Histrionic personality disorder

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In psychiatry, histrionic personality disorder (HPD), or hysterical personality disorder, is a personality disorder which involves a pattern of excessive emotional expression and attention-seeking, including an excessive need for approval and inappropriate seductiveness, that usually begins in early adulthood.

The essential feature of the histrionic personality disorder is a pervasive and excessive pattern of emotionality and attention-seeking behavior. These individuals are lively, dramatic, enthusiastic, and flirtatious. They may be inappropriately sexually provocative, express strong emotions with an impressionistic style, and be easily influenced by others.

The cause of this disorder is unknown, but childhood events and genetics may both be involved. It occurs more frequently in women than in men, although some feel it is simply more often diagnosed in women because attention-seeking and sexual forwardness is less socially acceptable for women.

People with this disorder are usually able to function at a high level and can be successful socially and at work. However, histrionic personality disorder may affect a person's social or romantic relationships or their ability to cope with losses or failures. People with this disorder may seek treatment for depression when romantic relationships end. They often fail to see their own situation realistically, instead tending to dramatize and exaggerate. Responsibility for failure or disappointment is usually blamed on others. They may go through frequent job changes, as they become easily bored and have trouble dealing with frustration. Because they tend to crave novelty and excitement, they may place themselves in risky situations. All of these factors may lead to greater risk of developing depression.

Contents

Symptoms

The symptoms include:

  • Constant seeking of reassurance or approval
  • Excessive dramatics with exaggerated displays of emotions
  • Excessive sensitivity to criticism or disapproval
  • Inappropriately seductive appearance or behavior
  • Excessive concern with physical appearance
  • A need to be the center of attention (self-centeredness)
  • Low tolerance for frustration or delayed gratification
  • Rapidly shifting emotional states that may appear shallow to others
  • Opinions are easily influenced by other people, but difficult to back up with details.
  • Tendency to believe that relationships are more intimate than they actually are.

Diagnosis and treatment

The person's appearance, behavior, and history, and a psychological evaluation are usually sufficient to establish the diagnosis. There is no test to confirm this diagnosis. Because the criteria are subjective, some people may be wrongly diagnosed as having the disorder while others with the disorder may not be diagnosed. Treatment is often prompted by depression associated with dissolved romantic relationships. Medication does little to affect this personality disorder, but may be helpful with symptoms such as depression. Psychotherapy may also be of benefit.

Diagnostic criteria (DSM-IV-TR)

The Diagnostic and Statistical Manual of Mental Disorders, a widely used manual for diagnosing mental disorders, defines histrionic personality disorder as a pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (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.

Mnemonic

A mnemonic that can be used to remember the criteria for histrionic personality disorder is PRAISE ME<ref>Pinkofsky HB. Mnemonics for DSM-IV personality disorders. Psychiatr Serv. 1997 Sep;48(9):1197-8. PMID 9285984.</ref><ref>Personality Disorders. www.personalityresearch.org. URL: http://www.personalityresearch.org/pd.html. Accessed May 2, 2006.</ref>:

  • P - provocative (or seductive) behaviour
  • R - relationships, considered more intimate than they are
  • A - attention, must be at centre of
  • I - influenced easily
  • S - speech (style) - wants to impress, lacks detail
  • E - emotional lability, shallowness
  • M - make-up - physical appearance used to draw attention to self
  • E - exaggerated emotions - theatrical

History of the DSM-IV diagnosis

Histrionic Personality Disorder shares a divergent history with Conversion disorder and Somatization Disorder. Historically, they are linked to the ancient notion of hysteria, or “wandering womb.” Ancient Greeks thought that excessive emotionality in women was caused by a displaced uterus and sexual discontent. Christian ascetics during the Middle Ages blamed women’s mental problems on witchery, sexual hunger, moral weakness, and demonic possession. By the 19th century, medical explanations proposed a weakness of women’s nervous system related to biological sex. Thus, "hysteria" reflected the stereotype for women as vulnerable, inferior, and emotionally unbalanced. The extent to which the definition of Histrionic Personality Disorder currently reflects gender bias remains the subject of a controversy (see writings by Paul Chodoff on this topic).

"Hysteria" differentiated into conversion hysteria (later to become Conversion disorder) and hysterical personality (later to become Histrionic personality disorder) in the psychoanalytic literature as well as with the writings of Kraepelin, Schneider, and others. Sigmund Freud wrote primarily about conversion hysteria. Wilhelm Reich wrote about hysteria as a set of personality characteristics and differentiated conversion hysteria as a transient disorder from hysterical character. These early conceptualizations of both kinds of hysteria carried notions of women’s deficiency due to penis envy and feelings of castration. Paul Chodoff has written about the ways in which these diagnoses paralleled the misogynous sentiment of the times.

The concept of hysterical personality was well developed by the mid-20th century and strongly resembled the current definition of Histrionic personality disorder. The first DSM featured a symptom-based category, “hysteria” (conversion) and a personality-based category, “emotionally unstable personality.” DSM-II distinguished between hysterical neurosis (conversion reaction and dissociative reaction) and hysterical (histrionic) personality. In DSM-III, the term Hysterical Personality changed to Histrionic Personality Disorder to emphasize the histrionic (derived from the Latin word histrio, or actor) behavior pattern and to reduce the confusion caused by the historical links of hysteria to conversion symptoms. DSM-III-R attempted to reduce the overlap between Histrionic Personality Disorder and Borderline Personality Disorder by dropping three overlapping criteria and adding two criteria that emphasized histrionicity. DSM-IV dropped two more criteria that did not appear to contribtue to the consistency of the diagnosis, according to research done by Bruce Pfohl.

Diagnostic criteria (ICD-10)

The International Statistical Classification of Diseases defines histrionic personality disorder as characterized by:

  • self-dramatization, theatricality, exaggerated expression of emotions;
  • suggestibility, easily influenced by others or by circumstances;
  • shallow and labile affectivity;
  • continual seeking for excitement and activities in which the patient is the centre of attention;
  • inappropriate seductiveness in appearance or behaviour;
  • over-concern with physical attractiveness.

Associated features may include egocentricity, self-indulgence, continuous longing for appreciation, feelings that are easily hurt, and persistent manipulative behaviour to achieve own needs.

A previous version of this text is from the US National Library of Medicine.

See also

References

<references/>

External links

ja:演技性人格障害 nl:Theatrale persoonlijkheidsstoornis pl:Osobowość histrioniczna sv:Histrionisk personlighetsstörning




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