Histrionic personality disorder

Histrionic personality disorder (HPD) is <noinclude>a personality disorder </noinclude>characterized by a pattern of excessive attention-seeking behaviors, usually beginning in adolescence or early adulthood, including inappropriate seduction and an excessive desire for approval.

People with HPD have a high desire for attention, make loud and inappropriate appearances, exaggerate their behaviors and emotions, and crave stimulation. They very often exhibit pervasive and persistent sexually provocative behavior, express strong emotions with an impressionistic style, and can be easily influenced by others. Associated features can include egocentrism, self-indulgence, continuous longing for appreciation, and persistent manipulative behavior to achieve their own wants.

Signs and symptoms

People diagnosed with HPD may be dramatic. They often fail to see their own personal situation realistically, instead dramatizing and exaggerating their difficulties. Patients with this disorder can have rapidly shifting emotions and a decreased ability to recognize the emotions of others. Their emotions may appear superficial or exaggerated to others. This disorder is associated with extraversion, a lower tolerance for frustration or delayed gratification, and openness to new experiences. People with HPD may have little self-doubt and often appear egocentric.

Research has also shown those with histrionic personality have a greater desire for social approval and reassurance and will constantly seek it out, making those with HPD more vulnerable to social media addiction. People with this disorder often display excessive sensitivity to criticism or disapproval. They will work hard to get others to pay attention to them, possibly as a method of testing the stability of relationships. They may enjoy situations in which they can be the center of attention, and may feel uncomfortable when people are not paying attention to them. and fake medical conditions in an attempt to draw others' attention. They may be inappropriately sexually provocative, flirtatious, or exploitative. Sexually suggestive and exhibitionist behavior are also behaviors people with this condition sometimes exhibit, and are more likely to seek out casual sexual relationships. When their desire for attention is not met, it can heighten the severity of their symptoms.

Patients with HPD are usually high-functioning, both socially and professionally. They usually have good social skills, despite tending to use them to make themselves the center of attention. They may seek treatment for clinical depression when romantic (or other close personal) relationships end.

Despite these traits, they can be prideful of their own personality, and may be unwilling to change, viewing any change as a threat. They may even blame their personal failures or disappointments on others.

Causes

Little research has been done to find evidence of what causes histrionic personality disorder. Although direct causes are inconclusive, various theories and studies suggest multiple possible causes, of a neurochemical, genetic, psychoanalytic, or environmental nature. Traits such as extravagance, vanity, and seductiveness of hysteria have similar qualities to women diagnosed with HPD. HPD symptoms typically do not fully develop until late teens or early 20s, while the onset of treatment only occurs, on average, at approximately 40 years of age.

Major character traits may be inherited, while other traits may be due to a combination of genetics and environment, including childhood experiences.

Psychoanalytic theories incriminate authoritarian or distant attitudes by one (mainly the mother) or both parents, along with conditional love based on expectations the child can never fully meet. He believed the reason for being unable to love could have resulted from a traumatic experience, such as the death of a close relative during childhood or divorce of one's parents, which gave the wrong impression of committed relationships. Exposure to one or multiple traumatic occurrences of a close friend or family member's leaving (via abandonment or mortality) could make the person unable to form true and affectionate attachments towards other people.

Neurochemical/physiological

Studies have shown that there is a strong correlation between the function of certain hormones, neurotransmitters, and the Cluster B personality disorders such as HPD. This seems to be especially evident with respect to the catecholamines. Individuals diagnosed with HPD have a highly responsive noradrenergic system, which is responsible for the synthesis, storage, and release of the neurotransmitter norepinephrine. High levels of norepinephrine lead to anxiety-proneness, dependency, novelty seeking, and high sociability.

Genetic

Twin studies have aided in breaking down the genetic vs. environment debate. A twin study conducted by the Department of Psychology at the University of Oslo attempted to establish a correlation between genetics and Cluster B personality disorders. With a test sample of 221 twins, 92 monozygotic and 129 dizygotic, researchers interviewed the subjects using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and concluded that there was a correlation of 0.67 that histrionic personality disorder is hereditary.

