Dsm 5 histrionic personality disorder criteria

Histrionic Personality Disorder - StatPearls

Continuing Education Activity

A histrionic personality disorder, or commonly known as a dramatic personality disorder, is a psychiatric disorder distinguished by a pattern of exaggerated emotionality and attention-seeking behaviors. A histrionic personality disorder is categorized within the "Cluster B" of personality disorders. Cluster B personality disorders include conditions such as narcissistic personality disorder, borderline personality disorder, and antisocial personality disorder. These personality disorders are commonly described as dramatic, excitable, erratic, or volatile. Specifically, people with histrionic personality disorder are typically characterized as flirtatious, seductive, charming, manipulative, impulsive, and lively. This activity reviews the evaluation, treatment, and management of histrionic personality disorder and highlights the role of the interprofessional team in managing patients with this condition.

Objectives:

Explain the etiology of histrionic personality disorder.
Review the anticipated presentation of a patient with a histrionic personality disorder.
Describe the treatment considerations for histrionic personality disorder.
Outline the importance of improving care coordination as well as collaboration and communication amongst the interprofessional team to improve outcomes for the patient affected by histrionic personality disorder.

Access free multiple choice questions on this topic.

Introduction

Personality is the set of established patterns of behavior by which one relates to and understands the world around them. A personality disorder arises when one develops an inflexible and intransigent pattern of maladaptive thinking and behaving, which significantly impairs social or occupational functioning and can cause interpersonal distress.[1] Patterns of thinking and behaving must significantly deviate from cultural norms to meet the diagnostic criteria for personality disorder. Divergence from cultural expectations would manifest as disturbances with affectivity, cognition (perceives self, others, or events inappropriately), impulse control, or interpersonal functioning.[2] These disturbances are not due to another mental disorder, substance abuse, or other medical condition.[3]

Histrionic personality disorder, or dramatic personality disorder, is a psychiatric disorder distinguished by a pattern of exaggerated emotionality and attention-seeking behaviors. Histrionic personality disorder falls within the “Cluster B” of personality disorders.[4] Cluster B personality disorders include conditions such as narcissistic personality disorder, borderline personality disorder, and antisocial personality disorder.[2] These personality disorders are commonly described as dramatic, excitable, erratic, or volatile.[1] Specifically, people with histrionic personality disorder typically present as flirtatious, seductive, charming, manipulative, impulsive, and lively. [5]

People with histrionic personality disorder may feel underappreciated or disregarded when they are not the center of attention. These people are typically the life of the party and have a “larger than life” presence.[3] They may be vibrant, enchanting, overly seductive, or inappropriately sexual with most of the people they meet, even when they are not sexually attracted to them.[6] People presenting with histrionic personality disorder may demonstrate rapidly shifting and shallow emotions that others may perceive as insincere. Physical appearance may be used to draw attention to oneself by wearing bright-colored clothing or revealing garments.[6] Those with histrionic personality disorder may speak in a vague style that lacks in detail.[4] Furthermore, they may be dramatic and extremely emotionally expressive, even embarrassing friends and family with public displays of emotions.[3] They may be impressionable, gullible, suggestible, and easily influenced--especially by the people they admire. Additionally, they tend to consider relationships closer than they usually are.

Etiology

While it is unknown what explicitly causes histrionic personality disorder, it is likely a disorder that is multifactorial in its origin. Histrionic personality disorder probably develops as a conglomeration of both learned and inherited factors.[6] One hypothesis is that histrionic personality disorder may develop as a result of trauma experienced during childhood. Children may endure their trauma by coping with their environment in ways that may ultimately lead to a personality disorder.[2] Personality disorders in childhood may originate as an adaptation to cope with a traumatic situation or traumatic environment.[7]

Parenting styles may also influence the likelihood of developing a histrionic personality disorder. Parenting which lacks boundaries is over-indulgent or inconsistent may predispose children to develop histrionic personality disorder.[8] Moreover, parents who role model dramatic, erratic, volatile, or inappropriate sexual behavior put their children at high risk for developing this personality disorder. [9] Because histrionic personality disorder tends to run in families, there is some consideration that there is a genetic susceptibility for this disorder.[8] As with many psychiatric disorders, having a family history of personality disorders, psychiatric illness, or substance use disorders is a risk factor for histrionic personality disorder.[6]

