Histrionic Personality Disorder is not an Illness

A few days ago it was reported in the media that the defense lawyers representing Jerry Sandusky, the football coach accused of sexually molesting young boys, plan to present evidence that he has histrionic personality disorder, and to argue that this should be accepted as a mitigating factor.

The logic here is sound.  Most jurisdictions accept the presence of a bona fide illness as a mitigating factor – sometimes to the point of total exculpation. Consider the case of a middle-aged man who has a heart attack while driving a car.  He passes out and the car, out of control, kills someone.  In cases like this the driver frequently isn’t even charged.

Presumably Sandusky’s lawyers will argue that the alleged offences were driven or caused by the illness histrionic personality disorder.  They cannot be faulted for trying this on, because histrionic personality disorder is listed in DSM as a diagnosis “officially” sanctioned by the APA (ostensibly an association of learned professionals).  Histrionic personality disorder, therefore, has as much “illness status” as depression or ADHD.  These latter conditions have been accepted as illnesses by the Social Security Administration, and are routinely accepted as grounds for a disability determination.

So what is histrionic personality disorder?  Here are the APA’s criteria, five of which have to be present for the “diagnosis” to be assigned:

    1. is uncomfortable in situations in which he or she is not the center of attention
    2. interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
    3. displays rapidly shifting and shallow expression of emotions
    4. consistently uses physical appearance to draw attention to self
    5. has a style of speech that is excessively impressionistic and lacking in detail
    6. shows self-dramatization, theatricality, and exaggerated expression of emotion
    7. is suggestible, i.e., easily influenced by others or circumstances
    8. considers relationships to be more intimate than they actually are

The most obvious feature of these so-called criteria is their vagueness.  Consider the first item.  How does one define “uncomfortable?”  Can it be measured?  Clearly it will have different meanings for different people. What is meant by “center of attention?”  Again, different people will interpret this in different ways.  The APA provides no protocols or procedures for sharpening these so-called criteria, and ultimately practitioners simply interpret these in accordance with their own, subjective, sense of phraseology and vocabulary.  To call these items criteria is stretching the meaning of the term.

In reading the list of “criteria,” some readers may have found themselves identifying with some items either wholly or partially.  This is because of the Barnum effect.

The best illustration of the Barnum effect occurs in many first year psychology courses in colleges all over the world.  On the first day of classes, the lecturer passes out a personality questionnaire and invites the students to complete it.  The questions concern lifestyle, preferences, etc.. He gathers up the completed forms at the end of the class and next week returns with the results.  Each student receives his or her completed personality profile, which describes their “personalities.”  The students are given a few minutes to read these, and then are asked if the reports seem accurate.  Almost always there is universal acknowledgement that the reports provide very accurate assessments of the personality of each student.  The lecturer then asks for a volunteer who might be willing to read his/her profile aloud.  Someone volunteers, and it is quickly discovered that all the “individual” profiles were identical.  The profiles consisted of Barnum statements.

A Barnum statement is a proposition that elicits agreement either by being complimentary or by being overly vague.  They are the stock-in-trade of politicians and professional marketers.  They are also to be found, tragically, in the DSM.

As mentioned above, virtually every psychology course in the world discusses the Barnum effect (or at least used to).  The compilers of DSM, however, seem to have little insight into this phenomenon – or perhaps, like professional marketers, they don’t care as long as they’re bringing in  business.

Of course, histrionic personality disorder is a spurious diagnosis.  It is simply a label for certain kinds of behavior, and not a very good label at that.  It is used by the APA to expand turf and to rope into their professional clutches increasing numbers of ordinary people with ordinary everyday problems and concerns.

DSM is a wrong turning in the history of thought.  But unlike most wrong turnings, it is not the result of an error – it is the result of blatant deception on the part of the APA.  Their objective from DSM-III onwards has been the medicalization of every conceivable human problem, even though the vast majority of these problems are not medical in nature.

The Sandusky fiasco, if media reports are accurate, is just the inevitable unfolding of the original deception.  How much longer are we going to put up with this?

  • Sweet63

    Criminal defense seems to be the primary refuge of psychoanalysis nowadays. I mean, do middle aged ladies still spend years on the psychiatrist’s couch?   It seems to be all about defending criminal behavior and medicalizing children in anticipation of future criminal behavior.

  • Phil_Hickey


    Thanks for coming in.  It’s a while now since I read Daniel Carlat’s book Unhinged, but I believe that he mentioned in there that a psychiatrist doing what they call “med checks” full-time can earn about $160,000 a year, which isn’t too shabby.  But I suspect that a psychiatrist doing criminal defense work could earn ten times that.  With “talk therapy” you can only see about six or seven clients a day.  So the earning potential is limited.

    As with so much else in our world – follow the money!

    Thanks for the comment, and best wishes.


  • Sweet63

    Well, thee APA aims to please, doesn’t it.  Need a disorder? Coming right up.

    Disorders While U Wait!  A special dispensation for all comers.   I wish I didn’t see through it, because I could probably use a few too.

  • Phil_Hickey


    Thanks for coming back.  You’re right – once you see it, you see it.