Internet Mental Health

HISTRIONIC PERSONALITY DISORDER



SYMPTOM DEFINITION SELF-DESCRIPTION
ANTAGONISM (Harming Others)
Attention Seeking Excessive attempts to attract and be the focus of the attention of others; admiration seeking "I crave attention." "I like to draw attention to myself."

Core Features of Personality Disorders:

The general requirements for the diagnosis of a personality disorder are:

  • a pervasive pattern of maladaptive traits and behaviours

  • beginning in early adult life

    • it usually has its first manifestations in childhood and is clearly evident in adolescence

    • it is not diagnosed before early adult life because these maladaptive traits are very common in childhood and adolescence, but most individuals age-out of these traits before early adulthood

  • leading to substantial personal distress and/or social dysfunction, and disruption to others

  • is of long duration, typically lasting at least several years

Severity Rating Scale For Personality Disorders:

Severity rating scale for personality disorders in the International Classification of Diseases (ICD)-11:

  • Mild Personality Disorder: There are notable problems in many interpersonal relationships and the performance of expected occupational and social roles, but some relationships are maintained and/or some roles carried out. Mild personality disorder is typically not associated with substantial harm to self or others .

  • Moderate Personality Disorder: There are marked problems in most interpersonal relationships and in the performance of expected occupational and social roles across a wide range of situations that are sufficiently extensive that most are compromised to some degree. Moderate personality disorder often is associated with a past history and future expectation of harm to self or others, but not to a degree that causes long-term damage or has endangered life .

  • Severe Personality Disorder: There are severe problems in interpersonal functioning affecting all areas of life. The individual's general social dysfunction is profound and the ability and/or willingness to perform expected occupational and social roles is absent or severely compromised. Severe personality disorder usually is associated with a past history and future expectation of severe harm to self or others that has caused long-term damage or has endangered life .

Onset:

Histrionic Personality Disorder occurs in 1.8% of Americans. Typical features of histrionic personality disorder are attention seeking and emotional instability.

For this diagnosis to be given, the individual must be at least in early adulthood. This disorder is only diagnosed when these behaviors become persistent and very disabling or harmful to others.

Treatment:

There is insufficient (randomized controlled trial) evidence to prove the effectiveness of any psychological intervention or medication for adults with this disorder. Lacking such evidence, it would be prudent to only offer crisis intervention or short-term psychotherapy, rather than long-term psychotherapy.

Prognosis:

Histrionic Personality Disorder can persist for a lifetime.

SAPAS Personality Screening Test

Individuals with this disorder would have a significant impairment in the behaviors that are displayed in red :

Most of the time and in most situations:

      In general, do you have difficulty making and keeping friends?
      Would you normally describe yourself as a loner?
      In general, do you trust other people? (No)
      Do you normally lose your temper easily?
      Are you normally an impulsive sort of person?
      Are you normally a worrier?
      In general, do you depend on others a lot?
      In general, are you a perfectionist?

Answer "Yes" or "No" to each of these 8 questions.




7-Question Well-Being Screening Test (By P. W. Long MD, 2020)

Individuals with this disorder would have a significant impairment in the behaviors that are displayed in red :

      Agreeableness: I was kind and honest. (Instead was attention seeking)
      Conscientiousness:I was diligent and self-disciplined.
      Openness/Intellect: I showed good problem-solving and curiosity.
      Sociality: I was gregarious, enthusiastic, and assertive.
      Emotional Stability: I was emotionally stable and calm.
      Physical Health: I was physically healthy.
      Role Functioning: I functioned well socially and at school/work. (Instead had significant impairment in social, academic, or occupational functioning.)

How often in the past week did you do each of these 7 behaviors:


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Diagnose Histrionic Personality Disorder

Diagnose All Personality Disorders

Limitations of Self-Diagnosis

Self-diagnosis of this disorder is often inaccurate. Accurate diagnosis of this disorder requires assessment by a qualified practitioner trained in psychiatric diagnosis and evidence-based treatment.

However, if no such professional is available, our free computerized diagnosis is usually accurate when completed by an informant who knows the patient well. Computerized diagnosis is less accurate when done by patients (because they often lack insight).

Example Of Our Computer Generated Diagnostic Assessment Of President Trump

Histrionic Personality Disorder 301.50

This diagnosis is based on the following findings:

  • Is uncomfortable in situations in which he was not the center of attention (still present)

  • Inappropriate sexually seductive or provocative behavior. (still present)

  • Has a style of speech is excessively impressionistic and lacking in detail (still present)

  • Shows self-dramatization, theatricality and exaggerated expression of emotion (still present)

  • Is suggestible (i.e., easily influenced by others or circumstances) (still present)

  • Considers relationships to be more intimate than they actually are (still present)

Treatment Goals:

  • Goal: stop always trying to be the center of attention.
    If this problem persists: He will alienate people by her constant demands for attention. When not the center of attention, he will continue to do something dramatic (e.g., make up stories, create a scene) to draw the focus of attention to himself.

  • Goal: stop being inappropriately sexually provocative or seductive.
    If this problem persists: He will alienate same-sexed friends because of his sexually provocative behavior towards his friend's romantic partners.

  • Goal: stop expressing strong opinions without supporting evidence.
    If this problem persists: He will alienate others with his strong opinions that are expressed with dramatic flair, but without supporting facts and details.

  • Goal: stop being so suggestible.
    If this problem persists: His opinions and feelings will continue to be easily influenced by others and by current fads. He must stop being overly trusting, especially of strong authority figures who will magically solve his problems.

  • Goal: be less dramatic and theatrical.
    If this problem persists: He will embarrass others by her excessive public display of emotions. Others will accuse him of faking his feelings because his emotions seem to be turned on and off too quickly to be deeply felt.

  • Goal: stop considering relationships to be more intimate than they actually are.
    If this problem persists: He will continue to think that mere acquaintances are actually close friends, or believe that casual relationships are more romantically intimate than they actually are.




Read This Before Diagnosing President Trump


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Diagnostic Features

"Histrionic Personality Disorder is characterized by shallow and labile affectivity, self-dramatization, theatricality, exaggerated expression of emotions, suggestibility, egocentricity, self-indulgence, lack of consideration for others, easily hurt feelings, and continuous seeking for appreciation, excitement and attention" (ICD10). It is "a pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts" (DSM-5)

In terms of the "Big-6" Dimensions of Mental Health this disorder is characterized by antagonism (attention seeking). This leads to substantial personal distress and/or social dysfunction, and disruption to others. This is not diagnosed before early adulthood because these maladaptive traits are very common in childhood and adolescence, but most individuals age-out of these traits before early adulthood. This disorder is of long duration, typically lasting at least several years.

