Histrionic Personality Disorder

This is a type of personality disorder, which is marked out by the sufferers need for constant attention and exaggerated show of emotion. It tends to occur more in women than men.

Individuals with HPD are lively, dramatic, enthusiastic, and flirtatious. They may be inappropriately sexually provocative, express strong emotions with an impressionistic style, and be easily influenced by others.

The World Health Organisation (WHO) defines personality disorders of all kinds as “deeply ingrained and enduring behaviour patterns, manifesting themselves as inflexible responses to a broad range of personal and social situation.”  Essentially, the disorder arises due to problems concerning the personality, or character of an individual. In effect who they are and how they behave are at odds with commonly held social and emotional expectations of what is regarded as ‘normal’.  This means that a diagnosis has to be made with regard to the context of the rules, obligations and social expectations held within a particular community.  What is considered normal in the army for example during war, will be different from what is considered normal among civilians in times of peace

How is it diagnosed?

People who have HPD usually have three of more of the following clinical symptoms.Diagnostic criteria (ICD-10)

(a) A tendency towards self-dramatisation, theatricality, and exaggerated expression of emotions;
(b) Heightened suggestibility, easily influenced by others or by circumstances;
(c) Shallow and labile affectivity;
(d) Continuous need for excitement, appreciation by others, and activities in which the patient is the centre of attention;
(e) Inappropriate seductiveness in appearance or behaviour;
(f) Over-concern with physical attractiveness.

Associated features may include egocentricity, self-indulgence, continuous longing for appreciation, feelings that are easily hurt, and persistent manipulative behaviour to achieve own needs.

What are the traits of PD?

Some of the signs include: aggression, alcohol and substance misuse, anxiety, depression, deliberate self-harm, eating disorders such as anorexia, suspiciousness, preoccupation with routine, displaying a lack of emotion/remorse, hypersensitivity to criticism, constantly seeking approval, dependence on others, deceitfulness, bullying and disregard for others. A diagnosis usually has to include at least three traits or behaviours, which are deemed to be evidence of a disorder. The literature differentiates HPD according to gender. Women with HPD are described as self-centered, self-indulgent, and intensely dependent on others. They are emotionally labile and cling to others in the context of immature relationships. Females with HPD over-identify with others; they project their own unrealistic, fantasied intentions onto people with whom they are involved. They are emotionally shallow and have difficulty understanding others or themselves in any depth. Selection of marital or sexual partners is often highly inappropriate. Pathology increases with the level of intimacy in relationships. Women with HPD may show inappropriate and intense anger. They may engage in manipulative suicide threats as one aspect of general manipulative interpersonal behaviour.

Males with HPD usually present with identity diffusion, disturbed relationships, and lack of impulse control. They have antisocial tendencies and are inclined to exploit physical symptoms. These men are emotionally immature, dramatic, and shallow. Both men and women with HPD engage in disinhibited behaviour.

When does it occur?

Personality disorder tends to appear in late childhood or adolescence and continues through to adulthood. It is, therefore, unlikely that the diagnosis of personality disorder will be appropriate before the age of 16 or 17 years.

 How common is it?

The prevalence of personality disorder in the UK ranges from 2-13 per cent, and it is more common among people who are in institutions, such as hospitals and prisons. Research published by the office of national statistics in 1998 found 64 per cent of sentenced male prisoners and 50 per cent of all female prisoners have a personality disorder.

 What causes it?

Experts cannot agree about the precise causes and there has been very little research done on the subject. However, it is believed that possible causes may include problems in early childhood such as abuse, inadequate parenting, neglect and trauma.  Low levels of serotonin may also play a part. There is growing evidence of a genetic link to some behaviour related to PD, such as alcoholism in young men. Other risk factors include head injury, substance misuse and mental illness.

Why is personality disorder so controversial?

Although the WHO and the American Psychiatric Association, two major international bodies on psychiatric health, agree on the general definition of personality disorder, they each give different categories within the definition. The WHO has substantially revised its classification of personality disorders in the past 20 years. Some doctors contend that some personality types represent little more than the personal opinion. Many psychiatrists believe PD are untreatable and mental health staff are often reluctant to take on people with the condition, which has led to charities such as Mind calling it a “dustbin diagnosis”.

There is now fairly universal agreement that PD is not a mental illness in the sense that schizophrenia and depression are, but rather an underlying fault in the core personality. However, some types of PD are closely linked to mental illness, particularly between those in cluster A and schizophrenia. A high proportion of people with PD also have mental health problems.

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The Hippocratic Editorial and VT team. Please send your suggestions to [email protected]
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