Histrionic Personality Disorder

Histrionic Personality Disorder is a personality disorder characterized by individuals who are flamboyant, seek attention, and demonstrate an excessive emotionality. Emotions are shallow and shift rapidly. Typically, they are attractive and seductive and, like narcissistic persons, overly concerned with their appearance. It is characterized by a pattern of excessive emotionality and attention seeking. These patients often use their physical appearance to draw the attention of others and may behave in a sexually provocative manner. They tend to exaggerate and dramatize their emotions, which otherwise lack depth.

Epidemiology
  • The prevalence is estimated to be 1.8%[1][2]
  • It is more commonly diagnosed in females than males
Prognosis
  • Individuals can have impaired relationships with same-sex friends because their sexually provocative interpersonal style may seem a threat to their friends' relationships.
  • Individuals may be at increased risk for suicidal gestures and threats as an attention-seeking behaviour
Comorbidity
Risk Factors

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following:

  1. Is uncomfortable in situations in which he or she is 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

Defenses used include reaction formation.

    • Although BPD disorder can also be characterized by attention-seeking, manipulative behavior, and emotional dysregulation, it is distinguished by self-destructive behaviours, fragile relationships, and chronic emptiness, and identity disturbance.
    • ASPD and histrionic personality disorder share common features, including impulsivity, superficial behaviours, excitement seeking, recklessness, seductive behaviours, and manipulative actions. In histrionic personality disorder, however, individuals tend to have more exaggerated emotions and do not engage in antisocial behaviors. In histrionic personality disorder, manipulative behaviours are to gain relationships, whereas in ASPD, the manipulation is to gain profit, power, or other material benefit.
    • In narcissistic personality disorder individuals will want attention and praise for their '“superiority,” over others, whereas in histrionic personality disorder, individuals are willing to be viewed as fragile or dependent if this helps in receiving attention. In narcissistic personality disorder, they may over-report the intimacy of their relationships with others, and are more likely to emphasize the “VIP” status or wealth of their friends.
    • In dependent personality disorder, the individual is overly dependent on others for praise and guidance. Importantly, there is no associated flamboyant, exaggerated, or emotional features as seen in histrionic personality disorder.
    • Histrionic personality disorder should be differentiated from personality changes due to another medical condition (e.g. - traumatic brain injury), where the traits that emerge are due to the effects of another medical condition on the central nervous system.
    • Histrionic personality disorder must also be distinguished from symptoms that may develop in association with persistent substance use.

Psychotherapy is the treatment of choice, with a particular focus on the therapeutic alliance.[3]

Personality Disorder Guidelines

Guideline Location Year PDF Website
World Federation of Societies of Biological Psychiatry (WFSBP) International 2009 - Link