Histrionic Personality Disorder
Patients with histrionic personality disorder (HPD) present with a pervasive pattern of excessive emotionality and attention-seeking behavior that begins in early adulthood. The individual must meet five or more of the following criteria:
- 1.Is uncomfortable in situations in which they are not the center of attention
- 2.Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
- 3.Displays rapidly shifting and shallow expression of emotions
- 4.Consistently uses physical appearance to draw attention to self
- 5.Has a style of speech that is excessively impressionistic and lacking in detail
- 6.Shows self-dramatization, theatricality, and exaggerated expression of emotion
- 7.Is suggestible (i.e., easily influenced by others or circumstances)
- 8.Considers relationships to be more intimate than they actually are
- Dramatic personality disorder
- Hysterical personality disorder
- Psycho-infantile personality disorder
- Personality disorder (nonspecific)
- Personality disorder (trait specified)
Epidemiology & Demographics
Prevalence (In U.S.)
- •Prevalence: 1.84% (DSM-5)
The disorder has been diagnosed more in females (DSM-5). Cultural factors may lead to more common diagnosis in women (e.g., attention-seeking and sexually seductive behavior is not as socially acceptable in women as it is in men). Alternatively, some studies have shown there is similar prevalence in males and females (DSM-5).
Begins in early adulthood.
Limited research using interview and self-report methods suggests that histrionic personality disorder has a moderate genetic component.
Physical Findings & Clinical Presentation
- •No specific physical findings
- •Exaggerated emotionality
- •Clinical presentation:
- 1.Exaggerated, shallow, and/or rapidly shifting emotions
- 2.A pattern of repeated attention-seeking behavior, often suggestive or provocative
- •Hypothesized that childhood events, psychosocial adversity, and genetics are contributory.
- •Other cluster B personality disorders, such as narcissistic, borderline, and antisocial personality disorders, share some common features including attention seeking and excitement seeking behavior as well as affective instability (DSM-5).
- •Dependent personality disorder shares similar characteristics to HPD including praise-seeking behavior (DSM-5).
- •Personality change attributable to a general medical condition.
- •Symptoms in association with chronic substance abuse.
There is no formal test to establish diagnosis. HPD is diagnosed clinically.
- •Long-term individual psychotherapy is treatment of choice.
- •One controlled study exists, suggesting that patients in schema therapy experience greater functional improvement and symptom reduction compared with treatment-as-usual and clarification-oriented psychotherapy.
- •Unlike other people who have personality disorders, individuals with HPD often seek treatment and exaggerate their symptoms and difficulties in functioning.
- •Patients tend to be more emotionally needy and are often reluctant to terminate therapy.
Acute General Rx
- •No placebo-controlled trials.
- •Impulsive-aggressive variants can occasionally benefit from selective serotonin reuptake inhibitor (SSRI) antidepressants.
- •Care should be given when prescribing medications because of the potential for self-destructive or otherwise harmful behaviors.
- •Therapeutic approaches should not focus on the long-term personality change but rather short-term alleviation of specific difficulties and deficits within the person’s life.
- •Therapeutic approaches that emphasize vague somatic, anxious, or depressive symptoms often fail.
- •Patients are likely to be intolerant or drop out of treatment approaches that use delayed gratification.
- •Symptoms are moderately stable over adulthood and may remit or decrease in intensity with age.
Primarily treated by mental health professionals
Pearls & Considerations
- •This disorder is difficult to treat.
- •Like most personality disorders, patients present for treatment primarily when stress or other situational factors within their lives have made their ability to function and cope effectively impossible.
- •Suicidality and risk of self-injury should be assessed on a regular basis, and suicidal threats and self-mutilation should not be ignored or dismissed. Patients may present with a higher risk for, or history of, suicidal gestures.
- •Patients may report high rates of impulsive behavior motivated by sensation- or novelty-seeking.
- •An alternative model in DSM-5, section III, reconceptualizes histrionic personality disorder as “Personality Disorder, Trait Specified,” which rates (1) impairment in personality functioning (identity, self-direction, empathy, and/or intimacy) and (2) pathologic trait domains such as attention seeking, grandiosity, and manipulativeness.
Patient & Family Education
Group and family therapy approaches are generally not recommended because individuals with this disorder often try to draw attention to themselves and exaggerate every action and reaction.
- Bamelis L., et al.: Results of a multicenter randomized controlled trial of the effectiveness of schema therapy for personality disorder. Am J Psych 2014; 171: pp. 305-322.
- Torgersen S., et al.: The heritability of cluster B personality disorders assessed both by personal interview and questionnaire. J Pers Disord 2012; 17: pp. 848-866.