What Some May Call “Superficial Personality Disorder”
Do you know anyone who is overly attention-seeking, overly theatrical, or the life of the party? Well, according to Dr. Ramani, that person could have Histrionic Personality Disorder or, at the very least, Histrionic traits. In this episode, you’ll learn how to recognize the behaviors of the condition and how to cope with those behaviors.
Transcription featuring Dr. Ramani.
Kyle Kittleson: On the break, I said this feels a lot like Borderline Personality Disorder.
Dr. Ramani: Very different.
Kyle Kittleson: And it’s very different.
Dr. Ramani: Very different.
Kyle Kittleson: For a lot of our viewers, have watched our series on Borderline Personality Disorder, let’s … I really want to separate this for them.
Dr. Ramani: Remember, Borderline Personality Disorder, the dysregulated emotion, the emotions that shift rapidly, the real inner sense of torment, there is such a subjective sense of discomfort, the sense that they’re going to be abandoned, and that’s accompanied by a feeling of panic.
Kyle Kittleson: We’re talking about Borderline Personality Disorder.
Dr. Ramani: Right. That’s Borderline. Okay. Now where it can get confusing is that you might have an individual with Borderline Personality Disorder who, in devaluing themselves so much, and wanting so much to get into a relationship, they will be very sort of seductive and attention-seeking in their presentation, right? They’re hoping in that, looking like that, being like that, somebody won’t leave them, so their motivation is not attention, it’s to create this really all-encompassing union with somebody who won’t leave them. There’s this chronic sense of panic.
A person with Histrionic Personality Disorder is not experiencing that torment, that panic, that fear of abandonment. They would be very uncomfortable if they were alone. People with Histrionic Personality Disorder need an audience. People with Borderline Personality Disorder need a partner.
Kyle Kittleson: Yes. I got it when on the break when you said, “Kyle, if you weren’t giving me attention, I’ll just go over here and get it from somebody else.”
Dr. Ramani: Histrionic Personality, like I said, that’s the idea of an audience. I don’t care who is in the audience, as long as all eyes are on me. There may be someone in that audience I like a little better but there’s probably a few of them. For the person with Borderline Personality, they very much cathect or they really get focused on that one person, their person. It’s like a mother, right? That’s a lot of what we look at, the earlier theoretical writings on Borderline Personality, it’s about that there’s something very interrupted in that early attachment of some kind.
Histrionic Personality likely has some of that attachment issue but it’s not with the depth and the torment. This is where to me Borderline Personality Disorder, clinically, it’s such an important to understand disorder or pattern because of how much torment the person is experiencing. They’re in a lot of inner pain.
I think a person with a Histrionic Personality can get hurt if people push back on it or are rejecting of them but it won’t be that literally suicidal pain a person has.
Kyle Kittleson: If I get rejected, there’s an amount of hurt.
Dr. Ramani: There’s hurt. Right.
Kyle Kittleson: [inaudible].
Dr. Ramani: That’s normal. That’s normal. You always want to look in any psychiatric pattern, you want to think also in terms of motivations, at least, that’s how I look at it. With the personality patterns, in particular, what are some of the motivators here? What are the key traits that are sort of playing out?
It’s different. This is really about getting attention. It’s almost like you only exist by your audience. Like the more audience you’ve got, the more you exist. It’s a bit of an existential conundrum.
1. Center of Attention
Kyle Kittleson: Let’s go right into the diagnostic criteria for Histrionic Personality Disorder. The first one, we’ve talked about it, center of attention. How does this manifest itself?
Dr. Ramani: They’ll do whatever they need to do to get that attention, whether it’s … Usually it’s their appearance, nine times out of 10, it’s their appearance and it’s they often take very good care of themselves. They go to the gym and they work out, they might get cosmetic surgeries or modifications or very careful with their appearance, they may dress very seductively or very expensively but whatever they do, they’re going to make sure all eyes are on them and maybe also how they talk about themselves. They may talk about, “Oh my celebrity friend this” or, “I just came back from this grand adventure there” and they will exaggerate the truth a little bit to make sure their story is the biggest and the best story.
Kyle Kittleson: Is this done consciously?
