Por Mark Zimmerman , MD, Rhode Island Hospital
Última modificação do conteúdo mai 2021
Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Diagnosis is by clinical criteria. Treatment is with psychodynamic psychotherapy.
(See also Overview of Personality Disorders.)
Patients with histrionic personality disorder use their physical appearance, acting inappropriately seductive or provocative, to get the attention of others. They lack a sense of self-direction and are highly suggestible, often acting submissively to retain the attention of others.
The estimated prevalence is < 2% of the general population. It is diagnosed more often in women, but this may just reflect the higher prevalence among women in the care settings where the data were obtained. In some studies, the prevalence among women and men was similar.
Comorbidities are common, particularly other personality disorders (antisocial, borderline, narcissistic), suggesting that these disorders share a biological vulnerability or casting doubt on whether histrionic personality disorder is a separate disorder. Some patients also have somatic symptom disorder, which may be the reason they present for evaluation. Major depressive disorder, persistent depressive disorder, and conversion disorder may also coexist.
Signs and symptoms of histrionic personality disorder
Patients with histrionic personality disorder continually demand to be the center of attention and are often depressed when they are not. They are often highly dramatic, enthusiastic, and flirtatious, and sometimes charm new acquaintances.
These patients often dress and act inappropriately seductive and provocative, not only with potential romantic interests, but in many contexts (eg, work, school). They want to impress others with their appearance and thus are often concerned about how they look.
Expression of emotion can be superficial (off and on very quickly) and exaggerated. They speak dramatically, expressing strong opinions but with few facts or details to support their views.
Patients with histrionic personality disorder are easily influenced by others and by current trends. They tend to trust others a lot, especially authority figures who they think may be able to solve all their problems. They often think relationships are closer than they are. They crave novelty and tend to get bored easily. So they can change jobs and friends frequently. Delayed gratification is very frustrating for them, so their actions are often motivated by immediate gratification.
Achieving emotional or sexual intimacy can be difficult. Patients may, often without being aware of it, play a role (eg, victim). They may try to control their partners using seduction or emotional manipulations and, at the same time, become very dependent on their partner.
Diagnosis of histrionic personality disorder
· Clinical criteria (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5])
For the diagnosis of histrionic personality disorder, patients must have
· Generalized pattern of excessive emotionality and attention seeking.
This pattern is characterized by ≥ 5 of the following:
· Discomfort when they are not the center of attention
· Interaction with others that is inappropriately seductive or sexually provocative
· Rapid change and superficial expression of emotions
· Consistent use of physical appearance to draw attention to themselves
· Discourse that is extremely impressionistic and vague
· Self-dramatization, theatricality and extravagant expression of emotions
· Suggestibility (easily influenced by other people or situations)
· Interpretation of relationships as more intimate than they are
In addition, symptoms must have occurred in early adulthood.
Differential diagnosis
Histrionic personality disorder can be distinguished from other personality disorders based on characteristic components:
· Narcissistic Personality Disorder: Patients with narcissistic personality disorder also seek attention, but, unlike those with histrionic personality disorder, they want to feel admired or praised; patients with histrionic personality disorder aren't as picky about the kind of attention they get and don't mind being thought of as smart or silly.
· Borderline Personality Disorder: Patients with Borderline Personality Disorder consider themselves to be bad and feel emotions in an intense and deep way; patients with histrionic personality disorder do not see themselves as bad, although their dependence on the reactions of others may be due to low self-esteem.
· Dependent personality disorder: Patients with dependent personality disorder, such as those with histrionic personality disorder, try to be around others but are more anxious, inhibited, and submissive (because they are preoccupied with rejection); patients with histrionic personality disorder are less inhibited and more flamboyant.
The differential diagnosis of histrionic personality disorder also comprises somatic symptom disorder and illness anxiety disorder.
Treatment of histrionic personality disorder
· Psychodynamic psychotherapy
The general treatment of histrionic personality disorder is the same as for all personality disorders.
Little is known about the effectiveness of cognitive behavioral therapy and drug therapy for histrionic personality disorder.
Psychodynamic psychotherapy, which focuses on underlying conflicts, can be tried. The therapist can start by encouraging patients to replace speech with behavior, so patients can understand themselves and communicate with others in a less dramatic way. Then, the therapist can help patients see how their histrionic behaviors are a maladaptive way of attracting attention from others and managing their self-esteem.
https://www.msdmanuals.com/pt-br/profissional/transtornos-psiqui%C3%A1tricos/transtornos-de-personalidade/transtorno-de-personalidade-histri%C3%B4nica-tph
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