Epidemiology

While approximately 9% of the general population has at least one personality disorder, the prevalence of histrionic personality disorder in the general populace runs about 2 to 3 %.[1] It is possible for people to have more than one personality disorder. Women are four times more likely to be diagnosed with histrionic personality disorder than men.[1] However, research suggests that women may be overly diagnosed with this disorder compared with men due to sexual-forwardness being less socially acceptable for women.[1] Furthermore, men may be less likely to report their symptoms and thereby be under-diagnosed.[1] Histrionic personality disorder tends to be ego-syntonic, meaning people with this disorder typically consider their behavior to be normal and struggle to identify a problem. [2] This lack of insight may contribute to the underdiagnosis of this personality disorder until later in life once patterns of behavior have significantly interfered with relationships, work, or interpersonal wellness.[3]

History and Physical

Mental health care professionals will make a diagnosis of histrionic personality disorder after evaluating for abiding patterns of behavior and symptomology.[4] Personality continues to evolve throughout development; therefore, histrionic personality disorders are typically not diagnosed until after age 18.[1]

Evaluation

Per DSM-5 criteria, a diagnosis of a histrionic personality disorder requires a pervasive and ubiquitous pattern of consistent attention-seeking behaviors and emotional dysregulation as outlined by specific manifestations. Diagnosis requires meeting five (or more) of the following criteria:

Uncomfortable when not the center of attention
Seductive or provocative behavior
Shifting and shallow emotions
Uses appearance to draw attention
Impressionistic and vague speech
Dramatic or exaggerated emotions
Suggestible (easily influenced by others)
Considers relationships more intimate than they are

These patients take repression and dissociation as a significant form of defense mechanism.

Treatment / Management

The treatment of choice for histrionic personality disorder is psychotherapy. Supportive psychotherapy is a recommended modality of treatment for patients with histrionic personality disorder, as this approach is found to be encouraging, reassuring, and non-threatening.[5] Supportive psychotherapy aims to reduce emotional distress, improve self-esteem, and to enhance the patient’s coping skills, all through attentive and sympathetic listening.[5]

Psychodynamic psychotherapy (also called insight-oriented therapy) has also proven to be a successful approach in treating patients with histrionic personality disorder.[8] The goal of this therapy is to alter an aspect of a patient’s dysfunctional personality by integrating crucial developmental milestones a patient may have missed during previous stages of emotional maturation.[4] Psychodynamic psychotherapy aims to resolve underlying, unconscious conflicts in an effort for patients to understand themselves and their behaviors better. [8] The patients are encouraged to substitute excessively dramatic speech for a more adaptive action or behavior, to promote better communication with others.[1] Through psychodynamic psychotherapy, patients learn to recognize that hyper-sexual, attention-seeking behaviors are maladaptive, and discover new, healthier ways to develop self-esteem.[4]

Group therapy and family therapy are not typically recommended as the first-line modality in treating histrionic personality disorder. People with histrionic personality disorder tend to desire to be the center of attention, which may be distracting from therapeutic goals in a group setting.[5] Additionally, people with this disorder may exhibit shallow emotions appearing insincere to those groups or family members participating in therapy concurrently.[5] Histrionic patients may be inappropriately sexual with their therapists; therefore, it is critical to set firm boundaries with patients.[1] The roleplay model and assertive approaches may help in minimizing conflicts.