Dr. Ramani: Yeah. I mean, they want to make sure they’re getting attention. If just the way they’re dressed isn’t working, then they’re definitely going to tell the story in a way that they keep ensuring the eyes are on them.
2. Being Sexually Seductive
Kyle Kittleson: The second one is being sexually seductive. How does that look?
Dr. Ramani: That links into that first one, right? The way to get attention is to be seductive but, again, it’s almost like a win, right? Most people we’re not going to be ultra-seductive but a lot of it is if it may not just be their style of dress, it’s also going to be in how they talk about things, that they’re going to be … Almost talk about things that are moderately inappropriate, talk about sexual things, be very sort of flirty in how they talk, that’s definitely going to get you attention and they’re sort of equal opportunity flirters. They’ll flirt with men, women, regardless of their sexual orientation. Then that way, they really can own a room and get a lot of attention for that.
Yeah. They’re very … I would say, of all of the disorders we will ever hear about in MedCircle, the most seductive.
Kyle Kittleson: This is the most seductive?
Dr. Ramani: This is the most seductive.
Kyle Kittleson: This is the seduction disorder.
Dr. Ramani: In terms of how they present themselves. It is a seduction disorder.
Kyle Kittleson: If they are married, it doesn’t keep them from …
Dr. Ramani: It’s messy. Oh, heck no. Oh no.
Kyle Kittleson: Getting attention from a stranger.
Dr. Ramani: It can really be … I’ve worked with couples like this where the one would say, “This is kind of uncomfortable. I think my wife is gorgeous but it’s hard when everyone’s eyes are popping out over her, because she’s dressed in this way.” It’s kind of a mixed blessing, if you will, so there is that …
It’s not like they’re being humble about it, like that person is working it.
Kyle Kittleson: “Thank you.”
Dr. Ramani: No. They’re working it. They’re out.
Kyle Kittleson: Now there are plenty of spouses who love when their spouse is the center of attention.
Dr. Ramani: Great.
Kyle Kittleson: Could two people who have Histrionic Personalities be really compatible that way?
Dr. Ramani: You know, I think at some point there’s just going to be way too much air in the room and it’s just too much. The only reason it could potentially work is they’re never really going to talk about much. It’s going to really be kind of … Maybe neither one would be bothered by the superficiality of it all, but I will tell you this, in no couple is it ever going to be even and the day one person is getting more attention than the other, all hell is going to break loose.
This is where, for example, if you have two stars in a relationship, if one person’s star is going up and the other one is not getting so many of the A-list gigs, that’s going to cause friction, that’s an example of what happens when two Histrionic individuals get into a relationship.
3. Shifting Emotions
Kyle Kittleson: Fascinating. Number three is shifting emotions. This is the one that made me think, “Oh, this is like Borderline Personality.”
Dr. Ramani: The shifting emotions is sort of that one overlap trait, that can give it some resemblance to a Borderline Personality pattern. By shifting emotions, because their emotion is so shallow, it can quickly go to meet whatever is happening in the room.
An example, I’ve used, maybe a lot of our viewers won’t get this because they don’t live in Los Angeles, the weather in Los Angeles is histrionic. We’ll have a hot, hot day and it’ll still get cool at night, because the way our weather is, it just doesn’t hold it. It lacks depth because there’s no humidity.
It’s like they don’t have humidity. They will be with a friend who is having a tough day, and they’re able to be there and nod wisely, “God, that sounds so hard. Yeah. I’m so sorry” and they’ll be a little pouty but then someone comes in the room, whose attention they may like more, who is cheerful, and they’ll pop right into cheerful. They’ll be like, “Kyle, I’m so sorry, I’m so sorry. Hey, hello.” That’s not normal. That’s the shift. It’s the shift in response whereas in a person with Borderline Personality, that shift is happening internally. There’s nothing in the environment … You’re like why did that just happen?
But for a person with Histrionic Personality, that shift is often in response to the external stimuli and demands in their environment.
4. Emphasis on Physical Appearance
Kyle Kittleson: We’ve talked about the next one a lot, physical appearance. They look good physically.
Dr. Ramani: They look good. But the thing is they invest so much time. These are the people who are going to the gym, because this is how they get attention. Even at the gym, they go to the gym in full hair and makeup. They spend more on their workout clothes than I think I once upon a time did on a wedding dress.
