Tip: click a paragraph to jump to the exact moment in the video. Predatory Women (Compilation 1 of 2)

1. 00:07 My name is Sam Batn and I’m the author of Malignant Self-Love, Narcissism Revisited. And don’t tell me that you
2. 00:14 didn’t miss this introduction. Today we’re going to discuss borderline personality disorder and psychopathy.
3. 00:21 Wait a minute. You see, border lines are the exact opposite of psychopaths. They
4. 00:27 have emotions. They have empathy. They’re disregulated. They’re not goal oriented like psychopaths. What gives? Well, it seems that we’ve all been
5. 00:38 wrong. Borderline and histrionic personality disorders may be manifestations in females in women of secondary type psychopathy.
6. 00:50 Secondary type psychopathy is a variant of antisocial personality disorder. variant of psychopathy which is measured by factor two factor number two in the
7. 01:01 standard PCLR test. In other words, borderline and histrionic women may
8. 01:08 actually be psychopaths. A growing body of recent studies supports this extremely startling
9. 01:15 conclusion. Let’s add even more. Survivors of
10. 01:21 CPTTSD, survivors of complex post-traumatic stress disorder, victims
11. 01:29 also manifest psychopathic and narcissistic behaviors, what I call psychopathic and narcissistic overlay. So border lines, victims of CPTTSD and
12. 01:41 psychopaths or psychopathic narcissist or secondary psychopaths may actually be
13. 01:48 one and the same. In the case of victims and survivors of CPTTSD,
14. 01:54 the psychopathic behaviors, the narcissistic choices, the traits that develop, they’re all transient. Not so in the case of borderline women.
15. 02:05 Intimate partners of borderline women will not be surprised. They are aware of, affected by, and
16. 02:14 familiar with the borderline woman’s impulsivity, her defiant grandiosity,
17. 02:21 antisocial and interpersonal aggression, her manipulativeness, her disregulated
18. 02:27 negative emotionality, paranoia, lack of object constancy or object impermanence.
19. 02:35 In other words, out of sight, out of mind, attachment dysfunctions, hostility, splitting or dichoamous thinking, all white, all black, high
20. 02:46 levels of distress, anxiety, depression, and substance abuse.
21. 02:52 This laundry list is typical of and common among secondary psychopaths, but
22. 02:59 also among borderline women and men, of course. But the majority of people
23. 03:05 diagnosed with borderline personality disorder are women. These women also defy gender roles and
24. 03:13 behavioral norms. They tend to be more masculine. They tend to adopt an ideology of anything a man can do, I can do better. And in this sense, they
25. 03:24 emulate and imitate psychopathic men. But the borderline woman adds a twist to
26. 03:31 this extremely toxic and pernicious cocktail. And this twist is dissociation.
27. 03:37 Whenever her stress levels, whenever her inner dissonance, for example, feelings
28. 03:44 of guilt and shame, pain, um, expectation or anticipation of
29. 03:51 abandonment, whenever there’s inner turmoil inside her, when it becomes intolerable, she hands over control to her inner secondary psychopath.
30. 04:03 and then she proceeds to depersonalize, to derealize or to develop amnesia. All
31. 04:11 three are considered dissociative phenomena and we will discuss them at length a bit later. As she hands over
32. 04:19 control to her inner psychopath, she becomes malicious, malevolent, some would say even evil. when the border alliance life partner is
33. 04:31 another proud member of the cluster B tribe. In other words, when her partner also
34. 04:37 suffers from a personality disorder, a dramatic or erratic personality disorder, when her partner is another
35. 04:44 borderline or another psychopath or another narcissist, he reacts with equal
36. 04:50 measures of abuse to her frequent misconduct and the relationship ineluctibly devolves into a kind of
37. 04:58 vicious power play and with with numerous warping cruel Oh, mind games,
38. 05:06 sadism, and this exacerbates the mental health outcomes for everyone involved. Yes,
39. 05:13 even narcissists, border lines, and psychopaths can be traumatized often are.
40. 05:20 So, let’s go back to dissociation. Dissociative dip, depersonalization
41. 05:26 and derealization are common reactions in borderline personality disorder but also in
42. 05:33 dissociative identity disorder did formerly known as multiple personality disorder. Similarly, dissociation is common in patients with post-traumatic stress
43. 05:45 disorder such as PTSD or CPTtsd. The experience of derealization and depersonalization is variously described as being on
44. 05:56 autopilot, sliding into anesthesia or reverting to
45. 06:02 the status of an empathic or said spectator. It is provoked by intolerable dissonance. As I said, for example, when the borderline woman cheats on her
46. 06:14 partner, when she is having ambivalent sex, when she’s breaking the law, or when she’s breaching some deeply held
47. 06:21 mores and values in all these cases, which are just examples of dissonance,
48. 06:27 she would tend to dissociate. Why? Why does she dissociate? What’s the aim? What’s the psychonamic aim? Well, by dissociating, the patient distances
49. 06:38 herself from the events, from her pain, and from anticipated abandonment and
50. 06:44 rejection. By dissociating, she’s no longer there.
51. 06:50 There are these are mechanisms of estrangement and alienation. It’s like she’s saying, “This is not happening to
52. 06:57 me. This is just a nightmare. This is not real.” Substance abuse and ambient destructions tend to exacerbate these reactive patterns.
53. 07:08 And so we find borderline women with borderline personality disorder bar hopping or getting addicted to video games or similar destructing activities.
54. 07:21 activities that are intended to take the borderline’s mind off
55. 07:27 the cataclysmic agony that she’s experiencing off the impending doom of
56. 07:33 abandonment and rejection of the guillotine of intolerable unbearable
57. 07:39 pain that is awaiting her once she’s dumped. And so
58. 07:46 these substance abuse and ambient distractions tend to exacerbate reactive
59. 07:53 patterns. The patient end up ends up usually misattributing to alcohol or to drugs
60. 08:02 the behaviors wrought by her altars wrought by her different self states.
