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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:

The patient is not comfortable unless he is the center of attention.

The patient is often inappropriately sexually seductive or provocative with

Rapidly shifting and shallow expression of emotions.

The patient consistently uses physical appearance to

Speech is excessively impressionistic and lacking in detail.

Dramatic, theatrical, and exaggerated expression of emotion.

The patient is easily influenced by others.

Relationships are considered to be more intimate than they are in reality.

Clinical Features of Histrionic Personality Disorder

The patient is bored with routine and dislikes delays in gratification.

The patient begins projects, but does not finish them (including relationships).

Dramatic emotional "performances" of the patient appear to lack sincerity.

These patients often attempt to control relationships with seduction, manipulation, or dependency.

The patient may resort to suicidal gestures and threats to get attention.

Epidemiology of Histrionic Personality Disorder

The prevalence of HPD is 2-3%.

Histrionic personality disorder is much more common in women than men.

These patients have higher rates of depression, somatization and conversion disorder compared to the general population.

Differential Diagnosis of Histrionic Personality Disorder

Borderline Personality Disorder

While patients with Borderline Personality can also be sensation-seeking, impulsive, superficially charming, and manipulative, they also have identity disturbance, transient psychosis, and dissociation which are not seen in histrionic patients.

Some patients meet criteria for both BPD and histrionic personality disorder

Antisocial Personality Disorder

Antisocial patients are also sensation-seeking, impulsive, superficially charming, and manipulative.

Histrionic patients are dramatic and theatrical but typically lack histories of antisocial behavior.

Narcissistic Personality Disorder

Narcissists also seek constant attention, but it must be positive in order to confirm grandiosity and superiority.

Histrionics are less selective and will readily appear weak and dependent in order 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.

Treatment

Insight-oriented psychotherapy is the treatment of choice. Keeping patients in therapy can be challenging since these patients dislike routine.

Antidepressants.