Histrionic personality disorder

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Histrionic personality disorder
Classification and external resources
ICD-10 F60.4
ICD-9 301.50
MeSH D006677
Personality
disorders
Cluster A (odd)
Cluster B (dramatic)
Cluster C (anxious)
Not specified

Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriately seductive behavior, usually beginning in early adulthood. These individuals are lively, dramatic, vivacious, enthusiastic, and flirtatious. Histrionic personality disorder (HPD) is one of the most common found in the United States and affects 40% of inpatients[2], affecting more women than men by about a 4:1 ratio.[3][citation needed]

This disorder can easily be mistaken for immaturity, however a person with HPD does not simply grow out of this selfish state of being. You may perceive people with HPD to be very dependent, rude and demanding, shallow, and far from genuine.[4]

"The Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) for concept of the histrionic personality disorder reflects a tendency to be self-dramatizing, attention seeking, overly gregarious, seductive and manipulative, exhibitionistic, shallow, frivolous, liable, vain, and demanding."[5] Histrionic Personality Disorder is considered to be in the dramatic cluster when classifying different groups of personalities.[6] These behaviors are overwhelming and can be difficult to deal with. People with HPD have a high need for attention, make loud and inappropriate appearances, exaggerate all of their behaviors and emotions, crave stimulation and usually make a big deal about nothing. However you may find that someone with HPD can be charming, lively or funny in small doses.[4]

It is very important to realize that those who suffer from HPD often may seem completely confident and into themselves, but can easily be rejected from those around them which "may lead into depression and suicidal ideation."[4]

They may be inappropriately sexually provocative, express strong emotions with an impressionistic style, and be easily influenced by others. Associated features may include egocentrism, self-indulgence, continuous longing for appreciation, and persistent manipulative behavior to achieve their own needs.

Characteristics

People with this disorder are usually able to function at a high level and can be successful socially and professionally. People with histrionic personality disorder usually have good social skills, but they tend to use these skills to manipulate other people and become the center of attention.[1] Furthermore, histrionic personality disorder may affect a person's social or romantic relationships or their ability to cope with losses or failures. They may seek treatment for depression when romantic relationships end, although this is by no means a feature exclusive to this disorder.

They often fail to see their own personal situation realistically, instead tending to dramatize and exaggerate their difficulties. 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.

Additional symptoms may include:

Causes

The cause of this disorder is unknown, but childhood events such as deaths in the immediate family, illnesses within the immediate family which present constant anxiety, divorce of parents and genetics may be involved. Histrionic Personality Disorder is more often diagnosed in women than men; men with some quite similar symptoms are often diagnosed with narcissistic personality disorder.[3]

Little research has been conducted to determine the biological sources, if any, of this disorder. Psychoanalytic theories incriminate authoritarian or distant attitudes by one (mainly mother) or both of the parents of these patients, or love based on expectations from the child that can never be fully met.[4]

Diagnosis

The person's appearance, behavior, and history, along with 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.[5]

DSM-IV-TR 301.50

The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines histrionic personality disorder (in Axis II Cluster B) as:[6]

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.

It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

ICD-10

The World Health Organization's ICD-10 lists histrionic personality disorder as (F60.4) Histrionic personality disorder.[7]

It is characterized by at least 3 of the following:
  1. self-dramatization, theatricality, exaggerated expression of emotions;
  2. suggestibility, easily influenced by others or by circumstances;
  3. shallow and labile affectivity;
  4. continual seeking for excitement and activities in which the patient is the center of attention;
  5. inappropriate seductiveness in appearance or behavior;
  6. over-concern with physical attractiveness.

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Millon's subtypes

Theodore Millon identified six subtypes of histrionic.[8][9] Any individual histrionic may exhibit none or one of the following:

Mnemonic

A mnemonic that can be used to remember the criteria for histrionic personality disorder is PRAISE ME:[10][11]

Differential diagnosis

Treatment

Question book-new.svg This unreferenced section requires citations to ensure verifiability.

Treatment involves psychotherapy and sometimes medication, psychodynamic treatment and cognitive therapy treatment.[4] However, the characteristics listed above, can make it very difficult for a therapist to do their job. HPD patients "can often make the therapist feel incompetent, responsible, and obliged toward the patient.[7] It is important that one analyst be assigned to the patient and very early off in the treatment with these incompetent expectations "to assign responsibility to the hysteric and to maintain aloof and highly professional integrity."[7]

Epidemiology

[icon] This section requires expansion.

Major character traits may be inherited. Other character traits due to a phenotypical combination of genetics and environment, including childhood experiences[12]

See also

References

  1. ^ a b "Histrionic Personality Disorder". Histrionic Personality Disorder. The Cleveland Clinic. http://www.clevelandclinic.org/health/health-info/docs/3700/3795.asp?index=9743. Retrieved 2011-11-23. 
  2. ^ Personality Disorders: Recognition and Clinical Management retrieved 9 February 2012, Jonathan H. Dowson, Adrian T. Grounds, page 74
  3. ^ Seligman, Martin E.P (1984). "11". Abnormal Psychology. W. W. Norton & Company. ISBN 0-393-94459-X. 
  4. ^ "Histrionic Personality Disorder". Personality Disorders. WebMD. 2006. http://www.emedicine.com/med/topic3472.htm. Retrieved 2007-01-10. 
  5. ^ Psych Central: Histrionic Personality Disorder Treatment
  6. ^ Histrionic personality disorder - Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)
  7. ^ Histrionic personality disorder - International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
  8. ^ Millon, Theodore, Personality Disorders in Modern Life, 2004
  9. ^ Millon, Theodore - Personality Subtypes
  10. ^ Pinkofsky HB. Mnemonics for DSM-IV personality disorders. Psychiatr Serv. 1997 Sep;48(9):1197-8. PMID 9285984.
  11. ^ Personality Disorders. www.personalityresearch.org. URL: http://www.personalityresearch.org/pd.html. Accessed May 2, 2006.
  12. ^ "Histrionic Personality Disorder". Histrionic Personality Disorder: Description, Incidence, Prevalence, Risk Factors, Causes, Associated Conditions, Diagnosis, Signs and symptoms and treatment. Armenian Medical Network. 2006. http://www.health.am/psy/histrionic-personality-disorder/. Retrieved 2007-01-10. .

External links

DSM-III-R only
DSM-IV
Antisocial · Borderline · Histrionic · Narcissistic
Schizotypal
Specific
Eccentric · Haltlose type · Immature · Narcissistic · Passive-aggressive · Psychoneurotic
Unspecified
Mixed and other