61. 08:10 So here’s here’s the sequence. she is in pain or she anticipates pain.
62. 08:17 She can’t take it. She can’t tolerate it. So she distracts herself. She distracts herself by drinking, by
63. 08:25 engaging in all kinds of activities, by having sex with a stranger. She does all these things as she consumes drugs and alcohol for example. So then she has amnesia or she depersonalizes or or she cuts
64. 08:43 herself off reality derealization and then in an attempt to explain to herself what had happened why why she can’t recall anything she says to herself must have been the alcohol must
65. 08:55 have been an alcoholic blackout must have been something the drugs did to me.
66. 09:01 So she explains the subsequent amnesia via the substance abuse. But that’s not the truth. The truth is that another
67. 09:13 state of self has emerged. Once the borderline is threatened with
68. 09:20 abandonment or experiences pain and rejection, another self emerges,
69. 09:26 the equivalent of an alter alternative personality in dissociative identity
70. 09:32 disorder. And this self that emerges is very often a secondary psychopath.
71. 09:40 Borderline personality disorder can best be described as a subspecies of dissociative identity disorder. The mood liability and emotional dysregulation
72. 09:52 are merely outward manifestations of changes in self states. They represent
73. 09:58 switching from a host personality A&P to an alter personality EP.
74. 10:06 The dissociative trigger in borderline personality disorder is typically either actual abandonment or the perceived threat of rejection and separation from an intimate partner within an
75. 10:18 interpersonal relation and this results in unbearable abandonment or separation
76. 10:24 anxiety. This borderline has very low uh tolerance of uncertainty and anxiety.
77. 10:30 She preempts. She generates the very situations that she is so fearful of. So
78. 10:37 she’s afraid of being abandoned, she abandons. She’s afraid of being abused, she abuses. Indeed, severe dissociation is even now
79. 10:48 a diagnostic criterion of BPD criterion number nine. So borderline personality disorder is diagnosed partly based on dissociative states. When one of the alters of the
80. 11:01 borderline is a psychopath, the borderline patient will be antisocial, impulsive, disempathic, mendacious. She she will lie about everything all the
81. 11:12 time, aggressive and defiant. She will be able to go for long periods without
82. 11:18 any romantic or sexual leazones. During these periods periods, she would be like a lone wolf in her lair. This is something that borderline personality disorder patients whose alters are not psychopathic cannot ever countenance or
83. 11:35 do. So when we want to differentiate the borderline personality disorder patient
84. 11:41 with a psychopathic self-state from a borderline personality patient
85. 11:48 without a psychopathic selfate with some other type of self- state let’s say a grandio self state all we have to do is look at the patterns of behavior and
86. 11:59 existence border lines with a psych with an inner psychopath they are lone wolves
87. 12:08 They spend a lot of time alone and sometimes they are avoidant. They avoid society and border lines with a grandiose self
88. 12:20 state with a grand grandio alter narcissistic. They would tend actually
89. 12:26 to seek company and they are incapable of surviving even for one day without an
90. 12:32 intimate partner. They feel horrible. They can’t. They feel abandoned. They feel dead. They feel dead inside. They
91. 12:39 don’t feel alive unless there’s someone who loves them or someone they perceive as loving and caring. It is a myth that people with borderline
92. 12:51 personality disorder or even dissociative identity disorder cannot fully control the behaviors and the choices of their altars. They can.
93. 13:02 This is why the the courts courts all over the world reject borderline personality disorder and dissociative identity disorder as a mitigating circumstance as a defense.
94. 13:15 They throw people in prison even when it is proven beyond doubt that when they
95. 13:21 had committed the felony of the crime they were under the control of an alter
96. 13:27 an alternative personality not the main host personality.
97. 13:33 According to Kavanaar, Sullivan and Malpi in longforgotten clinical note titled a
98. 13:43 clinical note on hysterical psychosis in the American Journal of Psychiatry June 1979. Well, according to these three scholars again, Coor, Sullivan, and Maltby, some
99. 13:54 narcissistic and histrionic people, mostly women, react with a transient
100. 14:00 form of psychosis to unwanted sexual advances. But here’s the surprise. They react exactly the same way with psychopathy
101. 14:12 and psychosis. Also, when they are interested in someone sexually, when their fervent sexual interest is not reciprocated, when they want someone
102. 14:25 and they are rejected by that person. In the footsteps of Martin, 1971,
103. 14:32 the three authors explicitly attribute such decompensation and acting out in
104. 14:38 some cases to oral narcissistic structures in the personality and to immature object relations. In other words, what the three authors postulate is that in women with borderline personality disorder, they
105. 14:54 are internal narcissistic structures which cause the borderline to
106. 15:01 decompensate and to act out sometimes psychopathically to sexual rejection or to unwanted sexual advances. In both cases, I would
107. 15:14 add to this list women who succeed actually to bed to have sex with the men
108. 15:21 that they desire but are then abandoned or ignored emotionally contrary to their
109. 15:28 wishes and fantasies. So, three cases. If there’s unwanted sexual advance, if
110. 15:35 the woman is interested in sex, but the man is not, or if they both end up having consensual sex, but then the man dumps her, vanishes, abandons her, and ignores her emotionally. In all three cases, there is a process of decompensation. All the defense
111. 15:52 mechanisms are switched off. and acting out. Acting out means reckless behaviors
112. 16:00 uh such as unprotected sex or binge drinking or reckless driving or a
113. 16:06 shopping spree. And many of these behaviors today can be described as secondary psychopathy. the connection between brief reactive
114. 16:18 psychotic episodes and symptomatic manifestations of dissociation including amnesia and even dissociative identity disorder. This connection is well established.
