This post is a summary of Nancy McWilliam's chapter on hysterical and histrionic personalities in her book Psychoanalytic Diagnosis.
The spectrum of functioning in this personality type ranges from higher functioning, known as hysterical, to lower functioning, known as histrionic. It is typically found in women, though not exclusively. Early trauma can trigger this personality type, particularly when a caregiver is the source of trauma. The reaction to this trauma shows up as adopting caregiving behaviors rather than aggressive ones. This type of personality also tends to have an anxious-resistant attachment style.
People with hysterical personalities have high anxiety, high intensity, and high reactivity, especially interpersonally. They are warm, energetic, and intuitive "people people," attracted to situations of personal drama and risk. They may be so addicted to excitement that they go from crisis to crisis. Because of their anxiety level and the conflicts they suffer, their own emotionality may look superficial, artificial, and exaggerated to others, and their feelings may shift rapidly.
Nancy McWilliams - Psychoanalytic Diagnosis
## The hysterical personality
Some of the qualities of the person with this personality include craving love, attention, and what is called "erotic closeness." They are trapped in a dynamic where they crave closeness and attention but then get overwhelmed by it. They move toward people, but then find people overstimulating and exhausting. The fear sex but behave seductively without necessarily being conscious of it. They may behave counter to their actual feelings in other domains than sex. They may provoke authority figures and be rebellious as a reaction to their fear of power.
It's thought that when a sensitive child, who deeply craves attention is mismatched with an unresponsive mother, she eventually rejects the mother and becomes almost obsessed with her father. The result is seeing males as powerful but women, including herself, as weak and needy. Since this is an uncomfortable dynamic, it eventually results in deep resentment, if not hate for men, while also believing her value is dependent upon them. Sex becomes a defensive act rather than one of love and creativity. Women with this personality type may have physical symptoms such as painful sex.
Hysterical personalities may sexualize themselves but then also be turned off by the attention they receive and be genuinely confused by it. However, they are addicted to the chaos that arises and seem to live life going from one dramatic event to another. They may be easily overwhelmed. Nonverbal behavior such as looking at the ceiling and "checking-out" of the situation is common. Hysterical personalities dissociate, but aren't true dissociative personalities. This dissociation can show up in caretaking behaviors, including sexual ones, where the belief that the other person's needs are more important than hers. This can result in people with this personality structure to have sex with people they aren't interested in.
The family dynamics of a person with histrionic or hysterical personality may include clear favorable treatment of a brother and explicit or implicit reinforcement of behaviors that are "nice" and "caring." She may notice that after puberty, her father treats her differently which may impact her attitude toward her sexuality both as something negative, but also something powerful to get close to powerful men. The father may be indulgent toward his daughter, but also be intimidating. It's thought that this contributes to the anxious-avoidance attachment style. Sadly, this may create a pattern in adulthood, where she seeks out strong, seemingly powerful men, but tries to bring out their sensitive side because the power scares her. When the men respond with sensitivity, she may then devalue them for expressing the "soft" qualities she devalues in herself.
Hysterical personalities may be very manipulative unconsciously in the pursuit of safety. They seek a bubble of security in an unsafe world. That bubble is typically associated with being in proximity to "powerful" men. They may show off their bodies to feel acceptable, but vacillate quickly between exhibition and guilt from the displays. The deep anxiety they feel in the face of expressing their true emotions to authority figures results in substituting authentic displays with unconscious seductive expressions. The existence of this unconscious conflict may result in the person with histrionic personality to bring this conflict to consciousness safely by expressing anger toward people she perceives as "being fake."
Gender conflicts will be central in psychotherapy with histrionic personality types. This will be most evident when heterosexual women work with heterosexual males. The unconscious gender dynamics will continuously rise to the surface in therapy. Therapists must resist the urge to infantilize the patient and treat them like "little girls." When male therapists treat females with hysterical personalities, the most important therapeutic goal is to resist unconscious seduction. The patient needs to experience a male in a position of authority that puts her needs first and doesn't exploit them.
Personality Analysis of the Histrionic Personality References
McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press.