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Person with histrionic personality disorder


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:

  1. Uncomfortable when not the center of attention

  2. Seductive or provocative behavior

  3. Shifting and shallow emotions

  4. Uses appearance to draw attention

  5. Impressionistic and vague speech

  6. Dramatic or exaggerated emotions

  7. Suggestible (easily influenced by others)

  8. 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 | Abnormal Psychology

Learning Objectives

  • Describe the characteristics and diagnosis of histrionic personality disorder

Cluster B personality disorders include those related to impulsive, dramatic, emotional, or erratic behavior. These include antisocial personality disorder (ASPD), borderline personality disorder (BPD), histrionic personality disorder (HPD), and narcissistic personality disorder (NPD). We will review histrionic personality disorder on this page.

Table 1. DSM-5 Personality Disorders
Antisocial continuously violates the rights of others; history of antisocial tendencies prior to age 15; often lies, fights, and has problems with the law; impulsive and fails to think ahead; can be deceitful and manipulative in order to gain profit or pleasure; irresponsible and often fails to hold down a job or pay financial debts; lacks feelings for others and remorse over misdeeds B
Histrionic excessively overdramatic, emotional, and theatrical; feels uncomfortable when not the center of others’ attention; behavior is often inappropriately seductive or provocative; speech is highly emotional but often vague and diffuse; emotions are shallow and often shift rapidly; may alienate friends with demands for constant attention B
Narcissistic overinflated and unjustified sense of self-importance and preoccupied with fantasies of success; feels entitled to special treatment from others; shows arrogant attitudes and behaviors; takes advantage of others; lacks empathy B
Borderline unstable in self-image, mood, and behavior; cannot tolerate being alone and experiences chronic feelings of emptiness; unstable and intense relationships with others; behavior is impulsive, unpredictable, and sometimes self-damaging; shows inappropriate and intense anger; makes suicidal gestures B

Histrionic Personality Disorder

Histrionic personality disorder (HPD) is a personality disorder characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early childhood, including inappropriate seduction and an excessive need for approval. People diagnosed with the disorder are said to be lively, dramatic, vivacious, enthusiastic, and flirtatious.

People with a histrionic personality disorder (HPD) may feel underappreciated or disregarded when they are not the center of attention. People with this disorder are typically “the life of the party” and have a “larger than life” presence. People with histrionic personality disorder (HPD) have a high need for attention, make loud and inappropriate appearances, exaggerate their behaviors and emotions, and crave stimulation. They may exhibit sexually provocative behavior, express strong emotions with an impressionistic style, and can be easily influenced by others.

Diagnostic Criteria

The DSM-5 defines histrionic personality disorder as 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 characteristics:

Differential Diagnosis

The differential diagnosis (unique attributes that differentiate a disorder from others with similar features) for histrionic personality disorder includes narcissistic personality disorder, borderline personality disorder, dependent personality disorder, somatic symptom disorder, and illness anxiety disorder.

  • Like histrionic personality disorder, patients with narcissistic personality disorder prefer to be the center of attention. 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 demographics of patients experience intense emotions; however, patients with borderline personality disorder usually dislike themselves.
  • 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. 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.
  • Somatic symptom disorder and illness anxiety disorder are also included in the differential for histrionic personality disorder as patients with a histrionic personality disorder may use physical symptoms and complaints to gain attention from others.

Comorbidity

Most people with histrionic personality disorder also have other mental disorders. Comorbid conditions include antisocial, dependent, borderline, and narcissistic personality disorders as well as depression, anxiety disorders, panic disorder, somatoform disorders, anorexia nervosa, substance use disorder, and attachment disorders.

Watch It

Watch this clip to see how histrionic personality disorder may be demonstrated.

You can view the transcript for “DSM 5 Histrionic Personality Disorder Criteria Example, Symptoms Video” here (opens in new window).

Epidemiology

The prevalence of histrionic personality disorder in the general population runs about 2%-3%. 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. However, research suggests that women may be overly diagnosed with this disorder when compared to men due to sexual-forwardness being less socially acceptable for women.  Furthermore, men may be less likely to report their symptoms and thereby be under-diagnosed. 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.

Etiology

Histrionic personality disorder probably develops as a combination of both learned and inherited factors. 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. Personality disorders in childhood may originate as an adaptation to cope with a traumatic situation or traumatic environment.

Parenting styles may also influence the likelihood of developing a histrionic personality disorder. Parenting that lacks boundaries is over-indulgent, or inconsistent may predispose children to develop a histrionic personality disorder. Because histrionic personality disorder tends to run in families, there is some consideration that there is genetic susceptibility for this disorder that may be inherited. As with all psychiatric disorders, having a family history of personality disorders, psychiatric illness, or substance use disorders is a risk factor for histrionic personality disorder.