115. 16:30 Say for example the definitive work dissociation and the dissociative disorders DSM5 and beyond edited by Dell
116. 16:37 and O’Neil published by Rutlage in 2009.
117. 16:43 So when these women borderline women disintegrate under stress or trauma or pain or anticipation or abandonment anxiety when there is this process of decompensation and disintegration the transition to dissociative psychosis is
118. 16:58 abrupt and shocking. It resembles switching from the core personality the
119. 17:05 host personality to an alter alternative personality in multiple personality
120. 17:11 disorder. Patients describe it as brain fog. Though they may appear to be perfectly oriented and goal focused, very often
121. 17:22 you can’t tell from the outside that this is happening to the inside. On such occasions, behavior changes marketkedly, becomes disorganized and
122. 17:33 then escalates to become aggressive, impulsive, disempathic, reckless, promiscuous and antisocial. So while you can’t very often one cannot
123. 17:45 tell when the switch switching took place after the switching had taken
124. 17:51 place a new personality emerges and takes over and this personality as
125. 17:57 you’ve just heard is a psychopath. Amnesia sets in much later and its aim
126. 18:05 is to repress painful and acutely uncomfortable egodistonic memories which
127. 18:11 had they remained in conscious awareness would have provoked extreme shame, extreme guilt and remorse. Where amnesia or fear where amnesia is
128. 18:23 absent the borderline woman undergoes depersonalization and derealization.
129. 18:29 She feels that she was acting as an observer on autopilot.
130. 18:36 Substance abuse such as binge drinking or getting stoned, as I said before,
131. 18:42 exacerbates all these mental health issues and defenses. More generally, I’ve been arguing in the past few years to reverse Kernberg’s
132. 18:53 hierarchy, Otto Kernberg. He suggested a hierarchy whereby border lines are closer to psychosis than narcissist. I postulate that the narcissist is far
133. 19:05 closer to psychosis. His personality is less organized than the borderline. Only the narcissist’s rigid grandiosity is keeping the narcissist together. And
134. 19:18 when this grandiosity is effectively challenged, the narcissist decompensates, acts out and
135. 19:24 disintegrates. Grostein postulated that the borderline
136. 19:30 is a failed narcissist. The pathology did not progress or devolve into
137. 19:36 narcissism, which is a full-fledged form of binary dissociative identity disorder with two selves, the false and the true.
138. 19:47 The narcissist’s solution to this duality of selves, the narcissist’s solution to having multiple personality
139. 19:54 disorder with two selves, true and false, his solution is to switch off the
140. 20:00 dilapidated, atrophied and dysfunctional true self, and to relegate the true self to the deepest recesses of the mind where it has no influence whatsoever on the narcissist psychonamics. So what is
141. 20:13 left? The false self. only the false self is left and this is the narcissist. In contrast,
142. 20:21 the borderline fails to repress and dissociate the true self. Where the narcissist succeeds to eliminate effectively the true self, the borderline fails. Consequently, she
143. 20:35 never becomes a narcissist. And this so-called failure causes the border lines two selves, the true and the false to compete for control of her identity
144. 20:46 and her memories. There is no such competition with in the narcissist. The narcissist is the false self. Take away the false self and there’s nobody there,
145. 20:57 nobody home. With the borderline, there are two selves in conflict in battle.
146. 21:05 It is this inner struggle that mimics other dissociative disorders and led
147. 21:12 scholars such as Masterson, Dell, Putnham, Ross, Riyle, and many others to
148. 21:19 suggest that borderline personality disorder may merely be another label for the identity diffusion and alteration common in dissociative disorders.
149. 21:30 So what we have in a borderline is a dissociative psychopath.
150. 21:36 A dissociative psychopath usually with the pronounced grandiosity of the narcissist and the seductiveness and flutatiousness of the histrionic when
151. 21:48 they are provoked by abandonment anxiety. Borderline personality disorder is a
152. 21:54 basket diagnosis. It is a diagnosis that unites all cluster B diagnosis
153. 22:01 and its foundation is in trauma. Therefore,
154. 22:07 via the conduit of borderline personality disorder, we can be begin to see a unifying picture. These are all post-traumatic conditions
155. 22:18 and they all involve forms of all pervasive ubiquitous dissociation.
156. 22:26 We are getting a sniff. We’re getting a hint of the future. The future will center around trauma and dissociation. Psychopathy,
157. 22:37 borderline, narcissist, these are difference, different
158. 22:43 uh behavioral modalities. They are not real clinical constructs. This is exactly what led to the abnormal phenomenon of co-orbidity.
159. 22:55 This is precisely why we had to make laundry leaves which over overlapped so massively that we had to invent
160. 23:01 differential diagnosis because these are not real clinical entities. They are simply facets of the caladoscope that is the soul of a cluster B.
161. 23:13 Borderline is another name for dissociation post-traumatic dissociation.
162. 23:20 And some border lines act as psychopaths, others act as narcissists.
163. 23:26 And all of them usually act as histrionic. It’s time to unify all these diagnosis
164. 23:33 into a single one. A diagnosis of personality disorder with emphasis.
165. 23:41 Personality disorder with grandio emphasis, with psychopathic or
166. 23:47 antisocial emphasis, with histrionic emphasis, and with disregulated
167. 23:53 emphasis, formerly known or called borderline.
168. 24:06 I’m Sam Vatmin and I’m the author of Malignant Self- Love Narcissism Revisited.
