Histrionic personality disorder
Encyclopedia
Histrionic personality disorder (HPD) is defined by the American Psychiatric Association
as a personality disorder
characterized by a pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriately seductive
behavior, usually beginning in early adulthood. These individuals are lively, dramatic, vivacious, enthusiastic, and flirtatious.
They may be inappropriately sexually provocative, express strong emotions with an impressionistic style, and be easily influenced by others. Associated features may include egocentrism
, self-indulgence, continuous longing for appreciation, and persistent manipulative
behavior to achieve their own needs.
, but they tend to use these skills to manipulate
other people and become the center of attention. Furthermore, histrionic personality disorder may affect a person's social or romantic relationships or their ability to cope with losses or failures. They may seek treatment for depression
when romantic relationships end, although this is by no means a feature exclusive to this disorder.
They often fail to see their own personal situation realistically, instead tending to dramatize and exaggerate their difficulties. They may go through frequent job changes, as they become easily bored and have trouble dealing with frustration
. 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.
Additional symptoms include:
may be involved. Histrionic Personality Disorder is more often diagnosed in women than men; men with some quite similar symptoms are often diagnosed with narcissistic personality disorder
.
Little research has been conducted to determine the biological sources, if any, of this disorder. Psychoanalytic
theories incriminate authoritarian or distant attitudes by one (mainly mother) or both of the parents of these patients, or love based on expectations from the child that can never be fully met.
, are usually sufficient to establish the diagnosis. There is no test to confirm this diagnosis. Because the criteria are subjective, some people may be wrongly diagnosed as having the disorder while others with the disorder may not be diagnosed. Treatment is often prompted by depression associated with dissolved romantic relationships. Medication does little to affect this personality disorder, but may be helpful with symptoms such as depression. Psychotherapy
may also be of benefit.
fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines histrionic personality disorder (in Axis II Cluster B) as:
It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.
's ICD-10
lists histrionic personality disorder as Histrionic personality disorder.
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.
identified six subtypes of histrionic. Any individual histrionic may exhibit none or one of the following:
that can be used to remember the criteria for histrionic personality disorder is PRAISE ME:
A person suffering from HPD is highly reactive. If there is another major disorder present, such as delusional disorder
, then emotional intensity will create anger, rage, abuse and distance in relationships.
It is important for the therapist and family members to monitor and record all situations that trigger the HPD so that the deep underlying overload of pain can be accessed and released for therapeutic change.
findings on the treatment of these disorders remain based on the case report method and not on clinical trial
s. On the basis of case presentations, the treatment of choice is psychotherapy and/or cognitive-behavioral therapy, aimed at self-development through resolution of conflict and advancement of inhibited developmental lines. Group therapy
can assist individuals with HPD to learn to decrease the display of excessively dramatic behaviors, but must be closely monitored because it may provide the person with an audience to play to (perform for), thus giving opportunity to perpetuate histrionic behavior.
combination of genetics and environment, including childhood experiences
and somatization disorder
. Historically, they are linked to the ancient notion of hysteria
, or "wandering womb."(Note, however, that according to the Online Etymology Dictionary, the word "histrionic" derives not from the Greek hystera, but from the Latin histrionicus, "pertaining to an actor.") Ancient Greeks
thought that excessive emotionality in women was caused by a displaced uterus
and sexual discontent.
"Hysteria" differentiated into conversion hysteria (later to become conversion disorder
) and hysterical personality (later to become histrionic personality disorder) in the psychoanalytic literature as well as with the writings of Kraepelin, Schneider, and others. Sigmund Freud
wrote primarily about conversion hysteria. Wilhelm Reich
wrote about hysteria as a set of personality characteristics and differentiated conversion hysteria as a transient disorder from hysterical character. These early conceptualizations of both kinds of hysteria carried notions of women's deficiency due to penis envy
and feelings of castration
. Paul Chodoff has written about the ways in which these diagnoses paralleled the misogynistic
sentiment of the times.
The concept of hysterical personality was well developed by the mid-20th century and strongly resembled the current definition of histrionic personality disorder. The first DSM
featured a symptom-based category, "hysteria" (conversion) and a personality-based category, "emotionally unstable personality." DSM-II distinguished between hysterical neurosis
(conversion reaction and dissociative reaction) and hysterical (histrionic) personality.
