Histrionic Women in Iran : A Qualitative Study of the Couple Interactive Pathology of the Women with Symptoms of Histrionic Personality Disorder ( HPD )

A variety of factors contribute to causes the couple’s vulnerabilities, including the personality traits that affect the couple’s healthy relationships. This study mainly aims to identify the couple’s vulnerabilities, notably women, with symptoms of the histrionic personality disorder. This is a qualitative study with a content analysis approach. The data collection process consists of 17 semi-structured interviews with the therapists, men with histrionic spouses, and the women with histrionic personality disorder, and using the related literature. The sampling process started purposefully and continued until data saturation. The data analysis led to the extraction of three categories including functional vulnerabilities, relationship vulnerabilities, and emotional vulnerabilities. Findings showed that personality traits of a histrionic woman dramatically affect the obvious individual behaviors and interpersonal relationships including couple’s relationships.


Introduction
Identifying the couple's vulnerabilities and studying the couple interaction structure facilitate the understanding of the couple's defective relationship cycles and decreasing the couple's dissatisfaction.Couple's vulnerabilities cause the couple's conflicts, reduce couples' satisfaction, and may lead to the divorce (Henri & Miller, 2004).
For better understanding the couple's relationships, in addition to the paying attention to the interaction between the systems' patterns, their individual personality system should be also taken into account.Personality characteristics as the intrapersonal factors are the effective predictors of the interpersonal relationships.As the relationships are more intimate, the impact of the individual personality traits would be higher.The couple's relationships are the interpersonal scope of the bilateral attachment systems that is basis of the development processes.
Nowadays, personality styles, particularly personality disorder pathology has been substantially taken into consideration.Based on the theoretical framework proposed by Millon (1996) for the description of the personality disorders, personality structure is based on the balance of three factors including pleasure-pain, self-other, and passive-active.This conceptualization is the basis of describing the prototypes of the clinical personality disorder that is characterized by an imbalance of one or more instances of the bipolar factors.They are described by four clinical concepts including behavioral, phenomenological, inter-psychical, biophysical ones and by considering the bipolar factors.
Therefore according to Millon (1996), the concept of the imbalanced bipolar factors, which are intertwined at four levels of clinical description, is a basis for describing and identifying personality disorders and is effective on couple's interaction, and may be efficient to achieve the therapeutic goals and use the methods.Personality disorders are a set of psychological disorders characterized by the inflexible and strict behaviors.This kind of behaviors affects people adversely, because they prevent them from being compatible with the life requirements, and disrupt their relationships with others (DIM-IV-TR).Based on DIM-IV-TR categorization, ten personality disorders are classified into three groups.One of B class disorders is the histrionic personality disorder.People with symptoms of histrionic personality disorder are provocative and emotional, and show the exhibitionist, exaggerated and extroverted behaviors.They are afflicted by the transient desires and suffer from the exaggerated emotional variations and extreme emotional behaviors.Multi-dimensional disorder model supports the notion that women with the symptoms of histrionic personality disorder tend to be highly dependent and need the confirmation (Kraus & Reynolds, 2001).They show a seductive and provocative behavior toward others, and cannot keep the deep relationships (Ferguson & Negi, 2014).
According to Millon, histrionic personality is moderate in terms of the bipolar factor of pleasure.In terms of passive-active factor, histrionic personality is active, and in terms of self-other, she mostly has tendency toward others.In terms of four-fold levels of clinical concepts, histrionic woman shows a highly exhibition and attention-seeking behavior at behavioral level, she mainly avoids recognition at phenomenological level, she shows disorganized and chaotic behaviors at inter-psychic level, and she is erratic at bio-physical level.Histrionic person is inconstant seeking of reassurance or approval, a need to be the center of attention, make loud and inappropriate appearances, and exaggerated behaviors and emotions.People with personality disorders simultaneously show some disorders in the course of their relations, and exhibit major defense against intimacy or attachment disorders that interfere with the therapeutic possibilities of the person (Magnavita, 2000).