While the gold standard for treating personality disorders is psychotherapy, patients with histrionic personality disorder may be profoundly symptomatic.[9] Patients may experience affective dysregulation, where they frequently endure mood swings, anger, tearfulness, anxiety, and depression. While there are no FDA-approved medications for the treatment of histrionic personality disorder, affective dysregulation may be treated with antidepressants, mood stabilizers, and antipsychotics.[9] Antidepressants have proven to be effective include desipramine, fluoxetine, amitriptyline, and fluvoxamine.[8] The mood stabilizers with proven therapeutic benefits include lamotrigine, carbamazepine, topiramate, valproate, and lithium.[9] Research has demonstrated that antipsychotics such as risperidone, aripiprazole, olanzapine, and haloperidol have been useful in treating affective dysregulation.[1] Patients with histrionic personality disorder may struggle with impulse control and regulation of their behaviors. Clinical trials have demonstrated that mood stabilizers specifically can target these symptoms.[9]

The biofeedback mechanism may help these patients control their inner feelings.

Differential Diagnosis

The differential diagnosis for histrionic personality disorder includes narcissistic personality disorder, borderline personality disorder, dependent personality disorder, somatic symptom disorder, and illness anxiety disorder.[1] Like histrionic personality disorder, patients with narcissistic personality disorder prefer to be the center of attention.[2] However, patients with narcissistic personality disorder want attention, which results from admiration or veneration, whereas people with histrionic personality disorder are not particular about what type of attention they garner. Patients with histrionic personality disorder are similar to those with borderline personality because both types of patients experience intense emotions; however, patients with borderline personality disorder usually dislike themselves. [5] Dependent personality disorder should be considered in the differential diagnosis for histrionic personality disorder as with both personality disorders, the patient will prefer to be around others.[6] However, patients with dependent personality disorder tend to be more submissive, and their behavior is more inhibited as they are preoccupied with fears of rejection.[5] Somatic symptom disorder and illness anxiety disorder are also included in the differential for histrionic personality disorder as patients with histrionic personality disorder may use physical symptoms and complaints to gain attention from others.[8]

Prognosis

While there is no cure for histrionic personality disorder, many people who have histrionic personality disorder can have useful and productive lives.[10] Patients who participate in therapy tend to have better outcomes as they gain insight into their condition and function more optimally socially and occupationally.[1] However, people with severe histrionic personality disorder may experience problems at work and in social or romantic relationships. [5]

Complications

People with histrionic personality disorder are at a higher risk of developing depression than the general population.[6] Additionally, people with histrionic personality disorder are at increased risk of developing substance use disorders such as cannabis use disorder and alcohol use disorder.[9] They are also prone to having somatization disorder, panic attacks, and conversion disorders. Attention seeking behavior may confer them in showing frequent suicidal threats and gestures.

Deterrence and Patient Education

As with other psychiatric disorders, patient education is a crucial component of successfully managing histrionic personality disorder. Patients diagnosed with histrionic personality disorder would benefit from understanding the maladaptive characteristics of their personality to gain insight and ultimately gain some control.[2] Patients should receive information that there is no cure to histrionic personality disorder; however, medications may be used to ameliorate symptoms. [1] Mood symptoms may correlate with life events, and moods are prone to highs and lows in association with life occurrences.[3] Nevertheless, medications should not be changed each time the patient experiences alterations in moods or emotional crises.[3] Patients with histrionic personality disorder may require longer trials on medications to determine if the medication is effective.[5] Premature termination of psychiatric medications does not allow for adequate medication trials.[10] Furthermore, it requires emphasis that psychotherapy is a vital element of treatment, specifically supportive psychotherapy or psychodynamic psychotherapy.[3]

Enhancing Healthcare Team Outcomes

To promote better outcomes for patients with histrionic personality disorder, it is vital for patients to receive an accurate diagnosis. All providers would benefit from having a greater understanding of this disorder so that patients may receive the care they need. Psychiatric disturbances can affect anyone; however, if the physician or nurse provider is not considering histrionic personality disorder as a differential diagnosis, the patient will not receive the treatment they need. [7] Once a qualified practitioner makes a diagnosis of histrionic personality disorder, a comprehensive care plan should be discussed with the patient, including access to psychiatry and psychotherapy.[1] It is paramount for patients to have a clear understanding that there is no FDA approved medications for histrionic personality disorder, and prescribing providers need to delineate treatment goals.[10] The treating psychiatrist, mental health nurse, and psychotherapist should collaborate to devise an optimal treatment plan.[10] Ideal treatment plans would include psychotherapy frequently (weekly to bi-weekly) and the use of psychiatric medications if mood symptoms are interfering with the patient’s functioning.[10] However, frequent medication changes should be avoided, drugs lethal in overdose should be avoided, and medications with addictive potential should be avoided.[7]