In DSM-III, the term hysterical personality changed to histrionic personality disorder to emphasize the histrionic (derived from the Latin
word histrio, or actor) behavior pattern and to reduce the confusion caused by the historical links of hysteria to conversion symptoms. The landmark case of Ruth E. helped to fully define and emphasize the characteristics of the current DSM-IV diagnostic. DSM-III-R attempted to reduce the overlap between Histrionic Personality Disorder and borderline personality disorder
by dropping three overlapping criteria and adding two criteria that emphasized histrionicity. DSM-IV dropped two more criteria that did not appear to contribute to the consistency of the diagnosis, according to research done by Bruce Pfohl.
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
as a personality disorder
Personality disorder
Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...
characterized by a pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriately seductive
Seduction
In social science, seduction is the process of deliberately enticing a person to engage. The word seduction stems from Latin and means literally "to lead astray". As a result, the term may have a positive or negative connotation...
behavior, usually beginning in early adulthood. These individuals are lively, dramatic, vivacious, enthusiastic, and flirtatious.
They may be inappropriately sexually provocative, express strong emotions with an impressionistic style, and be easily influenced by others. Associated features may include egocentrism
Egocentrism
Egocentrism is a personality trait which has the characteristic of regarding oneself and one's own opinions or interests as most important or valid...
, self-indulgence, continuous longing for appreciation, and persistent manipulative
Psychological manipulation
Psychological manipulation is a type of social influence that aims to change the perception or behavior of others through underhanded, deceptive, or even abusive tactics. By advancing the interests of the manipulator, often at the other's expense, such methods could be considered exploitative,...
behavior to achieve their own needs.
Characteristics
People with this disorder are usually able to function at a high level and can be successful socially and professionally. People with histrionic personality disorder usually have good social skillsSocial skills
A social skill is any skill facilitating interaction and communication with others. Social rules and relations are created, communicated, and changed in verbal and nonverbal ways. The process of learning such skills is called socialization...
, but they tend to use these skills to manipulate
Psychological manipulation
Psychological manipulation is a type of social influence that aims to change the perception or behavior of others through underhanded, deceptive, or even abusive tactics. By advancing the interests of the manipulator, often at the other's expense, such methods could be considered exploitative,...
other people and become the center of attention. Furthermore, histrionic personality disorder may affect a person's social or romantic relationships or their ability to cope with losses or failures. They may seek treatment for depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
when romantic relationships end, although this is by no means a feature exclusive to this disorder.
They often fail to see their own personal situation realistically, instead tending to dramatize and exaggerate their difficulties. They may go through frequent job changes, as they become easily bored and have trouble dealing with frustration
Frustration
This article concerns the field of psychology. The term frustration does, however, also concern physics. In this context, the term is treated in a different article, geometric frustration....
. 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.
Additional symptoms include:
- Exhibitionist behavior.
- Constant seeking of reassurance or approval.
- Excessive dramatics with exaggerated displays of emotions, such as hugging someone they have just met or crying uncontrollably during a sad movie (Svrakie & Cloninger, 2005).
- Excessive sensitivity to criticismCriticismCriticism is the judgement of the merits and faults of the work or actions of an individual or group by another . To criticize does not necessarily imply to find fault, but the word is often taken to mean the simple expression of an objection against prejudice, or a disapproval.Another meaning of...
or disapproval. - Proud of own personality, unwillingness to change and any change is viewed as a threat.
- Inappropriately seductive appearance or behavior.
- Somatic symptomsSomatoform disorderIn psychology, a somatoform disorder is a mental disorder characterized by physical symptoms that suggest physical illness or injury - symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder . The symptoms that...
, and using these symptoms as a means of garnering attention. - A need to be the center of attentionAttention seekingEnjoying the attention of others is quite socially acceptable. In some instances, however, the need for attention can lead to difficulties. The term attention seeking is generally reserved for such situations where excessive and "inappropriate attention seeking" is seen.-Styles:The following...