The diagnosis requires having 5 (or more) of the following:

  • Is uncomfortable in situations in which he or she is not the center of attention.

  • Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.

  • Displays rapidly shifting and shallow expression of emotions.

  • Consistently uses physical appearance to draw attention to self.

  • Has a style of speech that is excessively impressionistic and lacking in detail.

  • Shows self-dramatization, theatricality, and exaggerated expression of emotion.

  • Is suggestible (i.e., easily influenced by others or circumstances).

  • Considers relationships to be more intimate than they actually are.

Like all personality disorders, Histrionic Personality Disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.

Individuals with this disorder may have difficulty achieving emotional intimacy in romantic relationships. Without being aware of it, they often act out a role (e.g., "victim" or "princess"). They may seek to control their partner through emotional manipulation or seductiveness on one level, whereas displaying a marked dependency on them at another level.

Individuals with this disorder often have impaired relationships with same-sex friends because of their sexually provocative behavior or their demands for constant attention. They crave novelty, stimulation, and excitement and have a tendency to become bored with their usual routine. Often old relationships are neglected to make way for the excitement of new relationships. Although they often initiate a job or project with great enthusiasm, their interest may lag quickly.

Complications

The actual risk of suicide is not known, but individuals with Histrionic Personality Disorder are at increased risk for attention seeking suicidal gestures or threats.

Comorbidity

Some other disorders frequently occur with this disorder:

    Non-Personality Disorders

            Depressive Disorders:
      • Major Depressive Disorder
            Somatic Symptom and Related Disorders:
      • Somatic Symptom Disorder, Conversion Disorder (Functional Neurological Symptom Disorder)

    Personality Disorders

            Dependent Personality Disorder

            Antisocial Personality Disorder

            Borderline Personality Disorder

            Narcissistic Personality Disorder

Associated Laboratory Findings

No laboratory test has been found to be diagnostic of this disorder.

Prevalence

The frequency of Histrionic Personality Disorder is equal in males and females, and this disorder is present in about 1.8% of the general population (and 10%-15% of psychiatric outpatients).

Controlled Clinical Trials Of Therapy

Click here for a list of all the controlled clinical trials of therapy for this disorder.

Psychotherapy

There is insufficient (randomized controlled trial) evidence to prove the effectiveness of any psychological intervention for adults with this disorder. Lacking such evidence, it would be prudent to only offer crisis intervention or short-term psychotherapy, rather than long-term psychotherapy.

Pharmacotherapy

There are currently no medications approved by the FDA to treat this disorder. Vitamins, nutritional supplements, and special diets are all ineffective for all Personality Disorders.

Trustworthy Research (PubMed.gov)


A Dangerous Cult: Videos


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Videos


Stories

Rating Scales

Histrionic Traits

Individuals with Histrionic Personality Disorder must be the center of attention and "the life of the party". They are overly concerned with impressing others by their appearance. They are highly suggestible, and easily influenced by others and by fads. They are hypersensitive to criticism. They are impulsive, excitement seeking, reckless, and seductive.

Lack Of Social Skills In Personality Disorders

There are certain social skills that are essential for healthy social functioning. Individuals with Histrionic Personality Disorder lack the essential social skills of genuineness, chastity, and caution. They lack emotional stability (that is also lacking in individuals with Borderline Personality Disorder) and cooperation/generosity (that is also lacking in Narcissistic Personality Disorder).

A Good Life

How does one live a good life?

One approach to answering this question is to study the behavior of individuals who live troubled lives. Could the opposite of their maladaptive behavior define how to live a good life?

Consider the troubled lives of people with histrionic personality disorder. Individuals with histrionic personality disorder are inappropriately attention seeking and seductive.

Could the opposite of the maladaptive behaviors seen in histrionic personality disorder be a clue to how to live a good life? Many religions teach that we should be sincere and not seductive. This is the opposite of the inappropriately attention seeking and seductive behavior seen in histrionic personality disorder.

    Histrionic Personality Disorder The Opposite Of Histrionic Personality Disorder
    Inappropriate attention seeking: Sincerity:
    Shows self-dramatization, theatricality and exaggerated expression of emotion Does not show self-dramatization, theatricality, or exaggerated expression of emotion
    Is uncomfortable in situations in which she was not the center of attention Is comfortable in situations in which she is not the center of attention
    Consistently uses physical appearance to draw attention to herself Does not consistently use physical appearance to draw attention to herself
    Displays rapidly shifting and shallow expression of emotions Does not display rapidly shifting and shallow expression of emotions
    Has a style of speech is excessively impressionistic and lacking in detail Does not have a style of speech that is excessively impressionistic and lacking in detail
    Considers relationships to be more intimate than they actually are Does not consider relationships to be more intimate than they actually are
    Is suggestible (i.e., easily influenced by others or circumstances) Is not suggestible, i.e., not easily influenced by others or circumstances
    Inappropriate sexually seductive or provocative behavior. Does not show inappropriate sexually seductive or provocative behavior

Parental Behaviors Which Increase The Risk Of Developing A Personality Disorder

Research has shown that genetic, environmental, and prenatal factors all play important roles in the development of personality disorder. Research has also shown that low parental affection and harsh parenting increase the risk of a child later developing a personality disorder.

"Low affection" was defined as: low parental affection, low parental time spent with the child, poor parental communication with the child, poor home maintenance, low educational aspirations for the child, poor parental supervision, low paternal assistance to the child's mother, and poor paternal role fulfillment. "Harsh parenting" was defined as: harsh punishment, inconsistent maternal enforcement of rules, frequent loud arguments between the parents, difficulty controlling anger toward the child, possessiveness, use of guilt to control the child, and verbal abuse.


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(USE SLIDER ON RIGHT SIDE OF THE ABOVE PAGE TO SEE FULL CHECKLIST)



This disorder is characterized by pathological personality traits in the following domains:

  • Antagonism , characterized by:

    • Attention seeking:
      Excessive attempts to attract and be the focus of the attention of others; admiration seeking.

      Question: "Do you really like to be the center of attention? Do you like to show off if you get the chance? Do you really want to be admired by others?"

