The Horrific History of Histrionic Personality Disorder
Despite being a personality that is attention-seeking, hysteria and histrionic personality disorder have not had much current research attention. However, it does have an extensive and horrific history. From a wandering womb1 2 …to a hypnosis in a “museum of living pathology”3 4…to an etiology of penis envy1 5 6 7 …to conversion disorder8 9 10…Let’s look at the evolution of histrionic personality disorder throughout history.
Ancient and Medieval Times
Hysteria comes from the Greek word “hystera” which means uterus or womb11. Early philosophers like Hippocrates and Plato proposed that a uterus that is discontent wandered throughout the body, resulting in a multitude of physical symptoms, not the least of which involved lack of rationality in the mind1 2 4. The idea that the uterus was the cause for most female medical symptoms continued, though it started to evolve in the medieval times when women’s sexual and emotional parts were suppressed and condemned7 11 4. Emotionality during menstruation was to be treated with early marriage and lots of pregnancies, and hysteria even became a rationale for persecuting witches7 11.
Charcot
Fast-forward to the 1870s and we have Jean-Martin Charcot who first described hysteria as an actual medical condition…but his work was wrought with abuse and showmanship1 11 3. He created a hospital ward for women who had hystero-epilepsy, or seizures with no medical basis, and practiced hypnotism to treat hysteria7 3 4. Charcot was criticized for displaying and showcasing his patients like they were in a circus, and it was proposed that patients were not able to leave or get better enough to do so… it was a “museum of living pathology”11 3 4.
Freud
Signmund Freud was actually a student of Charcot and decided to ride on Charcot’s coattails to make a name for himself, studying hysteria from about 1880-19151 7. His take on hysteria was more psychological, involving the Oedipus complex (of course🙄) and believing that the source of women’s hysterical problems was that they were born without a penis, creating intense penis envy1 6 7. However, he did believe that there was psychic distress and previous trauma6 11. While we currently dispute that psychological basis, Freud did start asking the right questions such as,
- “How can you know and not know something at the same time?”6
- “Can the body actually express things that are too much for the mind to handle?”6
- “What attributes to forgetting experiences that were really important?”6
Questions like these shaped psychoanalytic theory, which is awesome. So while his answers to these questions didn’t hit the mark, the questions themselves are extremely important6. (Also, Freud thought he was somewhat hysterical himself5 6)
Hysteria, Hysterical, Histrionic, & the DSM
In 1952 the DSM-I12 proposed hysteria be condensed to two types of hysterical neuroses: dissociative and conversion. In the DSM-II13 (1968) the dissociative type included symptoms such as dissociative amnesia or dissociative trance (now captured under dissociative disorders), while the conversion type involved motor or sensory issues like blindness, deafness, loss of voice, numb appendages, paralysis, and seizures (now captured as functional neurological symptom disorder). The DSM-II also added the hysterical (histrionic) personality disorder, separating out the actual hysterical symptoms from the hysterical character. From there, the DSM-III8 (1980) and DSM-III-R9 (1987) significantly expanded histrionic personality disorder to include actual criteria and in depth description of diagnostic and associated features.
The DSM-IV10 (1994) revised some of those criteria, and since then, there have not been any major changes. So within the span of a century, hysteria moved from a female-only medical disorder involving horrific treatments that I won’t go into (1880s) all the way to histrionic personality disorder characterized by attention seeking and excessive emotionality (1980s)8 9. We’re making progress…but is it enough?
References
Blaney, P. H., Krueger, R. F., Millon, T. (Eds.). (2014). Oxford textbook of psychopathology (3rd ed.). Oxford University Press. ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
https://en.wikipedia.org/wiki/Jean-Martin_Charcot ↩︎ ↩︎ ↩︎ ↩︎
https://www.mcgill.ca/oss/article/history-quackery/history-hysteria ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Crews, F. (2017). Freud: The making of an illusion. Metropolitan Books. ↩︎ ↩︎
McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press. ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Millon, T. (2011). Disorders of personality: Introducing a DSM / ICD spectrum from normal to abnormal (3rd edition). John Wiley & Sons, Inc. ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders: DSM-III (3rd ed.). https://doi.org/10.1176/appi.books.9780521315289.dsm-iii ↩︎ ↩︎ ↩︎
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders: DSM-III-R (3rd edition, revised.). https://doi.org/10.1176/appi.books.9780890420188.dsm-iii-r ↩︎ ↩︎ ↩︎
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders: DSM-IV (4th ed.). https://doi.org/10.1176/appi.books.9780890420614.dsm-iv ↩︎ ↩︎
Paulon, M. (2022). Hysteria: Rise and fall of a baffling disease. A review on history of ideas in medicine. Journal of Psychopathology, 28(3), 152-161. https://doi.org/10.36148/2284-0249-461 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
American Psychiatric Association. (1952). Diagnostic and statistical manual: Mental disorders (1st ed.). https://doi.org/10.1176/appi.books.9780890420331.dsm-i ↩︎
American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders: DSM-II (2nd ed.). https://doi.org/10.1176/appi.books.9780890420355.dsm-ii ↩︎