. - Low tolerance for frustration or delayed gratification.
- Rapidly shifting emotional states that may appear superficialSuperficialSuperficial may refer to:*Superficial , an album by Heidi Montag*"Superficial" *The Superficial, a website devoted to celebrity gossip...
or exaggerated to others. - Tendency to believe that relationships are more intimate than they actually are.
- Making rash decisions.
Causes
The cause of this disorder is unknown, but childhood events such as deaths in the immediate family, illnesses within the immediate family which present constant anxiety, divorce of parents and geneticsGenetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
may be involved. Histrionic Personality Disorder is more often diagnosed in women than men; men with some quite similar symptoms are often diagnosed with narcissistic personality disorder
Narcissistic personality disorder
Narcissistic personality disorder is a personality disorder in which the individual is described as being excessively preoccupied with issues of personal adequacy, power, prestige and vanity...
.
Little research has been conducted to determine the biological sources, if any, of this disorder. Psychoanalytic
Psychoanalysis
Psychoanalysis is a psychological theory developed in the late 19th and early 20th centuries by Austrian neurologist Sigmund Freud. Psychoanalysis has expanded, been criticized and developed in different directions, mostly by some of Freud's former students, such as Alfred Adler and Carl Gustav...
theories incriminate authoritarian or distant attitudes by one (mainly mother) or both of the parents of these patients, or love based on expectations from the child that can never be fully met.
Diagnosis
The person's appearance, behavior, and history, along with a psychological evaluationPsychological evaluation
A psychological evaluation or mental examination is an examination into a person's mental health by a mental health professional such as a psychologist. A psychological evaluation may result in a diagnosis of a mental illness...
, are usually sufficient to establish the diagnosis. There is no test to confirm this diagnosis. Because the criteria are subjective, some people may be wrongly diagnosed as having the disorder while others with the disorder may not be diagnosed. Treatment is often prompted by depression associated with dissolved romantic relationships. Medication does little to affect this personality disorder, but may be helpful with symptoms such as depression. Psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
may also be of benefit.
DSM-IV-TR 301.50
The Diagnostic and Statistical Manual of Mental DisordersDiagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines histrionic personality disorder (in Axis II Cluster B) 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:
- is uncomfortable in situations in which he or she is not the center of attention
- interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
- displays rapidly shifting and shallow expression of emotions
- consistently uses physical appearance to draw attention to self
- has a style of speech that is excessively impressionistic and lacking in detail
- shows self-dramatization, theatricality, and exaggerated expression of emotion
- is suggestible, i.e., easily influenced by others or circumstances
- considers relationships to be more intimate than they actually are.
It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.
ICD-10
The World Health OrganizationWorld Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
's ICD-10
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...
lists histrionic personality disorder as Histrionic personality disorder.
- It is characterized by at least 3 of the following:
- self-dramatization, theatricality, exaggerated expression of emotions;
- suggestibility, easily influenced by others or by circumstances;
- shallow and labile affectivity;
- continual seeking for excitement and activities in which the patient is the center of attention;
- inappropriate seductiveness in appearance or behavior;
- over-concern with physical attractiveness.
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.
Millon's subtypes
Theodore MillonTheodore Millon
Theodore Millon is an American psychologist known for his work on personality disorders.-Biography:Millon was born in 1928, the only child of immigrant Jewish parents from Lithuania and Poland. His 19th-century ancestors came from the town of Valozhyn, then a part of the Russian Empire...
identified six subtypes of histrionic. Any individual histrionic may exhibit none or one of the following:
- Theatrical histrionic - especially dramatic, romantic and attention seeking.
- Infantile histrionic - including borderlineBorderline personality disorderBorderline personality disorder is a personality disorder described as a prolonged disturbance of personality function in a person , characterized by depth and variability of moods.The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the...
features. - Vivacious histrionic - synthesizes the seductiveness of the histrionic with the energy level typical of hypomaniaHypomaniaHypomania is a mood state characterized by persistent and pervasive elevated or irritable mood, as well as thoughts and behaviors that are consistent with such a mood state...