Kyle Kittleson: Right.
Dr. Ramani: It’s like the $500 exercise ensemble. They look fantastic at the gym. Everyone is staring at them and they’re like a peacock on the treadmill.
Kyle Kittleson: I used to go to a really expensive gym and I was … I’m basketball shorts and a t-shirt, right? Then I’m looking around and I go, “Oh, I have to get it together if I’m going to go here.” You know?
Dr. Ramani: Yeah. Yeah.
Kyle Kittleson: I have to go to a pre-gym, so I’m acceptable enough to go to the real gym.
Dr. Ramani: The [inaudible] time gym.
Kyle Kittleson: Yeah.
Dr. Ramani: Yeah. Very much physical appearance matters and not only do they overvalue it in themselves, they overvalue it in other people.
Kyle Kittleson: Ooh.
Dr. Ramani: Yeah.
Kyle Kittleson: Go into more detail.
Dr. Ramani: They may not want a friend that’s kind of frumpy or not well put together.
Kyle Kittleson: Oh no.
Dr. Ramani: Yeah. This is the person who will reject the bridesmaid for not being a size eight or under. It’s that, “My wedding is going to look a certain way, so here’s your diet and I expect you to fit this dress or maybe we’ll have you do a reading.”
Kyle Kittleson: Being a good person, is that important to them? In somebody else.
Dr. Ramani: No.
Kyle Kittleson: No?
Dr. Ramani: Not as much.
Kyle Kittleson: It’s more about status, physical appearance, what you can do for them?
Dr. Ramani: Mm-hmm. Yes. Yes.
5. Impressionistic and Vague Speech
Kyle Kittleson: What about speech style?
Dr. Ramani: Speech style is interesting. It’s what we call … The way we describe it diagnostically, it’s highly impressionistic and it lacks detail. Okay? What that means is they say a lot of words but they don’t say anything. “Yeah. I’m sort of feeling this energetic movement. There’s a rise in me. I’m just trying to do me and feel it out and find me, doing me, loving me” and you’re like …
Kyle Kittleson: What are you talking about?
Dr. Ramani: “Oh, wow. What is that?” You know? There is a … There’s not a lot of there there. You’ll see this in people sometimes who are over-subscribed to certain healing communities and there’s a what are you trying to do? They’re not able to clearly articulate a goal, an outcome, a process. If you’re trying to get something done, this is not the person you want on your team.
They’ll talk very ephemerally about stuff … Again, it’s superficial. Right? They cannot speak deeply, because they do not really feel deeply, so it is this sort of … Again, this style that is impressionistic.
Kyle Kittleson: So I’m understanding it, the speech pattern of this vagueness …
Dr. Ramani: It’s vagueness. Exactly.
Kyle Kittleson: Comes from the fact that they don’t feel deeply.
Dr. Ramani: Yeah. They’re not connected to that. You know, there is a …
Kyle Kittleson: Whoa.
Dr. Ramani: Because they’re not clear on their motives. You’ve got to remember this with a person with most Cluster B personality disorders, as we’ve talked about.
Kyle Kittleson: Yeah. We need to redefine Cluster B for them.
Dr. Ramani: Cluster B personality disorders are personality patterns that are characterized by dramatic, erratic, emotional behavior and very few of those patterns do the people have any insight. They lack insight. This means Narcissistic, Borderline, Anti-Social, as we’re talking about now, Histrionic.
They’re very unclear on their own motivations. They just don’t know what they are. They’re not not even clear why they’re doing what they’re doing, because what they’re not able to do is say, “Hey, the only thing that matters to me is everyone thinks I’m the hottest chick in the room.”
Kyle Kittleson: [inaudible].
Dr. Ramani: Who is going to say that, right? Because even they have enough insight to know that’s not what you’re supposed to say, and they’re not in touch with that motive. When you’re not in touch with your motivations, you’re not actually able to speak or behave clearly.
Kyle Kittleson: If they were running a business, and you said what’s your goal for next year?
Dr. Ramani: “I want to be the best cupcake store in Los Angeles.”
Kyle Kittleson: They’re like how are you going to do that?
