Histrionic Personality Disorder– Causes, Symptoms, Diagnosis, Treatment and Ongoing care

Basics

Description

  • A condition characterized by persistent patterns of dysfunctional behavior (excessive emotionality and attention seeking) deviating from one’s culture and social environment that leads to functional impairment and distress, both to the individual and those who have regular interaction with the individual.
  • Behaviors are perceived by the patient to be “normal” and “right,” and patients have little insight as to their responsibility for these behaviors.
  • Condition is classified based on the predominant symptoms and their severity.
  • Cluster B personality disorder (inclusive of antisocial, borderline, histrionic, and narcissistic personality disorders) characterized by a pervasive pattern of excessive emotionality and attention seeking, present in a variety of contexts (5 or more symptom patterns to diagnose) (1):
    • Shows self-dramatization, theatricality, and exaggerated expressions of emotion
    • Is easily influenced by others or circumstance
    • Uncomfortable when not center of attention
    • Interactions are often characterized by inappropriate sexually seductive behavior.
    • Rapidly shifting and shallow emotions
    • Draws attention through physical appearance
    • Has a style of speech that is excessively impressionistic and lacks detail
  • Considers relationships more intimate than they are (1)

Epidemiology

Incidence

Starts in adolescence and early 20s, and persists throughout one’s life in the absence of treatment (1)

Prevalence

  • 2–3% general population (1)
  • Tends to be identified more frequently in females (1)

Risk Factors

Genetics

  • Major character traits may be inherited.
  • Other character traits due to a combination of genetics and environment, including adverse childhood experiences

Etiology

Environmental and genetic factors, including adverse childhood experiences and lack of parental attention

Commonly Associated Conditions

  • Depression, anxiety, panic disorder
  • Somatization disorders
  • Body dysmorphic disorder (strong emphasis on physical appearance)
  • Anorexia
  • Post-traumatic stress disorder, including dissociative disorders
  • Substance abuse

Borderline personality disorder, Diagnostic and Statistical Manual of Mental Disorders, narcissistic personality disorders, anxiety panic disorder, excessive emotionality, adverse childhood experiences, depression anxiety, dramatization, character traits, physical appearance, theatricality,

Diagnosis

History

  • Distress, excessive emotionality (2)
  • Impairment of social and/or occupational functioning (2)
  • Not due to direct physiological effects of substance abuse, drug abuse, medication use, or general medical conditions
  • Comprehensive interview and mental status examination
  • Family session to assess persistent pattern of behavior

Diagnostic Tests & Interpretation

Lab

Initial lab tests

Thyroid-stimulating hormone (TSH), venereal disease research laboratory (VDRL), complete blood count (CBC), HIV

Imaging

Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain may be necessary in newly developed symptoms in the absence of a triggering event to rule out the rare instance of organic brain disease.

Diagnostic Procedures/Surgery

Psychological testing (e.g., MMPI-II)

Differential Diagnosis

  • Narcissistic personality disorder
  • Somatization disorder
  • Borderline personality disorder
  • Substance abuse
  • Can co-occur with borderline, narcissistic, antisocial, and dependent personality disorders

Treatment

Medication

No known drug to treat personality disorder; however, medications can reduce symptoms (3)[C] associated with the Axis I disorders, such as mood disorders (antidepressants: Selective serotonin reuptake inhibitors [SSRIs]) and anxiety disorders (anxiolytics: benzodiazepines, buspirone, and SSRIs) (3)[C]

Complementary and Alternative Medicine

  • Biofeedback
  • Meditation

In-Patient Considerations

Initial Stabilization

  • In patients who have attempted overdose, transport all appropriate pill bottles to hospital.
  • Appropriate psychiatric security measures should be in place to prevent lethality.

Ongoing Care

Follow-Up Recommendations

Exercise as a means of reducing stress

Patient Monitoring

  • If the patient is on a pharmacological regimen, initial monitoring should be frequent (every 2 weeks) to evaluate the effectiveness, potential side effects of medication, and suicidal ideation.
  • In the absence of pharmacological treatment, frequent regular visits (every 4–6 weeks) will help prevent attention-seeking phone calls/visits.

Diet

No known special diet

Complications

  • Unstable relationships with family, friends, and coworkers
  • May be characterized by separations and divorces.
  • Disruptive work patterns (e.g., absenteeism, frequent job changes, and decreased productivity)
  • Increased demand for outpatient medical visits due to psychological condition and attention-seeking behavior

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington DC: American Psychiatric Association; 1994.

2. Kraus G, Reynolds DJ. The “A-B-C’s” of the cluster B’s: identifying, understanding, and treating cluster B personality disorders. Clin Psychol Rev. 2001;21:345–73.

3. Ward RK. Assessment and management of personality disorders. Am Fam Phys. 2004;70(8):1505–12.

Additional Reading

Horowitz MJ. Psychotherapy for histrionic personality disorders. J Psychother Practice Res. 1997;6:93–107.

Codes

ICD9

301.50 Histrionic personality disorder, unspecified

Snomed

55341008 Histrionic personality disorder (disorder)

Clinical Pearls

  • Histrionic personality disorder is characterized by persistent patterns of excessive emotionality and attention seeking, deviating from one’s culture and social environment that leads to functional impairment and distress, both for the individual and those who have regular interaction with the individual.
  • Histrionic personality disorder can co-exist with other personality disorders.
  • No drugs explicitly treat personality disorders. However, medications can be considered to reduce symptoms associated with concomitant mood and anxiety disorders.

About the author

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