. - Appeasing histrionic - including dependentDependent personality disorderDependent personality disorder , formerly known as asthenic personality disorder, is a personality disorder that is characterized by a pervasive psychological dependence on other people...
and compulsiveObsessive-compulsive personality disorderObsessive–compulsive personality disorder is a personality disorder characterized by a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency.- Signs and symptoms :The primary symptoms of OCPD...
features. - Tempestuous histrionic - including negativistic (passive-aggressive) features.
- Disingenuous histrionic - antisocialAntisocial personality disorderAntisocial personality disorder is described by the American Psychiatric Association's Diagnostic and Statistical Manual, fourth edition , as an Axis II personality disorder characterized by "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood...
features.
Mnemonic
A mnemonicMnemonic
A mnemonic , or mnemonic device, is any learning technique that aids memory. To improve long term memory, mnemonic systems are used to make memorization easier. Commonly encountered mnemonics are often verbal, such as a very short poem or a special word used to help a person remember something,...
that can be used to remember the criteria for histrionic personality disorder is PRAISE ME:
- P - provocative (or seductive) behavior
- R - relationships, considered more intimate than they are
- A - attentionAttentionAttention is the cognitive process of paying attention to one aspect of the environment while ignoring others. Attention is one of the most intensely studied topics within psychology and cognitive neuroscience....
, must be at center of - I - influenced easily
- S - speech (style) - wants to impress, lacks detail
- E - emotional lability, shallowness
- M - make-up - physical appearance used to draw attention to self
- E - exaggerated emotions - theatrical
Differential diagnosis
- Clinical depressionClinical depressionMajor depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
- Anxiety disorders
- Panic disorderPanic disorderPanic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks...
- Somatoform disorders
A person suffering from HPD is highly reactive. If there is another major disorder present, such as delusional disorder
Delusional disorder
Delusional disorder is an uncommon psychiatric condition in which patients present with circumscribed symptoms of non-bizarre delusions, but with the absence of prominent hallucinations and no thought disorder, mood disorder, or significant flattening of affect...
, then emotional intensity will create anger, rage, abuse and distance in relationships.
It is important for the therapist and family members to monitor and record all situations that trigger the HPD so that the deep underlying overload of pain can be accessed and released for therapeutic change.
Treatment
Because of the lack of research support for work on personality disorders and long-term treatment with psychotherapy, the empiricalEmpiricism
Empiricism is a theory of knowledge that asserts that knowledge comes only or primarily via sensory experience. One of several views of epistemology, the study of human knowledge, along with rationalism, idealism and historicism, empiricism emphasizes the role of experience and evidence,...
findings on the treatment of these disorders remain based on the case report method and not on clinical trial
Clinical trial
Clinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions...
s. On the basis of case presentations, the treatment of choice is psychotherapy and/or cognitive-behavioral therapy, aimed at self-development through resolution of conflict and advancement of inhibited developmental lines. Group therapy
Group therapy
Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group...
can assist individuals with HPD to learn to decrease the display of excessively dramatic behaviors, but must be closely monitored because it may provide the person with an audience to play to (perform for), thus giving opportunity to perpetuate histrionic behavior.
- Psychoanalytic psychotherapy
- Family therapy
- Medications
- Alternative therapies
- Cognitive behavioral therapy
Epidemiology
Major character traits may be inherited. Other character traits due to a phenotypicalPhenotype
A phenotype is an organism's observable characteristics or traits: such as its morphology, development, biochemical or physiological properties, behavior, and products of behavior...
combination of genetics and environment, including childhood experiences
History
Histrionic personality disorder shares a divergent history with conversion disorderConversion disorder
Conversion disorder is a condition in which patients present with neurological symptoms such as numbness, blindness, paralysis, or fits without a neurological cause. It is thought that these problems arise in response to difficulties in the patient's life, and conversion is considered a psychiatric...
and somatization disorder
Somatization disorder
Somatization disorder is a psychiatric diagnosis applied to patients who persistently complain of varied physical symptoms that have no identifiable physical origin...
. Historically, they are linked to the ancient notion of hysteria
Hysteria
Hysteria, in its colloquial use, describes unmanageable emotional excesses. People who are "hysterical" often lose self-control due to an overwhelming fear that may be caused by multiple events in one's past that involved some sort of severe conflict; the fear can be centered on a body part, or,...