169. 24:12 A sizable minority of narcissists are women. I keep using the male third
170. 24:18 person because most narcissists about 3/4 are males, but more importantly
171. 24:24 because there is little difference between the male and female narcissists. in the manifestation of their narcissism. Female and male narcissists inevitably do tend to differ. They
172. 24:36 emphasize different things. They transform different elements of their personalities and and of their lives
173. 24:42 into the cornerstones of their disorder. Women, for instance, concentrate on their body. Many also suffer eating
174. 24:51 disorders. Women flaunt and exploit their physical chance, their sexuality, their socially
175. 24:57 and culturally determined femininity. They secure the narcissistic supply through their more traditional gender role, the home, children, suitable
176. 25:08 careers, their husbands, their feminine traits, their roles in society, etc., etc. It is no wonder that narcissists, both
177. 25:19 men and women, are chauvinistic and conservative. They depend to such an extent on the opinions of people around them that with time they are transformed
178. 25:30 into ultra sensitive sesmographs of public opinion, barometers of prevailing
179. 25:36 social fashions and guardians of conformity. The narcissist cannot afford to
180. 25:42 seriously alienate his constituency, the people who reflect his false self back
181. 25:48 at him. The very proper and ongoing functioning of functioning of the narcissist personality depends on the
182. 25:56 goodwill and on the collaboration of his human environment. It is true that besieged and consumed by pernicious guilt feelings, many narcissists finally seek to be punished.
183. 26:09 The self-destructive narcissist then plays the role of the bad guy or bad girl. But even then it is within the
184. 26:16 traditional socially allocated roles. To ensure social approates
185. 26:26 these roles of bad girl and bad guy to a caricature. A woman is likely to label herself a and a male narcissist to
186. 26:37 self-style himself a vicious unrepentant criminal. Yet these again are actually
187. 26:44 traditional social roles. Men are likely to emphasize intellect, power, aggression, money or social status. Women are likely to emphasize body, looks, charm, sexuality, feminine
188. 26:57 traits, homemaking, children and child rearing. even as they seek their mazoistic management. Another difference between male and female narcissist is in the way the
189. 27:08 genders react to treatment. Women are more likely to resort to therapy because
190. 27:14 they are more likely to admit to psychological problems. But while men may be less inclined to disclose or to
191. 27:22 expose their problems to others, macho men, it doesn’t necessarily imply that men are less are less prone to admit it to themselves. Women are also more likely to ask for help than men
192. 27:34 generally. Yet, the prime rule of narcissism is never forgotten. The narcissist uses
193. 27:41 everything around him or her to obtain his or her narcissistic supply.
194. 27:47 Children happen to be more attached to the female narcissist owing to the way our society is still structured and to
195. 27:54 the fact that women are the ones to give birth. It is easier therefore for a woman to think of her children as
196. 28:01 extensions because they once indeed were her physical extensions and because her ongoing interaction with them is both more intensive intensive and more extensive. This means that the male
197. 28:13 narcissist is more likely to regard his children as a nuisance than as a source of rewarding narcissistic supply. That
198. 28:20 is especially true as they grow older, become autonomous, and critical. Devoid of the diversity of alternatives available to men, narcissistic women fight to maintain their most reliable
199. 28:32 source of supply, their children. Through insidious indoctrination, guilt
200. 28:38 formation, emotional sanctions, deprivation, emotional blackmail and other psychological mechanisms, women narcissists try to induce in their children dependence which cannot be
201. 28:50 easily unraveled. But when we tackle the foundations of
202. 28:57 narcissism, when push comes to shove, in a way there is no psychonamic difference between
203. 29:04 children, money, intellect, possessions, positions, they all sources of narcissistic supply. So there’s no psychoamic difference between male and female narcissists.
204. 29:16 They simply choose different sources of supply, but it doesn’t make them different. The only real difference between them is as I said in their choices of n of sources of narcissistic supply. All other facets are literally identical.
205. 29:33 There are mental disorders which affect and afflict specific sex more often than
206. 29:39 not. This has to do with hormonal or physiological dispositions, with social cultural conditioning through the socialization process, and with role assignment through the gender
207. 29:50 differentiation process. But none of these seem to be strongly correlated to the formation of malignant narcissism.
208. 29:58 Narcissistic personality disorder as opposed for instance to borderline or histrionic personality disorder.
209. 30:06 Narcissistic personality disorder seems to conform to social mores and to the prevailing ethos of capitalism. Social
210. 30:14 thinkers like Christopher Lash and even Theodor Millan speculated that modern American culture in narcissistic ambitious individualistic and self-centered one increases the rate of
211. 30:25 incidence of narcissistic personality disorder among both males and females.
212. 30:31 As Kernburgg observed, the most I would be willing to say, he said, is that
213. 30:38 society can make serious psychological abnormalities which already exist in some percentage of a population seem to
214. 30:45 be at least superficially appropriate.
215. 30:54 We have all had the misfortune of coming across these types. The hyper muscular
216. 31:00 gym rat who is also over emotional and whiny and hypochondric.
217. 31:07 The flirtatious woman who aggressively flings herself at anything that moves
218. 31:14 and then becomes hysterical when rebuffed. These are the cliches or the stereotypes
219. 31:21 of histrionic personality disorder. And today we are going to review the cutting
220. 31:28 edge, bleeding edge, no pun intended, of the literature. The most recent studies
221. 31:35 in the past five years are threatening to upend our perception of histrionic
222. 31:41 personality disorders. We’ve gone through a cycle. We started by considering histrionic personality
223. 31:48 disorder as a form of narcissism and then we transitioned and there were scholars who suggested that histrionic personality disorder is a form of female psychopathy and today we are coming back more or less full cycle back into narcissism
224. 32:07 territory and a few added very fascinating features.
225. 32:14 So stay with me. My name is Sam Baknin. I’m the author of malignant self-love, narcissism revisited, a former visiting
226. 32:20 professor of psychology and currently a professor of psychology and of management studies in seps.
