Histrionic Personality Disorder

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:
is uncomfortable in situations in which he or she is not the center of attention.

• Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
• Displays rapidly shifting and shallow expression of emotions.
• Consistently uses physical appearance to draw attention to self.
• Has a style of speech that is excessively impressionistic and lacking in detail.
• Shows self-dramatization, theatricality, and exaggerated expression of emotion.
• Is suggestible, i.e., easily influenced by others or circumstances.
• Considers relationships to be more intimate than they actually are.

Associated Features:

• Depressed Mood
• Somatic or Sexual Dysfunction
• Anxious or Fearful or Dependent Personality
• Dramatic or Erratic or Antisocial Personality

Differential Diagnosis:

Some disorders have similar or even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which he needs to rule out to establish a precise diagnosis.

• Borderline Personality Disorder
• Antisocial Personality Disorder
• Narcissistic Personality Disorder
• Dependent Personality Disorder
• Personality Change Due to a General Medical Condition
• Symptoms that may develop in association with chronic substance use

Cause:

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 acceptible for women.

People with this disorder are usually able to function at a high level and can be successful socially and at work. They may seek treatment for depression when romantic relationships end.

They often fail to see their own situation realistically, instead tending to overdramatize and exaggerate. Responsibility for failure or disappointment is usually blamed on others.

Treatment:

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.

Counseling and Psychotherapy [ See Therapy Section ]:

Individuals who suffer from this disorder are usually difficult to treat for a multitude of reasons. As with most personality disorders, people present for treatment only when stress or some other situational factor within their lives has made their ability to function and cope effectively impossible. They are, however (unlike other people who suffer from personality disorders), much quicker to seek treatment and exaggerate their symptoms and difficulties in functioning. Because they also tend to be more emotionally needy, they are often reluctant to terminate therapy.

Pharmacotherapy [ See Psychopharmacology Section ] :

As with most personality disorders, medications are not indicated except for the treatment of specific, concurrent Axis I diagnoses. Care should be given when prescribing medications to someone who suffers from histrionic personality disorder, though, because of the potential for using the medication to contribute to self-destructive or otherwise harmful behaviors.