Dr. Ramani: How are you going to do that? “You know, we’re posting on Instagram, we have a new chocolate cupcake.” It’s very … Many times, the kinds of businesses they’re running are very much cupcake-y, very superficially, like cosmetics and accessories. I’m not saying those aren’t important things. I know they matter to the people who make them but they’re not trying to build carburetors. Okay?
It’s very much that kind of showy sort of a business and so what [inaudible], “We’re going to put it on Instagram and maybe I can get that billboard and I’m going to try a new recipe” or, “This is going to be pink.” You know, that’s not a goal.
It’s almost like when a child makes a lemonade stand. It can often have that sort of child-like motivation to it, but it can get confusing if you’re talking to them, because you’re like what are they saying? I don’t understand what their point is.
You might actually misinterpret it as being deep. You know? “Ooh, they’re talking about all this energy and stuff” and you’re like …
Kyle Kittleson: Got it.
Dr. Ramani: Yeah, but instead you have to come out and say, “What are you saying?”
Kyle Kittleson: I’m so fascinated by the speech part of it.
Dr. Ramani: Yeah. It’s very vague.
Kyle Kittleson: I think it’s because it’s probably a quicker way to … I mean, all of these are really fast … Center of attention, sexually seductive, shifting emotions, physical appearance, speech style. They’re all surface-y already, all of these traits.
Dr. Ramani: Yup. Yup.
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6. Dramatic Behaviors
Kyle Kittleson: Dramatic behaviors.
Dr. Ramani: Dramatic behaviors, so this would be like … These are people who wear capes and feathered boas.
Kyle Kittleson: What’s wrong with a cape and a feather boa? Not one thing.
Dr. Ramani: I don’t think it’s for Trader Joe’s. You know? There’s a time and a place. They definitely are very theatrical and there’s a lot of … You feel like you’re in a Wagner opera. There’s a lot of emotion and, “What do you mean there aren’t enough candles? We must have 82 on the cake.” You know, there’s a lot of this operatic …
Kyle Kittleson: Can you please turn everything she just did into a GIF, internet? I need to see all of that as much as possible. Okay, they’re very dramatic.
Dr. Ramani: Very dramatic. It’s like being in … It’s like performance art when they come to your house.
Kyle Kittleson: Okay. Let me tell you this story, I do so many of these interviews. I’ve exhausted my wardrobe. Okay? I don’t have enough clothes [inaudible].
Dr. Ramani: You and me both.
Kyle Kittleson: I go and I’m looking online. Another friend who is on camera, he sends me this website, and all of the clothes are pretty extravagant and there’s this one pink, furry shirt jacket and I sent it to him as a joke like, “Wouldn’t this be appropriate for me sitting down?” He goes, “Oh, yeah, you should get that.” I go, “No. There’s no way I could wear that.”
Dr. Ramani: That’s histrionic clothing.
Kyle Kittleson: That’s histrionic? But there’s a part of me, though, that would. Not for this but if a friend was having a birthday, I’m like, “I’m going to wear this pink jacket.”
Dr. Ramani: That’s fun. Okay, but see then the pink jacket … If you expected people to attend … Let’s say it wasn’t a pink jacket party. You know, it was this state affair, like brunch at a high end hotel, and you show up in your pink jacket, or you wore the pink jacket to a funeral where people weren’t dressing like that, it would show a lack of insight, what are you trying to show but they’re very … It’s big, big gestures.
They’ll show up to a baby shower with a gift that’s like seven feet tall. They’ll roll it in on a carriage. Their gifts are big, their gestures are big. Big, big, exciting, dramatic and you’ll often feel almost overwhelmed by it all and sometimes people feel guilty, they’re like, “Oh my God. They’re giving me a seven foot present. I should be nicer about this.”
Kyle Kittleson: Okay. Sometimes I just have to laugh. Okay? It’s a lot of mental health to take in every week. I’m laughing because I know these people.
Dr. Ramani: Right?
Kyle Kittleson: I know …
Dr. Ramani: We all do.
Kyle Kittleson: I know …
Dr. Ramani: We all do.
Kyle Kittleson: I’m literally thinking of this one woman. I go, “I didn’t know before but now I know.”
Dr. Ramani: We all do. Yeah. When we talk about how to manage it, it’s a very compassionate take on it.
