Psychological Repor&, 1990, 66, 835-838. O Psychological Reports 1990
HISTRIONIC DISORDER AMONG IRANIAN HIGH SCHOOL AND COLLEGE STUDENTS ' AZAR MAKAREMI Shiraz Universio Summary.-This study was designed to explore the sex and group Uferences in histrionic personalities of high school and university students, and also to explore the results of this study with those of Crown and Crisp from 1966 in England. A sample of 160 high school students (80 girls and 80 boys) were selected randomly from four high schools in Shiraz and Shiraz University. The mean ages for high school girls and boys were 15.3 and 17.3 yr., for university women and men were 20.6 and 23.2 yr., respectively. The hysteria (H) scale of the Middlesex Hospital Questionnaire was used. The questions of this scale refer to histrionic personality according to DSM-I11 and DSM-111-R. Analysis showed significant effects of group (h~ghschool, college) for histrionic personality disorder. It was concluded that more histrionic personality disorders were reported among British college students than among their Iranian peers.
There have been arguments about histronic personality and hysteria since Hippocrates described it 2400 years ago. For example, Bowlby (1) considered conversion hysteria and histrionic personality as two different disorders. Also, Chodoff and Lyons (3) stated five different uses of the term hysteria: (a) a personality or character type, (b) a conversion reaction, (c) a psychoneurotic disorder characterized by phobia and anxiety, (d) a particular type of underlying psychopathological pattern, and (e) a term of opprobrium. In DSM-111 hysteria is referred to conversion reactions such as hernianesthesias, glove and stocking areas of sensory loss, monocular or binocular blindness, seizures, aphonia, paresis of a limb or limbs of which the core of this abnormality is anxiety. O n the other hand, hysterical or histrionic personality is characterized under personality disorders. Personality disorders are learned behaviors (7). In both DSM-111 and DSM-111-R the following criteria are diagnosed for histrionic persondty: self-dramatization and exaggerated expression of emotions, craving for activity and excitement, emotional excitability in response to minor stimuli, capricious, immature, selfcentered, often vain and prone to emotional outbursts. Their provocative, attention-getting behavior appears to overlie a driving dependency need which is demanding in quality (2). Although histrionic personality disorder is more common in women, the "Don Juan" character represents this personality type in men. The drive for sexual exhibitionism and conquest often rests upon a hidden feeling of masculine inadequacy (12). Reich (13) left no doubt about the occurrence of the 'Address correspondence to A. Makaremi, Department of Psychology, College of Literature and Human Sciences, Shiraz University, Shiraz, Iran.
836
A . MAKAREMI
hysterical personality among men when he presented a man as a prototype for the hysterical character. Most subsequent descriptions of the hysterical personality have ignored this issue simply by considering only women (5, 11). Mackinnon and Michels (9) stated that hysterical personalities of both sexes exaggerate the traits that characterize normal femininity and speculated that hysterical personalities of both sexes are equally common in some cultures. They declared that in both sexes there is a strong interest in style and fashion. Among the men there may be a quality of foppishness or excessive masculinity. The main goal of this study was to investigate frequencies of histrionic personalities among high school and university students of both sexes and also to compare the results of this study in Iran with those of Crown and Crisp (4) in England.
Subjects were 160 high school students (80 girls and 80 boys) and 160 university students (80 women and 80 men), selected randomly from four high schools in Shiraz and from Shiraz University. The mean ages for high school girls and boys were 15.3 and 17.3 yr., for university women and men were 20.6 and 23.2 yr., respectively. Since failing in school happens more often for male students than female students, male high school and university students are older and have a higher mean age than the female students. The Middlesex Hospital Questionnaire (4) provides a rapid approximation for clinical psychatric diagnosis. There are 48 questions covering six groups of symptoms: free-floating anxiety, phobic anxiety, obsessive-compulsive traits and symptoms (anxiety-based hsorders), depressive symptoms (affective disorders), and hysteria scale (personality disorder according to DSMIII-R), with split-half reliabilities of .82, .73, .43, .37, .65, and .63, respectively. Since the questions for subscales, Obsession and Somatization, are fewer than the questions for other subscales, the split-half reliability is low and unreliab&ty is high. The questionnaire has been used in Middlesex Hospital in London and elsewhere (10, 15). In the present study the hysteria (H) scale of the questionnaire was given. Although this scale is called hysteria as a conversion reaction, the concept in the questions has reference to the histrionic personality according to DSM-III-R. The items of hysteria scale are: are your opinions easily influenced; have you at any time in your life enjoyed acting; are you normally an excessively emotional person; do you enjoy being the center of attention; do you find that you take advantage of circumstances for your own ends; do you often spend a lot of money on clothes; do you enjoy dramatic situations; do you sometimes find yourself posing or pretending? Four high schools were selected randomly among those in Shiraz. In
837
HISTRIONIC PERSONALITY DISORDER
each school students were randomly selected. At Shiraz University, from Colleges of Literature and Human Sciences and Educational Sciences, stuThe questionnaires were given to the dents were selected non~~stematically. subjects in group sessions. All subjects completed questionnaires except one high school boy.