Treatment

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. Supportive psychotherapy aims to reduce emotional distress, improve self-esteem, and to enhance the patient’s coping skills, all through attentive and sympathetic listening.

Psychodynamic psychotherapy (also called insight-oriented therapy) has also proven to be a successful approach in treating patients with histrionic personality disorder. 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. Psychodynamic psychotherapy aims to resolve underlying, unconscious conflicts in an effort for patients to understand themselves and their behaviors better. The patients are encouraged to substitute excessively dramatic speech for a more adaptive action or behavior, to promote better communication with others. Through psychodynamic psychotherapy, patients learn to recognize that hyper-sexual, attention-seeking behaviors are maladaptive, and discover new, healthier ways to develop self-esteem.

While the gold standard for treating personality disorders is psychotherapy, patients with histrionic personality disorder may be profoundly symptomatic. 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. Antidepressants that have proven to be effective include desipramine, fluoxetine, amitriptyline, and fluvoxamine. The mood stabilizers with proven therapeutic benefits include lamotrigine, carbamazepine, topiramate, valproate, and lithium. Research has demonstrated that antipsychotics such as risperidone, aripiprazole, olanzapine, and haloperidol have been useful in treating affective dysregulation. 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.

Key Takeaways: Histrionic Personality Disorder

Think it Over: Michael Scott’s Diagnosis

Many of you are familiar with the fictional character Michael Scott from the hit TV show The Office. Scott is a 46-year-old, Caucasian male from Scranton, Pennsylvania, and the regional manager at Dunder Mifflin Inc., a local paper and printer distribution company. Michael Scott’s outward appearance is well put together, as he presents as a business professional, and there are no obvious health concerns. Despite his seemingly composed demeanor, Scott displays exaggerated emotions and reactions. In addition to these exaggerations, romantic relationships have proven turbulent for Scott throughout his life, as he goes from one relationship to the next with the other person usually being the one to end the relationship. He has few close friends or relatives and tends to perceive new friendships as closer than they actually are. Scott believes his subordinates to be his family, and oftentimes gets involved in their personal lives without their consent. His parents divorced when he was young (age unknown), and he displays clear resentment towards his stepfather and sister, whom he once didn’t talk to for fifteen years. Scott has a very close relationship with his mother now, though this was not the case when he was a child. Though Scott seems to be lacking in managerial style, responsibility, and delegation, he demonstrates above-average sales abilities due to his personable qualities. Scott does not have a history of drug or alcohol abuse, though he will drink in social situations and when pressured to do so by coworkers.

Some of Michael Scott’s behaviors fit with the description of histrionic personality disorder, namely that he likes to be the center of attention, uses impressionistic speech, considers relationships to be more intimate than they actually are, and even shows self-dramatization at times. These things still do not meet all five criteria for the diagnosis, however. This video by Dr. Grande goes through each of the criteria for histrionic personality disorder (start at the 14:54 mark), then goes on to explain why Michael Scott may better fit the description for narcissistic personality disorder, which we’ll examine on the next page.

Because of the overlap in some of the criteria and frequent comorbidity of histrionic personality disorder with other personality disorders, some scholars have recommended removing the histrionic diagnosis altogether.

Bakkevig and Karterud (2010), in a study carried out with a sample of patients attending psychiatric day hospital, concluded that the prevalence of HPD was very low (0. 4%) and comorbidity was high, especially with borderline, narcissistic, and dependent personality disorders. They suggested that the HPD category should be deleted from the DSM system, excepting that clinical phenomena of exhibitionism and attention-seeking, which are the dominant personality features of HPD, should be preserved in an exhibitionistic subtype of narcissism.[1]

Try It

Glossary

histrionic personality disorder: characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early childhood, including inappropriate seduction and an excessive need for approval

personality disorder: group of DSM-5 disorders characterized by an inflexible and pervasive personality style that differs markedly from the expectations of one’s culture and causes distress and impairment

  1. Novais F, Araújo A and Godinho P (2015) Historical roots of histrionic personality disorder. Front. Psychol. 6:1463. doi: 10.3389/fpsyg.2015.01463 ↵

Hysterical personality disorder - treatment of hysteroid disorders in the Allianz Central Medical Health Center

Hysterical (hysterical) personality disorder is one of the variants of personality disorder (the obsolete name is “psychopathy”), characterized, along with the common features for this group, by the following distinctive features:

  • strong desire to be the center of attention. Situations where they are deprived of this attention cause severe discomfort, up to the appearance of various physical ailments; nine0006
  • theatricality of behavior: dramatization of events, pretentiousness of speech and gestures, hypertrophied manifestation of emotions;
  • increased suggestibility: easily influenced by other people or situations;
  • superficiality and lability of emotional experiences, frequent mood swings;
  • extreme preoccupation with their appearance. Physical attractiveness is another way for them to get attention;
  • inadequate assessment of the degree of closeness of relationships with other people (they consider relationships closer than they really are), as well as frequent provocative behavior aimed at seduction. nine0006

Symptoms

Extreme emotional variability and sensitivity, combined with an all-encompassing thirst for attention, form the core of this pathology.

