraisals.