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 themselves.
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 highly suggestible, i.e., easily influenced by others or circumstances.
8. Considers relationships to be more intimate than they actually are.
Individuals with Histrionic Personality Disorder may have difficulty achieving emotional intimacy in romantic or sexual relationships. Without being aware of it, they often act out a role (e.g., “victim” or “princess”) in their relationships to others. They may seek to control their partner through emotional manipulation or seductiveness on one level, whereas displaying a marked dependency on them at another level.
Individuals with this disorder often have impaired relationships with same-sex friends because their sexually provocative interpersonal style may seem a threat to their friends’ relationships. These individuals may also alienate friends with demands for constant attention. They often become depressed and upset when they are not the center of attention.
In order to make a diagnosis of histrionic personality disorder, a psychological examination is necessary, along with a general evaluation of the patient’s behavior and overall appearance.
Dr. Kevin Fleming
Histrionic Personality Disorder (In Detail)
Histrionic Personality Disorder is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.) diagnosis assigned to individuals who display patterns of attention-seeking, often dramatic behavior to gain the approval of others. This behavior may be flirtatious, emotional, seductive or otherwise in order to capture the attention of onlookers.
Introduction
Long associated with the historical term hysteria - histrionic being a derivative - histrionic personality disorder is a mental condition characterized by over-the-top behavior, such as emotional outbursts, noisy displays of temper, compulsive attention seeking and self-centredness.
Sufferers of histrionic personality disorder may overreact and exaggerate, assume greater familiarity with others than actually exists, pay excessive attention to their appearance and display narcissistic qualities. A Cluster B personality disorder, histrionic personality disorder is closely related to other conditions within the bracket, such as borderline, antisocial, and narcissistic personality disorders.
Histrionic personality disorder affects an estimated one to three per cent of the American population1) and is more prevalent among women than men. The condition often results in distress for the sufferer and may adversely impact on social, occupational and other areas of life.
Symptoms
Symptoms of histrionic personality disorder include the following:
- Shallow, changeable emotions
- Assumed intimacy with others
- Hypersensitivity to criticism
- Manipulative behavior
- Disproportionate emotional reactions
- Sexually provocative behavior
- A compulsive desire for attention
- Preoccupation with appearance
- Suggestible and easily influenced
Diagnosis criteria for histrionic personality disorder
There is no set test to determine whether someone has histrionic personality disorder. Previously, a number of pointers were specified in an earlier edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders in order to help clinicians make a diagnosis3). At least five of the following traits needed to be recorded for a diagnosis to be indicated:
- A compulsion to be the center of attention that results in discomfort if unmet
- Inappropriate sexual, seductive or provocative behavior when interacting with others
- Shallow, rapidly shifting emotions
- The use of physical appearance to draw others’ attention
- Dramatic, impressionistic speech that lacks detail
- Exaggerated, theatrical emotional expression
- Easily influenced by others or situations
- Assumes relationships are more intimate than they are
Unstructured or semi-structured interviews may also be carried out as part of the diagnostic process; these usually involve investigation into the patient’s concerns without a set series of questions, allowing for free-flowing conversation.
Often, an element of the diagnostic process is the self-report inventory, which usually takes the form of a short questionnaire designed to provide insight into the patient’s state of mind. The subject is required to answer questions pertaining to their lifestyle, symptoms, values and more, which are then assessed and scored by the healthcare professional to indicate the nature of the condition.
Causes of histrionic personality disorder
There is no single known cause of histrionic personality disorder but factors such as genetics and childhood experiences may play some part in the disorder’s development2). Links have been made between the development of personality disorders and the following factors:
Inherited personality traits Studies have determined a correlation between personality traits of extroversion, excitement-seeking and neuroticism and histrionic personality disorder, and there is significant research suggesting that these characteristics may be hereditary4) 5).
Parental influence During childhood, the role of primary caregivers is important in shaping a youngster’s personality; some theorists have put forth suggestions that dependency issues, conditional parental love and emotionally shallow parenting may be associated with the onset of histrionic personality disorder6) 7).
Antisocial personality disorder overlaps Histrionic personality disorder is thought to be closely related to antisocial personality disorder, with studies showing that individuals meeting the criteria for the former condition also meet similar criteria for the latter. Based on this finding, it could be inferred that the two disorders may stem from the same underlying cause; whether this is biological, environmental or otherwise is yet to be determined8).
Neurological factors Suggestions have been made that sufferers of personality disorders may have experienced childhood trauma, which could have affected the development and functioning of parts of the brain that deal with emotions, social functioning and self-control9). Research has also found that neurotransmitters - believed to contribute to emotion and impulse regulation - may be deficient among personality disorder sufferers.
The lack of a definitive cause for histrionic personality disorder allows for speculation that the condition could develop as a result of combined biological, psychological and social elements, rather than from a single specific cause9).
Comorbidity
Histrionic personality disorder may present comorbid with other conditions, including:
- Borderline personality disorder
- Narcissistic personality disorder
- Dependent personality disorder
- Major depressive disorder
- Somatic symptom disorder
- Conversion disorder
Other disorders may be diagnosed with personality disorders, such as anorexia nervosa10) and alcohol or substance misuse disorders11)
Living with histrionic personality disorder
Histrionic personality disorder is usually diagnosed when a sufferer is in their late teens or early twenties, when an individual’s personality is believed to have fully developed.
Many individuals suffering from histrionic personality disorder come across as charming, are able to function highly and achieve success in their occupation and in social circles. However, problems may be encountered in the sufferer’s personal life and romantic relationships.
People with histrionic personality disorder can struggle to deal with failure or loss, have difficulty overcoming the fallout of a failed relationship or find they become bored in their job quickly. Similarly, sufferers may crave new experiences and excitement, which can lead to risk-taking behavior. These factors may all increase the risk of depression2).
Treatment
Individuals suffering from histrionic personality disorder may be unaware of their condition until they seek treatment for something else, such as depression or anxiety from a failed relationship. A diagnosis will often determine that the problems reported by the patient are the symptomatic results of histrionic personality disorder.
There is no cure for histrionic personality disorder but the following treatment approaches are often suggested:
- Cognitive behavioral therapy
A talking therapy, cognitive behavioral therapy aims to change the way an individual thinks and behaves at the present and future time, rather than seeking to reconcile any underlying causes. CBT helps patients decode situations by assessing their thoughts, emotions, physical feelings and actions to become more mindful of how these elements are connected - and how they can be changed.
- Functional analytic psychotherapy
To better understand and treat patterns of patients’ behavior, functional analytic psychotherapy may be advised. This kind of therapy seeks to identify interpersonal problems both in and out of sessions, in different contexts. In this way, the therapist can assess the patient’s behavior and provide a better tailored treatment programme.
- Support groups
Sufferers of histrionic personality disorder may be able to find support at a specialist or general focus group for individuals with personality disorders. There are groups that meet in person at set times and places and groups based online, providing support for sufferers who cannot travel or who prefer less of a face-to-face approach.
- Medication
Medication is not a solution for underlying causes of histrionic personality disorder, which cannot be fully determined; however, medication may be prescribed to help sufferers’ manage symptoms of the condition, such as depression or anxiety.
Although histrionic personality disorder may affect sufferers for life, therapy can be effective in helping individuals make positive behavioral changes that enable them to manage the condition.
Dr. Kevin Fleming
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