People with hysterical personality disorder are very much like actors who live for praise and applause. Alternative names: theatrical, histrionic (from the Latin histrio - “actor”) disorder, reflect its essence. It was previously thought that women were more susceptible to this pathology, however, recent studies have shown that it occurs with the same frequency in men and women. nine0003

People with histrionic personality disorder often resort to various types of manipulative behavior to quench their thirst for attention. These can be both the aforementioned dramatic and theatrical speech and gestures, extravagant appearance and clothing, as well as more serious, even potentially dangerous options, such as demonstrative suicide attempts or simulation of somatic diseases.

Despite the brightness of the symptoms of hysteroid disorder, an important component of the differential diagnosis is the exclusion or detection of a real concomitant somatic or mental pathology. nine0003

Important

To conduct a competent differential diagnosis, you need to contact a specialist, otherwise there is a high risk of missing a concomitant disease and undergoing unnecessary medical examinations and procedures.

Treatment and prognosis

The prognosis for hysterical personality disorder is usually favorable - it is possible to achieve stable and long-term compensation.

nine0023

Correction is easier in individuals whose hysterical manifestations are concentrated mainly in the sphere of physical sensations and ailments (a hysterical lump in the throat, trembling in the whole body or in separate parts, numbness and other disturbances of sensitivity, etc. ). With adequate treatment, such people become well adapted socially and professionally by adulthood, although there are still noticeable elements of theatricality in their appearance, speech and gestures. nine0003

It must be emphasized that in this disorder, it is often not a true simulation of symptoms, in which the simulator lies about his malaise, but the result of the peculiarities of perception and thinking of a hysteroid personality. With this disorder, part of what is happening (external events or internal sensations) is perceived especially sharply, and part is only superficial or even escapes attention. In combination with the rich imagination inherent in people of this type, this leads to the fact that in places they blur the line between reality and fantasy. As a result, certain physical symptoms appear, which are not the fruit of true simulation, i.e. deliberate deception. A person really believes that the symptoms he produces are a manifestation of a real disease beyond his control. nine0003

The prognosis becomes less certain if the symptomatology is dominated by pathological fantasizing (pseudology), which manifests itself in telling a lot of invented facts about oneself, designed to impress listeners with the extraordinary significance and uniqueness of the narrator. Such people lie about themselves relentlessly and almost constantly, sometimes senselessly, even though it is obvious that they will be exposed. Often, pathological liars, possessing outstanding acting talent, resort to criminal activity - all kinds of fraud options. nine0003

Due to the peculiarities of the psyche, self-seeking for medical help is quite common for people with hysterical personality disorder. Treatment of this pathology, first of all, occurs by methods of psychotherapy. The most commonly used areas are: psychoanalysis, cognitive, psychodynamic and group psychotherapy. Drug treatment is used only in individual cases and is auxiliary.

The Alliance mental health center employs qualified psychotherapists who have effective methods for diagnosing and treating hysterical personality disorder. Our specialists have many years of successful experience in this field, individually and carefully approach the management of each case, which allows us to get a positive effect from the treatment in the shortest possible time and improve the patient's quality of life. nine0003

People with histrionic personality disorder are bright, emotionally charged and attention-hungry individuals. Resorting to various manipulations, they themselves are often used by others because of their suggestibility and desire to please. Tireless actors, they often lose the line between reality and fantasy. In a state of mental compensation, they manage to achieve a high level of social and professional adaptation and lead an active lifestyle.

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.

You can listen to the article. If it's more convenient for you, turn on the podcast.

If you have 100 people you know, 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. nine0003

But there is an assumption that in the case of men, hysterical traits - demonstrative behavior, 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.

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. nine0003

It is difficult to recognize a "dramatic" disorder. 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.

Nevertheless, there are important signs indicating that a person has crossed the line that separates eccentricity from a mental disorder.

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. nine0003

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.

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. nine0003

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. nine0003

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. nine0003

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.” nine0003

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. nine0003

Or another angle: because of the gullibility and love for revealing outfits, the histrionic now and then finds himself in risky situations.

Here is another example: due to the inability to be critical of himself, he cannot draw conclusions from past mistakes, so he falls into 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. nine0003

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. nine0003

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.

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