Description of Histrionic Personality Disorder

The essential feature of the histrionic personality disorder is a pervasive and excessive pattern of emotionality and attention-seeking behavior. These individuals are lively, dramatic, enthusiastic, and flirtatious. They may be inappropriately sexually provocative, express strong emotions with an impressionistic style, and be easily influenced by others (DSM-IV, 1994, p. 655).

The ICD-10 (1994, p. 230) describes the histrionic personality disorder as characterized by shallow and labile affect, self-dramatization, exaggerated expression of emotions, suggestibility, egocentricity, self-indulgence, and lack of consideration for others. These individuals may engage in inappropriate seductiveness and overconcern with physical attractiveness. They are easily hurt and seek continuous excitement, attention and appreciation.

Frances, et.al. (1995, p. 373) describes individuals with HPD as manipulative, vain, and demanding. However, in addition to the focus on physical appeal, the authors note that there may also be a genetic association between somatization disorder and the histrionic personality disorder. Benjamin (1993, pp. 165-166) believes that HPD falls into two subtypes: 1) those who are flirtatious and focused on physical attractiveness, and 2) those who are concerned with somatic symptoms. The DSM-IV Axis II HPD emphasizes the flirtatious version. However, individuals with HPD will vary in the degree to which they are sexually seductive or concerned about physical symptoms.

Histrionic Personality Disorder is commonly co-morbid with conversion disorders, hypochondriasis, dissociative disorders, and affective disorders (Richards, 1993, p. 246). Kernberg (1992, p. 53) suggests that the relationship of HPD to conversion reaction and dissociative symptoms is strongest when the personality disorder is most severe.

Akhtar (1992, p. 259) notes that the current description of HPD corresponds to the previous idea of an infantile personality. These individuals had few sexual inhibitions, were impulsive, experienced identity diffusion and emotional lability, and demonstrated what the author referred to as moral defects. Yet, as described in the DSM-IV, individuals with HPD demonstrate what our society tends to foster and admire -- to be well liked, successful, popular, extroverted, attractive, and sociable (Millon & Davis, 1996, p. 366). In fact, Widiger, et.al. (Costa & Widiger, eds., 1994, p. 47) describe HPD as an extreme variant of extroversion. Extroversion involves the tendency to be outgoing, talkative, convivial, warm and affectionate, energetic, and vigorous. In a non-pathological form, extroversion is being high-spirited, buoyant, and optimistic. These factors coalesce into a personality disorder only when the needs behind the behavior are pathologically inflexible, repetitious, and persistent (Millon & Davis, 1996, p. 366). It is then that the corruptibility, manipulativeness, and disinhibited exploitation of others become factors and the personality disordered version of extroversion becomes apparent.

The literature differentiates HPD according to gender. Women with Histrionic Personality Disorder are described as self-centered, self-indulgent, and intensely dependent on others. They are emotionally labile and cling to others in the context of immature relationships. Females with HPD over identify with others; they project their own unrealistic, fantasied intentions onto people with whom they are involved. They are emotionally shallow and have difficulty understanding others or themselves in any depth. Selection of marital or sexual partners is often highly inappropriate. Pathology increases with the level of intimacy in relationships. Women with HPD may show inappropriate and intense anger. They may engage in manipulative suicide threats as one aspect of general manipulative interpersonal behavior (Kernberg, 1992, pp. 58-59).

Males with Histrionic Personality Disorder usually present with identity diffusion, disturbed relationships, and lack of impulse control. They are often promiscuous and bisexual. They have antisocial tendencies and are inclined to exploit physical symptoms. These men are emotionally immature, dramatic, and shallow (Kernberg, 1992, p. 59). Both men and women with HPD engage in disinhibited behavior. This is apparent in females with HPD through affective lability, manipulativeness, and intense, brief relationships. In men with HPD, disinhibition may be expressed through impulsivity, aggressive behavior, drug abuse, interpersonal exploitation, and numerous shallow sexual relationships (Frances, et. al., 1995, p. 373). If the aggressive, impulsive, and exploitative behavior become dominant in men with HPD, differentiation from the antisocial personality disorder can become problematic. There are questions raised in the literature as to whether or not HPD is a female variant of APD in men. However, as currently described in the DSM-IV™, the two are differentiated by the need to please and inclination to seek reassurance found in men or women with HPD and the more calculating and indifferent determination to exploit others found in APD. Also, a diagnosis of HPD does not require adolescent correlates of antisocial behavior as does the diagnosis of APD.

Individuals with Histrionic Personality Disorder may decompensate in later adult years due to the cumulative effects of: 1) the incapacity to pursue personal, professional, cultural, and social values; 2) the frequent disruption of and failure in intimate relationships; and 3) identity diffusion. These factors interfere with ordinary social learning and consequences grow more severe with age. The usual course of untreated HPD is precarious as life opportunities are missed or destroyed (Kernberg, 1992, p. 65).

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Reviewed: 04/2006