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Behind the Scenes of Histrionic Personality Disorder

Part 1: The story of Nancy.

Key points

  • Separation anxiety in children often includes very real upset stomachs and headaches. It's not faking.
  • People with histrionic personalities learn that, with a little theatrics, they can turn up the volume of their physical discomforts.
  • They often land in the emergency room, and after considerable evaluation, no medical causes can be found.

"Is it all in my head?" pleaded Nancy, with a sensational flare.

She laid on the bed, hands draped across her forehead. "I've really lost it now," she announced, reaching for the doctor's hand. Two neurologists, independent of each other, found no reason for Nancy's fainting spells or bouts of deafness. The internists also documented a clean bill of health, yet her stomach cramping persisted.

Pexels/Andrea Piacquadio
Source: Pexels/Andrea Piacquadio

No stranger to strong emotions, Nancy (a composite identity) grew up in chaos, her anxiety running amok. She rarely saw her parents, who were more like roommates. Eve, her mother, preferred socializing to mothering and was cold towards Nancy's needs. She had little attention from her father, Alton, as he would be absent for weeks, working on the road. Unless that is when he was home and had to pick her up from the nurses' office at school.

Her anxious underpinnings

Separation anxiety in children often includes very real upset stomachs and headaches. It's not faking. It is likely corollary to the musculoskeletal tension from the intense anxiety. Subconsciously, though, the child learns that, while it's discomforting, it's useful: the rendered complaints are a ticket home to the attachment.

Alton showed a loving demeanor towards Nancy when he was around. He and Eve often argued about Eve's neglect while he was away. Nancy indeed had an ally but seemed to not be able to maintain his full attention, his job was calling. She hated it when he left and fantasized about running away with him.

Dealing with Eve, she could understand why he may prefer being away, but what about Nancy? Her greatest fear was that something would happen to him on the road, permanently depriving her of him. Then again, him being gone allowed her something to look forward to, his return.

Learning to make a scene

Desperate for Alton's attention when he was available, Nancy learned early on that, with a little theatrics, she could turn up the volume of the effects of her physical discomforts. Out of guilt for not being home enough for her, Alton invariably came running.

As she aged, Nancy honed her dramatic craft; if it worked with one person she wanted attention from, why not another? In high school, theatrical flirtation helped with the boys, who naturally became more interesting than her father, who continued to be missing in action.

The emotional undercurrents of histrionics

Though a seemingly playful and cheery kid, under the surface, years of anger towards her parents stewed, and anxiety about her image and worthiness festered. No attention was too much attention; it was the only balm for her wounds.

Pexels/Andrea Piacquadio
Source: Pexels/Andrea Piacquadio

Throughout, Nancy could never seem to put a finger on her emotions. She would catch herself leaking sadness, anger, and anxiety, but rebound by reflexively putting on a "life is good act," as if in denial of her valid woes.

Then came college. Though excited to move away, it proved too much to bear. Nancy would have to find new sources of attention. The pressure to do well also ran high. Nancy didn't only receive attention when she was theatrical and seductive, she also received plenty for being top of her class. In college, there was a lot of competition she needed to deal with.

Then the bomb dropped, her parents were officially divorcing. An empty nest was the last straw; there was no need to stay together. Deep down, Nancy always had a fantasy of her parents rekindling a good relationship and somehow gaining the childhood she never had. Now, it would be permanent unfinished business, and her guilt ran high, if only she hadn't moved out.

She was a medical mystery

Within days, an old, familiar discomfort crept up in her stomach. Nancy soon began asking people to repeat themselves, and she became deaf in her right ear. One day she fainted in her advisors' office and a day later at the nurse's. A third fainting spell led to the emergency room. After considerable evaluation, no medical causes were found.

Alton demanded a second opinion. His daughter was no liar. Similar results in the second opinion spurred a referral to the University Medical School Psychiatry Department, where Nancy was evaluated by Dr. H.

See Part 2 for details of Dr. H's assessment.