Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive attention-seeking emotions, usually beginning in early adulthood, including inappropriately seductive behavior and an excessive need for approval. Histrionic people are lively, dramatic, vivacious, enthusiastic, and flirtatious. HPD is diagnosed four times as frequently in women as men.[1] It affects 2–3% of the general population and 10–15% in inpatient and outpatient mental health institutions.[2] Histrionic personality disorder Specialty Psychiatry Symptoms Persistant attention seeking, exhibitionism HPD lies in the dramatic cluster of personality disorders.[3] People with HPD have a high need for attention, make loud and inappropriate appearances, exaggerate their behaviors and emotions, and crave stimulation.[3] They may exhibit sexually provocative behavior, express strong emotions with an impressionistic style, and can be easily influenced by others. Associated features include egocentrism, self-indulgence, continuous longing for appreciation, and persistent manipulative behavior to achieve their own needs. Contents

Signs and symptoms Edit

People with HPD are usually high-functioning, both socially and professionally. They usually have good social skills, despite tending to use them to manipulate others into making them the center of attention.[4] HPD may also affect a person's social and romantic relationships, as well as their ability to cope with losses or failures. They may seek treatment for clinical depression when romantic (or other close personal) relationships end.[citation needed] Individuals with HPD often fail to see their own personal situation realistically, instead dramatizing and exaggerating their difficulties. They may go through frequent job changes, as they become easily bored and may prefer withdrawing from frustration (instead of facing it). 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 clinical depression.[5] Additional characteristics may include: Exhibitionist behavior

Constant seeking of reassurance or approval

Excessive sensitivity to criticism or disapproval

Pride of own personality and unwillingness to change, viewing any change as a threat

Inappropriately seductive appearance or behavior of a sexual nature

Using somatic symptoms (of physical illness) to garner attention

A need to be the center of attention

Low tolerance for frustration or delayed gratification

Rapidly shifting emotional states that may appear superficial or exaggerated to others

Tendency to believe that relationships are more intimate than they actually are

Making rash decisions [4]

Blaming personal failures or disappointments on others

Being easily influenced by others, especially those who treat them approvingly

Being overly dramatic and emotional [6]

Influenced by the suggestions of others[7] Some people with histrionic traits or personality disorder change their seduction technique into a more maternal or paternal style as they age.[8] Mnemonic Edit A mnemonic that can be used to remember the characteristics of histrionic personality disorder is shortened as "PRAISE ME":[9][10] P rovocative (or seductive) behavior

rovocative (or seductive) behavior R elationships are considered more intimate than they actually are

elationships are considered more intimate than they actually are A ttention-seeking

ttention-seeking I nfluenced easily by others or circumstances

nfluenced easily by others or circumstances S peech (style) wants to impress; lacks detail

peech (style) wants to impress; lacks detail E motional lability; shallowness

motional lability; shallowness M ake-up; physical appearance is used to draw attention to self

ake-up; physical appearance is used to draw attention to self Exaggerated emotions; theatrical

Causes Edit

Little research has been done to find evidence of what causes histrionic personality disorder and from where it stems. Although direct causes are inconclusive there are a few theories and studies conducted that suggests there are multiple possible causes. There are neurochemical, genetic, psychoanalytical, and environmental causes contributing to histrionic personality disorder. Traits such as extravagance, vanity, and seductiveness of hysteria have similar qualities to women diagnosed with HPD.[11] HPD symptoms do not fully develop until the age of 15 with treatment only beginning at approximately 40 years of age.[12] An example of over-zealousness could be compared to the famous "grande hystérie", a well-known demonstration of hypnotism by Jean-Martin Charcot by using his best-known subject, Blanche Wittmann. Wittmann was known for her attractiveness and ability to make herself the center of attention, based on her hysteria and lavish performance.[13] Neurochemical/physiological Edit Studies have shown that there is a strong correlation between the function of neurotransmitters and the Cluster B personality disorders such as HPD. Individuals diagnosed with HPD have highly responsive noradrenergic systems which is responsible for the synthesis, storage, and release of the neurotransmitter, norepinephrine. High levels of norepinephrine leads to anxiety-proneness, dependency, and high sociability.[14] Genetic Edit Twin studies have aided in breaking down the genetic vs. environment debate. A twin study conducted by the department of Psychology at Oslo University attempted to establish a correlation between genetic and Cluster B personality disorders. With a test sample of 221 twins, 92 monozygotic and 129 dizygotic twins researchers interviewed the twins with 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.[15] Psychoanalytic theory Edit Though criticised as being unsupported by scientific evidence, 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.[3] Using psychoanalysis, Freud believed that lustfulness was a projection of the patient's lack of ability to love unconditionally and develop cognitively to maturity, and that such patients were overall emotionally shallow.[16] 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) would make the person unable to form true and affectionate attachments towards other people.[17] HPD and antisocial personality disorder Edit 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,[11] which suggests both disorders based towards sex-type expressions may have the same underlying cause. Women are hypersexualized in the media consistently, ingraining thoughts that the only way women are to get attention is by exploiting themselves, and when seductiveness isn't enough, theatricals are the next step in achieving attention.[18] Men can just as well be flirtatious towards multiple women yet feel no empathy or sense of compassion towards them.[11] They may also become the center of attention by exhibiting the "Don Juan" macho figure as a role-play.[18] Some family history studies have found that histrionic personality disorder, as well as borderline and antisocial personality disorders, tend to run in families, but it is unclear if this is due to genetic or environmental factors.[19] 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.[19] Little research has been conducted to determine the biological sources, if any, of this disorder.

Diagnosis Edit

Treatment Edit

Study of gender and its criteria Edit

When people talk about histrionic personality disorder, there is a significant amount of talk about its prevalent diagnosis in women compared to men as well as its stereotypical criteria. A study on this was performed by June Sprock and is published in Journal of Psychopathology and Behavioral Assessment, Vol. 22, No. 2. She had a group of first and second year psychology students separated into three different groups. They were each asked to look at the different criteria in the DSM-IIIR and the DSM-IV and create three behavioral examples for the gender they were assigned or a neutral condition.[27] The list was then edited before it was sent to a group of psychologists and psychiatrists for them to answer to get their results. The results of this test were that "masculine behaviors rated as significantly poorer examples of the HPD criteria than non-sex-typed and feminine (trend) behaviors."[27]

Epidemiology Edit

Approximately 2–3% of the general population may be diagnosed with HPD.[medical citation needed] Major character traits may be inherited, while other traits may be due to a combination of genetics and environment, including childhood experiences.[8] This personality is seen more often in women than in men.[28] Approximately 65% of HPD diagnoses are women while 35% are men. Women are generally over diagnosed due to potential biases[citation needed]. In Kaplan's "A Women's View of DSM-III", she expresses that even healthy women are often automatically diagnosed with HBD.[29] Many symptoms representing HPD in the DSM are exaggerations of traditional feminine behaviors. In a peer and self-review study it showed that femininity was correlated with histrionic, dependent, and narcissistic personality disorders.[30] Although two thirds of HPD diagnoses are female, however there have been a few exceptions.[31] Whether or not the rate will be significantly higher than the rate of women within a particular clinical setting depends upon many factors that are mostly independent of the differential sex prevalence for HPD.[32] Those with HPD are more likely to look for multiple people for attention which leads to marital problems due to jealousy and lack of trust from the other party. This makes them more likely to become divorced or separated once married.[33] With few studies done to find direct causations between HPD and culture, cultural and social aspects play a role in inhibiting and exhibiting HPD behaviors.

History Edit

See also Edit

Acting out

Femme fatale

Michael Alig, who was diagnosed with an extreme case of HPD