RESULTS AND DISCUSSION Means and standard deviations on hysteria (H) as measured by the questionnaire for the subjects are shown in Table 1. A 2 x 2 analysis of variance was applied in which group (high school, college) and sex (male, female) were TABLE 1 MUNS AND STANDARD DEVIATIONSFORGIRLSAND BOYSO N HYSTERIASCALE Hysteria
High School ,773 --
College
M
.M .-
-773 -
Girls 8.35 3.24 7.40 3.23 Boys* 9.10 3.28 7.11 2.92 *There was insufficient data for coding the response of one high school boy.
independent variables and hysteria was the dependent variable. The two-way analysis of variance is summarized in Table 2. The main effect of group (F,.,,, = 15.45) was significant (p .05). Results indicated that histrionic
AND
TABLE 2 TWO-WAY ANALYSIS OF VARIANCE OF GROUP(HIGHSCHOOL AND COLLEGE) SW[ (BOY,G m ) x SCOREO N HYSTERIASCUE OF MIDDLESEX HOSPITALQUESTIONNAIRE Source
df
MS
SS
F
Sex, boy, girl Education group, high school, university Interaction: group by sex Within groups
1 1 1 315
1.96 155.40 16.65 10.06
1.96 155.40 16.65 3169.01
0.19 15.45* 1.65
*p
HISTRIONIC DISORDER AMONG IRANIAN HIGH SCHOOL AND COLLEGE STUDENTS ' AZAR MAKAREMI Shiraz Universio Summary.-This study was designed to explore the sex and group Uferences in histrionic personalities of high school and university students, and also to explore the results of this study with those of Crown and Crisp from 1966 in England. A sample of 160 high school students (80 girls and 80 boys) were selected randomly from four high schools in Shiraz and Shiraz University. The mean ages for high school girls and boys were 15.3 and 17.3 yr., for university women and men were 20.6 and 23.2 yr., respectively. The hysteria (H) scale of the Middlesex Hospital Questionnaire was used. The questions of this scale refer to histrionic personality according to DSM-I11 and DSM-111-R. Analysis showed significant effects of group (h~ghschool, college) for histrionic personality disorder. It was concluded that more histrionic personality disorders were reported among British college students than among their Iranian peers.
There have been arguments about histronic personality and hysteria since Hippocrates described it 2400 years ago. For example, Bowlby (1) considered conversion hysteria and histrionic personality as two different disorders. Also, Chodoff and Lyons (3) stated five different uses of the term hysteria: (a) a personality or character type, (b) a conversion reaction, (c) a psychoneurotic disorder characterized by phobia and anxiety, (d) a particular type of underlying psychopathological pattern, and (e) a term of opprobrium. In DSM-111 hysteria is referred to conversion reactions such as hernianesthesias, glove and stocking areas of sensory loss, monocular or binocular blindness, seizures, aphonia, paresis of a limb or limbs of which the core of this abnormality is anxiety. O n the other hand, hysterical or histrionic personality is characterized under personality disorders. Personality disorders are learned behaviors (7). In both DSM-111 and DSM-111-R the following criteria are diagnosed for histrionic persondty: self-dramatization and exaggerated expression of emotions, craving for activity and excitement, emotional excitability in response to minor stimuli, capricious, immature, selfcentered, often vain and prone to emotional outbursts. Their provocative, attention-getting behavior appears to overlie a driving dependency need which is demanding in quality (2). Although histrionic personality disorder is more common in women, the "Don Juan" character represents this personality type in men. The drive for sexual exhibitionism and conquest often rests upon a hidden feeling of masculine inadequacy (12). Reich (13) left no doubt about the occurrence of the 'Address correspondence to A. Makaremi, Department of Psychology, College of Literature and Human Sciences, Shiraz University, Shiraz, Iran.