Histrionic personality disorder management requires the efforts of an interprofessional team that includes physicians, specialists, specialty-trained nursing staff, and pharmacists, all collaborating across disciplinary lines to drive outcomes positively. [Level V]

Review Questions

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References

1.: Nestadt G, Romanoski AJ, Chahal R, Merchant A, Folstein MF, Gruenberg EM, McHugh PR. An epidemiological study of histrionic personality disorder. Psychol Med. 1990 May;20(2):413-22. [PubMed: 2356266]
2.: Cale EM, Lilienfeld SO. Histrionic personality disorder and antisocial personality disorder: sex-differentiated manifestations of psychopathy? J Pers Disord. 2002 Feb;16(1):52-72. [PubMed: 11881161]
3.: Rienzi BM, Scrams DJ. Gender stereotypes for paranoid, antisocial, compulsive, dependent, and histrionic personality disorders. Psychol Rep. 1991 Dec;69(3 Pt 1):976-8. [PubMed: 1784694]
4.: Kellett S. A time series evaluation of the treatment of histrionic personality disorder with cognitive analytic therapy. Psychol Psychother. 2007 Sep;80(Pt 3):389-405. [PubMed: 17877864]
5.: Novais F, Araújo A, Godinho P. Historical roots of histrionic personality disorder. Front Psychol. 2015;6:1463. [PMC free article: PMC4585318] [PubMed: 26441812]
6.: Lilienfeld SO, Van Valkenburg C, Larntz K, Akiskal HS. The relationship of histrionic personality disorder to antisocial personality and somatization disorders. Am J Psychiatry. 1986 Jun;143(6):718-22. [PubMed: 3717392]
7.: Apt C, Hurlbert DF. The sexual attitudes, behavior, and relationships of women with histrionic personality disorder. J Sex Marital Ther. 1994 Summer;20(2):125-33. [PubMed: 8035469]
8.: Morrison J. Histrionic personality disorder in women with somatization disorder. Psychosomatics. 1989 Fall;30(4):433-7. [PubMed: 2798737]
9.: Sulz S. [Hysteria I. Histrionic personality disorder. A psychotherapeutic challenge]. Nervenarzt. 2010 Jul;81(7):879-87; quiz 888. [PubMed: 20585747]
10.: Hori A. Pharmacotherapy for personality disorders. Psychiatry Clin Neurosci. 1998 Feb;52(1):13-9. [PubMed: 9682928]

Histrionic Personality Disorder - StatPearls

Continuing Education Activity

Objectives:

Explain the etiology of histrionic personality disorder.
Review the anticipated presentation of a patient with a histrionic personality disorder.
Describe the treatment considerations for histrionic personality disorder.
Outline the importance of improving care coordination as well as collaboration and communication amongst the interprofessional team to improve outcomes for the patient affected by histrionic personality disorder.

Access free multiple choice questions on this topic.

Introduction

Etiology

Epidemiology

History and Physical

Evaluation

Uncomfortable when not the center of attention
Seductive or provocative behavior
Shifting and shallow emotions
Uses appearance to draw attention
Impressionistic and vague speech
Dramatic or exaggerated emotions
Suggestible (easily influenced by others)
Considers relationships more intimate than they are

These patients take repression and dissociation as a significant form of defense mechanism.

Treatment / Management

The biofeedback mechanism may help these patients control their inner feelings.

Differential Diagnosis

Prognosis

Complications

Deterrence and Patient Education

Enhancing Healthcare Team Outcomes

Review Questions

Access free multiple choice questions on this topic.
Comment on this article.

