Histrionic Personality Disorder

Excerpt

Histrionic personality disorder (HPD) is characterized by a pervasive pattern of attention-seeking behaviors and a theatrical level of emotional reactions. The condition is usually life-long, though onset is typically in late adolescence or early adulthood. Individuals with HPD are often described as narcissistic, self-indulgent, flirtatious, dramatic, extroverted, and animated. Individuals with HPD may feel underappreciated or disregarded when they are not the center of attention. They may be vibrant, enchanting, overly seductive, or inappropriately sexual. People presenting with HPD typically demonstrate rapidly shifting and shallow emotions that others may perceive as insincere.

The roots of histrionic behavior can be traced back to ancient times when Greek and Roman physicians observed individuals who displayed excessive theatricality and emotional expression. These individuals were described as "hysterical," a term derived from the Greek word "hystera," meaning uterus, as it was believed that these behaviors were exclusive to women and were caused by disturbances in the uterus. In the late 19th century, during the era of psychoanalysis, Sigmund Freud contributed to the understanding of histrionic behavior. He proposed the concept of "hysteria" as a psychological disorder primarily affecting women and characterized by emotional excesses and attention-seeking behavior. Freud's theories, although controversial and often criticized, laid the groundwork for the exploration of histrionic symptoms and behaviors.

HPD was formally recognized as a distinct diagnostic category in the mid-20th century. In 1980, the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) included Histrionic Personality Disorder as a diagnosable condition. The DSM-III identified key criteria, including a pervasive pattern of excessive emotionality, a need for attention, and exaggerated behaviors. Since inclusion in the DSM, HPD criteria have undergone refinements in subsequent editions. The DSM-IV (1994) and DSM-IV-TR (2000) maintained the core diagnostic criteria, emphasizing attention-seeking behavior and self-dramatization, but also emphasized the need to consider cultural context and gender differences when diagnosing the disorder. In the latest edition of the DSM, the DSM-5-TR (2022), HPD is still recognized as a distinct diagnosis.

The DSM-5-TR divides personality disorders into Cluster A, Cluster B, and Cluster C. Each cluster encompasses a distinct set of personality disorders with commonalities regarding symptoms, behaviors, and underlying psychological patterns.

Cluster A

Personality disorders with odd or eccentric characteristics. These include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Individuals within this cluster exhibit social withdrawal, peculiar or paranoid beliefs, and difficulties forming close relationships.

Cluster B

Personality disorders with dramatic, emotional, or erratic behaviors. This cluster includes antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder. Individuals within this cluster display impulsive actions, emotional instability, and challenges in maintaining stable relationships.

Cluster C

Personality disorders with anxious and fearful characteristics. These include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. Individuals within this cluster tend to experience significant anxiety, fear of abandonment, and an excessive need for control or perfectionism.

Despite the historical context of using the "cluster" system, limitations exist when approaching personality disorders, and the literature is inconclusive. While the diagnosis of HPD provides a framework for understanding and studying these behaviors, there is a debate within the field of psychology and psychiatry regarding the nature and validity of personality disorders as a whole, including HPD. Understanding histrionic traits and behaviors continues to evolve, with research still in progress.