      • "Continually seeks excitement and being the center of attention." (ICD-10) "Is uncomfortable in situations in which he or she is not the center of attention." (DSM-5)

      • "Self-dramatization, theatricality, or exaggerated expression of emotions." (ICD-10) "Shows self-dramatization, theatricality, and exaggerated expression of emotion." (DSM-5)

      • "Shallow and labile affectivity. (ICD-10) "Displays rapidly shifting and shallow expression of emotions." (DSM-5)

      • "Inappropriately seductive in appearance or behavior." (ICD-10) "Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior." (DSM-5)

      • "Considers relationships to be more intimate than they actually are." (DSM-5)

      • "Overly concerned with physical attractiveness." (ICD-10) "Consistently uses physical appearance to draw attention to self." (DSM-5)

      • "Suggestibility, easily influenced by others or by circumstances." (ICD-10) "Is suggestible (i.e., easily influenced by others or circumstances)." (DSM-5)

      • "Has a style of speech that is excessively impressionistic and lacking in detail." (DSM-5)



(Note: Recovery = symptomatic remission + full-time gainful employment + weekly contact with friends)


Histrionic Personality Disorder F60.4 - ICD10 Description, World Health Organization

Histrionic Personality Disorder is characterized by shallow and labile affectivity, self-dramatization, theatricality, exaggerated expression of emotions, suggestibility, egocentricity, self-indulgence, lack of consideration for others, easily hurt feelings, and continuous seeking for appreciation, excitement and attention.

ICD-10 International Personality Disorder Examination Screening Questions

  • I show my feelings for everyone to see.

  • I'm too easily influenced by what goes on around me.

  • My feelings are like the weather; they're always changing.

  • I like to dress so I stand out in a crowd.

  • I would rather not be the center of attention (False).

  • I have a reputation for being a flirt.

ICD-10 Diagnostic Criteria (For Research)

    A. The general criteria of personality disorder must be met:

    • Evidence that the individual's characteristic and enduring patterns of inner experience and behavior deviate markedly as a whole from the culturally expected and accepted range (or 'norm').

    • The deviation must manifest itself pervasively as behavior that is inflexible, maladaptive, or otherwise dysfunctional across a broad range of personal and social situations (i.e. not being limited to one specific 'triggering' stimulus or situation).

    • There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behavior.

    • There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence.

    • The deviation cannot be explained as a manifestation or consequence of other adult mental disorders.

    • Organic brain disease, injury, or dysfunction must be excluded as possible cause of the deviation.

    B. At least four of the following must be present:

    • Self-dramatization, theatricality, or exaggerated expression of emotions.
        (E.g., "I show my feelings for everyone to see.")

    • Suggestibility, easily influenced by others or by circumstances.
        (E.g., "I'm too easily influenced by what goes on around me.")

    • Shallow and labile affectivity.
        (E.g., "My feelings are like the weather; they are always changing.")

    • Continually seeks excitement and being the centre of attention.
        (E.g., "I like being the center of attention.")

    • Inappropriately seductive in appearance or behavior.
        (E.g., "I have a reputation for being a flirt.")

    • Overly concerned with physical attractiveness.
        (E.g., "I like to dress so that I stand out in a crowd.")

    • Comments: Egocentricity, self-indulgence, continuous longing for appreciation, lack of consideration for others, feelings that are easily hurt, and persistent manipulative behavior complete the clinical picture, but are not required for the diagnosis.

Histrionic Personality Disorder - Diagnostic Criteria, American Psychiatric Association

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following:

  • Is uncomfortable in situations in which he or she is not the center of attention.

  • Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.

  • Displays rapidly shifting and shallow expression of emotions.

  • Consistently uses physical appearance to draw attention to self.

  • Has a style of speech that is excessively impressionistic and lacking in detail.

  • Shows self-dramatization, theatricality, and exaggerated expression of emotion.

  • Is suggestible (i.e., easily influenced by others or circumstances).

  • Considers relationships to be more intimate than they actually are.

  • This enduring pattern of inner experience and behavior must deviate markedly from the expectations of the individual's culture.

  • This enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

  • This enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  • Empirically Derived Taxonomy for Personality Diagnosis: Histrionic Personality Disorder

    (This section uses an alternative classification system to that of the American Psychiatric Association)

    These individuals:

    • Are emotionally dramatic and prone to express emotion in exaggerated and theatrical ways.

    • Their reactions tend to be based on emotion rather than reflection, and their cognitive style tends to be glib, global, and impressionistic (e.g., missing details, glossing over inconsistencies, mispronouncing names).

    • Their beliefs and expectations seem cliche or stereotypical, as if taken from storybooks or movies, and they seem naive or innocent, seeming to know less about the ways of the world than would be expected.

    • Are sexually seductive or provocative. They use their physical attractiveness to an excessive degree to gain attention and notice, and they behave in ways that seem to epitomize gender stereotypes. They may be flirtatious, preoccupied with sexual conquest, prone to lead people on, or promiscuous.

    • Become involved in romantic or sexual "triangles" and may be drawn to people who are already attached or sought by someone else.

    • Have difficulty directing both tender feelings and sexual feelings toward the same person, tending to view others as either virtuous or sexy, but not both.

    • Are suggestible or easily influenced, and idealize and identify with admired others to the point of taking on their attitudes or mannerisms.

    • Fantasize about ideal, perfect love, yet tend to choose sexual or romantic partners who are emotionally unavailable, or who seem inappropriate (e.g., in terms of age or social or economic status).

    • Become attached quickly and intensely; however, beneath the surface, they often fear being alone, rejected, or abandoned.

      • (Editor's Note: These behaviors would be considered "normal" in 14-year-olds just "discovering" the opposite sex. Most adolescents mature out of their personality disorders within 2 years. Thus the question is: why do these maladaptive adolescent behaviors persist into adulthood in Histrionic Personality Disorder?)


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    Setting Goals In Therapy

      Questions To Ask When Setting Goals

      In The Past Week:
      • WHO: was your problem?

      • EVENT: what did he/she do?

      • RESPONSE: how did you respond to that event?

      • OUTCOME: did your response help?

      • TRIGGER: what did you do that could have triggered this problem?

      • GOAL: what life skill(s) do you have to work on? (from checklist)

      Example Of Setting Goals In Interviewing A Person With Histrionic Personality Disorder

      In The Past Week:
      • WHO: was your problem?
        "My boyfriend."

      • EVENT: what did he/she do?
        "I was just talking to this guy at a party, and my boyfriend got all jealous."

      • RESPONSE: how did you respond to that event?
        "I stormed out of the party. I wish now that we hadn't made such a scene."

      • OUTCOME: did your response help?
        "No, I over-reacted. It wasn't worth upsetting everyone at the party."

      • TRIGGER: what did you do that could have triggered this problem?
        "My boyfriend knows that I like to flirt. I just got a little carried away that night."

      • GOAL: what life skill(s) do you have to work on? (from checklist)
        "I want to work on: (1) Sincerity ("being genuine - not overly theatrical or attention seeking"), and (2) Chastity ("avoidance of casual sex ["one night stands"] AND absence of intense desire for illicit sex")."