Kyle Kittleson: Good. Good. Good. Suggestibility?
Dr. Ramani: Yeah. These are the people who go in for the sucker bet every single time. It’s very easy to convince them of magical things. This way, they’re dangerously vulnerable to things like cults or organizations that are trying to recruit members, almost like have a pyramid scheme feel to them. They’ll buy whatever you’re selling. They could be drawn into fringe religious communities, that kind of thing. They’re very … Again, there’s an innocence to them.
Kyle Kittleson: You mentioned time shares.
Dr. Ramani: Time shares. Any kind of a bad investment.
Kyle Kittleson: What about all these multi-level marketing?
Dr. Ramani: Oh, heck yeah. Histrionic people fall for that in a second. “You’re going to get to go on a cruise with all of your other cosmetic-selling friends.” You know? It’s cult-y. They’re drawn to that kind of stuff, because they’re suggestible. Just like a child would be.
Think about it, a child is still learning their emotional depth. That’s why we can trick them into Santa Clause and tooth fairies and all of those fantasies, they’re still impressionable. As they get a greater capacity for critical thinking, the child tends to reject that on their own.
I’ve noticed that, by and large, many people with Histrionic Personality Disorder lack as much of a capacity for critical thinking as would be expected for someone at their stage, so they’ll fall for conspiracy theories online. They’ll fall for ridiculous bargains online. That can put them in trouble financially, they could put themselves at harm or risk, give away their information, waste time, waste money.
Kyle Kittleson: The person who gets an email from the prince of some African country?
Dr. Ramani: You know what? Their suggestibility often happens in a self-serving way. It could be the African country, “Look, someone wants to give me a million dollars” but it can also be … Let’s go back to that vague kind of style of speech. “These people are going to help me harness all of my inner energy and let me demons go, so I can love.” I don’t know. What is that? What group is this? They’re asking you $10,000 for that? For $10,000, I’ll do that for you too.
Kyle Kittleson: Right. Yeah.
Dr. Ramani: You know? There is this sense of getting drawn into schemes and a lot of people take advantage of that. It’s almost like you can see them coming in. Their eyes are a little wider. They’re more vulnerable to that. Again, they don’t think critically because there’s almost a child-like quality to this.
8. Overestimation of Intimacy
Kyle Kittleson: The last one is overestimation of intimacy.
Dr. Ramani: Yes.
Kyle Kittleson: What is that?
Dr. Ramani: Yeah. The overestimation of intimacy one is a very interesting one, especially in our modern times. They think a relationship is much closer than it really is. They’ll meet someone at a party, they’ll exchange numbers, whether intimately or as friends, and they’ll think we’re best friends.
The next day, it’s like, “Hey, loved meeting you last night. Coffee? Three o’clock?” Or they’ll get your address and all of a sudden you’re getting gifts from them. In conversation with other people, they’ll talk about you as though you are their best friend. They’ll go on a date, they’ll call the person their boyfriend.
There’s this fast forward. It’s interesting. This dynamic can also play out … Let’s say they meet someone famous. They love famous people. They meet someone famous in, I don’t know, a bar or a club or an airport or hotel or something and then they’ll say, “Oh gosh, me and such and such are friends now.” They might even have a photograph they put on social media. There’s this assumed intimacy that isn’t there, which can actually be a little destabilizing for you, who now thinks why is this person asking me to have coffee with them? We just happened to like the same book.
Kyle Kittleson: Right.
Dr. Ramani: Now all of a sudden … They’ll keep texting you and say, “Hey, do you want to hang out? Do you want to do this? Do you want to do that?” It’s as though they’re misreading the situation, because, again, it’s very superficial to them, “Hey, you gave me your phone number, we must be friends.”
Kyle Kittleson: Right. Very superficial. Yes. I get that now. Now do they have to have all of these signs?
Dr. Ramani: No. Typically, for any of these patterns and any diagnostic manual, I think there’s about nine, eight or nine we’ve talked about, usually it’s five of those.
Kyle Kittleson: Okay, so five. We have one, two, three, four, five, six, seven, eight. These are the eight.
Dr. Ramani: Yeah, four to five of them. Yeah. Yeah, a little over half of them. You’ll see a lot of them clustered together, the physical seductiveness, the physical appearance, the getting attention. This the core.
