Histrionic Personality Disorder: Symptoms and Diagnosis
Meeting a person with histrionic personality disorder is typically a memorable experience, even when it is not exciting, dramatic, or catastrophic (although it often will be). One may get the sense that this individual is acting out a part, playing a role, or possibly even intoxicated. They will often exhibit overly flirtatious or provocative behavior, giving the impression that they have few inhibitions. But, perhaps paradoxically, they can also exhibit extreme sensitivity, being offended, hurt, or angered with seemingly little provocation. All their experiences are exaggerated and extreme, and while highs may be especially high, the lows are likewise especially low.
Symptoms of Histrionic Personality Disorder
Histrionic Personality Disorder is most prominently characterized by a high degree of emotionality, ego-centrism, manipulation, attention seeking, and instability. Histrionic individuals typically display a need to be the center of attention along with a corresponding lack of insight. As a result, they are often perceived by others to be acting or playing a certain role, without themselves being aware they are doing so.
Individuals with histrionic personality disorder may also be especially sensitive to criticism, frequently seek approval, have difficulty managing frustration, display high impulsivity, and possess an excessive concern with physical attractiveness.
While they are often fairly high functioning both professionally and socially, they typically have difficulty maintaining relationships beyond casual acquaintances. Often they display a pattern of short relationships that “flare up” quickly and passionately, then “flame out” just as dramatically.
This pattern is a result of a number of characteristics, including their need to be the center of attention, an inability to empathize with others, being easily hurt emotionally, and a lack of insight into their own behaviors. These individuals tend to judge others in extreme terms, slipping quickly from idealization to devaluation.
Individuals with histrionic personality disorder will most often come into contact with mental health or psychiatric professionals when they seek treatment for depression after the dramatic end of a relationship.
Diagnosing Histrionic Personality Disorder
According to the Diagnostic and Statistical Manual IV-TR, histrionic personality disorder is characterized by “a pervasive pattern of excessive emotionality and attention seeking behavior.” This pattern typically emerges by early adulthood.
A diagnosis of histrionic personality disorder can be made if any five of the following eight characteristics are present: 1) uncomfortable in situations in which he or she is not the center of attention; 2) interaction with others is often characterized by inappropriate sexually seductive or provocative behavior; 3) displaying rapidly shifting and shallow expression of emotions; 4) consistently uses physical appearance to draw attention to self; 5) has a style of speech that is excessively impressionistic and lacking in detail; 6) shows self-dramatization, theatricality, and exaggerated expression of emotion; 7) is suggestible, i.e., easily influenced by others or circumstances; 8) considers relationships to be more intimate than they actually are.
These criteria are somewhat subjective judgments and there are no diagnostic tests available to establish a diagnosis of histrionic personality disorder, therefore, diagnosis may differ from one clinician to another.
Also, the World Health Organization ID-10 outlines a different set of criteria to diagnosis the disorder and requires the presence of only three of six criteria as opposed to the DSM-IV which requires five of eight. As a result, symptoms of histrionic personality disorder are actually different depending on the set of criteria used for diagnosis.
The disorder is just as common in men as in women, at around 2-3% of the general population, although among psychiatric populations the proportion is higher, between 10-15%.