References

1.: Nestadt G, Romanoski AJ, Chahal R, Merchant A, Folstein MF, Gruenberg EM, McHugh PR. An epidemiological study of histrionic personality disorder. Psychol Med. 1990 May;20(2):413-22. [PubMed: 2356266]
2.: Cale EM, Lilienfeld SO. Histrionic personality disorder and antisocial personality disorder: sex-differentiated manifestations of psychopathy? J Pers Disord. 2002 Feb;16(1):52-72. [PubMed: 11881161]
3.: Rienzi BM, Scrams DJ. Gender stereotypes for paranoid, antisocial, compulsive, dependent, and histrionic personality disorders. Psychol Rep. 1991 Dec;69(3 Pt 1):976-8. [PubMed: 1784694]
4.: Kellett S. A time series evaluation of the treatment of histrionic personality disorder with cognitive analytic therapy. Psychol Psychother. 2007 Sep;80(Pt 3):389-405. [PubMed: 17877864]
5.: Novais F, Araújo A, Godinho P. Historical roots of histrionic personality disorder. Front Psychol. 2015;6:1463. [PMC free article: PMC4585318] [PubMed: 26441812]
6.: Lilienfeld SO, Van Valkenburg C, Larntz K, Akiskal HS. The relationship of histrionic personality disorder to antisocial personality and somatization disorders. Am J Psychiatry. 1986 Jun;143(6):718-22. [PubMed: 3717392]
7.: Apt C, Hurlbert DF. The sexual attitudes, behavior, and relationships of women with histrionic personality disorder. J Sex Marital Ther. 1994 Summer;20(2):125-33. [PubMed: 8035469]
8.: Morrison J. Histrionic personality disorder in women with somatization disorder. Psychosomatics. 1989 Fall;30(4):433-7. [PubMed: 2798737]
9.: Sulz S. [Hysteria I. Histrionic personality disorder. A psychotherapeutic challenge]. Nervenarzt. 2010 Jul;81(7):879-87; quiz 888. [PubMed: 20585747]
10.: Hori A. Pharmacotherapy for personality disorders. Psychiatry Clin Neurosci. 1998 Feb;52(1):13-9. [PubMed: 9682928]

FGBNU NTsPZ. ‹‹Borderline mental disorders››

Hysterical personality disorder, or hysterical type of psychopathy. Hysterical reactions (stigmas, fainting, etc.) and other forms of hysterical behavior (extravagance, a tendency to dramatize trivial situations, the desire to be in the spotlight), characteristic of this type of psychopathy, are quite widespread and are often observed in psychopathic personalities of other types with the development of neurotic reactions or reactive psychoses. Hysterical psychopathy is characterized not only by psychogenic hysterical reactions and behaviors, but also by a certain personality type. These people are internally empty, sometimes empty and even miserable; external impressions play the greatest role in the balance of their mental life. They do not have their own opinion, their own established views on life; their judgments lack maturity, seriousness, and depth. Their behavior is not dictated by internal motives, but is calculated for an external effect. The desire to attract attention to oneself, the "thirst for recognition", a tendency to imitate, fiction and fantasies, capriciousness are noted in tantrums even in the preschool period. In adolescence and youth, along with this, their egocentrism, disorganization, a tendency to frivolous acts, wastefulness, and various adventures come out more clearly. They are incapable of systematic, hard work, prefer amateurish activity when choosing their occupation and succumb to tasks that require perseverance, thorough knowledge and solid professional training. Most of all, they like an idle life with external, ostentatious splendor, various entertainments, and frequent changes of impressions. They willingly and selflessly perform the rituals of festivities and banquets, strive to follow fashion in everything, attend successful performances, “idolize” popular artists, discuss sensational books, etc. nine0007

For the most part, they are gullible, easily attached to people. At the same time, a tendency to eroticize interpersonal relationships is often found [Yakubik A., 1982]; quickly fall in love, starting numerous, often short-lived novels, accompanied at first by violent manifestations of feelings. However, being fickle in their hobbies, they cool down just as quickly. In more rare cases, persistent ecstatic attachments are formed, which are formed according to the type of overvalued formations [Dubnitskaya E. B., 1979; Filts A. O., 1987].