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    Monitoring Your Progress

    NOTE: When each of the following presentations finish; you must exit by manually closing its window in order to return to this webpage.

    The Healthy Social Behavior Scale lists social behaviors that research has found to be associated with healthy social relationships. You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



    The Mental Health Scale lists behaviors and symptoms that research has found to be associated with mental health (or disorder). You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



    The Life Satisfaction Scale lists the survey questions often used to measure overall satisfaction with life. You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



    Life Satisfaction Scale (5-Minute Video)

    The "Big 6" Dimensions of Mental Health

    Research has shown that there are 5 major dimensions (the "Big 5 Factors" or Five-Factor Model) of personality disorders and other mental disorders.

    This website uses these 5 major dimensions of human behavior (i.e., Agreeableness, Conscientiousness, Openness/Intellect, Extraversion/Sociability, and Emotional Stability) to describe all mental disorders. This website adds one more dimension, "Physical Health", to create the "Big 6" dimensions of mental health.

    The behaviors of the "Five Factor Model of Personality" represent five adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociability" ], (4) decide whether to proceed in a cautious or impulsive manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness/Intellect" ].



    Desiderata (5-Minute Video)



    The following "Morning Meditation" allows you to plan your day using these "Big 6" dimensions of mental health.



    The following "Evening Meditation" allows you to review your progress on these "Big 6" dimensions of mental health.




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      "In physical science a first essential step in the direction of learning any subject is to find principles of numerical reckoning and practicable methods for measuring some quality connected with it. I often say that when you can measure what you are speaking about and express it in numbers you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind: it may be the beginning of knowledge, but you have scarcely, in your thoughts, advanced to the stage of science, whatever the matter may be."

      Lord Kelvin (1824 – 1907)


    • The best summary on bad research is given by Laura Arnold in this TEDx lecture. If you read nothing else about research, you owe it to yourself to watch this short video - it is excellent!

    • Economist in grim battle against deceptive scholarship

    • List of Predatory Journals and Publishers

    • The power of asking "what if?"

    • The active placebo effect: 2300 years ago, the Greek Stoic philosophers taught that it is not the objective event, but our subjective judgment about the event, that determines our behavior. The active placebo effect bears witness to this ancient wisdom.

    • Criteria For High Quality Research Studies

    • It is troubling that a recent study found that two-thirds of important psychological research studies couldn't be replicated. High quality research must meet the following criteria:

      • Randomized Controlled Trial:
        Ask: Was the trial randomized? Was the randomization procedure described and was it appropriate? The best research design is to have research subjects randomly assigned to an experimental or control group. It is essential that confounding factors be controlled for by having a control group or comparator condition (no intervention, placebo, care as usual etc.).

      • Representative Sample:
        Ask: Do the research subjects represent a normal cross-section of the population being studied? Many psychological research studies using university students are flawed because their subjects are not representative of the normal population since they are all W.E.I.R.D. (White, Educated, Intelligent, Rich, and living in a Democracy).

      • Single Blind Trial:
        Ask: Was the treatment allocation concealed? It is essential that the research subjects are kept "blind" as to whether they are in the experimental or control group (in order to control for any placebo effects).

      • Double Blind Trial (Better Than Single Blind Trial):
        Ask: Were blind outcome assessments conducted? In a double blind study, neither the research subjects nor the outcome assessors know if the research subject is in the experimental or control group. This controls for both the placebo effect and assessor bias.

      • Baseline Comparability:
        Ask: Were groups similar at baseline on prognostic indicators? The experimental and control groups must be shown to be comparable at the beginning of the study.

      • Confounding Factors:
        Ask: Were there factors, that weren't controlled for, that could have seriously distorted the study's results? For example, research studies on the effectiveness of mindfulness cognitive therapy in preventing depressive relapse forgot to control for whether the research subjects were also simultaneously receiving antidepressant medication or other psychological treatments for depression.

      • Intervention Integrity:
        Ask: Was the research study protocal strictly followed? The research subjects must be shown to be compliant (e.g., taking their pills, attending therapy) and the therapists must be shown to be reliably delivering the intervention (e.g., staying on the research protocol).

      • Statistical analysis:
        Ask: Was a statistical power calculation described? The study should discuss its statistical power analysis; that is whether the study size is large enough to statistically detect a difference between the experimental and control group (should it occur) and usually this requires at least 50 research subjects in the study.

        Ask: Are the results both statistically significant and clinically significant? Many medical research findings are statistically significant (with a p-value <0.05), but they are not clinically significant because the difference between the experimental and control groups is too small to be clinically relevant.

        For example, the effect of a new drug may be found to be 2% better than placebo. Statistically (if the sample size was large enough) this 2% difference could be statistically significant (with a p-value <0.05). However, clinicians would say that this 2% difference is not clinically significant (i.e., that it was too small to really make any difference).

        Statistically, the best way to test for clinical significance is to test for effect size (i.e., the size of the difference between two groups rather than confounding this with statistical probability).

        When the outcome of interest is a dichotomous variable, the commonly used measures of effect size include the odds ratio (OR), the relative risk (RR), and the risk difference (RD).

        When the outcome is a continuous variable, then the effect size is commonly represented as either the mean difference (MD) or the standardised mean difference (SMD) .

        The MD is the difference in the means of the treatment group and the control group, while the SMD is the MD divided by the standard deviation (SD), derived from either or both of the groups. Depending on how this SD is calculated, the SMD has several versions such, as Cohen's d, Glass's Δ, and Hedges' g.

          Clinical Significance: With Standard Mean Difference, the general rule of thumb is that a score of 0 to 0.25 indicates small to no effect, 0.25-0.50 a mild benefit, 0.5-1 a moderate to large benefit, and above 1.0 a huge benefit. It is a convention that a SMD of 0.5 or larger is a standard threshold for clinically meaningful benefit.

        The statistical summary should report what percentage of the total variance of the dependent variable (e.g., outcome) can be explained by the independent variable (e.g., intervention).

        In clinical studies, the study should report the number needed to treat for an additional beneficial outcome (NNTB), and the number needed to treat for an additional harmful outcome (NNTH).

          Number Needed To Benefit (NNTB): This is defined as the number of patients that need to be treated for one of them to benefit compared with a control in a clinical trial. (It is defined as the inverse of the absolute risk reduction.) Note: Statistically, the NNTB depends on which control group is used for comparison - e.g., active treatment vs. placebo treatment, or active treatment vs. no treatment.

          Number Needed To Harm (NNTH): This is defined as the number of patients that need to be treated for one of them to be harmed compared with a control in a clinical trial. (It is defined as the inverse of the absolute increase in risk of harm.)