227. 32:28 Histrionic personality disorder. It is sometimes also called the dramatic
228. 32:35 personality disorder. It’s a cluster B uh disorder and it’s characterized by a
229. 32:42 pattern of exaggerated attention seeking behaviors and emotionality.
230. 32:49 Now this is an artificial distinction because the histrionic uses ostentatious
231. 32:57 in yourrface emotionality in order to attract attention.
232. 33:03 So the histrionics emotionality is largely an instrument, a way to
233. 33:09 manipulate the environment and extract favorable outcomes.
234. 33:15 The self-efficacy of the histrionic relies on the externalization
235. 33:22 of her emotions, the exaggeration of her feelings, and the communication of these
236. 33:28 inner steerings and processes to an unwilling usually audience or crowd.
237. 33:35 She’s a performer. He is an actor. Now, we don’t have exact statistics. The
238. 33:42 belief was that vast majority of people with histrionic personality disorder are women. That gender bias is long behind us. And today we believe that it’s more
239. 33:53 or less 50/50. To remind you, other cluster B personality disorders include antisocial
240. 34:00 personality disorder, the extreme form of which is known as psychopathy, borderline personality disorder, which
241. 34:07 has a self state as a secondary psychopath. When the borderline is exposed to stress or to anxiety or to
242. 34:15 rejection or to humiliation or to abandonment, real or anticipated and narcissistic personalities or all
243. 34:22 these are known as the excitable, erratic, dramatic or volatile cluster.
244. 34:32 In short, the kind of people you want as your friends, as your spouses, and as
245. 34:39 your colleagues. All right, Shanim, that was a joke, of course. Now, patients
246. 34:46 with histrionic personality disorder exhibit unique behaviors. They can be charming and often are. They’re always flirtatious. They’re lively. They’re the life of a
247. 34:58 party. They’re manipulative. and even sometimes mavelian and they’re always
248. 35:05 seductive but some of them are flirtatious and seductive by
249. 35:13 displaying sexual behavior that is known as hypersexualized behavior
250. 35:20 by acting flirtatious by signaling availability sexual availability.
251. 35:26 Although studies have repeatedly demonstrated that people with histrionic personality disorder hate sex, believe
252. 35:34 it or not, still they use sexual signaling in order to attract attention
253. 35:42 and to conquer the element of chase and conquest are very important in
254. 35:48 histrionic personality disorder. But there’s a subgroup of histrionics who attract attention
255. 35:55 by emphasizing their neediness, their helplessness.
256. 36:01 They elicit the savior or the fixer complex in other people.
257. 36:08 They pretend to be in need of some service or some rescue or some input.
258. 36:18 And this way they emotionally blackmail people around them into submission and
259. 36:25 collaboration. Patients with personality disorder
260. 36:31 um therefore are not monolithic. This is not a monolithic disorder. You
261. 36:37 could find many varants. But what is common to all these behaviors sometimes diametrically
262. 36:43 opposed behaviors is attention. the garnering of attention, the
263. 36:49 processing of attention, the manipulation of attention, the um interactions that involve an
264. 36:57 exchange of attention. It’s the attention economy in effect. Okay. Now, histrionic personality disorder emphasizes the body. Emphasize
265. 37:08 the body because body equals sex and sex equals attention. Also these kind of
266. 37:15 people somatize somatize emotions. They display emotions via bodily uh gestures, bodily uh body
267. 37:26 posture, post posture and body language. It is not a surprise therefore that histrionic personality disorder is intimately linked with somatform
268. 37:38 disorders and has important coorbidities with other disorders other mental health
269. 37:45 disorders which have to do with the body. It’s a body complex in effect.
270. 37:51 So there’s been a recent review and it tried to find whether there’s any connection between histrionic personality disorder and race, racism or
271. 38:02 gender bias in diagnosis. Um and the belief is that we tended in
272. 38:11 the past well into the 1980s or 1990s we tended to group mental health
273. 38:17 disorders according to gender and sometimes according to race but definitely according to gender. So for
274. 38:23 example we held we held the belief that borderline personality disorder is emotional dysregulation. U there are
275. 38:32 this disorder is common among women. It’s a female disorder. Similarly
276. 38:38 histrionic personality disorder was perceived to be a woman’s business a woman’s issue and narcissism was male.
277. 38:46 And so recently we’ve been unwinding this gender bias. The survey indicated, the review
278. 38:53 indicated that gender bias does occur in the diagnosis of histrionic personality
279. 38:59 disorder as well as by the way in ADHD, attention deficit, hyperactivity
280. 39:05 disorder, and in autism spectrum disorder. In all of these, there’s gender bias. And the study is uh was
281. 39:13 authored by Garb GB entitled race bias and gender bias in the diagnosis of
282. 39:19 psychological disorders. It was published in clinical in the journal clinical psychology. Now in the
283. 39:25 description which is still under the video in the description you will find the literature um a list of the articles I’ve relied on to produce this video.
284. 39:38 The results of this uh review indicated that race bias occurs in the diagnosis
285. 39:45 of eating disorders, comorbid mood disorders and substance abuse,
286. 39:51 post-traumatic stress disorder and the differential diagnosis of psychotic effective disorders and schizophrenia.
287. 39:59 But there was no race bias uh when it came to histrionic personality disorder only gender bias. The researchers found that racialized manifestations of
288. 40:10 symptoms such as black cultural expressions of depression, blacks express depression differently to whites for example. The clinical interpretation of these um behaviors and these displays
289. 40:24 and these outward signs and symptoms, these critically affect diagnosis
290. 40:33 there. So there’s no cultural sensitivity and there’s no gender sensitivity in diagnosing.
