Borderline Personality Disorder and Histrionic Personality Disorder

I don't know who I am. I will think I want one thing one minute, and then totally change my mind the next. I also have out-of-body experiences, for example: like I am in a movie, that I am going through the motions and not experiencing them, and that I am in someone else's body. I have mentioned things like this to my parents and they easily dismissed the statement, attributing it to my overactive imagination. Only after suffering for 23 years, did I finally find out that I have BPD and HPD. For those of you unfamiliar with the illness, I will try to explain it from what I have researched.

What is Borderline Personality Disorder?

The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, lists 9 symptoms of BPD. You must display 5 to qualify for BPD.

1. Frantic efforts to avoid real or imagined abandonment. Doesn't include suicidal or self injuring behavior listed in #5.

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

4. Impulsivity in at least 2 areas that are potentially self-damaging: binge eating, eating disorders, promiscuous sex, substance abuse, reckless driving, or excessive spending. This does not include behavior listed in #5.

5. Recurrent suicidal behavior, gestures, threats or self-mutilating behavior such as cutting, or not letting scars heal.

6. Affective instability due to a marked reactivity of mood: intense episodic dysphoria, irritability or anxiety lasting a few hours and only rarely more than a few days.

7. Chronic feelings of emptiness.

8. Inappropriate anger or difficulty controlling anger: frequent displays of temper, constant anger, recurrent physical fights.

9. Transient, stress-related paranoid ideation, delusions, or severe dissociative symptoms.

International Classification of Disease

The World Health Organization's ICD-10 describes a similar disorder to BPD, which is called, Emotionally Unstable Personality Disorder. There are 2 categories below.

F60.30 Impulsive type

You must display 3 of the 5 symptoms to qualify.

1. Marked tendency to act unexpectedly without consideration of the consequences.

2. Marked tendency to quarrelsome behavior and to conflicts with others, especially when impulsive acts are thwarted or criticized.

3. Liability to outbursts of anger and violence, with the inability to control the resulting behavioral explosions.

4. Difficulty of maintaining any course of action that doesn't offer an immediate reward.

5. Unstable and capricious mood.

F60.31 Borderline type:

3 of the symptoms listed in the Impulsive type above, must be displayed with 2 of the 5 symptoms listed below.

1. Disturbances in and uncertainty about self-image, aims, and internal preferences (including sexual).

2. Liability to become involved in intense and unstable relationships, often leading to emotional crisis.

3. Excessive efforts to avoid abandonment.

4. Recurrent acts or threats of self-harm.

5. Chronic feelings of emptiness.

Millon's subtypes

Theodore Millon lists 4 subtypes of BPD.

Discouraged borderline- including avoidant, depressive, or dependent features.

Impulsive borderline- including histrionic or antisocial features.

Petulant borderline- including negativistic (passive-aggressive) features.

Self-destructive borderline- including depressive or masochistic features.

Now that we have covered BPD, I am going to cover HPD.

What is Histrionic Personality Disorder?

HPD is described by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriate seductiveness. People who have HPD are lively, dramatic, enthusiastic, and flirtatious.

The DSM IV-TR 301.50 lists 8 symptoms. You must display 5 of the 8 to qualify.

1. Is uncomfortable in situations where he or she is not the center of attention.

2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.

3. Displays rapidly shifting and shallow expression of emotions.

4. Consistently uses physical appearance to draw attention to self.

5. Has a style of speech that is excessively expressionistic and lacking in detail.

6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.

7. Is suggestible: easily influenced by others or circumstances.

8. Considers relationships to be more intimate than they really are.

International Classification of HPD

The World Health Organization's ICD-10 (F60.4) lists 6 symptoms HPD . You must display 3 of the following to qualify.

1. Self-dramatization, theatricality, exaggerated expression of emotions.

2. Suggestiblity, easily influenced by others or by circumstances.

3. Shallow and labile affectivity.

4. Continual seeking for excitement and activities in which the person is the center of attention.

5. Inappropriate seductiveness in appearance or behavior.

6. Over-concern with physical appearance.

Millon's subtypes

Theodore Millon describes 6 subtypes of HPD.

Theatrical histrionic- especially dramatic, romantic and attention seeking.

Infantile histrionic- including borderline features.

Vivacious histrionic- synthesizes the seductiveness or the histrionic with the energy level typical of hypomania.

Appeasing histrionic- including dependent and compulsive features.

Tempestuous histrionic- including negativistic (passive-aggressive) features.

Disingenuous histrionic- antisocial features.

BPD and HPD Combined

After much research, I have found 2 subtypes of HPD that are combined with BPD.

The Infantile Histrionic

This type of histrionic is very dependent on significant others. They become romantically involved very quickly, pull capable people into their lives, and by doing this, the infantile histrionic is well taken care of. This subtype of histrionic doesn't need to develop a strong sense of identity, because they don't really understand the reality principle, the realization that life is so very naturally hard, that the ego will be left to deal with it. Therefore, this subtype is continually drawn to being the center of attention, seeking out excitement, and fantasizing, all of which is pleasing to them.

In the more childlike infantile histrionic, all these traits are more extreme. This subtype doesn't really have identity formation, so their dependence on significant others is more demanding than the other subtype. This childlike infantile histrionic seeks for approval constantly to maintain a shred of their solidity. They can be very accomodating and if they are not approved of, they can experience severe depression. This subtype has no sense of self to regulate their basic drives, thus their emotions are liable to change very quickly, running from extreme love, to fierce hate, to extraordinary guilt, all of these may be expressed at the same time. During good times, this subtype may exude the fascination of a child, and become sulky the next moment. These histrionics may state that they aren't loved and aren't treated fairly, and if someone objects to these statements, temper tantrums can occur.

The Tempestuous Histrionic

This subtype is a mix of histrionic traits and a negativistic personality. Tempestuous histrionics are emotionally unpredictable and can be very sullen and moody. During good times, their histrionic traits come out, acting in superficially friendly manner, conversing pleasingly with others and adding their own lively comments. The theatrical histrionic and this subtype get bored easily, can be very dramatic, overreactive to other's actions and comments, and impulsively seek out excitement. When borderline features are combined, their emotions go into upheaval. Tempestuous histrionics are like borderlines, they are both very sensitive to criticism, they can't stand frustration, and they aren't socially mature. This subtype can alter between periods of extreme emotional excitement and acting out impulsively, followed by periods of anger that transform into symptoms like depression and sleep and eating pattern changes.

Most people develop a strong sense of self-identity that suppresses basic drives and contains emotions, but this subtype is more thinly veneered than the usual histrionic, but kind of broken up and fragmented like the borderline. Thus, the tempestuous histrionic is more prone to raw and quickly changing emotions. When crossed, they can lose control of themselves and react with turbulence to even small slights. When this subtype can't be the center of attention, they search frenetically for approval, and if it's not expressed, they can become very unhappy and argumentative. Over time, this subtype may become more scrutinizing of others, more dissatisfied with life, and less histrionic. They may also become occupied with bodily functions and exabercate their illnesses to regain attention that they have lost.

So, as we can see, the tempestuous histrionic is a combination of the impulsive borderline and the petulant borderline. I have been a tempestuous histrionic since the age of 3 and I feel like I am 2 different people. Please feel free to comment, as I would like to discuss this topic with others if they are suffering from it, or if they are interested in the subject. God Bless!