They become aggressive in case of not receiving attention, approval and admiration (Kaplan & Sadok, 2007).Mental health professionals agree that some personality disorders are related with increasing tendency to the violence and uncertainty and extent of the relationship between the spouses (Gilbert & Daffern, 2011).People with the pathological personality traits are more likely to have an unhappy marriage.However, more importantly is that they often fail to identify the fact that the source of marriage dissatisfaction is in their processing and interactive style with their surrounding world (South, Turkheimer, & Oltmanns, 2008).Smith (2012) suggests that the lack of the self-knowledge about the thoughts, behaviors, and feelings may be one of the main causes of an unhappy marriage.Inability to maintain an intimate relationship plays a key role in forming some of the personality susceptibilities (Kruger et al., 2007).
"Unaware of how their thoughts and feelings are related to their behavior, histrionic persons claim innocence when their naive and inappropriate behavior leads to interpersonal conflict" (Dorfman, 2010).This kind of people quickly build the cordial and passionate relationships, but quickly get tired and feel that they have not been treated with sufficient gratitude (France, 2013).An increasing number of the literature shows that psychological vulnerabilities are intrinsically related with sexual relationships (Whisman & Uebelacker, 2004).Of main nine principles proposed by Millon (1996) for conceptualizing the personality disorders, the following two ones are adaptable to the systematic thinking.Firstly, personality virulence is not linear, but it is continuously and increasingly interactive, and is distributed in the whole system.Secondly, personality criteria by which pathology is recognized should logically be coordinated with the model of the systems.With regard to these principles, using the couple's or whole family's systems family system is normally coordinated with the individual systems.Based on literature, couple's features are one of the most important predictors of the couple's life quality, and personality processes are the main components of the dynamic close relationships (Dale, Halorson, Havil, quoted by O'Rourke, Claxton, Chou, Smith, & Hadjistavropoulos, 2011).
A number of personality disorders including the histrionic personality disorders and paranoid are positively correlated with the divorce rate (Disney, Weinstein, & Oltmans, 2012).The SPH histrionic personality also often reports a growing disaffection with his or her mate, a feeling that the vitality that supposedly characterized earlier years together has now palled.Sexual interest may have faded, and the frequency of relations may have dropped due to importance or frigidity.
As disaffection intensifies, conflicts and tension rise, prompting the patient to feel not only a sense of loss but of rejection and hostility from his or her mate.Life feels as if it has taken on a purposeless and meaningless quality.The patient may begin to dramatize this plight, feeling that every recourse is hopeless and futile (Milon, 2011).
Therefore based on Millon's (1996) theoretical assumptions and with regard to the effects of interpersonal characteristics in interpersonal systems, this study aims to identify the interactive couple's vulnerabilities using a qualitative research based on the content analysis among the women with histrionic personality symptoms.Since the individual effect on the system necessitates the people's perception within the system, this study tries to examine this interaction performed by the histrionic women, their spouses, and couple's therapists who are involved in the system during the therapy and present the relevant literature.Based on the literature review, no study in Iran has investigated the vulnerabilities of the histrionic women.Therefore, conducting this type of the research is of great importance.From an applied perspective, the results of this study may be useful for all the counseling centers and all the therapists, and may increase the couple's life quality and nourishment of the couple's relationship.In addition, this study provides a proper context for doing the similar future studies.

Materials and Methods
This qualitative content analysis uses a conventional content analysis approach.Qualitative content analysis may be considered a research method for content-subjective interpretation of the textual data using a systematic classification process, encoding, theme creation, or design of well-known patterns (Hsieh & Shannon, 2005).Contractual and conventional content analysis is usually used in the research projects that aimed at describing a phenomenon (Kripendorf, 2004).
Data were collected through interviews and semantic association is analyzed, and pre-existing theories are not used.The researcher relies on his perception and understanding of the text in order to present an initial analysis, and this continues to the extent, which a background is created for the emergence of the themes (Tesch, 1990).Reducing and categorizing the qualitative data are used for analyzing the data (Corbin, 2008).The purposeful sampling method was used in order to answer the research questions (Creswell, 1998).
The samples were selected with regard to the maximum data variation for achieving the data saturation.Data saturation shows that a new concept was not formed, and conceptual levels were completed (Elo & Kyngäs, 2008).At first, available and relevant domestic and foreign academic resources in the field of histrionic personality in 1980-2014 (electronic resources, books, theses, and papers) were collected, analyses were carried out to the extent which data saturation was conducted, and then the semantic units were formed.The process of data analysis in this research (Figure 1) was performed using a qualitative content analysis with conventional approach (Kripendorf, 2004).