291. 40:39 The research also indicated that it might be possible to decrease bias by using self-report measures including
292. 40:46 psychological tests, mental health screening, structured interviews, and statistical prediction. But we are very
293. 40:53 far from it at this stage. The diagnosis of personality disorder should include
294. 40:59 training in cultural diversity, dimensional ratings, debiasing strategies, but again, we’re very very far from it. So this is point number one. Histrionic personality disorder is
295. 41:11 most probably equally represented among men and women. But we don’t have
296. 41:17 sufficient data to support this contention or this assumption because we
297. 41:23 have been gender biased when we diagnose people. If a man presented with all the
298. 41:31 signs of histrionic personality disorder, it is like the person the man would have been likely diagnosed with
299. 41:37 narcissism. Whereas if a woman presented with these signs and symptoms, she would likely have been diagnosed with borderline or histrionic personality disorder. Next,
300. 41:48 there was a prospective follow-up study to this and it aimed to report the presence of categorical and dimensional
301. 41:55 personality disorders, including histrionic personality disorder, in adults with long-standing eating
302. 42:01 disorders lasting more than 17 years. and to investigate whether changes in
303. 42:07 personality disorder symptoms predict changes in symptoms of eating disorders and so on. So in short this follow-up study tried to find the connection
304. 42:18 between histrionic personality disorder and eating disorders. Now intuitively
305. 42:25 we would tend to assume that people with histrionic personality disorder which is essentially a somatic disorder. It’s a
306. 42:32 disorder that makes use of the body in order to manipulate the environment and regulate the regulate internal processes
307. 42:40 in the patient. So we would tend to assume that a personality disorder so
308. 42:46 focused on the body would be linked to and to eating disorders would be linked
309. 42:52 to sumatophhone disorders. The study was authored by Ison Vel Hoffart and others
310. 43:00 and it’s titled reciprocal relationships between personality disorders and eating disorders in a prospective 17-year
311. 43:08 follow-up study. It was published in the international journal of eating disorders. Again, literature in the
312. 43:15 description. What they found is that high level high levels of personality disorders were predictive of eating
313. 43:23 disorders but this association was strongest not for histrionic personality
314. 43:29 disorder but for borderline personality disorder. In other words, border lines
315. 43:35 were much more likely to have eating disorders than histrionics. Surprisingly, although histrionics tend to be far more invested in diet
316. 43:48 fads, cosmetic surgeries, plastic surgeries, you name it. The border lines
317. 43:54 are the ones who engage in eating disorders. And possibly one of the
318. 44:00 reasons is that eating disorder is a form of reasserting control over one’s
319. 44:07 life. And the borderline feels that her life is out of control and so she can’t
320. 44:13 control her life but she can control her food intake which is a great definition
321. 44:19 of an eating disorder. Where the association was observed in patients with histrionic personality disorder. The researchers in this uh study saw that long-term treatment
322. 44:34 reduced both eating disorder symptoms and personality disorder symptoms. And
323. 44:40 this was in line with other studies over the past two decades where we found out
324. 44:47 that when you treat one of of the pair of coorbidities, it has an effect on the
325. 44:54 other member of the pair. So if you have a patient with two diagnosis, three diagnosis, six diagnosis, if you treat
326. 45:01 one or two of them, the others also get better, also get ameliorated even if you
327. 45:08 did not treat them specifically. It’s a very interesting uh trend or or
328. 45:14 discovery. Again, the only exception was borderline personality disorder, which is totally
329. 45:20 resistant to treatment. So we know by now that um narcissistic
330. 45:27 personality disorder is resistant to treatment. But we are finding out that
331. 45:33 when we treat coorbidities when we treat situations where the same person is diagnosed with multiple
332. 45:40 personality multiple mental health issues borderites are most resistant.
333. 45:47 When there is narcissistic personality disorder in conjunction with other mental health issues, it’s possible to
334. 45:54 treat the other mental health issues. For example, obsessivecompulsive disorder, depression. We can treat these
335. 46:01 in narcissists. We cannot touch the narcissist the the pathological core of narcissism, but we can touch the coorbidities. With border
336. 46:12 lines is exactly the opposite. We can treat the core of borderline the engine of borderline personality disorder. We have treatment modalities which are very efficient and efficacious
337. 46:24 with borderline personality disorder for example DBT but we fail to treat the
338. 46:30 coorbidities. It seems that the borderline is emotionally invested in
339. 46:36 her other mental health disorders. A borderline with it and eating disorder
340. 46:42 would be emotionally invested in the eating disorder, but she would like to get rid of the borderline disorder and
341. 46:49 that’s why treatment is successful there and a failure here.
