Histrionic personality disorder 181636 225407452 2008-07-13T14:54:53Z 204.85.81.181 /* Causes */ {{Infobox_Disease | Name = {{PAGENAME}} | Image = | Caption = | DiseasesDB = | ICD10 = {{ICD10|F|60|4|f|60}} | ICD9 = {{ICD9|301.50}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = D006677 }} '''''Histrionic personality disorder (HPD'')''' is a [[personality disorder]] characterized by a pattern of excessive emotionality and [[attention]]-seeking, including an excessive need for approval and inappropriate seductiveness, usually beginning in early adulthood. The essential feature of histrionic personality disorder is an excessive pattern of emotionality and attention-seeking behavior. These individuals are lively, dramatic, enthusiastic, and flirtatious. They may be inappropriately [[sex]]ually provocative, express strong emotions with an impressionistic style, and be easily influenced by others. Women with HPD are described as self-centered, self-indulgent, and intensely dependent on others. They are emotionally [[labile affect|labile]] and cling to others in the context of immature relationships. Females with HPD over-identify with others; they project their own unrealistic, [[fantasy (psychology)|fantasized]] intentions onto people with whom they are involved. They are emotionally shallow to avoid distress and have difficulty understanding themselves or others in any depth. Selection of marital or sexual partners is often highly inappropriate. The majority of the time their partners will have symptoms of personality disorders far worse than their own. Women with HPD often tend to enter into [[abusive relationship]]s with partners who increase the abuse as time wears on. [[Pathology]] increases with the level of intimacy in relationships, which is exactly the same for males with HPD. Women with HPD may show inappropriate and intense anger masking their internal battle between the quest for intimacy and avoiding pathology. HPD women with [[borderline personality disorder|borderline tendencies]] often form entirely negative convictions towards the male gender and treat them like pawns as a defense mechanism concealing their own inadequacies. They may engage in self-mutilation and/or manipulative suicide threats as one aspect of general manipulative interpersonal behavior.<ref>{{cite book | last = Kernberg | first = Otto | title = Severe Personality Disorders: Psychotherapeutic | publisher = Yale University Press | date = 1993 | isbn = 0-300-05349-5 | pages = 58-59}} </ref> Males with HPD usually present problems of [[identity crisis (psychology)|identity crisis]], disturbed relationships, and lack of impulse control. They have [[antisocial]] tendencies and are inclined to exploit physical [[symptoms]] as a method of false control. These men are emotionally immature (although they tend to believe the exact opposite), dramatic (although many are adept at covering it up), and shallow (although they tend to believe their feelings are so deep that no other single person could ever understand). Men with HPD tend to be very introspective and create a false sense of reality, effectively convincing themselves of whatever they need to believe in order to remain emotionally unattached from anything or anyone. HPD males with antisocial tendencies shift between periods of isolation and those of extreme social conquest (each shift can last a matter of days to periods lasting several years). They may require isolated retreats in order to obtain a comfortable level of understanding and acceptable functioning. HPD antisocial males are dependent upon no one in particular, but crave the dependence of others. Although males often have [[chameleon]]-like social skills (similar to HPD females), they tend to have trouble keeping lengthy friendships afloat as their [[paranoia]] (real and imagined) may eventually lead to a near complete and permanent disposal of all interpersonal relationships at a given time, effectively eliminating any emotional responsibility and accountability. They tend to genuinely search for intimacy (many believe in "the one") while remaining unable to regulate their perceived level of intimacy for any given interpersonal relationship, making it very difficult to build anything other than turbulent relations. Males with HPD may believe in the [[supernatural]], such as [[fortune telling]] or [[telepathy]], including the belief that there are many hidden messages and notions in public works that are specifically meant for them. When HPD antisocial males believe they are being manipulated, they may morph into [[sociopathy|sociopath]]ic relations with their perceived enemies, yet remain overtly loyal to perceived friends. HPD men are often times intensely driven by their quest to conquer life, despite having no real sense of direction or control, resulting in frequent changes of overly passionate interests. <ref>{{cite book | last = Kernberg | first = Otto | title = Severe Personality Disorders: Psychotherapeutic | publisher = Yale University Press | date = 1993 | isbn = 0-300-05349-5 | pages = 58-59}} </ref> Both men and women with HPD engage in disinhibited behavior, such as promiscuity and [[substance abuse]].