How Can I Help My Histrionic Sister?

Reader’s Question

How do you get someone with Histrionic Personality Disorder traits to get help or to recognize the disorder without making it worse?

I have been doing a lot of reading on the subject and have become rather apathetic about the prospect of my sister ever getting help. Most of what I have read about the disorder recommends against intervention-type settings, or group therapies as the person often feels victimized and uses the attention to dramatize their situation. My sister’s flagrant abuse of prescription medication really worries me. She has lost her last four jobs in 2 years due to inappropriate sexual behavior in the office and unprofessional dramatic episodes at work. There always seems to be an excuse for not confronting her, because she constantly has so much drama in her life. She is on at least 8 different, highly addictive, prescription drugs from multiple doctors: things like anti-seizure meds because she says she has “migraines” that have never been diagnosed, and muscle relaxers and sleeping pills because her jaw always hurts. Every month or so she checks herself into an E.R. and begs the doctors to give her medication for mysterious illnesses that develop when her husband is away for even a few hours without her.

She stumbles around in front of our parents, slurring her speech and looking like Anna Nicole Smith, egging us on to try and say something about her behavior, then acts mortified and victimized when we do. She constantly refers to her painful past and her stress levels. I feel like any sort of pain she encounters is instantly dulled and she never confronts any of her past or her problems because she can easily justify her “pain” with a medical illness. Before she began taking all this medication, she was constantly taking homeopathic supplements, so many that she carried a duffle bag with her everywhere to hold about 25 different bottles.

I don’t know what to do for her. She is almost 30 and cannot hold down a job. At the rate she is going, I truly fear for her life. I cannot see her living beyond a year. I feel that her behavior reflects many of the traits associated with Histrionic Personality Disorder: Highly dramatic, shallow emotions, tendency toward drug abuse, inappropriate behavior and sexually suggestive in odd situations, casually flippant behavior in professional settings, imagines a comfort level, or rapport, with people she hardly knows, etc. What can I do as a family member to help her?

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— Lindsay in Dallas, TX

Psychologist’s Reply

Lindsay, your family has a difficult problem. From your description of her behavior, you’ve made the correct diagnosis — Histrionic Personality Disorder. However, we would probably need to add Substance Abuse. As you found in the research, intervention and treatment is very difficult when the combination is Histrionic Personality and Substance Abuse. As a personality disorder, she will not accept responsibility for her behavior, will always claim that she is the victim, will feel “picked on” when anyone tries to help, feel “entitled” to seek medications/drugs for her imagined pains, and will have a list of “wrongs” done to her by everyone in her life that justifies her current situation. Individuals with Histrionic Personality are truly the kings and queens of drama. They are so preoccupied with attention that they are often jealous at a child’s birthday party because the child is getting the attention. I worked with one individual of this personality who always managed to have a “spell” at the birthday parties of her nieces and nephews — complete with calling the emergency squad.

As individuals with Histrionic Personality become older, opportunities for high drama and positive/sexual attention decrease. In an effort to maintain the same high level of self-dramatization and attention, they often become a hypochondriac, exhibiting a variety of physical complaints in almost all major body-system areas. They frequently doctor-shop and accumulate a variety of mostly antianxiety and pain medications. Over time they emotionally burn-out their physicians, family, friends, and partners.

Because of her histrionic behavior and substance abuse, your sister is likely to experience several crisis episodes. Some of these will bring her to the attention of medical and often mental health professionals. These are often small windows of opportunity for the family members — informing physicians at the emergency room of her poly-pharmacy and often drugged appearance and behavior. At times, she will be referred for mental health consultation which may be of some help. Sadly, despite the loss of jobs and other difficulties she is experiencing — she feels things are still going her way.

In dealings with her, the family should be watchful for manipulations and con-games. Keep in mind that any attempt to confront or correct her behavior will be met with anger, resentment, accusations of how the family has mistreated her for the last 30 years, excuses, and denial. In your research, also review interventions and family strategies for those with substance abuse problems. The abuse and overuse of prescription medications is still drug abuse.

As I’ve mentioned in the discussion groups, as family members, we are often in the job of a trapeze janitor. He’s the guy who sweeps the floor quietly under the trapeze artist who has all the attention and focus — swinging without a net. The trapeze janitor keeps a watchful eye on the histrionic…trapeze artist, and may be required to intervene if they fall, hopefully catching them or at least breaking their fall. Your family may be required to monitor her status and be prepared to intervene as each high drama spirals out of control.

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