Histrionic Personality Disorder among children can be tough on parents

The Jains had always thought their 10-year-old daughter Niharika felt responsible for her barely one-year-old brother Manav. But the shock of what happened in April refuses to leave their minds. Niraj Jain, 38, remembers the day. "It was a Sunday and I was sleeping after lunch. My wife Madhu had stepped into the kitchen to tell the maid something, leaving Manav on the floor. Niharika was sitting a few feet away and playing with my phone when our son began crawling and reached the point where the drawing room is divided into two levels, and fell down. Madhu and the maid rushed in, but Niharika continued to be engrossed with the Barbie game on the phone," recounts the Ghatkopar resident. Multiple visits to psychiatrists revealed the problem — histrionic personality disorder (HPD).

"She has had a tendency to throw 'fits' since she was very young. These tantrums (bawling in public, sitting down even on the road and flailing her legs) would happen when she didn't have her way or we expressed disapproval. My husband and I thought she's just a difficult child and she will get over it. But these 'fits' are still frequent," says the distraught Madhu.

A friend suggested they take Niharika to a child psychiatrist, who initially diagnosed her condition. Over many sessions, the psychiatrist found in her "a strong need to be the centre of attention and behaviour patterns to draw attention to herself, extremely beguiling behaviour, shallow expression of emotions, lack of empathy, overly dramatic behaviour and seeing relationships as more intimate than they really are."

Niharika is very loving, and extremely creative. She wants to be an artist when she grows up and is also gifted and prolific, far ahead of kids her age in drawing and painting. She has friends and is doing well in school. Not surprisingly, her parents were aghast with the diagnosis. They have since sought two more opinions. The diagnoses matched and they agreed to psychotherapy. This is seen as taboo among Indians so we are keeping it to ourselves, say the parents.

What the Jains are going through is not unique, says leading psychiatrist Rajendra Barve. "Parents themselves need several sittings to deal with children who are difficult. I have met parents who have confided in me that they fear their child because of her or his tantrums. Such parents can be helped to break out of typical response patterns that encourages the the child to continue being difficult to have her or his way. Establishing that calm communication will get the child more dividends than a tantrum, but it may take a while to work."

According to him, the exact cause of HPD is unknown, but research suggests both learned and inherited factors have a role to play. "For example, the tendency for histrionic personality disorder to run in families suggests that a genetic susceptibility for the disorder might be inherited. However, the child of a parent with this disorder might simply be repeating learned behaviour s/he keeps seeing. Other factors include a lack of criticism or punishment as a child, positive reinforcement that is given only when a child completes certain approved behaviours, and unpredictable attention given to a child by her or his parent(s), all leading to confusion about what types of behaviour earn parental approval." Personality disorders, Barve says, develop in relation to individual temperaments and psychological styles and ways children learn to cope with stress and anxiety while growing up.

The Pune-based Prabhus should know about that. They got a distant aunt, who was living alone in Karwar, to stay with them. "I felt instead of the maid, it will be great that the children would have someone grandmotherly at home," says Sandhya Prabhu, 35, a railway employee. "She was very sweet and took over the kitchen and we were eating long forgotten Gaud Saraswat Brahmin recipes. The children began reciting shlokas and I was very happy."

About three months later, the Prabhus took their children Mayur, 12, and Swati, 14, to a mall. "Swati was insisting on buying a really expensive designer top which was way over our budget. I tried to explain this to her when she just snapped at me, 'If you can't afford it why did you have children?' I was shocked into silence. She's generally so affable. Her father rebuked her for her behaviour and we came home," recounts Sandhya.

This was not the last or isolated episode. Swati's repeated insolence began to shatter the peace of what was otherwise a typical quiet middle class household. Once when she spoke to her teacher terribly, the school sent for her parents and suggested they take her to a child psychiatrist. Sandhya remembers being baffled when the psychiatrist asked her whether Swati had acquired new friends or was there someone new at home. "I found it strange because the only person new to our circumstances was the aunt and I saw her as a paragon of virtue." Yet what the doctor said kept playing on Sandhya's mind.

One day, Sandhya had a bad attack of migraine and came home early from work. "As I came out of the lift I heard the aunt screaming at the maid and using language which shocked me. It wasn't vulgar but hurt to the quick. I stood outside the door and slapped my head."

The maid told her in confidence that any excuse was enough for the lady to lose her temper. "So this mellow, kind, motherly master-cook would transform into a different person. We sent her back and my daughter is still undergoing therapy."

Psychiatrists admit that HPD is more common in girls than in boys. "But there are some young boys too who show these symptoms," points out Dr Barve.

(Some names have been changed on request)