<ref name=toad>{{cite web | Sharon C. Ekleberry, 2000 | title =The Histrionic Personality Disorder (HPD) | publisher= | work =[[Comorbidity|Dual Diagnosis] and the Histrionic Personality Disorder (HPD) | url=http://web.archive.org/web/20060104065152/http://www.toad.net/~arcturus/dd/hpdtable.htm | date=[[2000-03-31]] | accessdate=2007-03-19}}</ref> 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 skills, but they tend to use these skills to manipulate other people and become the center of attention. <ref>[http://www.clevelandclinic.org/health/health-info/docs/3700/3795.asp?index=9743 Histrionic Personality Disorder<!-- Bot generated title -->]</ref> Furthermore, histrionic personality disorder may affect a person's social or romantic relationships or their ability to [[cope]] with losses or failures. People with this disorder may seek treatment for [[Clinical depression|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 usually blame others for failures or disappointments. 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. ==Causes== The cause of this disorder is unknown, but childhood events such as deaths in the immediate family and [[genetics]] may both be involved. Histrionic Personality Disorder is more often diagnosed in woman than men; men with some quite similar symptoms are often diagnosed with [[antisocial personality disorder]].<ref>{{cite book | last = Seligman | first = Martin E.P. | title = Abnormal Psychology | publisher = W. W. Norton & Company | date = 1984 | chapters = 11 | isbn = 039394459X }} </ref> However, some psychologists argue {{who}} that it is more often diagnosed in women for the simple reason that attention-seeking and sexual forwardness are considered to be less socially acceptable for women than for men. <ref>[http://www.psychnet-uk.com/clinical_psychology/criteria_personality_histrionic.htm Histrionic Personality Disorder<!-- Bot generated title -->]</ref> Little research has been conducted to determine the biological sources of this disorder. [[psychoanalysis|Psychoanalytic]] theories incriminate seductive and [[authoritarian]] attitudes by fathers of these patients.<ref name=WebMD>{{cite web | title =Histrionic Personality Disorder | publisher=WebMD | work =Personality Disorders | url=http://www.emedicine.com/med/topic3472.htm | year = 2006 | accessdate=2007-01-10}}</ref> ==Risk Factors== '''Genetics''' * Major character traits may be inherited * Other character traits due to a [[phenotype|phenotypical]] combination of genetics and environment, including childhood experiences<ref name=AMN>{{cite web | Melissa Arthur LCSW MA & Baha M. Sibai, MD | title =Histrionic Personality Disorder | publisher=Armenian Medical Network | work =Histrionic Personality Disorder: Description, Incidence, Prevalence, Risk Factors, Causes, Associated Conditions, Diagnosis, Signs and symptoms and treatment | url=http://www.health.am/psy/histrionic-personality-disorder/ | year = 2006 | accessdate=2007-01-10}}</ref> ==Symptoms== The symptoms include: * Constant seeking of reassurance or approval. * Excessive dramatics with exaggerated displays of emotions. * Excessive sensitivity to [[critic]]ism 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. * Making rash decisions. * Threatening or attempting [[suicide]] to get attention.<ref name=Cleveland>{{cite web | The Cleveland Clinic Department of Patient Education and Health Information | title =Histrionic Personality Disorder | publisher=The Cleveland Clinic | work =Histrionic Personality Disorder | url=http://www.clevelandclinic.org/health/health-info/docs/3700/3795.asp?index=9743 | accessdate=2007-01-10}}</ref> ==Diagnosis== The person's appearance, behavior, and history, along with a [[psychological evaluation]], 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.