Histrionic personality disorder

Histrionic personality disorder is characterized by excessive emotionality, attention seeking, dramatic, colourful and extroverted behaviour.

Egocentric, dependent & demanding interpersonal relationships are typical of this disorder.

Epidemiology:

2-3% of general population.
10-15% in clinical settings.
Female>Male

Aetiology:

Genetics:

Traits such as extraversion, emotional expression & rewards dependence have a strong genetic origin.

Biological:

Serotonin deficiency is found in histrionic patients with marked emotional instability & impulsive behaviours.

Developmental:

Abnormally intense attachment with parental figures is seen.

Clinical Features:

ICD-10 diagnostic criteria(F60.4)

1. Self dramatization, theatricality, exaggerated expressions of emotions.
2. Suggestible, easily influenced by others.
3. Shallow & labile affect.
4. Seek for excitement & appreciation by others, & activities in which the patient is center of attention.
5. Inappropriate seductiveness in appearance or behaviour.
6. Over concern with physical attractiveness.

Comorbidity:

(a) Somatization disorder.
(b) Conversion disorder
(c) Dissociative disorder
(d) Brief reactive psychosis.

Differential Diagnosis:

(a) Hypomania/ Mania.
(b) Narcissistic personality disorder.

Course & Prognosis:

(a) Depressive symptoms & suicide attempts are frequent.
(b) Histrionic personality disorder may gradually improve with age, as if a maturation of histrionic infantilism occurs over the years.

Treatment:

Pharmacotherapy:

For Depressive & Anxious symptoms:
•Antidepressants
•Anxiolytics
(Vulnerable for medication abuse & non-compliance.)

Psychotherapy:

Supportive therapy:For acutely distressed patient.

Psychoanalytic techniques:For clarification of patient’s covert inner feelings.

*Patient often want to take special place in therapist’s life & act out during sessions, threaten to abandon treatment or undertake dangerous actions.

So clear limits should be set & demanding behaviour should not be rewarded.

Reference:

• New Oxford Textbook of Psychiatry(2nd edition).
• ICD-10 Classification of Mental and Behavioural Disorders.