Histrionic personality disorder (or HPD) is a personality disorder that may co-occur with borderline personality disorder (BPD). There is a great deal of overlap between BPD and HPD features, so much so that some experts believe that HPD may not actually be distinguishable from BPD.
What is Histrionic Personality Disorder?
HPD is one of 11 personality disorders recognized in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). HPD is one of the "Cluster B" or dramatic/erratic personality disorders.
The DSM-IV criteria define histrionic personality disorder as "as a pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts." In addition, an individual must have five or more of the following signs or symptoms:
- Discomfort in situations in which he or she is not the center of attention
- Interaction with others that is often characterized by inappropriate sexually seductive or provocative behavior
- Rapidly shifting and shallow expression of emotion
- Consistently uses physical appearance to draw attention to self
- Style of speech that is excessively impressionistic and lacking in detail
- Shows self-dramatization, theatricality, and exaggerated expression of emotion
- Is suggestible (easily influenced by others or circumstances)
- Considers relationships to be more intimate than they actually are
People with HPD might be described as being overly dramatic, emotional, or attention-seeking. This pattern of behavior rises to the level of a clinical disorder when it significantly interferes with relationships, occupation, or other important domains in life.
How Often do HPD and BPD Co-Occur?
There are only a few studies that have examined the co-occurrence of HPD and BPD. One particularly rigorous study found that about 15 percent of patients with BPD also meet the diagnostic criteria for HPD. In another study that used a community sample, about 10 percent of people with BPD also met criteria for HPD.
Are Histrionic Personality Disorder and BPD Distinct Disorders?
There is marked overlap between the symptoms of HPD and BPD. For example, both share the features of rapidly shifting and reactive emotions, both are associated with impulsive behavior, and both are characterized by very strong expression of emotion.
While some clinicians argue that the qualities of these symptoms are different in HPD versus BPD (for example, that the rapidly shifting emotions in HPD are not experienced with the same depth and intensity as those in BPD), other experts have argued that HPD and BPD are not necessarily distinct disorders.
The DSM-IV criteria for HPD and BPD overlap to a great extent (this is called convergence), which makes some researchers wonder whether it is accurate or useful to keep these as two separate diagnostic categories. The next edition of the DSM (the DSM-V) is expected to address some of these problems in the personality disorder diagnostic categories. Preliminary drafts of the DSM-V do not include HPD.
Treatment for Histrionic Personality Disorder and BPD
There are currently no published clinical trials that have examined treatments for HPD -- the research literature is limited to case studies and single-subject studies, which tend to be unreliable and subject to bias. While there is some advice for clinicians treating HPD, it is generally based on expert opinion or experiences rather than on research data. Much more research is needed on this topic.
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