Histrionic personality disorder
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Histrionic personality disorder
Classification and external resources
ICD-10
F60.4
ICD-9
301.50
MedlinePlus
001531
MeSH
D006677
Personality
disorders
Cluster A (odd)
Paranoid·
Schizoid·
Schizotypal
Cluster B (dramatic)
Antisocial·
Borderline·
Histrionic·
Narcissistic
Cluster C (anxious)
Avoidant·
Dependent·
Obsessive–compulsive
Not specified
Depressive·
Passive-aggressive·
Sadistic·
Self-defeating
v·
t·
e
Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive emotionality and attention-seeking, including inappropriately seductive behaviour and an excessive need for approval, usually beginning in early adulthood. People affected by HPD are lively, dramatic, vivacious, enthusiastic, and flirtatious. HPD affects four times as many women as men.[1] It has a prevalence of 2–3% in the general population, and 10–15% in inpatient and outpatient mental health institutions.[2]
HPD lies in the dramatic cluster of personality disorders.[3] People with HPD have a high need for attention, make loud and inappropriate appearances, exaggerate their behaviors and emotions, and crave stimulation.[3] They may exhibit sexually provocative behavior, express strong emotions with an impressionistic style, and can be easily influenced by others. Associated features include egocentrism, self-indulgence, continuous longing for appreciation, and persistent manipulative behavior to achieve their own needs.
People with HPD are usually high-functioning, both socially and professionally. They usually have good social skills, despite tending to use them to manipulate others into making them the center of attention.[4] HPD may also affect a person's social and/or romantic relationships, as well as their ability to cope with losses or failures. They may seek treatment for clinical depression when romantic (or, other close personal) relationships end.
Individuals with HPD often fail to see their own personal situation realistically, instead dramatizing and exaggerating their difficulties. They may go through frequent job changes, as they become easily bored and may prefer withdrawing from frustration (instead of facing it). Because they tend to crave novelty and excitement, they may place themselves in risky situations. All of these factors may lead to greater risk of developing clinical depression.[5] Additional characteristics may include:
Exhibitionist behavior
Constant seeking of reassurance or approval
Excessive sensitivity to criticism or disapproval
Pride of own personality and unwillingness to change, viewing any change as a threat
Inappropriately seductive appearance or behavior of a sexual nature
Using somatic symptoms (of physical illness) to garner attention
A need to be the center of attention
Low tolerance for frustration or delayed gratification
Rapidly shifting emotional states that may appear superficial or exaggerated to others
Tendency to believe that relationships are more intimate than they actually are
Making rash decisions[4]
Blaming personal failures or disappointments on others
Being easily influenced by others, especially those who treat them approvingly
Being overly dramatic and emotional[6]
Some histrionics change their seduction technique into a more maternal/paternal style as they age.[7]
Mnemonic[edit source]
A mnemonic that can be used to remember the characteristics of histrionic personality disorder is "PRAISE ME":[8][9]
Provocative (or seductive) behavior
Relationships are considered more intimate than they actually are
Attention-seeking
Influenced easily
Speech (style) wants to impress; lacks detail
Emotional lability; shallowness
Make-up; physical appearance is used to draw attention to self
Exaggerated emotions; theatrical
Causes[edit source]
The cause of histrionic personality disorder is unknown, but childhood events such as deaths or illnesses in the immediate family (which present constant anxiety), divorce of parents, and genetics may be involved. HPD is more often diagnosed in women than men; men with some similar symptoms are often diagnosed with narcissistic personality disorder.[1]
Little research has been conducted to determine the biological sources, if any, of this disorder. Psychoanalytic theories incriminate authoritarian or distant attitudes by one (mainly the mother) or both of parents, along with conditional love based on expectations the child can never fully meet.[3]
Diagnosis[edit source]
The person's appearance, behavior, and history, along with a psychological evaluation, are usually sufficient to establish a diagnosis. There is no test to confirm this diagnosis. Because the criteria are subjective, some people may be wrongly diagnosed.[10]
DSM-IV-TR[edit source]
The previous edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM IV-TR, defines histrionic personality disorder (in Cluster B) as:[2]
A pervasive pattern of excessive emotionality and attention-seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: is uncomfortable in situations in which he or she is not the center of attention
interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
displays rapidly shifting and shallow expression of emotions
consistently uses physical appearance to draw attention to self
has a style of speech that is excessively impressionistic and lacking in detail
shows self-dramatization, theatricality, and exaggerated expression of emotion
is suggestible, i.e., easily influenced by others or circumstances
considers relationships to be more intimate than they actually are
The DSM-IV requires that a diagnosis for any specific personality disorder also satisfies a set of general personality disorder criteria.
ICD-10[edit source]
The World Health Organization's ICD-10 lists histrionic personality disorder as:[11]
A personality disorder is characterized by: shallow and labile affectivity,
self-dramatization,
theatricality,
exaggerated expression of emotions,
suggestibility,
egocentricity,
self-indulgence,
lack of consideration for others,
easily hurt feelings, and
continuous seeking for appreciation, excitement and attention.
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.
Comorbidity[edit source]
Most histrionics also have other mental disorders. Comorbid conditions include: antisocial, dependent, borderline, and narcissistic personality disorders,[12] as well as depression, bipolar disorder,[citation needed] anxiety disorders, panic disorder, somatoform disorders, anorexia nervosa, substance use disorder[13] and attachment disorders, including reactive attachment disorder.[citation needed]
