Dsm 5 Histrionic Personality Disorder (A Comprehensive Guide)

In this guide, DSM 5 Histrionic Personality Disorder, symptoms of Histrionic Personality Disorder along with the diagnostic criteria, causes, and treatment options will be discussed.

What is Histrionic Personality disorder according to the DSM- V?

Histrionic personality disorder is one of the Cluster B personality disorders categorised in the Diagnostic and statistical manual for mental disorders as being dramatic, emotional, or erratic.

People with Histrionic personality disorder tend to have problems related to their self-esteem which is often based on the approval and validation of other people this leads to their distorted sense of self or self-image, 

This need for approval in individuals with this disorder causes them to develop a need to be seen or noticed by others, thus their behaviours tend to be marked by dramatic antics. 

Histrionic personality disorder is not a dangerous disorder and many individuals with this disorder can lead functional lives however they might struggle with some interpersonal issues as well as their own self image. 

This disorder is often marked by individuals who are regarded as someone who wants to be the centre of attention all the time as well as someone who can do anything to gain this attention including seductive and provocative behaviour.

They also tend to exhibit shallow or overly dramatic and inappropriate emotions and are easily influenced by other people. They also struggle with realistic views of their relationships and tend to believe their relationships mean more than it actually does. 

What is the DSM criteria for Histrionic Personality disorder diagnosis?

The Diagnostic and statistical manual of Mental Disorders (5th ed) DSM 5 outlines the following criterion to make a diagnosis of Histrionic Personality disorder. 

Histrionic personality disorder is marked by a pattern of consistent attention seeking behaviours that is present throughout various areas of their lives. 

The disorder is also marked by emotional dysregulation that has specific manifestations along with at least five of the following criteria:

  • Uncomfortable when not the centre of attention

Individuals with this disorder tend to thrive when they are the centre of attention and are usually the “mood makers” or “life of the party”. 

However, their constant need to be the centre of attention tends to wear people out because of their tendency to do dramatic things to attain this attention. 

  • Seductive or provocative behaviour

They are often provocative in their behaviour not only towards their romantic interest but also in general irrespective of the relationship or the situation which at times become inappropriate. 

  • Shifting and shallow emotions which tend to shift rapidly. They might claim to have a certain emotion but there are sudden and noticeable changes soon after. It almost seems like they do not feel their emotions deely leading to others thinking that they are faking it. 
  • Uses appearance to draw attention. Individuals with this disorder often use appearance and spend a lot of time, money, and effort in impressing others with their appearance. 

For them their appearance, or how they are perceived is very important and because of this a negative comment or an unflattering image can quickly make them upset. 

  • Impressionistic and vague speech. They also tend to have strong opinions that are often expressed dramatically however they tend to lack valid reasons or are unable to back their opinions with facts. 
  • Dramatic or exaggerated emotions that may involve excessive expression of emotions that makes other people around them uneasy. 
  • Suggestible (easily influenced by others) adn tend to be easily influenced by fads and trends as well as  by people they perceive to be a figure of authority who they believe will solve their problem or rescue them.
  • Considers relationships more intimate than they are and often behave inappropriately in these relationships because of their assumptions. 

What are the prevalence rates of Histrionic Personality disorder according to the DSM-V?

The DSM 5 estimates that there is only 1.8 percent prevalence of this disorder however, more recent studies suggest that the prevalence of histrionic personality disorder in the general populace could be about 2 to 3 %.

The disorder is observed or diagnosed more in women however, it is speculated that this is because men tend to underreport their symptoms as well as because, due to societal expections, consider their sexual-forwardness less acceptable and hence, seen as a condition leading to over-diagnosis. 

What are the Risk factors and comorbidity risks?

It is not clearly known what are the factors that cause the development of  histrionic personality disorder, however, it is speculated that it could be a cause of multiple factors- both learned and inherited. It is hypothesised that it could be a result of trauma during childhood.

Parenting staples could be another factor, specifically p[atenting styles that are overly-indulgent and lack boundaries. 

It is also speculated that there could be a genetic factor due to the fact that it has been observed to run in families, while family ebnbvimroennts could also be a causal factor. 

How does Histrionic Personality disorder impact an individual’s life?

The major impact that histrionic personality disorder has on an individual is it;’s impact on the individual relationships- with their parents, their family, friends, and even their coworkers. 

When it comes to their romantic relationships, they struggle with satisfaction and attaining emotional fulfilment because of how they behave in their relationships. 

They tend to take on the victim role and at times even manipulate their partners to get what they want with their provocative behaviours or even impulsive behaviours.