Then, according to the text content, summarizing and tabulating were performed, and the compact semantic units were formed.Then, materials were coded, and the relevant similar codes were assigned as the lower categories.After that, main categories were classified for obtaining the desired theme by collecting and adding information on the interviews (Figure 1).
In addition, 17 semi-structured interviews were distributed to the three groups of therapists, women with histrionic personality disorder symptoms and their spouses.The first group consisted of the therapists who are expert in the field of personality disorders, and work in the area of psychological and psychiatric counseling in Iran.The second group was the women with the symptoms of the histrionic personality disorder who were analyzed using the diagnostic test of 36-item questionnaire proposed by Ferguson and Negy (2014).
They have been selected by specifying the diversity of the demographic characteristics in terms of age (25 to 40), gender (woman), duration of marriage (1-15), education (at least diploma) and main reasons to refer to counseling center (desire to divorce, marital satisfaction, post-marital relations).
The samples were selected to the extent of data saturation.The third group was the women's spouses with the histrionic disorder.After a brief explanation and clarification of the research objectives, justifying the reasons for using tape recorders and ensuring the confidentiality of the personal data, the research was performed with the formal consent of the interviewees.Duration of the interview was subjected to some constraints, and it lasted 26-70 min.The interview was consisted of a range of the overall questions.
The questions were used only as the guides to initiate the interview on the issue of the conflict, and they were developed during the interview.These questions were distributed to the different groups of the respondents on the same areas of couple's life in a different way.Some of the interview questions included speaking about their couple's relationships, if they tended to explain their couple's life story, how was the story?How were their sex relationships?Did they think what would be the effects of the sex relationships on their couple's life?How were their relationships with their partner's family?How did these relationships affect their couple's life?Some of the questions were asked from the experts included how was the marital life of a woman with histrionic personality disorder?How was the sexual relationships between a histrionic woman and her husband?What effect did they think the sexual relationship of a histrionic have on the marital life?What kind of relationship a histrionic woman did have with the family of her husband?What were the impacts of such relationships on marital life?Therefore the results of the interviewees were recorded and transcribed as soon as possible.Meaning units included keywords or classes of analysis, which were extracted from the statements made by the interviewees and then summarized (Streubert, 2006).
Summarization is reducing the size of the meaning units, and it does not create a change in the quality of data, and does not generate the compact meaning units.Then, analysis units were categorized several times following coding and based on conceptual and semantic similarity.The categorization means that the codes that are more similar to each other are placed in the same category (Downe-Wamboldt, 1992).
The main attempt was to establish the highest homogeneity within the classes and highest heterogeneity between the classes.Categorization was performed using the separate codes, frequent review, and integration of the similar codes in order to create the main categories (Grove & Burns, 2005).The content and the title of the category were permanently changed in order to explain the content in a better way.New data were simultaneously compared with the whole data to reveal the proper centrality between them.After summarizing, analyzing, and extracting the main categories of all of the texts and interviews, the theme compatible with each of the main categories was finally obtained (Figure 1).

Figure 1. Data analysis process
In order to achieve creditability, documents, interviews, and analyzed articles with the initial derived codes were presented to several skilled researchers, and their final comments received, the revisions were conducted, and the necessary amendments were suggested.In addition, some experts were asked to analyze and change data and revise the coding.In addition, the supplementary comments made by colleagues were utilized.Ensuring sufficient time to perform the research, establishing the open and empathetic relationships with the interviewees were other factors that increased the creditability of data (Sandelowski, 2000).Accordingly, the interviews, the extracted codes, and the categories were examined by the member Check.

Results
After determining the initial semantic units through texts and interviews, the compressed semantic units were derived, and the codes were extracted.Then, these codes were contrasted, and categorized into eleven subcategories.By more detailed classification and accurate proportions in a conceptual and abstract from, three main categories in the area of the couple's vulnerabilities among the women with symptoms of the histrionic personalities were recognized, which show the obvious content.The major extracted categories included: a) relationship vulnerabilities; b) functional vulnerabilities; and c) emotional vulnerabilities.Finally, fundamental meanings or covert content were extracted using the main category.Then, by explaining a number of semantic units of the texts and interviews, couple's vulnerabilities of the histrionic women were identified and explained in this study.The statements presented by the interviewees are shown using the quotation marks.

Relationship Vulnerabilities
Relationship vulnerabilities are composed of the three subcategories including the distorted interpersonal relationships, problems with couple's marital relationship and sexual impotence (Table 1).Based on the literature and the interviewees' experiences, it was found that the failure in the establishment of healthy relations is one of the most common problems, which is expressed by the unhappy couples.Distorted interpersonal relationships include the relationship between the male spouse and children, women's family, relationship with colleagues, neighbors, classmates, husband's family, and social friendships."The extremist attention-seeking behaviors of the histrionic women create a number of problems in their social relationships" (Interviewee #5, therapist).The relationships are mainly established to obtain approval, appreciation, and influence others."Whether the confirming source derives from the same sex or the opposite sex, the histrionic woman demands a mirror that regards her as the best" (Interviewee #6, therapist)."These people cannot hold a deep attachment for a long time" (Kaplan & Sadok, 2007).Tendency to the multiplicity of caressing sources reduces their commitment.Additionally, the kind of their marital relationships differs from the tension, mistrust, and doubt.
From the view of a histrionic woman, life is an exhibition scene for acting, and she is the leading actor who everybody should pay attention to her even in the social interactions, and such behaviors make their spouses severely suspicions.
"My wife is more emotional and sensitive toward the opposite sex than the same sex" (Interviewee #15, the spouse of a histrionic woman)."In a period of my life, I liked to have a relationship with the opposite sex, especially when I was angry with my husband, and I also had some liaisons, I always would consider the sex as betrayal, but it was not difficult for me just to communicate with others" (Interviewee #8, histrionic woman).The problematic couple's relationships are a subcategory of the relevant category.
Couple's interactions of the histrionic women are accompanied by the superiority, exhibitionist actions, severe fluctuations, and irresponsibility, and self-centeredness in the various fields."Many times we lacked the mutual understanding, and sometimes even intense disputes.My wife expects me to confirm her, pay attention to her talks, and help her in the time of illness" (Interviewee #5, husband with a histrionic woman).
From the view of a histrionic woman, the relationship is vague, false, and unpredictable.Due to the histrionic woman's lack of privacy and irrational and unreasonable decisions, the male spouse has a permanent feeling of the insecurity, frustration, and dissatisfaction with the relationship.The main problem in this relationship is that the reality of the relationship is unclear, as if it has two levels, visible and invisible.
Their relationships are false, and not real, shallow, and are on the threshold of decline (interviewee #7, therapist).A histrionic woman constantly attempts to receive the positive and special feedbacks from the husband, thus she lacks any opportunity to pay attention to the husband and satisfy his needs."Lack is what husband and children experience in contact with a histrionic woman" (Interviewee #6, therapist).In general, their marital interactions are defective, their dissatisfaction and detachment increasingly follows an ascending pattern, and histrionic women's families are highly susceptible to disintegration.My marital story is sad, and there was no love for starting a mutual life, our talk leads to the dispute, or shouting, or derision and these all have deepened our gaps."I had seriously decided to divorce two or three months ago" (interviewee #8, histrionic woman).Inability in sexual relationships is another component of the couple's vulnerabilities.
According to Apt and Hurlbert (1994), "the women with the disorder evidenced lower sexual assertiveness, more negative attitudes toward sex, lower sexual desire, greater orgasmic dysfunction and sexual boredom than did their non disordered counterparts".The histrionic women usually do not experience the warm and pleasant sexual relationships.They are susceptible to the sexual mental dysfunction.
Histrionic women suffer from anorgasmia, and in order to ensure that they are attractable to the opposite sex, they may act out their sexual momentum (Kaplan & Sadoc, 2007).Jacques in sexual relations, histrionic woman exposes her tempting sexual excitations and sexual impulses."She is not able to enjoy the sex, because she has not a profound sense, and more than conceiving sex, she thinks of the sex positions and relevant marginal issues" (Interviewee #6, therapist)."Unlike the false appearance, most of them lack high sexual ability" (Interviewee #4, therapist)."Our sexual relationships in the past was much better but we are too far now" (Interviewee #15, the spouse of a histrionic woman).
A histrionic woman has continuous sexual seduction, flirting language, ostentatious and extravagant clothing, manipulative behaviors and actions, sexual tempting stimulations, and she can show her sexual impulse so well in order to attract the attention and admiration.Such types of behaviors create ambiguities and suspicion in the mind of husband.
"We cannot say histrionic person does betrayal, but we can say that she creates misunderstanding, and husband is often suspicious of her.They have behavioral tempting styles in the way of walking, speaking, etc., which these all damage their life" (interviewee #3, therapist)."Feeling of being ignored by husband may create misinterpretations for her, and may even affects her self-esteem or even sexual ability" (Interviewee #6, therapist).
Therefore through collection, summarization, coding, and categorization of the data relevant to the texts and interviews that were mentioned above, some factors including hidden content (theme), strong tendency to establish the relationship and failure to maintain the intimate and constant attachment were obtained.Such factors are indicative of the fact that histrionic woman shows the excessive interest in creating new interpersonal relations due to her urgent need to be admired and appreciated by others.However she fails to organize and perpetuate her relations.

Functional Vulnerabilities
Functional vulnerabilities include four subcategories including the irresponsible maternal performance, weakness in job performance, self-centeredness of economic performance, and fluctuation in household performance (Table 1).This study showed that a histrionic woman is weak in terms of performance.She pursues an action that enables her to perform the personal exhibition behaviors, and to attract others' attention.
Irresponsible maternal performance is one of the relevant subcategories.Histrionic woman has no consistent and proper pattern for parenting, and reacts based on her moods, emotions, and mental needs."My case created highly severe triangulation with one of her children at different ages, and if they wanted to live independently, it was the very beginning of their conflict and debate" (Interviewee #1, therapist)."They are less responsible for their children" (Interviewee #2, therapist).
The main aim of histrionic woman in the course of decision making for the children is to achieve a source through which she can attract attention.In some cases, she performs some collisions and triangulations with them."She does not consider children's needs, and gives priority to her own needs in relation to children.In this regard, her performance depends on how to fulfill her needs" (Interviewee #2, therapist)."She is not properly capable of satisfying the children and fulfilling their emotional and mental needs, I have registered my son in many classes but because of my husband's discontent, I should take him lonely which really bothers me" (Interviewee #17, histrionic woman).
Children significantly vacillate between hot and extreme emotional dependency and the sense of acute rejection and neglect.They are not able to construct a safe and secure environment for their children."Her maternal behaviors are superficial, and usually a proper attachment is not established" (Interviewee #3, therapist).
Thus, the histrionic woman's maternal performance imposes the extreme pressure on the couple's relationship."A family with histrionic mother is highly susceptible to disintegration" (Interviewee #3, therapist).Weakness in job performance is another issue in the area of functional vulnerabilities.The results obtained from a research conducted on women showed that the tension caused by job insecurity is associated with declining marital adjustment, poor overall performance of family, weakness in solving the problems in the family, low emotional intervention, and reducing the effective control (Larson, Wilson, & Beley, 1994).The participants believed that histrionic women in her job functional are highly inaccurate and stressful, and by inflow of such pressures into the family, conflict and debate will be ensued."Her job performance is not accurate, planned, and purposive, and she follows the issues that can draw others' attention" (Interviewee #4, therapist).
A histrionic woman experiences periods of unemployment, abandonment, job change, and dissatisfaction with and complaints of job pressures and colleagues' behaviors, which all emanate from her neglect to the extent of her desired level."She has some problems in her communication with others; these problems may oblige her to quit or shift the job, and abandon all her duties" (Interviewee #5, therapist).
Vacillation in household performance is another subcategory of the functional vulnerabilities.Histrionic woman soon feels boredom and burnout with repetitive and routine works, and to fulfill such household obligations, she exploits family, acquaintances, or workers."She does not attempt to perform his housekeeping tasks properly and especially she is highly dissatisfied with the birth of children" (Interviewee #14, the man with a histrionic wife)."I urge my daughter to clean her room, but she does not listen to me, my husband says I am obsessive, but I soon get tired" (Interviewee #10, histrionic woman)."Any work with repetition does not attract these women's emotions, and is associated with a feeling of destruction and decay" (Interviewee #6, therapist).In doing housework chores, some factors such as burnout and depression, the involvement of the spouse and children, the extreme attention to the cosmetic aspects of home, and personal irresponsibility for personal tasks can make marital relationships more distorted, and lead to misunderstanding.
"These women's relationships are overshadowed by exploitation.They even exploit their children.It seems that all people surrounding these women must be subservient to them" (Interviewee #1, therapist).
Autonomy in economic performance is another subcategory of functional vulnerabilities.By inefficient management and unrealistic evaluations on income, and unrealistic projections of income, expenditure and consumption cravings cause the loss of financial resources, lack of savings, and severe economic problems for the family."Many financial resources owned by husband may be lost, and even he get tired, and the husband complain that all my income is invested on the extra and unimportant things, thus more conflict can be happened" (Interviewee #7, therapist).
The results obtained from a research indicated that high levels of economic stress are associated with marital conflicts (Rubila & Kumar, 2005)."I have not financial savings, and I think my husband is not well off and do not attempt too much, and he does not satisfy many of my needs" (Interviewee #17, histrionic woman)."My wife does not pay attention to economic difficulties and is very spendthrift" (Interviewee #14, a spouse with a histrionic wife).Histrionic woman finds a temporary palliative for her inner world, yet it loses its effects instantly, and the final result is more negative consequences and higher costs which lead to higher economic pressures to the spouse, and his intense dissatisfaction and protest."The problem is that she disappointed with achieving pleasure.These extra costs can put the family into trouble and inflict unnecessary costs" (Interviewee #6, therapist).
Therefore through collection, summarization, coding, and categorization of the data relevant to the texts and interviews that were mentioned above, some factors including hidden content (theme), poor performances in a coordinated, consistent and responsible manner were obtained.This theme shows that histrionic woman pursues an action that provides her with the possibility to play personal show to attract more attention, and the reward, which is received by histrionic woman, enables her to play roles all the time and find a temporary psychological relief, rather than acting effectively and to fulfill its maternal or marital responsibilities.

Emotional Vulnerabilities
Emotional vulnerabilities is composed of four subcategories including the emotional instability, extreme reactions in the time of crisis, irrational expectations of husband and physical attraction concerns (Table 1).The emergence of intense, unstable and inappropriate emotions in patients with histrionic characters may be considered as the emotional impulsivity.This group of individuals feels obvious emotional concerns in their close relationships (Ingram, 2010).These people spend their mental energy on avoiding conflicting emotions and irrational memories (Ferguson, 2014).
According to the statements made by the interviewees, the couple's emotional relationship is associated with the limited and superficial emotional intimacy."The most important thing is that histrionic woman has problems in terms of the depth of feelings and continuity in any ideal and relationship which requires continuous and deep emotions.The superficiality of mother's emotions can hurt husband and children, and they may feel the lack of a real mother" (Interviewee #7, therapist)."When my husband pays little attention to me, I feel bad, because I am highly emotional and sensitive and I cry even over a small matter" (Interviewee #10, histrionic woman)."Power of empathy in this population is poor and very poor empathy is one of the most important emotional vulnerabilities" (Interviewee #3, therapist).They express their emotions so passionately, and another side feels that there is no emotional honesty.
Thus, the lack of emotional honesty and improper extreme excitement to draw more attention creates distrust and dissatisfaction in couple relationship.Excessive reaction in the time of crisis is also one of the main categories of emotional vulnerabilities.
Exhibitionist women exaggerate problems and crises, and they seek external sources in order to get rid of the stress and they proceed even to the brink of depression, conversion disorders, and even suicide."My wife acts very weak and irritable in difficult conditions and she herself really needs the cooperation and assistance" (Interviewee #15, a spouse with a histrionic wife)."I cry in the course of crises and I get nervous, I do not like to see people around, and I think all these problems my husband's fault, and I like to leave the home for a while" (Interviewee #17, histrionic woman)."In crisis situations, they suffer from conversion disorders, they lack crisis management and problem solving style, and they even resort to an external and rational source of solace" (Interviewee #1, therapist).
Therefore, inflexibility and inconsistency with critical situations cause the flooding of problems into family life and couple's relationships.Unrealistic expectations from the husband are another subcategory of emotional vulnerabilities.Histrionic people form expectations that cannot be justified through the history and context of the relationship.
They expect to be preferred over others, and expect to be admired and loved by them (Blagov & Westen, 2008).
The core of the expectations of a histrionic woman is to be seen as constant brightness by her husband."She expects her husband to think of her, and praise and appreciate her, and she believes that nobody must participate in the husband's emotions except her" (Interviewee #5, therapist)."I like my husband loves me everywhere, and accompanies me without any excuse" (Interviewee #16, a histrionic woman).
