DSM-II

In DSM-II, this disorder is called Hysterical personality

These behavior patterns are characterized by excitability, emotional instability, over-reactivity, and self-dramatization. This self-dramatization is always attention-seeking and often seductive, whether or not the patient is aware of its purpose. These personalities are also immature, self-centered, often vain, and usually dependent on others. This disorder must be differentiated from Hysterical neurosis.

DSM-III

Diagnostic Criteria

The following are characteristic of the individual's current and long-term functioning, are not limited to episodes of illness, and cause either significant impairment in social or occupational functioning or subjective distress.

A. Behavior that is overly dramatic, reactive, and intensely expressed, as indicated by at least three of the following:

  1. self-dramatization, e.g., exaggerated expression of emotions
  2. incessant drawing of attention to oneself
  3. craving for activity and excitement
  4. overreaction to minor events
  5. irrational, angry outbursts or tantrums

B. Characteristic disturbances in interpersonal relationships as indicated by at least two of the following:

  1. perceived by others as shallow and lacking genuineness, even if superficially warm and charming
  2. egocentric, self-indulgent, and inconsiderate of others
  3. vain and demanding
  4. dependent, helpless, constantly seeking reassurance
  5. prone to manipulative suicidal threats, gestures, or attempts

Differential Diagnosis

Somatization Disorder

In Somatization Disorder complaints of physical illness dominate the clinical picture, although histrionic features are common. In many cases Somatization Disorder and Histrionic Personality Disorder coexist.

Borderline Personality Disorder

Borderline Personality Disorder is often also present; in such cases both diagnoses should be made.

DSM-IV

Diagnostic Criteria

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. is uncomfortable in situations in which he or 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

Differential Diagnosis

Other Personality Disorders

Other Personality Disorders may be confused with Histrionic Personality Disorder because they have certain features in common. It is, therefore, important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more Personality Disorders in addition to Histrionic Personality Disorder, all can be diagnosed.

Borderline Personality Disorder

Although Borderline Personality Disorder can also be characterized by attention seeking, manipulative behavior, and rapidly shifting emotions, it is distinguished by self-destructiveness, angry disruptions in close relationships, and chronic feelings of deep emptiness and identity disturbance.

Antisocial Personality Disorder

Individuals with Antisocial Personality Disorder and Histrionic Personality Disorder share a tendency to be impulsive, superficial, excitement seeking, reckless, seductive, and manipulative, but persons with Histrionic Personality Disorder tend to be more exaggerated in their emotions and do not characteristically engage in antisocial behaviors. Individuals with Histrionic Personality Disorder are manipulative to gain nurturance, whereas those with Antisocial Personality Disorder are manipulative to gain profit, power, or some other material gratification.

Narcissistic Personality Disorder

Although individuals with Narcissistic Personality Disorder also crave attention from others, they usually want praise for their "superiority," whereas the individual with Histrionic Personality Disorder is willing to be viewed as fragile or dependent if this is instrumental in getting attention. Individuals with Narcissistic Personality Disorder may exaggerate the intimacy of their relationships with other people, but they are more apt to emphasize the "VIP" status or wealth of their friends.

Dependent Personality Disorder

In Dependent Personality Disorder, the person is excessively dependent on others for praise and guidance, but is without the flamboyant, exaggerated, emotional features of Histrionic Personality Disorder.

Personality Change Due to a General Medical Condition and symptoms related to substance use

Histrionic Personality Disorder must be distinguished from Personality Change Due to a General Medical Condition, in which the traits emerge due to the direct effects of a general medical condition on the central nervous system. It must also be distinguished from symptoms that may develop in association with chronic substance use (e.g., Cocaine-Related Disorder Not Otherwise Specified).

Normal personality traits

Many individuals may display histrionic personality traits. Only when these traits are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress do they constitute Histrionic Personality Disorder.

 DSM-5

Diagnostic Criteria

A pervasive pattern of excessive emotionally and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. Is uncomfortable in situations in which he or 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, theatrically, 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.

Differential Diagnosis

Other personality disorders

Other personality disorders may be confused with histrionic personality disorder because they have certain features in common. It is therefore important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more personality disorders in addition to histrionic personality disorder, all can be diagnosed.

Borderline personality disorder

Although borderline personality disorder can also be characterized by attention seeking, manipulative behavior, and rapidly shifting emotions, it is distinguished by self-destructiveness, angry disruptions in close relationships, and chronic feelings of deep emptiness and identity disturbance.

Antisocial personality disorder

Individuals with antisocial personality disorder and histrionic personality disorder share a tendency to be impulsive, superficial, excitement seeking, reckless, seductive, and manipulative, but persons with histrionic personality disorder tend to be more exaggerated in their emotions and do not characteristically engage in antisocial behaviors. Individuals with histrionic personality disorder are manipulative to gain nurturance, whereas those with antisocial personality disorder are manipulative to gain profit, power, or some other material gratification.

Narcissistic personality disorder

Although individuals with narcissistic personality disorder also crave attention from others, they usually want praise for their "superiority," whereas individuals with histrionic personality disorder are willing to be viewed as fragile or dependent if this is instrumental in getting attention. Individuals with narcissistic personality disorder may exaggerate the intimacy of their relationships with other people, but they are more apt to emphasize the "VIP" status or wealth of their friends.

Dependent personality disorder

In dependent personality disorder, the individual is excessively dependent on others for praise and guidance, but is without the flamboyant, exaggerated, emotional features of individuals with histrionic personality disorder.

Other personality traits

Many individuals may display histrionic personality traits. Only when these traits are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress do they constitute histrionic personality disorder.

Personality change due to another medical condition

Histrionic personality disorder must be distinguished from personality change due to another medical condition, in which the traits that emerge are attributable to the effects of another medical condition on the central nervous system.

Substance use disorders

The disorder must also be distinguished from symptoms that may develop in association with persistent substance use.

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