, or "wandering womb."(Note, however, that according to the Online Etymology Dictionary, the word "histrionic" derives not from the Greek hystera, but from the Latin histrionicus, "pertaining to an actor.") Ancient Greeks
Ancient Greece
Ancient Greece is a civilization belonging to a period of Greek history that lasted from the Archaic period of the 8th to 6th centuries BC to the end of antiquity. Immediately following this period was the beginning of the Early Middle Ages and the Byzantine era. Included in Ancient Greece is the...
thought that excessive emotionality in women was caused by a displaced uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
and sexual discontent.
"Hysteria" differentiated into conversion hysteria (later to become conversion disorder
Conversion disorder
Conversion disorder is a condition in which patients present with neurological symptoms such as numbness, blindness, paralysis, or fits without a neurological cause. It is thought that these problems arise in response to difficulties in the patient's life, and conversion is considered a psychiatric...
) and hysterical personality (later to become histrionic personality disorder) in the psychoanalytic literature as well as with the writings of Kraepelin, Schneider, and others. Sigmund Freud
Sigmund Freud
Sigmund Freud , born Sigismund Schlomo Freud , was an Austrian neurologist who founded the discipline of psychoanalysis...
wrote primarily about conversion hysteria. Wilhelm Reich
Wilhelm Reich
Wilhelm Reich was an Austrian-American psychiatrist and psychoanalyst, known as one of the most radical figures in the history of psychiatry...
wrote about hysteria as a set of personality characteristics and differentiated conversion hysteria as a transient disorder from hysterical character. These early conceptualizations of both kinds of hysteria carried notions of women's deficiency due to penis envy
Penis envy
Penis envy in Freudian psychoanalysis refers to the theorized reaction of a girl during her psychosexual development to the realization that she does not have a penis....
and feelings of castration
Castration
Castration is any action, surgical, chemical, or otherwise, by which a male loses the functions of the testicles or a female loses the functions of the ovaries.-Humans:...
. Paul Chodoff has written about the ways in which these diagnoses paralleled the misogynistic
Misogyny
Misogyny is the hatred or dislike of women or girls. Philogyny, meaning fondness, love or admiration towards women, is the antonym of misogyny. The term misandry is the term for men that is parallel to misogyny...
sentiment of the times.
The concept of hysterical personality was well developed by the mid-20th century and strongly resembled the current definition of histrionic personality disorder. The first DSM
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
featured a symptom-based category, "hysteria" (conversion) and a personality-based category, "emotionally unstable personality." DSM-II distinguished between hysterical neurosis
Neurosis
Neurosis is a class of functional mental disorders involving distress but neither delusions nor hallucinations, whereby behavior is not outside socially acceptable norms. It is also known as psychoneurosis or neurotic disorder, and thus those suffering from it are said to be neurotic...
(conversion reaction and dissociative reaction) and hysterical (histrionic) personality.
In DSM-III, the term hysterical personality changed to histrionic personality disorder to emphasize the histrionic (derived from the Latin
Latin
Latin is an Italic language originally spoken in Latium and Ancient Rome. It, along with most European languages, is a descendant of the ancient Proto-Indo-European language. Although it is considered a dead language, a number of scholars and members of the Christian clergy speak it fluently, and...
word histrio, or actor) behavior pattern and to reduce the confusion caused by the historical links of hysteria to conversion symptoms. The landmark case of Ruth E. helped to fully define and emphasize the characteristics of the current DSM-IV diagnostic. DSM-III-R attempted to reduce the overlap between Histrionic Personality Disorder and borderline personality disorder
Borderline personality disorder
Borderline personality disorder is a personality disorder described as a prolonged disturbance of personality function in a person , characterized by depth and variability of moods.The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the...
by dropping three overlapping criteria and adding two criteria that emphasized histrionicity. DSM-IV dropped two more criteria that did not appear to contribute to the consistency of the diagnosis, according to research done by Bruce Pfohl.
External links
- Histrionic personality disorder - Causes, Diagnosis, Demographics, Treatment - well-referenced.