"My wife wants me to lover her so much, confirm her always, pay attention to his sayings, and help her in disease" (Interviewee #15, the husband with histrionic wife)."She looks for a mirror to show her always bright and beautiful, if not, she breaks the mirror" (Interviewee #6, therapist).
It seems that expectations of a histrionic woman are highly demanding and improbable, and leads to conflict and frustration in the long run, and they have social relational consequences based on the husband's personal traits.
The fourth subcategories of emotional trauma involved are concerns about the physical attractiveness.Histrionic woman who lacks inner wealth uses the external beauty to achieve peace."In fact, she could have the last version of fashion in the field of cosmetics and clothing.Histrionic people follow the different beauty surgeries and diets, which these actions are not driven by the physical needs, but to draw attention" (Interviewee #3, therapist).The results of the research (Saba, 2012) indicates that people applying for cosmetic surgery are afflicted with histrionic personality disorders than non-applicants (Napoleon & Lewis, 1989).They believe that they derive their self-esteem from their appearance, and when their self-esteem comes down, they seek to undergo surgery.
"Paying too much attention to the appearance is not the infrastructure for drawing the attention of the opposite sex, it is merely a cosmetic treatment, but would be strongly opposed by her husband" (Interviewee #4, therapist).
To show their social and economic rank and class, histrionic people should necessarily resort to surgery, because they have a greater need the attention and admiration than others do (Saba, 2012).According to the research conducted by Malik, Howard, and Koo (2008) beauty surgery volunteers suffer from a disorder such as body dysmorphic disorder, and narcissistic and histrionic personality disorder."Beauty and appearance is very important to me.I even got my nose operation, and I think appearance shows personality, but my husband does not understand me and we continue to dispute" (Interviewee #17, histrionic woman)."Apparently she is so uptight and obsessed, and prepares herself with so much difficulty to go out" (Interviewee #15, the husband of a histrionic woman).
Therefore through collection, summarization, coding, and categorization of the data relevant to the texts and interviews that were mentioned above, some factors including hidden content (theme), inability to express sincere, deep, and constant emotions and extreme need to the others' confirmation and attention were obtained.This theme shows that histrionic woman at the lower levels of emotional arousal experiences the quality of fear, loneliness, and rejection, and despite her burning desire for establishing relationship, she fails to achieve empathy and genuine intimacy.
Findings indicate that damages to marital relationship caused by a histrionic woman in different areas such as extreme release of emotion, lack of responsibility in administrative areas, shallow relationships to satisfy psychological needs cause marital conflicts.

Discussion
The present study aims to identify couple's relationship of the women with symptoms of histrionic personality disorder.By adopting a qualitative research methodology in this research, three main categories including relationship, functional, and emotional vulnerabilities in identifying marital life vulnerabilities were extracted that each of them is the outcome of the underlying linked and relevant issues (Figure1).
Given the personality characteristics of histrionic women, the current research sought to identify their marital vulnerabilities.
The research findings indicate that when the histrionic women get involved in deep and lasting relationships, they mostly feel ambivalence and then resign.Millon, Grossman, Meagher and Everly (1999) avoid presenting a static view of the person, and they acknowledge the situation in which personalities should be considered as systems rather than disorders.Millon's view is in parallel with those of many previous systematic theorists.Individuals are understood only as a structural level of life systems, but other levels of the organization should also be analyzed.
Thus, they may be considered as units of a larger ecological system such as couples, families, relationships and ultimately cultures (Millon, Grossman, Meagher, & Everly, 1999).
According to this theoretical assumption, the devastating impacts of personality disorders on marital life have been confirmed in a number of studies, including South, Turkheimer and Oltmanns (2008) who examined the relationship between personality pathology and marital disorder.
In this research, which was consisted of a sample of 82 married couples, a multi-level analysis was carried out to estimate the relationship between self-reported personality disorder symptoms with marital satisfaction level, verbal aggression, and physical violence.A person with personality disorders report more problems and tensions than others (Whisman, Tolejko, & Chatav, 2007).The result of this research is consistent with those of the current research.
In this study relational vulnerabilities are of main categories (Figure 2).According to Carney and Bradbury (1995), perceiving a type of the marriage with no taking into account the enduring characteristics that each spouse brings to the relationship is difficult.Women with personality problems and disorders often act in their marital relationship in ways that the results are the abuse of the men.