Kyle Kittleson: Can someone have Histrionic Personality Disorder and Borderline Personality Disorder?
Dr. Ramani: You know what typically we would see is that the Histrionic patterns are largely getting subsumed under the Borderline piece and they’re using the attention-seeking seductive patterns as a way to create an overly intense attachment with another person.
Kyle Kittleson: Okay. How long do these symptoms have to last?
Dr. Ramani: We see that these are patterns that generalize. What we don’t want to do … Let’s say somebody goes to college, they’re desperately trying to fit in or graduate school or some new job or new city, they’re desperately trying to fit in and they go and they buy the new wardrobe and they do themselves up and they’re trying so hard. Then after a couple months, they give it up like, “I’ve met my friends. I’m cool. It’s good.”
This is not flash in the pan. These are patterns that are consistent across intimate relationships, family relationships, work relationships, in the world in general and it characterizes much of their adult life. This is not … Does that make sense? It’s not just the [inaudible].
Kyle Kittleson: This isn’t depression where you have to have symptoms.
Dr. Ramani: No, it’s not episodic. It’s chronic. It’s chronic.
Kyle Kittleson: Now are there different types of Histrionic Personality Disorder?
Dr. Ramani: You know, there is a famous and well vaunted personality theorist, a guy named Theodore Millon. He recently passed in the last couple of years and he really had an incredibly well articulated theory of personality and personality disorder patterns. For most of them, whether it be Borderline or Histrionic, he would identify sub-patterns because we use this word broadly, but these patterns exist on a continuum from relatively benign to quite severe and they can manifest in different ways.
For example, one form that I believe that this might be in Theodore Millon’s taxonomy is this idea of the appeasing histrionic individual. The appeasing histrionic individual will do anything to make sure everyone around them is happy and taken care of. They are very solicitous but it’s almost like they look like the rescuer, they are the leader of the tribe, and they’re almost a little bit anxious about all of that.
There is also more of the vivacious histrionic. That’s more of our classical histrionic, that’s the life of the party and give me all the attention and here I am and looking fabulous and I am fabulous.
He identifies those sub-types and I think that’s a wise distinction. What we see, though, is the way those sub-types line up, they actually then explain a lot of the overlap with the other personality patterns. For example, the more appeasing histrionic style looks like a different personality style that we call dependent personality style, the vivacious histrionic looks like a classical histrionic.
The I think he even talks about more of a … I don’t remember how he termed it, almost like a sullen or a kind of histrionic and these are people who get really brooding and resentful when they’re not getting all of the attention they want. That feels a little bit more like a borderline pattern.
You see now how this blob called Histrionic gets cut up into different pieces of pie that might overlap with other patterns. These things are very heterogeneous, they’re very nuanced, because human beings are.
Kyle Kittleson: When will these symptoms start to display?
Dr. Ramani: Here’s where it gets tricky with Histrionic, many teenagers are by definition Histrionic. “Look at me. Look at me. Look at me. No, no, I have blue hair. No, no, I did this, I did that. Look at my social media.”
I always say you got to let an adolescent bake for a little while before you pull it out of the oven. I would not overly get lost in the use of this term until maybe early to mid-twenties. Then see if it sustains. I’ve got to be frank with you, there are people in their sixties who are like this. A woman in her sixties who will still go out, sexy, seductive and she really will feel like she’s past her prime but she’s still out there working it and getting the attention.
It will sustain over the lifespan but I would not bandy the term around until the person’s found a little bit of their stride in adulthood, to rule it out from just the anxiety of trying to find their place in the world.
Kyle Kittleson: You’ve talked a little bit about this. Do you find a lot of differences on how men display these symptoms versus women?
Dr. Ramani: There are histrionic men. What makes it tricky is I wish this was called superficial personality disorder.
Kyle Kittleson: I totally agree.
Dr. Ramani: Yeah. Yeah. The word histrionic is a gendered term. Like I said, as a feminist, I really dislike this term wholly. I think it pathologizes women, which I have a problem with. I think anyone can be attention-seeking. For men with histrionic personality style, what you see is they’ll often use money, wealth and the trappings of that, Lamborghini sports car, $40,000 watch, fancy man shoes.
