Histrionic personality disorder .
Histrionic personality disorder (HPD) is a personality disorder characterized by a pattern of excessive emotionality and att…ention-seeking, including an excessive need for approval and inappropriate seductiveness, usually beginning in early adulthood..
The essential feature of the histrionic personality disorder is apervasive and excessive pattern of emotionality and attention-seekingbehavior. These individuals are lively, dramatic, enthusiastic, andflirtatious. They may be inappropriately sexually provocative, express strong emotions with an impressionistic style, and be easily influenced by others..
The literature differentiates HPD according to gender. Women withHPD are described as self-centered, self-indulgent, and intenselydependent on others. They are emotionally labileand cling to others in the context of immature relationships. Femaleswith HPD over identify with others; they project their own unrealistic,fantasied intentions onto people with whom they are involved. They areemotionally shallow and have difficulty understanding others orthemselves in any depth. Selection of marital or sexual partners isoften highly inappropriate. Pathology increases with the level ofintimacy in relationships. Women with HPD may show inappropriate andintense anger. They may engage in manipulative suicide threats as oneaspect of general manipulative interpersonal behavior.  .
Males with HPD usually present with identity diffusion, disturbedrelationships, and lack of impulse control. They have antisocialtendencies and are inclined to exploit physical symptoms. These men are emotionally immature, dramatic, and shallow.  Both men and women with HPD engage in disinhibited behavior.  .
People with this disorder are usually able to function at a highlevel and can be successful socially and at work. However, histrionicpersonality disorder may affect a person's social or romanticrelationships or their ability to cope with losses or failures. Peoplewith this disorder may seek treatment for depressionwhen romantic relationships end, although this is by no means a featureexclusive to this disorder. They often fail to see their own situationrealistically, instead tending to dramatize and exaggerate.Responsibility for failure or disappointment is usually blamed onothers. They may go through frequent job changes, as they become easilybored and have trouble dealing with frustration. Because they tend tocrave novelty and excitement, they may place themselves in riskysituations. All of these factors may lead to greater risk of developingdepression. .
The cause of this disorder is unknown, but childhood events and geneticsmay both be involved. It occurs more frequently in women than in men.Histrionic Personality Disorder is only rarely found in men; men withsimilar symptoms are often diagnosed with antisocial personality disorder.  However, in cases where the HPD diagnosis is more appropriate, theremay be additional difficulties with regard to the person's sexualidentification..
Little research has been conducted to determine the biologic sourcesof this disorder. Psychoanalytic theories incriminate seductive andauthoritarian attitudes by fathers of these patients.  .
Risk Factors .
Major character traits may be inherited .
Other character traits due to a combination of genetics and environment including adverse childhood experiences .
The symptoms include: .
Constant seeking of reassurance or approval. .
Excessive dramatics with exaggerated displays of emotions. .
Excessive sensitivity to criticism or disapproval. .
Inappropriately seductive appearance or behavior. .
Excessive concern with physical appearance. .
A need to be the center of attention (self-centeredness). .
Low tolerance for frustration or delayed gratification. .
Rapidly shifting emotional states that may appear shallow to others. .
Opinions are easily influenced by other people, but difficult to back up with details. .
Tendency to believe that relationships are more intimate than they actually are. .
Make rash decisions .
Threaten or attempt suicide to get attention .
The person's appearance, behavior, and history, and a psychologicalevaluation are usually sufficient to establish the diagnosis. There isno test to confirm this diagnosis. Because the criteria are subjective,some people may be wrongly diagnosed as having the disorder whileothers with the disorder may not be diagnosed. Treatment is oftenprompted by depression associated with dissolved romanticrelationships. Medication does little to affect this personalitydisorder, but may be helpful with symptoms such as depression.Psychotherapy may also be of benefit. .
Diagnostic criteria (DSM-IV-TR) .
The Diagnostic and Statistical Manual of Mental Disorders, a widely used manual for diagnosing mental disorders,defines histrionic personality disorder as a pervasive pattern ofexcessive emotionality and attention seeking, beginning by earlyadulthood 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. Mnemonic .
A mnemonic 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 - attention, 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 .
History of the DSM-IV diagnosis .
Histrionic Personality Disorder shares a divergent history with Conversion disorder and Somatization Disorder. Historically, they are linked to the ancient notion of hysteria, or âwandering womb.â (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. Christian ascetics during the Middle Ages blamed women's mental problems on witchery, sexual hunger, moral weakness, and demonic possession. By the 19th century, medical explanations proposed a weakness of women's nervous system related to biological sex. Thus, "hysteria" reflected the stereotypefor women as vulnerable, inferior, and emotionally unbalanced. Theextent to which the definition of Histrionic Personality Disordercurrently reflects gender bias remains the subject of a controversy (see writings by Paul Chodoff on this topic)..
"Hysteria" differentiated into conversion hysteria (later to become Conversion disorder)and hysterical personality (later to become Histrionic personalitydisorder) in the psychoanalytic literature as well as with the writingsof Kraepelin, Schneider, and others. Sigmund Freud wrote primarily about conversion hysteria. Wilhelm Reichwrote about hysteria as a set of personality characteristics anddifferentiated conversion hysteria as a transient disorder fromhysterical character. These early conceptualizations of both kinds ofhysteria 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 misogynous sentiment of the times..
The concept of hysterical personality was well developed by themid-20th century and strongly resembled the current definition ofHistrionic personality disorder. The first DSMfeatured a symptom-based category, âhysteriaâ (conversion) and apersonality-based category, âemotionally unstable personality.â DSM-IIdistinguished between hysterical neurosis (conversion reaction and dissociative reaction) and hysterical (histrionic) personality. In DSM-III,the term Hysterical Personality changed to Histrionic PersonalityDisorder to emphasize the histrionic (derived from the Latin wordhistrio, or actor) behavior pattern and to reduce the confusion causedby the historical links of hysteria to conversion symptoms. Thelandmark case of Ruth E. helped to fully define and emphasize thecharacteristics 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..
 Diagnostic criteria (ICD-10) .
The International Statistical Classification of Diseases defines histrionic personality disorder as characterized by: .
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 centre of attention; .
inappropriate seductiveness in appearance or behaviour; .
over-concern with physical attractiveness. .
Associated features may include egocentricity,self-indulgence, continuous longing for appreciation, feelings that areeasily hurt, and persistent manipulative behaviour to achieve own needs..
 Treatment .
Because of the lack of research support for work on personalitydisorders and long-term treatment with psychotherapy, the empiricalfindings on the treatment of these disorders remain based on the casereport method and not on clinical trials. On the basis of casepresentations, the treatment of choice is psychotherapy aimed atself-development through resolution of conflict and advancement ofinhibited developmental lines. Group therapy is not recommended forthose with HPD because it often perpetuates histrionic behavior becausethe person then has an audience to play off of.  .
Family therapy .
Alternative therapies  .
The HPD is highly reactive. If there is another major disorderpresent, such as delusional disorder, then emotional intensity willcreate anger, rage, abuse and distance in relationships..
It is important for the therapist and family members to monitor andrecord all situations that trigger the HPD so that the deep underlyingoverload of pain can be accessed and released for therapeutic change.  .
Associated conditions .
Anxiety disorders .
Panic disorder .
Somatization disorders .
Anorexia . ( Full Answer )