836
A . MAKAREMI
hysterical personality among men when he presented a man as a prototype for the hysterical character. Most subsequent descriptions of the hysterical personality have ignored this issue simply by considering only women (5, 11). Mackinnon and Michels (9) stated that hysterical personalities of both sexes exaggerate the traits that characterize normal femininity and speculated that hysterical personalities of both sexes are equally common in some cultures. They declared that in both sexes there is a strong interest in style and fashion. Among the men there may be a quality of foppishness or excessive masculinity. The main goal of this study was to investigate frequencies of histrionic personalities among high school and university students of both sexes and also to compare the results of this study in Iran with those of Crown and Crisp (4) in England.
Subjects were 160 high school students (80 girls and 80 boys) and 160 university students (80 women and 80 men), selected randomly from four high schools in Shiraz and from Shiraz University. The mean ages for high school girls and boys were 15.3 and 17.3 yr., for university women and men were 20.6 and 23.2 yr., respectively. Since failing in school happens more often for male students than female students, male high school and university students are older and have a higher mean age than the female students. The Middlesex Hospital Questionnaire (4) provides a rapid approximation for clinical psychatric diagnosis. There are 48 questions covering six groups of symptoms: free-floating anxiety, phobic anxiety, obsessive-compulsive traits and symptoms (anxiety-based hsorders), depressive symptoms (affective disorders), and hysteria scale (personality disorder according to DSMIII-R), with split-half reliabilities of .82, .73, .43, .37, .65, and .63, respectively. Since the questions for subscales, Obsession and Somatization, are fewer than the questions for other subscales, the split-half reliability is low and unreliab&ty is high. The questionnaire has been used in Middlesex Hospital in London and elsewhere (10, 15). In the present study the hysteria (H) scale of the questionnaire was given. Although this scale is called hysteria as a conversion reaction, the concept in the questions has reference to the histrionic personality according to DSM-III-R. The items of hysteria scale are: are your opinions easily influenced; have you at any time in your life enjoyed acting; are you normally an excessively emotional person; do you enjoy being the center of attention; do you find that you take advantage of circumstances for your own ends; do you often spend a lot of money on clothes; do you enjoy dramatic situations; do you sometimes find yourself posing or pretending? Four high schools were selected randomly among those in Shiraz. In
837
HISTRIONIC PERSONALITY DISORDER
each school students were randomly selected. At Shiraz University, from Colleges of Literature and Human Sciences and Educational Sciences, stuThe questionnaires were given to the dents were selected non~~stematically. subjects in group sessions. All subjects completed questionnaires except one high school boy.
RESULTS AND DISCUSSION Means and standard deviations on hysteria (H) as measured by the questionnaire for the subjects are shown in Table 1. A 2 x 2 analysis of variance was applied in which group (high school, college) and sex (male, female) were TABLE 1 MUNS AND STANDARD DEVIATIONSFORGIRLSAND BOYSO N HYSTERIASCALE Hysteria
High School ,773 --
College
M
.M .-
-773 -
Girls 8.35 3.24 7.40 3.23 Boys* 9.10 3.28 7.11 2.92 *There was insufficient data for coding the response of one high school boy.
independent variables and hysteria was the dependent variable. The two-way analysis of variance is summarized in Table 2. The main effect of group (F,.,,, = 15.45) was significant (p .05). Results indicated that histrionic
AND
TABLE 2 TWO-WAY ANALYSIS OF VARIANCE OF GROUP(HIGHSCHOOL AND COLLEGE) SW[ (BOY,G m ) x SCOREO N HYSTERIASCUE OF MIDDLESEX HOSPITALQUESTIONNAIRE Source
df
MS
SS
F
Sex, boy, girl Education group, high school, university Interaction: group by sex Within groups
1 1 1 315
1.96 155.40 16.65 10.06
1.96 155.40 16.65 3169.01
0.19 15.45* 1.65
*p