Kyle Kittleson: Right. Fancy man shoes? I need some of those. Goodness.
Dr. Ramani: Fancy man clothes, like the labeled clothes and the suit cut just so and bottle service. “I’m going to spend $4000 and everyone is going to see how great I am. Come give me attention in the bar or the club.” It’s in some ways, men display the histrionic through more of their trappings, because it’s a little odd for a man … Men don’t have cleavage, do they?
It’s a little cliché and sort of Studio 54-ish to have your shirt unbuttoned and that kind of thing but …
Kyle Kittleson: Making sure.
Dr. Ramani: You know, they may really spend a lot of time at the gym, so they can go and be glistening and ab-y and all of that. They like going to resorts where they can show off their bodies. All of that. You’ll see that in men. Some similar to women, but the attention-seeking might take more of the wealth, power, possession kind of a path.
Kyle Kittleson: What about for women?
Dr. Ramani: For women, they may use straight up appearance … Women can use cosmetics and accessories and color in a different way. It would be unusual for a heterosexual man to go out in a magenta shirt and high heels.
Kyle Kittleson: Yes. Unless they’re in West Hollywood.
Dr. Ramani: For women, they may really be able to … They’ll use style of dress, seductiveness of dress, cosmetic enhancement of their bodies, which isn’t as much something you would see in a man, that kind of thing. I think it’s both appearance but for women, it might be literally their physical appearance while for men it might be the trappings around that physical appearance.
Kyle Kittleson: What are the common co-morbid or co-occurring disorders that you see?
Dr. Ramani: Interestingly, I think with Histrionic Personality, it would not be unusual to see substance use disorders, all this socializing and attention-seeking, you’re definitely going to increase the disinhibition, if you will, if you keep drinking.
In addition, you can’t always have all the attention. Unless you really are a celebrity celebrity superstar superstar, all eyes are not always going to be on you, and so when that doesn’t happen, it’s not unusual to see depressive symptomatology in folks with Histrionic Personality. You may also see some co-morbid anxious symptomatology.
I actually don’t know the literature on this, so I’m going to spitball on this, you might possibly see disordered eating patterns. Maybe not a full-blown eating disorder but in the quest to look a certain way, there may be … If not body dysmorphic symptoms, eating disordered symptoms of restriction or over-exercise or something like that as a way to maintain a certain physical appearance, you might see that as well. You’re going to see patterns from other personality disorders.
Kyle Kittleson: In our example therapy session, where you were attempting to see if I had Narcissistic Personality Disorder, did you ever think, “Oh, but he’s Histrionic”?
Dr. Ramani: You know, if I’m going to call you out straight on this one, Kyle, is that you’re in a performance-based industry, right? You can turn it on and off. I’ve seen you be able to do that. We’ll be chit chatting and you’ll be on your phone and you’ll be like, “Three, two, one. Here I am.”
That on/off-ness, it can smell like Histrionic. Over the past many months, you and I have gotten to know each other. You see what I’m saying? I would not … If all I had done was judge you on the first 30 minutes I met you when you were in and out of a shoot, okay, I might be like, “What’s his story?” And you’re in the media. Okay, two strikes.
Then I got to know you and we’ve gotten to know each other quite well, I know the depth of your inner world, I know the stuff that you’re about, so no. That superficial kind of la la la, that can really make people think that and it’s like the Glee club people. You got to talk to them and make sure … I have kids who are in the choir and they are whatever the opposite of histrionic is, my kids, but they were in that world and they would always look shocked at the other Glee club-esque people. I do remember that. I do think that you can be …
I’ve been working in the media for a long time too. I’ve even met people who do the kind of stuff I do, who they can be like ta-da and jazz hands-y, sort of jazz hands therapists. It really is … But then you get to know the person and you realize they’re able to hold a room but they are also able to be present with you and keep out the distractions and they don’t care that they’re no longer the center of attention. It’s the center of attention piece.
Kyle Kittleson: Important to note that. In our next episode, Dr. Ramani is going to explain how to make sure that you get the right diagnosis, because you don’t want to be treated for something that you don’t have. That and more as we continue this fascinating discussion on Histrionic Personality Disorder.