342. 46:55 There was an exploratory analysis uh which investigated possible differences in medical and psychosocial parameters
343. 47:02 between patients with uh vaginismos and patients with other sexual symptoms
344. 47:08 among uh various uh female patients. So women came uh to clinics and they
345. 47:16 reported sexual dysfunctions. Vagonismus uh was one of them and this was compared
346. 47:24 uh to the prevalence of histrionic personality disorder in this population
347. 47:30 in this cohort. The studies titled psychobiological correlates of vaginismas
348. 47:36 an exploratory analysis. It was published in the journal of sexual medicine. the authors of Maseroli, the
349. 47:42 lucky authors, Amasaroli, Scavlo, Chikuyani and other Italians and the researchers found no differences for traditional risk factors such as a
350. 47:53 history of gynecologic diseases, sexual abuse or relational parameters or even
351. 47:59 for newly investigated parameters such as hormonal, neurological or metabolic alterations. None of these had any
352. 48:07 predictive value, but they did find that patients with vaginismos
353. 48:13 showed significantly higher histrionic hysterical symptoms. Vaginismos, as I’m
354. 48:20 used to pronouncing it, Vaginismos seems to be connected to histrionic
355. 48:26 personality disorder, or at the very least to somehic traits and behaviors or
356. 48:32 hysterical traits or behaviors compared with other sexual symptoms. After adjustment for age, patients with vaginismos had significantly higher
357. 48:43 total scores on the female sexual function index and female sexual distress scale revised. It is known as the FSDS. The FSDA’s total score increased with the duration of ainismos in age related
358. 49:00 in age adjusted model. So the problem tends to exacerbate with age. It doesn’t
359. 49:06 become better, becomes worse. The researchers concluded that histrionic traits should be investigated as novel
360. 49:15 contributions or contributors to vaginismus and other forms of sexual dysfunction and that histrionic traits
361. 49:22 as a psychological coorbidity could offer clinicians valuable insights for
362. 49:28 managing complications in patients experiencing vaginismos and other sexual dysfunctions. You remember what I told
363. 49:34 you earlier? I told you that people with histrionic personality disorder dislike sex. And one of the reason they dislike
364. 49:42 sex is the fact that they suffer from multiple sexual dysfunctions. Some of which like vaginismus are highly painful and that of course applies only to
365. 49:54 women. At this stage only women have vaginas. Um
366. 50:00 now there was another study aimed to estimate the extent of overlapping ethiology between response to caf caffeine consumption coffee coffee consumption or coke Coca-Cola
367. 50:13 consumption and normative pathological personality. You see psychologists are going everywhere. Is coffee consumption related to histrionic personality disorder? is sexual dysfunction related? Is there anything else we’ve missed? They’re
368. 50:30 trying to form an integrity view of histrionic personality disorder and other mental health issues. Anyhow, this
369. 50:38 particular study focused on uh caffeine, coffee, Coca-Cola, other drinks, um
370. 50:46 energy drinks with caffeine and so on. The researchers found that caffeine
371. 50:52 uh was somehow moderately
372. 50:58 u related to personality disorder. But I’ll try to explain how. The first thing the the these scholars these researchers established is that caffeine measures
373. 51:10 including for example caffeine tolerance are moderately heritable. There is a
374. 51:16 genetic component in how we react to caffeine and that all four personality traits
375. 51:23 antisocial, borderline, dependent, and paranoid are significantly associated
376. 51:29 with at least one caffeine variable. Now it’s very difficult to tell whether
377. 51:36 people who are antisocial, borderline dependent and paranoid consume caffeine
378. 51:43 or whether the caffeine created some changes in the brain or elsewhere and induced mental illness or
379. 51:52 whether there’s a third factor unknown at this stage which creates both
380. 51:58 caffeine tolerance or caffeine interactivity and personality disorders. We don’t know
381. 52:05 yet. They found that a small proportion about 11% of the variance in caffeine
382. 52:11 consumption was attributable to genetic factors shared with personality disorders. So it seems you have the same
383. 52:18 genes for personality disorders and for caffeine consumption. And histrionic personality disorder was
384. 52:25 the only exception. Amazingly, it was not linked to any caffeine related behaviors, which I’m sure is a sigh of
385. 52:33 relief. Even if you’re histrionic, at least you’re not addicted to caffeine.
386. 52:39 You know, thank God for Oh, thank the researchers for small favors.
387. 52:46 Antisocial personality disorder was linked to higher daily use of coffee or consumption of coffee. And both antisocial and borderline personality disorders were linked to caffeine
388. 52:58 toxicity. Borderline personality disorder was linked to caffeine tolerance. Caffeine seems to be somehow
389. 53:06 connected to personality disorders via some kind of genetic conduit or genetic channel. It’s not clear at all at this stage. And to another study, a population-based
390. 53:18 twin study. My favorites, my favorite studies are randomized trials on twins,
391. 53:26 especially identical twins. The identical twins are basically copies of the same person, clones. So we can forget the genetic part and focus on the
392. 53:37 environment, forget nature and focus on nurture. So twin studies are far more
393. 53:43 valuable in my view than any other type of study in psychology. So here’s a study population of twins which aimed to determine which personality disorder traits were linked phenotypically and genetically to cocaine use from caffeine
394. 54:00 to cocaine. Who knows what’s next? So the study was offered by Guillispy, Aen,
395. 54:08 Gentry and others, many others, and it’s titled testing genetic and environmental
396. 54:15 associations between personality disorders and cocaine use, a population-based twin study, and it was
397. 54:21 published in um a journal, academic journal dedicated to twin studies, uh
398. 54:27 twin human genetics. Again, in the literature, you can find a reference to the study.
399. 54:34 Not so surprisingly, the researchers discovered, presumably not under the influence of coke, they discovered that
400. 54:42 having antisocial and borderline personality disorder traits, these were significant predictors of cocaine use. If you were a psychopath or even if you
401. 54:53 had only were diagnosed only with antisocial personality disorder, this would explain 72% of the reason why you
402. 55:01 are using coke. There’s no need for any other input or parameters.
403. 55:09 Socioeconomic, education, upbringing, family background. None of these were remotely
404. 55:16 as important in explaining why you are using coke as the fact that you have
405. 55:22 antisocial personality disorder. 72%. Similarly, someone with borderline
406. 55:28 personality disorder. Borderline personality disorder in itself accounted
407. 55:34 for 25% u of the explanation for cocaine use. In
408. 55:42 other words, if you were if you were diagnosed with antisocial personality disorder or borderline personality
409. 55:48 disorder, you were more likely to use coke to use cocaine,
410. 55:55 much more likely if you’re antisocial and considerably more likely if you were
411. 56:01 borderline. The total genetic risks, the predisposition, the predictability of cocaine use increased dramatically with the
412. 56:13 diagnosis of antisocial and borderline uh personality. There was a modest correlation of genetic risks also in histrionic personality disorder but it
413. 56:25 was not related to cocaine use. We are beginning to see that people with histrionic personality disorder contr
414. 56:33 myths and stereotypes are actually not prone to substance
415. 56:39 abuse. Antisocial people with antisocial personality disorder and people with borderline personality disorder are prone to substance abuse. They abuse co they
416. 56:51 abuse caffeine. They abuse coke cocaine. They abuse drugs. They abuse alcohol.
