Histrionic Personality Disorder
Histrionic personality disorder is characterized by constant attention-seeking, emotional overreaction, and suggestibility. A person with this condition tends to over-dramatize situations, which may impair relationships and lead to depression.
The word personality describes deeply ingrained patterns of behavior and the manner in which individuals perceive, relate to, and think about themselves and their world. Personality traits are conspicuous features of personality and are not necessarily pathological, although certain styles of personality may cause interpersonal problems.
Personality disorders are rigid, inflexible and maladaptive, causing impairment in functioning or internal distress. A personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment.
Individuals with histrionic personality disorder exhibit excessive emotionality—a tendency to regard things in an emotional manner—and are attention seekers. People with this disorder are uncomfortable or feel unappreciated when they are not the center of attention. Behaviors may include constant seeking of approval or attention, self-dramatization, theatricality, and striking self-centeredness or sexual seductiveness in inappropriate situations, including social, occupational, and professional relationships, beyond what is appropriate for the social context. They may be lively and dramatic and initially charm new acquaintances with their enthusiasm, apparent openness, or flirtatiousness. They may also, however, embarrass friends and acquaintances with excessive public displays of emotion, such as embracing casual acquaintances with passion, sobbing uncontrollably over minor setbacks, or having temper tantrums.
People with histrionic personality disorder commandeer the role of “life of the party.” Interests and conversation will be self-focused. They use physical appearance to draw attention to themselves. Emotional expression may be shallow and rapidly shifting. Their style of speech is excessively impressionistic and lacking in detail. They may do well with jobs that value and require imagination and creativity but will probably have difficulty with tasks that demand logical or analytical thinking.
The disorder occurs more frequently in women, although this may be because it is more often diagnosed in women than men. Data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions estimate that the prevalence of histrionic personality disorder is 1.84 percent.
For a diagnosis of histrionic personality disorder to be given, five or more of the following symptoms must be present:
- Self-centeredness, uncomfortable when not the center of attention
- Constantly seeking reassurance or approval
- Inappropriately seductive appearance or behavior
- Rapidly shifting emotional states that appear shallow to others
- Overly concerned with physical appearance, and using physical appearance to draw attention to self
- Opinions are easily influenced by other people, but difficult to back up with details
- Excessive dramatics with exaggerated displays of emotion
- Tendency to believe that relationships are more intimate than they actually are
- Is highly suggestible (easily influenced by others)
For these symptoms to be considered a disorder, they must cause significant impairment or distress in an individual.
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 are less socially acceptable for women than for men.
People with this disorder are usually able to function at a high level and can function well in social and occupational environments. 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. 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.
A diagnosis can be made by knowing the patient’s history and by doing a psychological examination.
Individual displays five or more of the following criteria: • 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 • Has a high degree of suggestibility, that is, easily influenced by others or circumstances • Considers relationships to be more intimate than they actually are.
The recommended form of treatment for histrionic personality disorder is psychotherapy. Therapy with people with this diagnosis is often challenging because they may exaggerate their symptoms or ability to function. They may also be emotionally needy and challenge the boundaries set up by the therapist. Therapy should generally be supportive and solution-focused.
Because depression can be associated with failed romantic relationships, patients with histrionic personality disorder often seek treatment when they are experiencing symptoms of depression. Depression can be treated through psychotherapy and psychotropic medications.
- American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
- American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised
- National Institutes of Health
- National Library of Medicine