As K. Jaspers (1923) points out, one of the main properties of hysterics is the desire to appear larger than they really are, to experience more than they are able to survive. Some try to emphasize their talent, while operating with very superficial information from various fields of science and art, others exaggerate their social position, hinting at close ties with high-ranking officials; others, without stinting on promises, talk about their vast possibilities, which in fact turn out to be the fruit of their rich imagination. Hysterics use everything possible to be in the spotlight: eccentricity in clothing, “flashy” forms of external behavior, unusual actions that contrast with generally accepted views, allegedly mysterious symptoms of an unknown illness, fainting, etc. nine0007

A feature of the hysterical psyche is also the absence of clear boundaries between the products of one's own imagination and reality. Focusing on this property, P. B. Gannushkin emphasizes that the real world for a person with a hysterical psyche acquires a peculiar bizarre shape; the objective criterion for him is lost, which often gives those around him a reason to accuse such a person, at best, of lying and pretense. The hysteric perceives the processes in his own body and his own psyche in the same way. Some experiences completely escape his attention, while others, on the contrary, are evaluated extremely thinly. Because of the brightness of some images and ideas and the pallor of others, a person with a hysterical mentality very often does not see the difference between fantasy and reality, between what happened in reality and what was seen in a dream, or, more precisely, is not able to do it. nine0007

The prognosis for hysterical psychopathy in general cannot be considered unfavorable. In adulthood, with good social conditions and a working environment, in most cases, long-term and stable compensation is possible [Semke V. Ya., 1988]. During this period, the pathocharacterological structure of hysterical psychopathy largely coincides with the accentuated personalities of the “demonstrative” type described by K. Leonhard (1968). Compensated hysterical psychopathic personalities are infantile, youthfully graceful, with emphasized plasticity and expressiveness of movements. Among them there are people with a certain stage talent, artistic natures, but also poseurs and "dandies", dressed with exaggerated elegance. With age, they become smoother and more serious, acquire the necessary labor skills, but the elements of theatricality in behavior remain; First of all, this is reflected in the ability to make a good, favorable impression for oneself, to arouse sympathy, and if necessary, sympathy. Most fully in hysterical psychopathy, compensation processes occur in the case of a predominance of psychopathic manifestations of a tendency to various autonomic and hysterical paroxysms (spasms, a feeling of suffocation during excitement, globus hystericus, nausea, vomiting, aphonia, tremor of the fingers, numbness of the extremities and other sensitivity disorders). Already by the age of 30-35, such psychopathic personalities are sufficiently adapted to the real situation, they can correct their behavior. In life, these are emphasized obligatory people, diligent, successfully coping with their professional duties, maintaining fairly strong family ties. However, with such variants of hysterical psychopathy, the risk of decompensation at involutionary age is more likely, which is often associated with a deterioration in the somatic condition (hypertension, coronary artery disease and other diseases) and menopause. Manifestations of decompensation (usually in the form of emotional instability, violent hysterical reactions and paroxysms) in more severe cases correspond to the clinic of involutional hysteria [Geyer T. I., 1925]. Along with increasing depression, asthenia, tearfulness, anxious fears for one's health, more persistent hypochondriacal symptoms, accompanied by various algias, conversion and vegetative disorders, may come to the fore.