<ref>http://psychcentral.com/disorders/sx17t.htm#psych</ref> ===Diagnostic criteria (DSM-IV-TR = 301.50)=== The [[Diagnostic and Statistical Manual of Mental Disorders]], a widely used manual for diagnosing [[mental disorder]]s, defines 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. ===Diagnostic criteria (ICD-10)=== The [[ICD|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. ====Mnemonic==== A [[mnemonic]] that can be used to remember the criteria for histrionic personality disorder is '''''PRAISE ME''''':<ref>Pinkofsky HB. Mnemonics for DSM-IV personality disorders. Psychiatr Serv. 1997 Sep;48(9):1197-8. PMID 9285984.</ref><ref>Personality Disorders. www.personalityresearch.org. URL: [http://www.personalityresearch.org/pd.html http://www.personalityresearch.org/pd.html]. Accessed May 2, 2006.</ref> *'''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 “wandering [[womb]].” (Note, however, that according to the [http://www.etymonline.com Online Etymology Dictionary], the word "histrionic" derives not from the Greek ''hystera'', but from the Latin ''histrionicus'', "pertaining to an actor.") [[Ancient Greece|Ancient Greeks]] thought that excessive emotionality in women was caused by a displaced [[uterus]] and sexual discontent. [[Christian asceticism|Christian ascetics]] during the [[Middle Ages]] blamed women's mental problems on [[witchcraft]], 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 [[stereotype]] for women as vulnerable, inferior, and emotionally unbalanced. The extent to which the definition of Histrionic Personality Disorder currently reflects [[gender bias]] remains the subject of a controversy. "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 [[misogyny|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]]. '''Associated features''' may include egocentricity, self-indulgence, continuous longing for appreciation, feelings that are easily hurt, and persistent manipulative behaviour to achieve own needs. ==Treatment== Because of the lack of research support for work on personality disorders and long-term treatment with psychotherapy, the [[empiricism|empirical]] 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 aimed at self-development through resolution of conflict and advancement of inhibited developmental lines. [[Group therapy]] is not recommended for those with HPD because it often perpetuates histrionic behavior because the person then has an audience to play off.<ref name=AMN1>{{cite web | Mardi J. Horowitz, M.D. | title =Histrionic Personality Disorder | publisher=Armenian Medical Network | work =Histrionic Personality Disorder - Choice of Treatment | url=http://www.health.am/psy/more/histrionic_personality_disorder_pro/ | year = 2006 | accessdate=2007-01-10}}</ref> * Family therapy * Medications * Alternative therapies<ref name=MIND>{{cite web | Encyclopedia of Mental Disorders | title =Histrionic Personality Disorder | publisher=Encyclopedia of Mental Disorders - Thomson Gale, a part of the Thomson Corporation | work =Histrionic Personality Disorder - Choice of Treatment | url=http://www.minddisorders.com/Flu-Inv/Histrionic-personality-disorder.html | accessdate=2007-01-10}}</ref> ==Relationships== The 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.<ref name=Recurrent>{{cite web | | title =Histrionic Personality Disorder | publisher=Recurrent Depression Inc. | work =Histrionic Personality Disorder | url=http://www.recurrentdepression.com/site/histrionic-personality-disorder/ | year = 2006 | accessdate=2007-01-10}}</ref> ==Associated conditions== * [[Clinical depression]] * [[Anxiety disorders]] * [[Panic disorder]] * [[Somatoform disorders]] * [[Anorexia]] ---- :''A previous version of this text is from the [http://www.nlm.nih.gov US National Library of Medicine].'' ==See also== *[[Antisocial personality disorder]] * [[Borderline personality disorder]] * [[Conversion disorder| Hysteria (conversion disorder)]] * [[Narcissistic personality disorder]] ==References== {{reflist|2}} ==External links== * [http://www.schrodingers-cat.org/dd/histrion.htm Dual Diagnosis and the Histrionic Personality] - well-referenced * [http://www.minddisorders.com/Flu-Inv/Histrionic-personality-disorder.html Histrionic personality disorder - Causes,Diagnosis, Demographics, Treatment] - well-referenced * [http://www.psychforums.com/viewforum.php?f=143&sid=30dd5fe1f342acb6da06c84bb280d22e Psych Forums: Histrionic Personality Forum] * [http://mentalhelp.net/poc/view_doc.php?type=doc&id=608&cn=8 Treatment - Histrionic Personality Disorder] {{DSM_personality_disorders}} [[Category:Personality disorders]] [[de:Histrionische Persönlichkeitsstörung]] [[es:Trastorno histriónico de la personalidad]] [[fr:Trouble de la personnalité histrionique]] [[it:Disturbo istrionico di personalità]] [[nl:Theatrale persoonlijkheidsstoornis]] [[ja:演技性人格障害]] [[pl:Osobowość histrioniczna]] [[sv:Histrionisk personlighetsstörning]] [[zh:戲劇化人格違常]]