          Tomlinson found “an NNTB of 5 or less was probably associated with a meaningful health benefit,” while “an NNTB of 15 or more was quite certain to be associated with at most a small net health benefit.”

        Ask: Does the researcher accept full responsibility for the study's statistical analysis? The researcher should not just hand over the study's raw data to a corporation (that may have $1,000 million invested in the study) to do the statistical analysis.

      • Completeness of follow-up data:
        Ask: Was the number of withdrawals or dropouts in each group mentioned, and were reasons given for these withdrawals or dropouts? Less than 20% of the research subjects should drop out of the study. The intervention effect should persist over an adequate length of time.

      • Handling of missing data:
        Ask: Was the statistical analysis conducted on the intention-to-treat sample? There must be use of intention-to-treat analysis (as opposed to a completers-only analysis). In this way, all of the research subjects that started the study are included in the final statistical analysis. A completers-only analysis would disregard those research subjects that dropped out.

      • Replication of Findings:
        Ask: Can other researchers replicate this study's results? The research study's methodology should be clearly described so that the study can be easily replicated. The researcher's raw data should be available to other researchers to review (in order to detect errors or fraud).

      • Fraud:
        Ask: Is there a suspicion of fraud? In a research study, examine the independent and dependent variables that are always measured as a positive whole number (e.g., a variable measured on a 5-point Likert-type scale ranging from "1 = definitely false to 5 = definitely true" etc.). For each of these variables, look at their sample size ( n ), mean ( M ) and standard deviation ( SD ) before they undergo statistical analysis. There is a high suspicion of fraud in a study's statistics:

        • If the M is mathematically impossible (online calculator): This is one of the easiest ways to mathematically detect fraud. The mean ( M ) is defined as "the sum ( Sum ) of the values of each observation divided by the total number ( n ) of observations". So: M = Sum / n . Thus: ( Sum ) = ( M ) multiplied by ( n ). We know that, if a variable is always measured as a positive whole number, the sum of these observations always has to be a whole number. For these variables to test for fraud: calculate ( M ) multiplied by ( n ). This calculates the Sum which MUST be a positive whole number. If the calculated Sum isn't a positive whole number; the reported mean ( M ) is mathematically impossible - thus the researcher either cooked the data or made a mistake. A recent study of 260 research papers published in highly reputable psychological journals found that 1 in 2 of these research papers reported at least one impossible value , and 1 in 5 of these research papers reported multiple impossible values. When the authors of the 21 worst offending research papers were asked for their raw data (so that its reliability could be checked) - 57% angrily refused. Yet such release of raw data to other researchers is required by most scientific journals. (Here is an example of a research paper filled with mathematically impossible means.)

        • If the SD is mathematically impossible (online calculator): When researchers fraudulently "cook" their data, they may accidently give their data a mean and standard deviation that is mathematically impossible.

        • If the SD/M is very small (i.e., the variable's standard deviation is very small compared to the mean suggesting data smoothing).

        • If the SD's are almost identical (i.e., the variables have different means but almost identical standard deviations).

        • If the 4th digit of the values of the variables aren't uniformly distributed - since each should occur 10% of the time (Benford's Law).

        • If the researcher is legally prevented from publishing negative findings about a drug or therapy because that would violate the "nondisclosure of trade secrets" clause in the research contract (i.e., it is a "trade secret" that the drug or therapy is ineffective - hence this can not be "disclosed"). Approximately half of all registered clinical trials fail to publish their results.

        • If the researcher refuses to release his raw data to fellow researchers (so that they can check its validity). In order to be published in most scientific journals, a researcher must promise to share his raw data with fellow researchers. Thus a researcher's refusal to do so is almost a sure indicator of fraud.

        • If the research study's data contradicts the study's own conclusions - surprisingly, this often occurs.

    • Calling Bullshit In The Age of Big Data - "Bullshit is language, statistical figures, data graphics, and other forms of presentation intended to persuade by impressing and overwhelming a reader or listener, with a blatant disregard for truth and logical coherence." Reading the syllabus of this university course should be required reading for every student of mental health. This syllabus is absolutely fantastic!

    • Statistical Methods in Psychology Journals: Guidelines and Explanations - American Psychologist 1999

    • Not All Scientific Studies Are Created Equal - video

    • The efficacy of psychological, educational, and behavioral treatment

    • Estimating the reproducibility of psychological science

    • Psychologists grapple with validity of research

    • Industry sponsorship and research outcome (Review) - Cochrane Library

    • 'We've been deceived': Many clinical trial results are never published - (text and video)

    • Junk science misleading doctors and researchers

    • Junk science under spotlight after controversial firm buys Canadian journals

    • Medicine with a side of mysticism: Top hospitals promote unproven therapies - Are some doctors becoming modern witchdoctors?

    • When Evidence Says No, But Doctors Say Yes


    • Cochrane Reviews (the best evidence-based, standardized reviews available)

    Research Topics

    Histrionic Personality Disorder - Core Clinical Journals

    Histrionic Personality - All Journals

    Histrionic Personality - Review Articles - Core Clinical Journals

    Histrionic Personality - Review Articles - All Journals

    Histrionic Personality Disorder - Treatment - Core Clinical Journals

    Histrionic Personality Disorder - Treatment - All Journals

    Recommended Free Full Text Articles


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    Normal Distribution Of Human Attributes

    Regression to the Mean (Or Why Scientific Experiments Require A Control Group)

    The "Big 6" Dimensions of Mental Health

    Research has shown that there are 5 major dimensions (the "Big 5 Factors" or Five-Factor Model) of personality disorders and other mental disorders. There are two free online personality tests that assess your personality in terms of the "Five Factor Model of Personality". Although not computerized online, the Big Five Inventory (BFI) is a 44-item test often used in personality research.

    This website uses these 5 major dimensions of human behavior to describe all mental disorders. (This website adds one more dimension, "Physical Health", to create the "Big 6" dimensions of mental health.)

    The behaviors of the "Five Factor Model of Personality" represent five adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociability" ], (4) decide whether to proceed in a cautious or impulsive manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness/Intellect" ].

    What Are The 6 Major Dimensions of Histrionic Personality Disorder?

    THE POSITIVE SIDE OF THE "BIG 6" DIMENSIONS OF MENTAL HEALTH THE NEGATIVE SIDE OF THE "BIG 6" DIMENSIONS OF MENTAL HEALTH THIS DISORDER
    Agreeableness
    Being kind and honest.
    Antagonism
    Being unkind or dishonest.
          Antagonism
    Conscientiousness
    Being diligent and self-disciplined.
    Disinhibition
    Being distractible, impulsive or undisciplined.
    Openness/Intellect
    Showing good creativity, problem-solving, and learning ability
    Impaired Intellect
    Showing decreased creativity, problem-solving, or learning ability.
    Extraversion
    Being gregarious, assertive and enthusiastic.
    Detachment
    Being detached, unassertive, and unenthusiastic.
    Emotional Stability
    Being emotionally stable and calm.
    Emotional Distress
    Being emotionally unstable/distressed.
    Physical Health
    Being physically fit and healthy.
    Physical Symptoms
    Being physically unfit or ill.