The prognosis is less favorable in the case of a predominance in the structure of the hysterical personality of a tendency to pathological fantasizing. Such psychopathic personalities are distinguished by some authors into a separate group - pathological swindlers and pseudologists according to A. Delbruck (1891), mythomaniacs according to E. Durpe (1909), liars and deceivers according to E. Kraepelin (1915), pathological liars according to P. B. Gannushkin (1964). These people lie from a young age, sometimes without any reason or meaning. Some get so used to the situations created by their imagination that they themselves believe in them. Some can enthusiastically talk about journeys into the remote taiga as part of a geological expedition in which they have never participated; others, having no medical education, describe as if they performed complex surgical operations. Fantasies sometimes turn into self-incrimination with confessions to fictional crimes and even murders. Decompensation, usually quite frequent, occurs either already in the school years, or somewhat later, with the transition to independent activity. For the first time after starting a job or moving to a new place, they impress others as thoughtful, conscientious, enterprising, gifted specialists. However, their complete failure is soon discovered. They are extremely frivolous about the assigned work, incapable of systematic work, instead of real problems, they are busy with fantastic fictions. Compared to ordinary hysterics, as G. E. Sukhareva points out, pseudologists are more active in their desire to realize their plans. It's not always an innocent lie. More often, certain selfish goals are pursued, which leads to a collision with the law. A motley gallery of petty swindlers, soothsayers, marriage swindlers, charlatans posing as doctors, or extortionists who accept valuable gifts and cash advances for services that they can never provide is formed from among the pseudologists. nine0007

Some taxonomies (DSM-IV) distinguish narcissistic personality disorder, having in common with hysterical psychopathy. The definition of "narcissus" goes back to Greek mythology (Narcissus fell in love ¹ with his own reflection in the water and died while trying to hug him). Conceptualization of the concept "narcissistic" belongs to Z. Freud. Later, the concept of narcissism developed in the context of psychoanalytic research. The term "narcissistic personality disorder" was introduced by H. Kohut in 1968. Narcissistic and hysterical personality disorder bring together the features of demonstrativeness, a tendency to dramatize, a thirst for recognition, but significant differences are also found. Narcissistic personalities are characterized by pathological ambition, conceit, arrogance, a sense of superiority over others. "Narcissists" are always confident in their significance, correctness, cannot stand criticism, tend to exaggerate their knowledge and achievements (narcissistic falsification of reality according to H. Kohut, 1971). The ability to work effectively is often combined with the pursuit of universal attention and admiration. The choice of progression also corresponds to this goal: they are not satisfied with activities that do not promise quick fame and public recognition. If hysterical personalities retain the ability to care for their neighbors and love them, then narcissists are devoid of empathy, indifferent to the interests and feelings of others, “perceive others as a faceless applauding mass” [Svrakic D. M., 1989].

How to recognize and deal with histrionic personality disorder

August 7, 2020 Likbez Health

Stress will help to heal, and in order to start therapy, it is enough to detect five out of ten signs.

If you have 100 acquaintances, about two of them have hysterical personality disorder. Most likely, these two are women.

Histrionic personality disorder is diagnosed four times more often in women than in men.

But there is an assumption that in the case of men, hysterical traits - demonstrative behavior, a thirst for recognition, emotional outbursts, communication in raised tones - simply seem acceptable to society, natural, therefore, they do not seem to require correction and treatment to a doctor. However, in fact, both men and women are hysterical with equal frequency. nine0007

Actually, for this reason, in English-language literature, the concept of “hysterical” (hysterical) was abandoned in favor of “dramatic, simulated, theatrical” (histrionic). The word "hysteria" comes from the ancient Greek "womb", which means that only women can suffer from a hysterical disorder. Histrionic disorder is not related to gender.

Recognizing a "dramatic" violation is quite difficult. This conduct disorder (which is how the International Classification of Diseases ICD-10 defines hysterical personality disorder) often looks like openness, originality, a kind of cute expression characteristic of charming creative characters. nine0007

However, there are important clues that the person has crossed the line that separates eccentricity from mental impairment.

What are the symptoms of histrionic personality disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists 10 key features of this disorder. To suggest a hysterical personality disorder, it is enough to notice at least five of them in a person’s behavior.

1. Egocentricity

A person feels the need to be in the center of attention, to outshine others. If for some reason this is objectively impossible, he will try to attract attention by all available means.

For example, if a histrionic is a student at a lecture, he will interrupt the lecturer with questions, and if, let's say, he is just a guest at a party with a star, he will deliberately laugh out loud or even intentionally break something.

