Histrionic: Definition, Symptoms, Signs, Diagnosis and Treatment

Histrionic personality disorder is characterized by a generalized pattern of excessive emotionality and attention seeking.

The diagnosis is by clinical criteria, the treatment is with psychodynamic psychotherapy.

Patients with histrionic personality disorder use their physical appearance, acting in inappropriate seductive or provocative ways, to get the attention of others.

They lack a sense of self-direction and are highly suggestible, often acting submissively to retain the attention of others.

The estimated prevalence is <2% of the general population. It is most often diagnosed in women, but this finding may only reflect a higher prevalence among women in clinical settings, where the data were obtained.

In some studies, the prevalence in women and men was similar.

Comorbidities are common, particularly other personality disorders (antisocial, borderline, narcissistic), suggesting that these disorders share a biological vulnerability or casting doubt on whether histrionic personality disorder is a separate disorder.

Some patients also have a somatic symptom disorder, which may be the reason they present for evaluation. Major depressive disorder, dysthymia, and conversion disorder can also coexist.

Symptoms and Signs of Histrionic Personality Disorder

  • Patients with histrionic personality disorder continually demand to be the center of attention and often become depressed when they are not. They are often lively, dramatic, enthusiastic, and flirtatious, sometimes attracting new acquaintances.
  • These patients often dress and act in inappropriately seductive and provocative ways, not only with potential romantic interests, but in many contexts (eg, work, school). They want to impress others with their appearance and therefore often care about how they look.
  • Expression of emotion can be superficial (fading on and off too quickly) and exaggerated. They speak dramatically, express strong opinions, but with few facts or details to back up their opinions.
  • Patients with histrionic personality disorder are easily influenced by others and by current trends.
  • They tend to trust too much, especially in authority figures who, according to them, can solve all their problems. They often think that relationships are closer than they are.
  • They crave novelty and tend to get bored easily. Therefore, they can change jobs and friends frequently. Delayed gratification is very frustrating for them, so their actions are often motivated by immediate satisfaction.
  • Achieving emotional or sexual intimacy can be difficult. Patients can, often inadvertently, play a role (eg, Victim). They may try to control their partner using seduction or emotional manipulations while becoming very dependent on the partner.

Diagnosis

Clinical criteria (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5]) For a diagnosis of histrionic personality disorder, patients must have:

  • A persistent pattern of excessive emotionality and attention seeking.

This pattern is shown by the presence of ≥ 5 of the following:

  • Discomfort when they are not the center of attention.
  • Interaction with others that is inappropriately sexually seductive or provocative.
  • Quickly changing and superficial expression of emotions.
  • Constant use of physical appearance to draw attention to themselves.
  • An extremely impressionistic and vague speech.
  • Self-dramatization, theatricality and extravagant expression of emotion.
  • Suggestibility (easily influenced by others or situations).
  • Interpretation of relationships as more intimate than they are.
  • Also, symptoms must have started before adulthood.

Differential diagnosis

Histrionic personality disorders can be distinguished from other personality disorders based on the characteristics:

Narcissistic Personality Disorder : Patients with Narcissistic Personality Disorder also seek attention, but unlike those with Histrionic Personality Disorder, they want to feel admired or elevated by it.

Patients with Histrionic Personality Disorder are not as picky about the type of care they receive and they don’t mind being considered cute or silly.

Borderline personality disorder : patients with borderline personality disorder consider themselves ill and experience emotions intensely and deeply; Those with histrionic personality disorder do not see themselves as bad, even though their dependence on the reaction of others may be due to low self-esteem.

Dependent personality disorder: Patients with dependent personality disorder, such as those with histrionic personality disorder, try to be around others but are more anxious, inhibited, and submissive (because they are concerned about rejection).

Patients with histrionic personality disorder are less inhibited and more outlandish.

The differential diagnosis for histrionic personality disorder also includes somatic symptom disorder and illness anxiety disorder.

Treatment of histrionic personality disorder

psychodynamic psychotherapy

The general treatment for histrionic personality disorder is the same as for all personality disorders.

Little is known about the efficacy of cognitive behavioral therapy and drug therapy for histrionic personality disorder.

Psychodynamic psychotherapy, which focuses on underlying conflicts, can be tried. The therapist can begin by encouraging patients to substitute for speech behavior, and thus patients can understand themselves and communicate with others in a less dramatic way.

The therapist can then help patients to realize that their histrionic behaviors are a maladaptive way of attracting the attention of others and controlling their self-esteem.