Category: Articles

QUESTION:

Dear Dr. Heller,

I have a daughter who is very ill.  What exactly is Histrionic Personality Disorder?

Thanks.

ANSWER:

The Histrionic Personality Disorder (HPD) is characterized by severe attention seeking and inappropriately excessive emotions.  They usually need to be the center of attention, can be sexually inappropriate – particularly about appearance, have rapidly shifting and shallow emotions, and are easily influenced by others.  They tend to be very dramatic, and their speech lacks details.  They tend to consider relationships to be more intimate than they actually are. The literature in Medline has shown no neurological abnormalities nor any good medical treatment for the HPD.  The HPD rarely exists by itself, and when other medically treatable diagnoses are successfully treated their histrionic nature tends to improve.  The screening test I use for my patients may be of assistance in this regard. The HPD is part of the “dramatic” cluster of personality disorders, also referred to as “Cluster B Personality Disorders”.  Some symptoms can be dramatically improved by SSRI medications like Prozac.

QUESTION:

Dr. Heller,

You are my last hope.  My son is falling apart.  He is only 16 y/o.  Last year he was attacked 7 times in one week, luckily he wasn’t hurt but since then he is totally unable to leave the house and has mass panic attacks.  He is sick at the thought of going out and is a totally changed young man.  I have spent the last few months on the phone and find it totally disgusting that no one seems to want to know.  Our doctor has just prescribed him half Inderal and referred him to a hospital again.  We have been waiting over a year to no avail.  It is breaking my heart and I find it hard to help him any more.  He is becoming suicidal as he thinks his life is over.  One main problem with the groups I have contacted is that Simon cannot go to them and they won’t come to him.  Please can you give me some positive advice.  I am terrified of what may happen.

ANSWER:

He likely has both panic disorder and post traumatic stress disorder.  There are medications that can work relatively quickly.  Usually Prozac (fluoxetine) combined with Remeron 30mg (mirtazapine) will cause a dramatic change quickly.  A benzodiazepine will likely be necessary as well.  The screening test I use for my patients may give you some clues about additional diagnoses.

QUESTION:

Dear Doctor,

I am romantically involved with a man who seems to choose lying over telling the truth for no apparent reason. I would like a more in-depth approach to the term “pathological liar” and would really like to know what, if anything, can be done to treat this disastrous disorder.

We are on the verge of breaking up due to his latest series of lies. But I would feel like a rotten individual if I am actually turning my back on a man who needs real help. He has cried hard and told me he simply cannot stop doing this and he does not understand. He wanted to break up with me to avoid hurting me any more with this absurd behavior. Please help. I need more info.

Thank you.

ANSWER:

While anxiety problems and attention deficit disorder can trigger lying, the term “pathological liar” implies a character disorder. This means the person considers lying to be a reasonable approach to life, not just an anxiety reducing behavior or acting without thinking. Currently, there is no medication or other effective treatment for lying. If the individual genuinely wants to stop this behavior, I highly recommend getting Zig Ziglar’s “How to Stay Motivated” tape series and see what happens. If the individual then disagrees with the importance of telling the truth, it’s unlikely that the behavior will change.

QUESTION:

Hi,

I don’t know quite what to look under. Well, my friends lies to us every day and it’s like when you ask her the truth she just looks at you funny and acts like a totally different person! It’s not like a once in a while–it’s like a daily thing. So I was wondering if you could tell me what to look up on it so I can help my friend!

Thank you!

ANSWER:

While those with severe anxiety and attention deficit disorder learn to lie to reduce their stress, it’s usually a “character disorder.” The screening test I use for my patients can be useful in looking for anxiety disorders and attention deficit disorder. There’s not much available at this time for character disorders.

QUESTION:

Dear Dr. Heller,

My 24 year old daughter is mentally retarded. she is on Tegretol, Paxil, and Loxapine she has calmed down some. she was placed in a group home yesterday and she became violent. is there anything that I can do to help her/ or something that can be done for her?

ANSWER:

Assuming she has the BPD, the medications are a good choice. It’s very, very difficult working with these mental health diagnoses in someone who is mentally retarded. Making diagnoses is also very difficult. I often recommend that my screening test be taken by both biological parents to look for clues regarding the child’s diagnoses. Attention deficit disorder needs to be looked at as well, because impulsive anger can worsen her condition. The atypical antipsychotics, especially Clozaril, Risperdal and Seroquel may be of significant use as well. I have generally found that high normal blood levels are needed for Tegretol to have it’s maximum effectiveness.