    The Following Will Only Discuss The Dimensions of Mental Illness That Are Abnormal In This Disorder

    The problems that are characteristic of this disorder are highlighted with this pink background color .


    AGREEABLENESS VS. ANTAGONISM

    AGREEABLENESS (Helping Others)
    Description: Agreeableness is synonymous with compassion and politeness. Compassion reflects empathy, sympathy, and caring for others. Politeness reflects respect for others. Individuals with high Agreeableness do not hold grudges, are lenient in judging others, are willing to compromise and cooperate with others, and can easily control their temper. The Agreeableness dimension measures the behaviors that are central to the concept of JUSTICE and equality (fair, honest, and helpful behavior - living in harmony with others, neither harming nor allowing harm). Basic human rights are enshrined in the UN Universal Declaration of Human Rights. Individuals with high Agreeableness avoid manipulating others for personal gain, feel little temptation to break rules, are uninterested in lavish wealth and luxuries, and feel no special entitlement to elevated social status. High Agreeableness is associated with better: longevity, helping others, giving to charity, job [team] performance, and marital success. (This dimension appears to measure the behaviors that differentiate friend from foe.)
    Descriptors: Honest, humble, compassionate, polite, cooperative, nonaggressive.
    • From Between facets and domains: 10 aspects of the Big Five
      • Compassion:
        • Forgiving nature
        • Considerate and kind
        • Feel other's emotions
        • Inquire about others’ well-being
        • Sympathize with others’ feelings
        • Take an interest in other people’s lives
        • Like to do things for others
      • Politeness:
        • Seldom rude
        • Respect authority
        • Hate to seem pushy
        • Avoid imposing my will on others
        • Rarely put people under pressure
    • From International Personality Item Pool:
      • Would never cheat on taxes
      • Sympathize with the homeless
      • Trust others
      • Make people feel welcome
      • Am easy to satisfy
      • Dislike being the center of attention
    Chimpanzees: The Agreeableness-Antagonism dimension of human behavior can be traced back to our chimpanzee ancestory. Chimpanzee communities, like every social species, organize themselves according to status (video). In such status hierarchies, the dominant members actively protect their privileged status within the community by using domineering, antagonistic behavior towards subordinate members. This antagonistic, competitive behavior by high-status dominant members of the community is in contrast to the agreeable, cooperative behavior of the low-status, subordinant members. In humans, this same antagonistic behavior is used by those seeking to dominate others.
    Evolution: The brains of social species evolved to allow cooperation and altruism which require coordinating one’s goals with those of others. The core features of Agreeableness are empathy and fairness. In more intelligent species, there appears to be an almost instinctual sense of empathy and fairness (video).
    Language Characteristics: Pleasure talk, agreement, compliments, empathy, few personal attacks, few commands or global rejections, many self-references, few negations, few swear words, few threats, many insight words.
    Research: Higher scores on Agreeableness are associated with deeper relationships. Are you a giver or taker? (video). *MRI research found that Agreeableness was associated with increased volume in regions that process information about the intentions and mental states of other individuals.
    "I am helpful and unselfish with others."
    "I have a forgiving nature."
    "I am generally trusting."
    "I am considerate and kind to almost everyone."
    "I like to cooperate with others."
    "I don't find fault with others."
    "I don't start quarrels with others."
    "I am not cold and aloof."
    "I am not rude to others."
    "I feel other's emotions."
    "I inquire about others' well-being."
    "I sympathize with others' feelings."
    "I take an interest in other people's lives."
    "I like to do things for others."
    "I respect authority."
    "I hate to seem pushy."
    "I avoid imposing my will on others."
    "I rarely put people under pressure."
    ANTAGONISM (Harming Others)
    Description: Antagonism is synonymous with being very self-centered and lacking empathy. They find it hard to forgive, are critical of others' shortcomings, are stubborn in defending their point of view, and readily feel anger when provoked. They will flatter others to get what they want, break rules for personal profit, and feel a strong sense of self-importance.
    ICD-11 Description: The core feature of the Antagonism (or Dissociality) trait domain is disregard for the rights and feelings of others. Common manifestations of Antagonism (or Dissociality) include: self-centeredness (e.g., sense of entitlement, expectation of others’ admiration, positive or negative attention-seeking behaviors, selfishness); and lack of empathy (i.e., indifference to whether one’s actions hurt others, which may include being deceptive, manipulative, and exploitative of others, being mean and physically aggressive, callousness in response to others' suffering, and ruthlessness in obtaining one’s goals).
    Descriptors: Dishonest, arrogant, callous, rude, manipulative, aggressive.
    • From Between facets and domains: 10 aspects of the Big Five
      • Callousness:
        • Am not interested in other people’s problems
        • Can’t be bothered with other’s needs
        • Am indifferent to the feelings of others
        • Take no time for others
        • Don’t have a soft side
      • Manipulativeness:
        • Insult people
        • Believe that I am better than others
        • Take advantage of others
        • Seek conflict
        • Love a good fight
        • Am out for my own personal gain
    • From International Personality Item Pool:
      • Use flattery to get ahead
      • Believe in eye for eye
      • Distrust people
      • Look down on others
      • Have a sharp tongue
      • Think highly of myself
    Language Characteristics: Problem talk, dissatisfaction, little empathy, many personal attacks, many commands or global rejections, few self-references, many negations, many swear words, many threats, little politeness, few insight words.
    Video Example: Here is an example of a very antagonistic person - President Trump at a Mississippi political rally.
    Screening Questions:
    • "It’s no big deal if I hurt other peoples’ feelings."
    • "I crave attention."
    • "I often have to deal with people who are less important than me."
    • "I use people to get what I want."
    • "It is easy for me to take advantage of others."
    • "Others see me as irresponsible."
    Attention Seeking
    "I like to draw attention to myself."
    "I crave attention."
    "I do things to make sure people notice me."
    "I do things so that people just have to admire me."
    "My behavior is often bold and grabs peoples' attention."
    ("Agreeableness vs. Antagonism" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five) [More Information]
    *MRI Research:
    Testing predictions from personality neuroscience. Brain structure and the big five.