HPD and antisocial personality disorder

Another theory suggests a possible relationship between histrionic personality disorder and antisocial personality disorder. Research has found 2/3 of patients diagnosed with histrionic personality disorder also meet criteria similar to those of the antisocial personality disorder, Both examples suggest that predisposition could be a factor as to why certain people are diagnosed with histrionic personality disorder, however little is known about whether or not the disorder is influenced by any biological compound or is genetically inheritable.

Assessment

In general clinical practice with assessment of personality disorders, one form of interview is the most popular: an unstructured interview. The actual preferred method is a semi-structured interview but there is reluctance to use this type of interview because they can seem impractical or superficial. There is also a hybrid model, called the Alternative DSM-5 model for personality disorders (AMPD), which defines personality disorder diagnoses through combinations of pathological traits and areas of overall impairment. HPD is characterized as a "pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts"; what is conceptualized as histrionic personality disorder can instead be diagnosed as personality disorder – trait specified (PD-TS), as manifested in both a general impairment in personality functioning (criterion A) along with at least one pathological personality trait (criterion B). It has been found that of these, the "traits most consistent with descriptions of HPD are attention seeking, separation insecurity, manipulativeness, emotional lability, intimacy avoidance (low), and restricted affectivity (low)." Severity is assessed based on the pervasiveness of impairment in several areas of functioning, as well as on the level of distress and harm caused by the disorder, while trait and pattern specifiers are used for recording the manner in which the disturbance is manifested. Histrionic personality disorder has been linked to moderate associations with the trait domains Dissociality (), Disinhibition (), and Negative Affectivity (), reflecting tendencies toward emotional intensity, impulsivity, and a strong need for attention. Some studies have also found inverse associations with Detachment (), consistent with the highly expressive and socially engaged behavior typical of the disorder. There are several other conditions to consider, as they may appear similar to HPD. Other Cluster B personality disorders share features with HPD, particularly borderline (BPD) and narcissistic (NPD) personality disorders, with some characteristic features, however, facilitating telling them apart.

{| class="wikitable"

!Subtype

!Features

!Traits

|Appeasing histrionic

|Including dependent and compulsive features

|Seeks to placate, mend, patch up, smooth over troubles; knack for settling differences, moderating tempers by yielding, compromising, conceding; sacrifices self for commendation; fruitlessly placates the unplacatable.

|Vivacious histrionic

|Including hypomanic features, and possibly narcissistic features

|Vigorous, charming, bubbly, brisk, spirited, flippant, impulsive; seeks momentary cheerfulness and playful adventures; animated, energetic, ebullient.

|Tempestuous histrionic

|Including negativistic features

|Impulsive, out of control; moody complaints, sulking; precipitous emotion, stormy, impassioned, easily wrought-up, periodically inflamed, turbulent.

|Disingenuous histrionic

|Including antisocial features

|Underhanded, double-dealing, scheming, contriving, plotting, crafty, false-hearted; egocentric, insincere, deceitful, calculating, guileful.

|Theatrical histrionic

|Variant of "pure" pattern

|Affected, mannered, put-on; postures are striking, eyecatching, graphic; markets self-appearance; is synthesized, stagy; simulates desirable/dramatic poses.

|Infantile histrionic

|Including borderline features

|Labile, high-strung, volatile emotions; childlike hysteria and nascent pouting; demanding, overwrought; fastens and clutches to another; is excessively attached, hangs on, stays fused to and clinging.

Treatment

Treatment is often prompted by depression associated with dissolved relationships. Medication does little to affect the personality disorder, but may be helpful with symptoms such as depression. The job of a functional analytic psychotherapist is to identify the interpersonal problems with the patient as they happen in session or out of session. They also have an increased risk of suicide.

Epidemiology

Prevalence

Reported prevalence rates for HPD vary by source, with studies having reported rates within a range from 0–3.2% among the general population. In clinical populations, this rises to 1–6%; furthermore, more recent studies, as of 2020, have estimated this prevalence to fall within the range of 10–15%. anxiety disorders, panic disorder, somatoform disorders, anorexia nervosa, substance use disorder (such as alcohol use disorder or opioid use disorder), body dysmorphia, and attachment disorders, including reactive attachment disorder.

Sex ratio

More women than men receive a diagnosis of HPD, but this may not reflect actual prevalence, with several findings indicating a similar prevalence for women and men. Furthermore, a higher rate among women may be related to other factors, such as a greater amount of women than men in the clinical setting,