Diagnostic Criteria for Histrionic Personality Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994, pp. 657-658) describes 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:

• 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.

The Dimensional Perspective

Dimensions

• High Neuroticism: Chronic negative affects, including anxiety, fearfulness, tension, irritability, anger, dejection, hopelessness, guilt, shame; difficulty in inhibiting impulses: for example, to eat, drink, or spend money; irrational beliefs: for example, unrealistic expectations, perfectionistic demands on self, unwarranted pessimism; unfounded somatic concerns; helplessness and dependence on others for emotional support and decision making.
• Low Extraversion: Social isolation, interpersonal detachment, and lack of support networks; flattened affect; lack of joy and zest for life; reluctance to assert self or assume leadership roles, even when qualified; social inhibition and shyness.
• High Openness: Preoccupation with fantasy and daydreaming; lack of practicality; eccentric thinking (e.g., belief in ghosts, reincarnation, UFOs); diffuse identity and changing goals: for example, joining religious cult; susceptibility to nightmares and states of altered consciousness; social rebelliousness and nonconformity that can interfere with social or vocational advancement.
• High Agreeableness: Gullibility: indiscriminate trust of others; excessive candor and generosity, to detriment of self-interest; inability to stand up to others and fight back; easily taken advantage of.
• Low Conscientiousness: Underachievement: not fulfilling intellectual or artistic potential; poor academic performance relative to ability; disregard of rules and responsibilities can lead to trouble with the law; unable to discipline self (e.g., stick to diet, exercise plan) even when required for medical reasons; personal and occupational aimlessness.

Specific Affects

• Exaggerated, shallow emotions; enthusiasm, anger, boredom (Millon, pg. 158).
• Hysteria; sadness, jealousy, disappointment, fear, boredom (Stone [Briquet], pg. 318).

Character Weaknesses and Vices

• praise-hungry
• seductive
• over-dramatic
• shallow
• self-centered
• impressionistic
• attention-seeking

The Behavior Perspective

Motivations

Desire to coerce, manipulate, and deceive others into giving help and to establish and maintain dependency.

"The inordinate and demanding dependency displayed by many of these patients plays so important a role in hysterical psychopathology as to constitute a kind of organizing principle for many of the other features, which can be seen as distorted efforts to gratify dependency or as defensive reactions to its presence" (Chodoff, pg. 2727).

Behaviors

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Overly dramatic, reactive, and intensely expressed behavior; strident and superficial emotionality, emotional storms, constant attention-seeking, sexually seductive behavior, histrionics, submissiveness, eagerness to please, ruthless willfulness (Chodoff, pp. 2727-2728).

Affectation, overreaction, stimulus-seeking, intolerance of inactivity, impulsiveness, theatricality, flirtatiousness, demandingness, attention-seeking, exhibitionism (Millon, pp. 138, 140).

Emotional manipulation, seductiveness; demands for constant attention; cravings for novelty, stimulation, and excitement; suicide gestures and threats (American Psychiatric Association, pg. 656).

Bombast.

Associated Disorders

Somatization Disorder, Conversion Disorder, Major Depressive Disorder (American Psychiatric Association, pg. 656).

Depression, Hysteroid Dysphoria (Chodoff, pp. 2735-2736).

The Life Story Perspective

Childhood

Inconsistent parenting style: alternation between insensitive non-involvement and rewards for exhibitionist behavior.

continue: Symptoms, Causes and Risk Factors for HPD

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Reviewed: 04/2006