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Histrionic Personality Disorder

DSM-IV Diagnostic Criteria

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood, as indicated by five or more of the following:

  1. The patient is not comfortable unless he is the center of attention.
  2. The patient is often inappropriately sexually seductive or provocative with others.
  3. The patient displays rapidly shifting and shallow expression of emotions.
  4. The patient consistently uses physical appearance to attract attention.
  5. Speech is excessively impressionistic and lacking in detail.
  6. Dramatic, theatrical and exaggerated expression of emotion is used.
  7. The patient is easily influenced by others or by circumstances.
  8. Relationships are considered to be more intimate than they are in reality.
Clinical Features of Histrionic Personality Disorder
  1. The patient is bored with routine, and dislikes delays in gratification.
  2. The patient begins projects, but does not finish them (including relationships).
  3. Dramatic emotional "performances" appear to lack sincerity
  4. The patient attempts to control relationships with seduction, manipulation, or dependency.
  5. The patient may resort to suicidal gestures and threats to get attention.
Epidemiology of Histrionic Personality Disorder
  1. Histrionic Personality Disorder is much more common in women than men.
  2. These patients have higher rates of depression, somatization and conversion.
Differential Diagnosis

Borderline Personality Disorder

  1. Patients with Borderline Personality can also be sensation-seeking, impulsive, superficially charming and manipulative.
  2. Histrionic patients lack identity disturbance, transient psychosis and dissociation seen in Borderline patients.
  3. Some patients meet criteria for both diagnoses.
Histronic Personality Disorder
  1. Antisocial patients are also sensation-seeking, impulsive, superficially charming and manipulative.
  2. Histrionic patients are dramatic and theatrical but typically lack histories of antisocial behavior.
Narcissistic Personality Disorder
  1. Narcissists also seek constant attention, but it must be positive in order to confirm grandiosity and superiority.
  2. Histrionics are less selective and will appear weak and dependent to get attention.
Personality Change Due to a General Medical Condition and Substance-Related Disorder: Acute symptoms are temporally related to medication, drugs or a medical condition.


  1. Insight-oriented psychotherapy is the treatment of choice.
  2. Keeping them in therapy can be challenging since these patients dislike routine.
  3. Use antidepressants if criteria for Major Depres