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Histrionic Personality Disorder

Symptoms and Signs

The DSM-IV states that the essential feature of this disorder is "pervasive" and excessive emotionality.

Patients with histrionic personality disorder experience reactive dysphoria in the face of loss or rejection as well as difficulty with linear, analytic thought, although they are often creative.

Patients are impressionable, suggestible, and intuitive; ie, they "play hunches" instead of thinking decisions.

They draw attention to themselves by their dramatic, lively, and at times seductive social behavior. There is a tendency toward somatization, with dramatic and shifting presentations of histronic personality disorder.

Differential Diagnosis

Histrionic personality disorder must be differentiated from somatization disorder, borderline personality disorder, and narcissistic personality disorder. These three disorders may coexist in some combination with histrionic personality disorder, in which case all relevant diagnoses may be assigned.


The prevalence has been estimated to be 10% to 15% of psychiatric outpatient and inpatient populations.

Etiology & Pathogenesis

The causes of histrionic personality disorder are mainly psychological; in better-functioning patients, these are typically unresolved oedipal.

The more immature, dependent (so-called oral) hysteric has a history of disturbance early in life in attachments.


Long-term psychoanalytic psychotherapy is the treatment of choice and should focus on developing the patient's insight into the reasons for repetitive difficulties in sustaining love relationships.

The therapist should also help the patient think more clearly and systematically, so that information processing and decision making are not distorted by vagueness or failure to attend.

For people with histrionic personalities, self-esteem is heavily centered in perception of their body image, with physical prowess and attractiveness being prized attributes. Men with histrionic personality disorder may, when physically ill, display.

Such counterphobic behavior may worsen the course of illness. Such men may act in an overtly seductive fashion toward female physicians.