Tag Archives: Histrionic Personality Disorder

Histrionic Personality Disorder (HPD) #Write31Days

31 Days of Mental Health

Welcome to day 12 in the 31 Days of Mental Health. Yesterday, I was originally intending on writing a post on personality disorders. I didn’t and I didn’t even write a draft. However, since this 31-day series is raising awareness of the borad spectrum of mental illness, I thought I’d make use of the opportunity to discuss some disorders I’ve not been diagnosed with. Today, I’m writing about a disorder that my therapist at one point hinted at when discussing the possibility that I had imagined my dissociation: histrionic personality disorder. For your information: she never suggested I had this and, when my husband looked over the criteria to make his own judgment, he said I’m about the opposite of this.

Histrionic personality disorder (HPD) is a personality disorder characterized by a pattern of excessive emotionality and attention-seeking. Like all personality disorders, it sets on in early adulthood and is relatively stable across time and situations. People with HPD meet at least five of the following eight criteria:

  1. Is uncomfortable in situations in which he/she is not the center of attention.

  2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.

  3. Displays 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.

People with HPD are often referred to as “drama queens”. Though this was my first online nickname and many people agreed I was a real drama queen, I only meet one criterion of HPD (suggestibility) consistently now.

Histrionic personality diosrder is more common in females than males. It occurs in about 1.8% of the general population. Like most personality disorders, the presentation of HPD tends to become less pronounced as the affected person ages.

People with HPD are quicker to seek help than those with other personality disorders. However, this may reflect a symptom of their condition, because they exaggerate their symptoms and difficulty functioning. They also may display all emotions with the same depth of expression, unaware of the subtleties of emotional experience. People with HPD are also emotionally needy. Therefore, once in therapy, it’s hard for them to terminate treatment.

Therapy for HPD should usually be supportive, relatively short-term and solution-focused. It is unlikely that a therapist will be able to “cure” a HPD sufferer, so it doesn’t make sense to invest in long-term therapy.

People with HPD may exhibit suicidal behavior or make suicidal gestures. They may also self-harm. Though this might be an expression of their need for attention, suicidality and self-harm should always be taken very seriously. Even if the person is just crying out for help, death or serious bodily harm may occur. Like with all people who are suicidal or engage in self-injury, a safety contract may help establish boundaries while keeping the patient safe.

What Are Personality Disorders? #Write31Days

31 Days of Mental Health

Welcome to day 10 in the #Write31Days challenge on mental health. Today, I will discuss the broad category of disorders I’ve been diagnosed with: personality disorders. Though there is some debate as to whether borderline personality disorder should be conceptualized as a personality disorder, it currently is.

A personality disorder is a pervasive pattern of dysfunctional thought, behavior and emotion that is stable across time and across situations. It is out of line with cultural expectations and causes distress or impairment. It usually emerges in early adulthood, though adolescents may be diagnosed as being at risk for developing a personality disorder. In fact. when I attended a conference on BPD in 2013, a psychiatrist specializing in this said that BPD can be reliably diagnosed from age sixteen on. In other disorders, such as antisocial personality disorder, there is a specific age requirement of being over eighteen.

The Diagnostic and Statisticla Manual of Mental Disorders, both DSM-IV and DSM-5, divides specific personality disorders into three subcategories, called clusters. These are:

  • Cluster A includes paranoid, schizoid and schizotypal personality disorders. Individuals exhibiting these disorders often appear odd or eccentric. The disorders in this cluster can precede schizophrenia. I tend to think of cluster A personality disorders as “psychosis light”.

  • Cluster B includes antisocial, narcissistic, borderline and histrionic personality disorders. Individuals with disorders in this cluster are often seen as dramatic, emotional or erratic. People with cluster B personality disorders are often perceived as among the most difficult people to get along with. When peope think of personality disorders in general, they mostly mean cluster B disorders. The same goes for treatment programs focused on personality disorders.

  • Cluster C includes avoidant, dependent and obsessive-compulsive personality disorders. Individuals with cluster C personality disorders tend to be anxious or fearful.

In DSM-5, it is stated clearly that the clustering of personality disorders, while it has some merit, may not be very useful in clinical practice. After all, many people exhibit traits of personality disorders across clusters. When a person has features of more than one personality disorder but doesn’t teet the full criteria of any, they may be diagnosed with an unspecified personality disorder. People with other specified personality disorder display behavior that is seen as a personality disorder but isn’t listed specifically in DSM-5. Examples include passive-aggressive and self-defeating personality disorder.

There are some clear gender differences in how commonly personality disorders occur. Antisocial personality disorder occurs far more often in males than females. Borderline, histrionic and dependent personality disorder occur more in females. Though this may reflect real gender differences, it is also likely that stereotypical views shape clinicians’ diagnoses. For example, I once read that BPD is really about as common in males as in females but is overdiagnosed in women and underdiagnosed in men. Women misdiagnosed with BPD are often later found to have ADHD, which interestingly used to be seen as a typical male disorder.

diagnosticians always need to be aware of a patient’s cultural background and life history. After all, in some cultures, behavior that is seen as disordered in the western world may be normal. People who experienced extreme stress or trauma may also exhibit long-lasting dysfunctional behavior patterns and be misdiagnosed with personality disorders when they really have PTSD. Veterans are disproportionately often diagnosed with personality disorders, for example.