2. Demonstrative behavior

This is, for example, the habit of talking loudly, active gestures, exaggerated display of emotions. For example, if such a person sees a friend, he will not limit himself to a simple “Hello!” He throws himself on his neck and kisses him. nine0007

3. The tendency to consider relationships with people closer than they are

Familiarity is another characteristic feature of histrionics. A person really wants to be loved and accepted, so he unconsciously seeks to show that everywhere and for everyone he is “his own”.

Histrionic easily pours out his soul, sometimes even to casual acquaintances. True, he speaks only on a limited number of topics: for example, how many trials he passed with dignity, how he was admired, or, on the contrary, how callously and vilely he was betrayed. nine0007

4. Love for provocative outfits

Unusual, eye-catching clothing is one of the easiest ways to stand out from the crowd and attract attention. And the histrionic uses it to the fullest, choosing things in bright colors, adding abundant decorations and creating provocative sets.

5. Inappropriately seductive appearance or behavior

If the histrionic is a woman, she is a vamp. If a man is a mysterious macho. A person with this disorder needs compliments and knows that the easiest way to "squeeze" them from the opposite sex. Hence the undisguised sexuality that permeates the entire image. nine0007

6. An obsessive thirst for recognition and approval

A Histrionic should be admired - only then will he be complacent and satisfied. If he is not noticed or, even worse, criticized, he will make a dramatic scandal and leave, wringing his hands theatrically, slamming the door in parting.

7. Frequent and rapid mood swings

A person with a hysterical disorder is very emotional, and the most insignificant factors can cause a violent change of emotions. For example, a histrionic may sob sincerely when he loses a twenty or discovers that someone has not washed his cup again. But in a minute he will laugh just as sincerely when he hears an insipid anecdote from a significant person. nine0007

8. Hypersensitivity to criticism

It is difficult to discuss conflict issues with a histrionic, whether domestic or work. The slightest dissatisfaction or a request not to do this again, he immediately takes into account. And he begins to defend himself, often according to the principle "the best defense is an attack."

The search for a compromise turns into a quarrel with raised voices and becomes hopeless.

9. Suggestibility

Critical thinking, fact-checking, analysis are not about histrionics. His point of view is based on emotions: “It’s close to me, so it’s true.” nine0007

A huge influence on the formation of the views of a person with a hysterical disorder is exerted by authorities, that is, people who are personally significant to him. He perceives their words completely uncritically, often as the ultimate truth.

10. Deterioration in the quality of life due to behavioral characteristics

This is a common symptom of behavioral disorders: they ruin a person's life.

For example, an overly emotional histrionic, prone to dramatization, cannot build stable personal or business relationships: partners run away from him after the very first theatrical scandals. nine0007

Or another angle: because of his gullibility and love for revealing outfits, a histrionic every now and then gets into risky situations.

Here's another example: due to the inability to be critical of himself, he cannot draw conclusions from past mistakes, so he steps on the same rake again and again, blaming anyone but himself for his problems.

What to do if a person has histrionic personality disorder

The most effective treatment for histrionic disorder is psychotherapy. The problem is that histrionics, as a rule, do not consider their behavior to require correction and are often not ready to turn to a psychotherapist. nine0007

The easiest way is to proceed as follows. Sooner or later, the histrionic once again gets hit on the forehead by life. Against this background, he experiences severe stress, anxiety, sometimes he develops depression. It is at this moment that it is worth taking a person by the hand and leading him to a specialist. To begin with, to solve the “stress” problem, and after it, deal with histrionic disorder.

Most likely, the doctor will choose the so-called psychodynamic approach to work with the patient. It is based on psychoanalysis: with the help of a specialist, a person learns to understand what exactly makes him perform certain actions. nine0007

In the first step, the therapist will ask the patient to replace active behavior with words. For example, if a histrionic wants to throw himself on someone's neck, he should stop and explain to himself what is happening: "I'm glad to meet you." This deciphering of emotions, which should become a habit, helps to understand yourself and learn to communicate less theatrically with others.

Next, the psychotherapist will help the histrionic to realize that drama, excessive emotionality is just a way to attract attention, to feel significant.

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