On the other hand, such group of people interprets the actions exercised by their husbands as threatening and negative.
The results of current research also showed that histrionic woman looks attractive, passionate, enthusiastic, sociable, and appealing at the beginning of the relationship, but because of self-centeredness, lack of empathy, exploitation, and persistent begging, she recedes another party into frustration and disgust after a short period.
At the end of the relationship, another party is introduced by her as blamed, but due to emotional attachment and a sense of lack of identity, and need to be seen constantly by others, she starts a new relationship instantly, and begins again her ostentatious and exhibition behaviors, and this cycle continues.Exhibition behaviors may lead to avoidance or cause debate and conflict.
Emotional vulnerabilities are related to the core issues in the area of the pathology of a histrionic woman.
According to Baverpylag et al. (2006) continued search for intimacy in important inter-personal relationships accompanied by high anxiety and stress leads to increased stress and higher tension.In fact, the challenge of establishing a continuous relationship for most people with personality disorders is a horrific activity (Bouchard & Sabourin, 2009).
The findings obtained from the current research show that the lack of emotional honesty in the relationship with husband and the incidence of disproportionate extreme emotions in order to get more attention creates more mistrust and discontent in marital relationship.The permanent concern of a histrionic woman to be seen, makes her oblivious to the emotional needs of husband, and cause a feeling of anger and lack of positive emotions in husband.Underlying fear, feelings of insecurity, loneliness, and rejection leave no place for intimacy, understanding, empathy, and expression of genuine emotions.
The functional vulnerabilities are also another core category of pathology of the relationships of a histrionic woman.People with personality disorders are often faced with some problems related to school, work, family and relationships, substance abuse, violence and crime, suicide, death, accidents, child custody issues, treatment failure, and dropout.People with personality disorders are often reluctant to accept professional help and blame others for their problems (Madeddu et al., 2009).There is a relationship between the quality and stability of the relationship between the couple with different positive educational, vocational, social, and individual results (Bouchard & Sabourin, 2009).
Permanent and intense tendency of a histrionic woman to be presented as an extravagant and showy entity in different settings leads to the inefficiency in the implementation of tasks and neglect of the exchange of equal benefits in family relationships.Therefore, improper performances, tensions arising from failure to perform duties, overflow of the pressures into the family, permanent failures of the husband to show compensation behaviors all lead to couple's debates and conflicts, and increases marital avoidance and detachment.This study indicates that any damage to the inter-personal relationships and any failure to fulfill the main life tasks relevant to the adulthood, especially intimate and close relationships is the theme of all personality problems.It also shows the symptoms of personality pathology may lead to some problems in relation to inter-personal world, and especially marital relations (Krueger, Skodol, Livesley, Shrout, & Huang, 2007).
Two limitations of this study were inability to assess the personality traits of the men with histrionic women, and an analysis of the general dynamics of their marital relationship.Of course, the second limitation is a feature unique to qualitative research, and it is recommended that this phenomenon is analyzed in other research.
Figure 2. Marital vulnerabilities of a woman with Symptoms of histrionic personality disorder

Conclusion
The findings of the present research indicate that histrionic woman as a female actress feels that she should always appear with her special makeup, gestures, costumes and dialogues in order to have an attractively and entertaining play in different stages of her life and needy looks for the audience's admiration.Concerning her underlying pain of not seen by the others, she appear as an caricature in the role of spouse mother, friend and colleague instead of fulfilling her responsibilities and contact with the reality, and experience not only ostracism and loneliness but also being a loser.Because of Her lack of emotional security, she cannot achieve intimacy; in her relationship with her husband who is the most related person, she is deprived of enjoyment and exchange of love and surrender herself to transient personal desire instead of the goals of marital relation.Therefore such a relationship fails to have original and enduring emotions as the cornerstone for each intimate relationship, and the quality of their intimate relationship will wane over the time, and the function of the couple's life balance may be disrupted.
Thus based on Millon's theory, the fact that where the couple is placed given their disorders or personality styles, along with the strengthening marital system in connection with polar factors and conceptual levels provide a basis for deciding the level and the type of therapeutic approach.
sincere, deep, and constant emotions and extreme need to the others' confirmation and attention Extreme reactions in the time of crisis Irrational expectations of husband Physical attraction concerns