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    Comment by Phillip Long MD (Psychiatrist and Editor):


    It's A Wonder We're Still Alive

    The Man Who Saved The World

    The world barely avoided being annihilated in 1983. On 26 September 1983, the nuclear early warning system of the Soviet Union erroneously reported an incoming attack against Russia by American intercontinental missiles. Russia has a "launch on warning" policy whereby it launches its missiles against America on the first warning of an incoming American missile attack.

    Fortunately this missile attack warning was correctly identified as a false alarm by Stanislav Petrov, lieutenant colonel of the Soviet Air Defence Forces. Petrov's decision to disregard the erroneous radar warnings is credited with having prevented a retaliatory nuclear attack on the United States and its NATO allies that could have resulted in large-scale nuclear war.

    Stanislav Petrov had the courage to disobey his military orders (to "launch on warning") because of his personal knowledge and convictions. He knew that launching a large-scale nuclear war would annihilate humanity, and he knew that the Russian early warning system could not be trusted.

    9 Times the World Was at the Brink of Nuclear War — and Pulled Back

    Due to human error, there have been nine times that the world was at the brink of nuclear war — but pulled back. Accidental false alerts which could trigger a nuclear war are not a rare occurrence. Given how incompetent our nuclear "launch on warning" system is - it is a miracle that we haven't already annihilated all life on earth.



    The 2 Men Who Could End The World

    America and Russia possess 93% of the world's nuclear weapons. Thus Valdimir Putin and President Trump are the only two people on earth who could single-handedly start a nuclear World War III and thus annihilate all life on our planet.

    The problem now is that the leaders of Russia and America have severe personality flaws that make them incapable of appreciating the enormity of harm that they may cause.

    Both Vladimir Putin and President Trump have Antisocial, Narcissistic, and Paranoid Personality Disorders.

    Why is the mental health of Vladimir Putin or President Trump important?

    The world's fate is now in the hands of two leaders who have the following severe personality flaws:

    Antisocial Personality Disorder

    Narcissistic Personality Disorder

    • Arrogance:
      Being boastful or excessively proud; offensive display of superiority or self-importance.

    • Manipulation:
      Exploiting, conning, or taking unfair advantage of others.

    • Callousness:
      Lack of guilt or remorse about causing others harm; indifference to the suffering of others.

    • Attention Seeking:
      Trying to be the center of attention; being overly dramatic or flamboyant.

    Paranoid Personality Disorder

    • Suspiciousness:
      Suspecting, without sufficient basis, that others are harming or deceiving him.

    • Bearing grudges:
      Blaming others; seeking revenge

    • Being Hot-Headed:
      Easily angered; quick to take offense; unable to take criticism, blame or rejection.

    Histrionic Personality Disorder

    • Attention Seeking:
      Trying to be the center of attention; being overly dramatic or flamboyant.


    Tony Schwartz wrote "The Art of the Deal" for Donald Trump, and spent 18 months in Donald Trump's office observing him in order to write this Donald Trump biography. In 2016, immediately before the presidential election, Tony Schwartz gave a scathing lecture entitled "The Truth About Trump" at Oxford University. Every American who voted for President Trump should watch this Oxford lecture video.

    Jan. 29, 2017: Alexandre Bissonnette, a white, 27-year-old, French-Canadian male far right extremist shot 25 Muslims in the back while they were at prayer in their mosque in Quebec City, Canada. Six were killed, 5 were hospitalized in critical condition, and the other wounded required only brief hospitalization. All of Canada mourned this barbaric act of senseless hatred against Muslims. Canadians are now asking how can the flood of far right anti-Muslim hatred coming into Canada from other countries be stopped? Take a good look at where the far right anti-Muslim hatred is taking us. [Racism can be untaught: How getting beat up taught a new Canadian not to be racist]

    P.S. In the past 2 years, Canada has accepted more than 40,000 Syrian refugees. Not one of these Syrian refugees has attempted a terrorist attack in Canada or America.

    A Counterargument To President Trump's Xenophobia:
    (Interview with Jack Ma, a Chinese businessman worth US$ 35 billion) "In the past 30 years, America has had 13 wars spending US$ 14.2 trillion . What if they spent a fraction of that money building up [America's] infrastructure, and helping white collar and blue collar workers? ... You are supposed to spend money on your own people. The money has gone to Wall Street. And what happened? In 2008, the financial crisis wiped out US$ 19.2 trillion in USA alone, and destroyed 34 million jobs globally . What if that money wasn't spent on Wall Street? What if that money was spent on middle America and the rest of the United States developing the industry there? So it's not the other countries stealing jobs from America, it is your strategy [over-spending on war and on Wall Street]. You did not distribute your money in the proper way."


    The "Five Factor Model of Personality" as Shown In Dogs

    All animals have personalities - that is, consistent individual differences in behavior. Within virtually any population, some individuals are consistently more active, more aggressive, or are more willing to engage in risk-taking behavior. Thus the same "Big 5 Factors" of personality found in humans can be found in dogs.



    AGREEABLENESS VS. ANTAGONISM
    Agreeableness ("Friend")
    Dog is friendly towards unfamiliar people.
    Dog is friendly towards other dogs.
    When off leash, dog comes immediately when called.
    Dog willingly shares toys with other dogs.
    Dog leaves food or objects alone when told to do so.
    Antagonism ("Foe")
    Dog is dominant over other dogs.
    Dog is assertive with other dogs (e.g., if in a home with other dogs, when greeting).
    Dog behaves aggressively towards unfamiliar people.
    Dog shows aggression when nervous or fearful.
    Dog aggressively guards coveted items (e.g., stolen item, treats, food bowl).
    Dog is quick to sneak out through open doors, gates.

    CONSCIENTIOUSNESS VS. DISINHIBITION
    .
    Conscientiousness ("Self-Controlled")
    Dog works at tasks (e.g., getting treats out of a dispenser, shredding toys) until entirely finished.
    Dog works hard all day herding or pulling a sleigh (if a "working dog" on the farm or in the snow). *
    Dog is curious.
    Disinhibition ("Disinhibited")
    Dog is boisterous.
    Dog seeks constant activity.
    Dog is very excitable around other dogs.

    OPEN-MINDEDNESS / INTELLECT VS. CLOSED-MINDEDNESS / IMPAIRED INTELLECT
    .
    Intellect
    Dog is able to focus on a task in a distracting situation (e.g., loud or busy places, around other dogs).
    Impaired Intellect
    Dog is slow to respond to corrections.
    Dog ignores commands.
    Dog is slow to learn new tricks or tasks.