417. 56:57 But this is not common among people with histrionic personality disorder.
418. 57:03 And this, of course, flies in the face, defies everything we thought we knew about histrionic personality disorder. And finally, there’s a clustering
419. 57:14 analysis published u that aimed to empirically classify patients with
420. 57:21 internet gaming disorder on the basis of personality variables and describe the
421. 57:27 resulting groups in terms of social demographic and clinical um strata. So
422. 57:33 the study is titled uh internet gaming disorder clustering based on personality traits in adolescence and its relation
423. 57:41 with comorbid psychological symptoms. The authors are Gonzalez buo Santa Maria
424. 57:47 and others and the researchers observed that patients were grouped in two clusters of
425. 57:54 high and low comorbid symptoms. Patients with histrionic traits were in the
426. 58:00 cluster with low comorbid symptoms. And this was this is again very
427. 58:07 interesting. It flies in the face of our common popular misperceptions of
428. 58:13 histrionics. We think histrionics are loose. We think histrionics are out of control. We think histrionics are
429. 58:20 disinhibited. Actually, the emerging picture is that histrionic personality
430. 58:26 disorder is a form of rigid self-control,
431. 58:32 not substance abuse, no internet um addiction. These are people who are goal
432. 58:39 oriented, focused on obtaining attention. And the way they obtain attention is by
433. 58:46 acting hyper emotional by by ostentatiously displaying their emotions
434. 58:52 and by being seductive and flirtatious. It begins to look indeed as a variant of
435. 59:01 machavelanism as a kind of dark personality albeit not psychopathic. So it was a mistake to consider histrionic as a psychopathic disorder.
436. 59:13 But it is not a mistake to consider histrionic as a kind of dark personality because histrionics have narcissistic components, psychopathic behaviors
437. 59:25 and a lot of machavelianism. And this is a a great description of the
438. 59:32 dark triad personality. There was a recent study aimed to to
439. 59:38 detail how sexual abuse, physical or emotional neglect and other forms of childhood trauma known as adverse
440. 59:44 childhood experiences. How these might influence histrionic personality pathology relative to others. So the
441. 59:53 study is child abuse and neglect uh on histrionic personality path. The influence of child abuse and neglect on histrionic personality pathology. The authors are Yal, Cerrone and others. And
442. 60:06 it was published in the journal of trauma and dissociation. Again, all the links and all the references and all the
443. 60:12 bibliography and the literature in the description. What they found is that sexual abuse was the strongest predictor
444. 60:20 and that women and men who experienced sexual abuse as children were more likely to exhibit histrionic personality
445. 60:27 traits. But they also found that physical neglect was linked to histrionic personality traits in adult women. Whereas emotional abuse and neglect
446. 60:38 along with physical abuse were all linked to histrionic personality traits in men. Different ideologies, same
447. 60:45 outcome. They concluded that different clinical interventions might have
448. 60:51 varying levels of success. success for adults with histrionic personality pathology based in part on
449. 60:58 the differences observed in this study and a cross-sectional study aimed to investigate whether rash impulsiveness impulsivity and features of each of the
450. 61:10 cluster B personality disorders including histrionic personality disorder were linked by positive alcohol
451. 61:16 expecties and indirectly associated with alcohol use severity.
452. 61:23 This is a study titled cluster B personality disorder traits and impulsivity indirect associations with
453. 61:29 alcohol use severity through positive alcohol expecties. And so what they discovered was that traits specific to each cluster B
454. 61:40 personality disorder and impulsivity were indirectly associate indirectly
455. 61:46 associated with alcohol use severity through positive alcohol expectancies both uniquely and together. And this demonstrates that positive alcohol
456. 61:57 expecties can connect people with personalities at risk for impulsive behavior.
457. 62:03 They found that positive alcohol expectancies might be more important to increased risk for more severe alcohol
458. 62:11 use in patients with histrionic traits. In other words, people with histrionic
459. 62:17 personality disorder or histrionic traits who favored alcohol, who expected alcohol to have some favorable outcomes. positive alcohol expectancy were more
460. 62:28 likely to use alcohol and were more likely to use it severely overuse it.
461. 62:35 The current findings showed that patients with borderline histrionic and narcissistic personality disorder traits
462. 62:41 were less rationally impulsive but remained at risk for increased alcohol use severity owing to other forms of
463. 62:48 impulsivity such as negative urgency, agreeableness, excitement seeking extraversion or neuroticism.
464. 62:56 These findings did not extend to patients with histrionic personality disorder traits. gain. In other words,
465. 63:04 these patients were uniquely vulnerable to rationally impulsive behavior, especially those driven by positive
466. 63:11 alcohol expectancies. And it is exactly this that ties the knot.
467. 63:17 The the person with histrionic personality disorder internally
468. 63:23 is disregulated, impulsive, maybe even reckless. Histrionic personality disorder seems to be a rigid reaction to this. An attempt
469. 63:36 to discipline the internal turmoil to regain control internally by gaining
470. 63:43 control over other people externally. And this is done in a highly ritualized
471. 63:49 manner a bit reminiscent of compulsion obsessive compulsive. So, and the ritual
472. 63:58 involves manipulation via seduction and flirtation,
473. 64:04 emotional blackmail, hyper emotionality, displays of neediness and so on,
474. 64:11 coupled with u conquest or chase or subjugation
475. 64:20 of the other. So, it’s a power play. IC personality disorder has nothing to do with sex. It
476. 64:27 has to do with power. The histrionic attempts to uh abscond with the power of others to gain power over others as a way to
477. 64:40 self-regulate and regain power over herself or
478. 64:46 himself.