GIVE ME ATTENTION

It is 1.00 a.m. and Sarah Williams is in the midst of a group of men who are listening with rapt attention as she narrates an incident of how she was cheated while buying jewelry that afternoon. Her husband Thomas is standing in a far corner shaking his head as he sees his wife once again in the spotlight. It has been 5 years since they have been married and every social gathering that they attend always sees the same sequence of events. It is often a late but dramatic entry by Sarah with her husband in tow, a period of relative quiet as she assesses the atmosphere and then the she starts. She exhibits her talents and is always surrounded by people who are always mesmerized by the way and what she talks. Often there are stories, which are made up, some events, which are exaggerated, some distortions and some, which are totally blatant lies but told in such an incredulous way that she always wins the admiration of the onlookers. There is a lot of sympathy for her and in the way that she has been able to survive the ordeal that she has been describing. Thomas is utterly helpless as all the efforts that he has made to correct her falls on deaf ears. He also is often a victim as many details of his private life have been divulged in the utmost naïve manner.

Sarah is a histrionic personality. She is often uncomfortable in situations in which she is not the center of attention and tries to draw attention to her by being lively, charming and flirtatious. Her husband is tired of her self-centered behavior even though her creativity, energy and openness are appealing. But on a closer look she seems to have little interest in intellectual achievement and careful analytic thought. Her interaction with even a stranger may be inappropriate and provocative even though she does not have a romantic interest in him. Even though she displays excess emotionality, it is very shallow and rapidly shifting. Warmth is expressed as ardor, sadness as excessive tearfulness or melancholy and anger as intense rage. She is often gregarious and flamboyant. She consistently uses her physical appearance to draw attention to herself and has a style of speech which although impressionistic, lacks in detail. She is always hunting for highly valued compliments on her appearance and spends an enormous amount of time on dressing and grooming. This colorful display of emotions is often engaging but may appear insincere. It is often embarrassing to people who accompany her. She is very suggestible and easily influenced by the circumstances or other people. The relationships that she has are often unstable, shallow and ungratifying. She feels extremely uncomfortable or helpless when alone because of an exaggerated fear of being unable to care for own self. Therefore she constantly seeks company as a source of care and support. She has a tendency to neglect long-term relationships for the excitement of new relationships and this often leads to marital conflicts. She often uses threats to coerce better care giving. She has little tolerance for delayed gratification and is easily frustrated. She trusts easily and looks for magical solutions to her problems. She often undervalues the traits and achievements of women while overvaluing the qualities in men. She is often unable to tolerate ambivalence and is more likely to be angry or bear sustained feelings of mistreatment. She often presents to be very weak and dependent to get the attention that she desires. She often voices an inability to make everyday decisions without an excessive amount of advice and reassurance from others. She often goes to excessive lengths to obtain nurturance and support from others because she has difficulty initiating things on her own. There is a deep lack of self-confidence in judgment and abilities, which is covered superficially by a display of lot of motivation and energy. Thomas often feels that he has to assume responsibility for most major areas of her life. While Sarah has difficulty expressing disagreement with Thomas because of the fear of loss of his support, she does not listen to him also. Thomas often gets the feeling that he is playing second fiddle to a woman who enjoys the limelight, craves for it but needs him to be around just for a supportive role. When the two of them are alone, there is an enormous amount of submissive clinging behavior. She often subordinates her needs to his, agrees with him and tries to please him- sometimes to the point of being self-effacing, obsequious and ingratiating. She may sometimes excessively admire his “superior” strength and competence but only in privacy. Once in the company of others, she almost seems to be blind to his presence and often makes a nasty comment about some quality which she has praised just moments ago.

What to do for Sarah?

The primary focus is to delineate the behaviors as a defense against the underlying erotic feelings. The dependent and manipulative motivations that lie behind these typical forms of relationships have to be addressed. It is important for them to identify and express their true feelings. All this has to be done in a firm yet loving structured relationship without being tempted to accept or feel pleased by the seductive idealization that only reinforces the dependence. There should be a promotion of growth towards independence, which may increase self-esteem. A lot of support should be expressed for the initiation of such activities even when there is an anticipation of the inevitable failures. Autonomy should be encouraged and self-denigrating behavior confronted. At the same time, care has to be taken that the approach is not overtly directive, authoritarian or reassuring as this may actually encourage further dependence and submissiveness. There is a danger of Sarah falling into a depressive state temporarily as there is a realization of the uselessness of the superficial seductive nature but a stable personality generally replaces this if the primary relationship is loving and tolerant.