They also tend to get bored easily and go through multiple partners fairly quickly because of their need for excitement that a new relationship can bring about. 

When it comes to friendships, they also struggle in this aspect because of their competitiveness for attention, which might develop unhealthy and toxic competition that impacts their relationships with their friends. 

While this disorder is not as dangerous, it is possible that individuals can enage in suicidal behaviours to manipulate, gain attention, and get what they want which puts them at risk.

What are the treatments for Histrionic Personality disorder?

The various treatments for Histrionic Personality disorder include:

Psychotherapy

When it comes to the treatment of this disorder, the treatment of choice is psychotherapy. 

 For clients with thai disorder, psychotherapy that aims to reduce emotional distress, improve self-esteem, and to enhance the patient’s coping skills is often helpful and effective. 

It is also possible that group therapy or family oriented therapy can be used but it is not recommended as the first line of treatment. Rather one to one treatment is important for them because of their tendency to want to be the centre of attention. 

Some effective treatments for this disorder can include Dialectical behavioural therapy as well as psychodynamic approach

DBT, a form of CBT that was created specifically to help individuals with BOrderline Personality Disorder, is designed to help individuals develop acceptance of their struggle and develop healthier lives by learning various skills related to Interpersonal effectiveness, emotional regulation, mindfulness, and distress tolerance.

Psychodynamic psychotherapy is also considered to be a suitable treatment for this disorder where the focus is on helping clients develop insight into their issues and resolve underlying conflicts related to their psychological development so as to help the client understand themselves and their behaviours. 

In this form of treatment the patients are encouraged to replace dramatic speech and behaviours with adaptive behaviour, learn better communication with others, and also discover new, healthier ways to develop self-esteem that is not reliant on another individual or on external validation. 

Medication

Individuals with histrionic personality disorder are often symptomatic and struggle with mood swings, anger, anxiety, and depression. 

As of right now there is not designated medication for Histrionic Personality disorder however doctors might prescribe a pharmacological treatment for individuals with HPD who has a comorbid mental disorder such as:

  • antidepressants to treat depression
  • antipsychotics to treat aggressive symptoms
  • antianxiety medications to treat anxiety

Conclusion

In this guide, DSM 5 Histrionic Personality disorder, symptoms of Histrionic Personality disorder along with the diagnostic criteria, causes, and treatment options has been discussed.

Frequently asked questions related to “DSM 5 Histrionic Personality disorder”

What are symptoms of histrionic personality?

The symptoms of histrionic personality disorder include:

  • They have a preoccupation with physical appearance
  • Constantly seeks to be the centre of attention
  • Behaves or talks dramatically
  • Considers relationships closer than they are
  • Easily influenced by others
  • They tend to be inappropriately sexual
  • Engage in provocative behaviour 
  • Have rapid shifts in emotion

Do histrionics have empathy?

Their behaviours tend to make people perceive people with histrionic personality disorder as someone who lacks empathy.

However, they do have empathy but because of their lack of emotional literacy and awareness, it can cause them to find it difficult to understand other people’s feelings, and their experiences. 

Although most people with HPD can function on a day-to-day basis, this lack of emotional awareness and empathy often interfere with their social lives.

Are histrionics narcissists?

Histrionics are not narcissistic- they do not have a grand idea of themselves rather they just want to be the centre of attention and often behave in dramatic ways to do so which might make people assume that they are narcissistic. 

What is histrionic personality disorder called now?

Histrionic personality disorder is also known as  “dramatic” personality disorders because of their dramatic and provocative ways of behaving. 

What are the cluster C personality disorders?

Cluster C personality disorders are characterised by anxious thoughts or fearful thinking as well as ways of behaving related to fear and anxiety. 

These disorders include avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder. 

Are histrionics manipulative?

Persons with histrionic personality disorder can be manipulative inorder to remain the centre of attention and keep the interest of others on them. In this regard, they can be charming, expressive, and dramatic.

They may use various behaviors, such seductive sexual behavior, suicide attempts, or even physical illness, to obtain attention and remain a perosn of interest. 

How do you set boundaries with histrionics?

To set boundaries with an individual with this disorder, it is best to have a discussion with the person. 

During this discussion it is important that you assertively communicate how you will respond to certain behaviours from now on while also maintaining that you will choose to do what is right for you in the face of their “”dramatics”.

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.

French JH, Shrestha S. Histrionic Personality Disorder. [Updated 2021 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542325/

Wint.C. Histrionic Personality Disorder. Healthline. Retrieved on 31st January 2022. https://www.healthline.com/health/histrionic-personality-disorder

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