Ernst Kretschmer, (1888–1964), a German psychiatrist known for the establishment of a typology based on the human constitution, suggested that hysterics show “a preference for what is loud and lively, a theatrical pathos, an inclination for brilliant roles…(and) a naive, sulky egotism” (Bornstein et al., 2015).
The first providing a detailed psychoanalytic description of the hysterical personality style was Wilhelm Reich, (1897–1957), an Austrian psychoanalyst. He wrote “coquetry in gait, look or speech betrays, especially in women, the hysterical character type…We find fickleness of reactions…and…a strong suggestibility, which never appears alone but is coupled with a strong tendency to reactions of disappointment…”
Easser and Lesser, (1965) seek to integrate two different earlier approaches: the ego psychology school and Freud’s libido theory. They proposed a classification of hysterics consisting on two extremes-the hysterical personality and the “hysteroid” (borderline) personality. Zetzel, (1968) also divided patients into “good” hysterics, who function well, and “bad” hysterics, who have weak egos and poor object relations. This latter group of patients has a profile and level of functioning similar to the one seen in borderline patients (Slipp, 2014).
Several theorists studied the particular traits of this type of personality including histrionic’s impressionist cognitive style and inattention to detail. In his book, “Hysterical Personality Style and the Histrionic Personality Disorder,” Horowitz (1991), focused on the connection between perception and behavior in histrionic personality; he argued that it was based on an underlying information processing bias. A disturbed mental representation of the self would constitute the link to the various features of this type of character. On the other hand, according to the biosocial-learning model, proposed by Theodore Millon and other authors, this personality type may arise from unconscious patterns of reinforcement provided by parents and others (Blaney et al., 2015). The cognitivists Beck et al. (2004) suggested that histrionic person believe that potential caregivers are not trustful and should be manipulated instead. ”
According to these authors, their core believes include “I am inadequate and unable to handle the life on my own” and “It is necessary to be loved by everyone, all the time
Since the first attempts to the establishment of diagnostic criteria in hysteria, there has been considerable controversy, considering the etiology, the definition and even the existence of such condition.
A decade after his work, Otto Fenichel, (1897–1946), a psychoanalyst of the so-called “second generation,” added another characteristic to this description: the pseudo-hypersexuality, noting that these individuals “are inclined to sexualize all nonsexual relations
The terms hysteria, hysterical personality, and HPD ent of unceasing attempts to identify a distinct pattern of psychopathology (Bakkevig and Karterud, 2010).
The first edition of the American Diagnostic and Statistical Manual (DSM-I), published in American Psychiatric Association (1952), had no category for hysterical personality although some of its features were included in the “emotionally unstable personality.” The DSM-II (American Psychiatric Association, 1968) was strongly impacted by psychoanalysis: some personality disorders had to be differentiated from other neuroses with the same name (e.g., hysterical, obsessive-compulsive, and neurasthenic personalities and neuroses). Following the medical model created by Emil Kraepelin, in DSM-III (American Psychiatric Association, 1980), and the subsequent DSM-III-R (American Psychiatric Association, 1987) and DSM-IV (American Psychiatric Association, 1994), personality disorders were described as discrete types and grouped into three clusters. The term hysterical from DSM-II was replaced with “histrionic” in DSM-III following the proposition of Paul Chodoff who considered pejorative the description of the “hysterical female” as labile, egocentric, seductive, frigid and childish, as described in his article “The diagnoses of hysteria: An overview” (Chodoff, 1974). From DSM-III to DSM-IV-TR, (American Psychiatric Association, 2000) diagnostic criteria of HPD had several changes mainly due to the argument of “unspecificity.” An important change occurred from DSM-III-R to DSM-IV:5 criteria were considered the threshold for obtaining the diagnosis, as compared to 4 criteria in DSM-III–R. This lead to a decline in the number of patients diagnosed with HPD (Blais and Baity, 2006).
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