    EXTRAVERSION VS. DETACHMENT
    .
    Sociality ("Approach")
    Dog is attention seeking (e.g., nuzzling, pawing or jumping up on family members looking for attention and physical contact).*
    Dog seeks companionship from people.
    Dog is affectionate.
    Detachment ("Avoidance")
    Dog is aloof.
    Dog gets bored in play quickly.
    Dog is lethargic.

    EMOTIONAL STABILITY VS. EMOTIONAL DISTRESS
    .
    Emotional Stability ("Safety")
    .
    Dog tends to be calm.
    Dog is relaxed when greeting people.
    Dog is confident.
    Dog adapts easily to new situations and environments.
    Emotional Distress ("Danger")
    Dog is anxious.
    Dog is shy.
    Dog behaves fearfully towards unfamiliar people.
    Dog exhibits fearful behaviors when restrained.
    Dog avoids other dogs.
    Dog behaves fearfully towards other dogs.
    Dog behaves submissively (e.g., rolls over, avoids eye contact, licks lips) when greeting other dogs.
    Modified from Jones, A. C. (2009). Development and validation of a dog personality questionnaire. Ph.D. Thesis. University of Texas, Austin.

    * New items added by Phillip W. Long MD

    The "Five Factor Model of Personality" In A Social Species

    The behaviors of the "Five Factor Model of Personality" serve adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociality" ], (4) decide whether to proceed in a self-controlled or disinhibited manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness to Experience" ].

    Spider Personalities

    All animals have personalities (defined as consistent behavioral differences among individuals). Animals can consistently differ on: (1) Antagonism (e.g., aggression), (2) Disinhibition (e.g., risk taking), (3) Intellect (e.g., inventiveness), (4) Extraversion (e.g., assertiveness), and (5) Emotional Stability (e.g., calmness).

    Some social spiders live in colonies of up to several hundred individuals, and exhibit cooperative behaviours such as prey capture and maternal care. Researchers have found that spider personalities differ in aggressiveness:
    • Aggressive spiders are more likely to attack their mirror image than are shy spiders who are more likely to run away.
    • In a spider colony, individual spiders differ in degree of boldness (aggression) vs. shyness (nonaggression). [Aggressive spiders show shorter latencies to attack prey and to resume movement after a disturbance.] Hunting prey for these social spiders is a collective effort. The presence of a bold spider causes the shy spiders to become bolder which increases the effectiveness of their collective hunting effort. A positive feedback loop is established whereby hunting success increases spider boldness which increases future collective hunting success. However, when researchers removed these bold "leader" spiders, the collective hunting by the remaining spiders became less successful. The bold "leader" spiders thus were shown to have a disproportionately large impact on the group, and so were named "keystone individuals". Because of their special personality characteristic (boldness) the "leader" spiders performed a vital function (making the shy spiders bolder) which fascilitated collective social action.

      This research made the very important finding that the spiders modified each other's personalities. The bold spiders became bolder because of their hunting success. However their hunting success was entirely dependent upon gaining the collective support of the shy spiders. Likewise, the shy spiders owed their hunting success to being made bolder by association with the bold spider. Thus for more successful collective action, the bold "leader" spider needed to have followers, and the shy "follower" spiders needed to have a "leader". To make their collective social action more successful, the different spider personalities had to bring out the "best" in each other.

    The "Five Factor Model of Personality" and Personality Disorders

    The following diagram shows the relationship between the "Five Factor Model of Personality" and personality disorders. This diagram is based on the research of Sam Gosling, Jason Rentfrow, and Bill Swann, Gerard Saucier, Colin G. DeYoung, and Douglas Samuel and Thomas Widiger.


    Enlarge Image



    3D Models of How the Personality Disorders Are Correlated



    The DSM-IV personality disorders in the National Comorbidity Survey Replication study determined how personality disorders statistically correlated with each other. The above 3D model was created (by P.W. Long MD) from this correlational data.

    This statistical model shows that all of the personality disorders are highly correlated - they are overlapping entities that blend into each other with no clear boundaries. This 3D model groups personality disorders into two highly interrelated large clusters (named "greed" and "fear" by PWL).

    The fact that these personality disorders are so highly interrelated suggests that it is common for individuals to have multiple personality disorders.



    Section III of the DSM-5 presents an alternative model for personality disorders. Based on research findings, this model drops four personality disorders: Schizoid, Paranoid, Dependent, and Histrionic.

    The above 3D model shows the statistical correlations between personality disorders in this alternative DSM-5 model.

      Note: Borderline Personality Disorder plays a central role in this model. It is correlated to all of the other major personality disorders (except Schizotypal Personality Disorder). It could be argued that Borderline Personality Disorder may not be a true personality disorder. Instead, it may more represent chaotic instability - an advanced stage in which a previous stable personality disorder becomes unstable and goes from order into chaos. This would explain why Borderline Personality Disorder is usually diagnosed in combination with another personality disorder.

      Thus, it is argued, instead of diagnosing someone as having both "Paranoid and Borderline Personality Disorders"; it would be more correct to diagnose "Paranoid Personality Disorder with Emotionally Unstable Traits".

      Chaos theory states that balanced systems under stress can be pushed into instability. Specifically, as stress on a stable system is increased, a "tipping point" is reached wherein the system quickly goes from stability to instability. The following animated graphs illustrate this mathematical principle. The vertical (y) axis represents the stress level. As the stress level increases, a tipping point is reached whereafter the system becomes more unstable. (These animations recycle.)

      Logistic map animation.gif
      By Snaily CC BY-SA 3.0, The "tipping point" between stability and instability



      According to chaos theory, these animations could represent what happens when a personality disorder is under increasing stress. Initially, the personality disorder remains stable; then under increasing stress a tipping point is reached wherein the previously stable personality disorder becomes chaotic. Any further stress makes the personality disorder even more unstable.

      Thus the emotional instability, chaotic social functioning, and self-harming behavior of Borderline Personality Disorder could represent a chaotic, unstable state of a previously stable personality disorder.


    Primate Evolution

    There appears to be three different ways in which primates have evolved socially:

    • The chimpanzees have evolved to be socially antagonistic, competitive, callous, and manipulative. Chimpanzees are the only primates (apart from humans) that wage organized war. Thus chimpanzee social behavior most closely mirrors the antagonistic behavior of the antisocial-paranoid-narcissistic-histrionic-borderline cluster of personality disorders.

    • In contrast, the bonobos have evolved to be socially anxious, peaceful, cooperative, and loving. Thus bonobo social behavior most closely mirrors the emotional distress (anxious) behavior of the avoidant-dependent cluster of personality disorders.

    • Another separate evolutionary path was followed by the orangutans. They evolved to become solitary hermits. Thus orangutan social behavior most closely mirrors the detached behavior of the schizoid-schizotypal cluster of personality disorders.


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