Description

• Histrionic personality disorder (HPD) is one of the cluster B personality disorders (PDs).
• HPD is characterized by persistent and excessive emotionality and attention seeking that deviate from cultural and social norms and produce functional impairment or distress.
• Associated with overuse of general medical resources, particularly later in life (1)[B]
• With the advent of the DSM-5, an alternative model is being promulgated that may come to define diagnosis as impairment in personality function AND the presence of pathologic traits. Using this alternative model, a person previously diagnosed with HPD would be diagnosed with PD—trait-specified. The alternative model does not include the HPD diagnosis. Poor construct validity has been suggested for the diagnostic category of HPD.

Epidemiology

Incidence

• No data available on the incidence of HPD
• HPD typically begins to manifest by early adulthood and persists throughout life in the absence of treatment (2).

Prevalence

• <1–3% in general population (2)[C]
• Has been identified more frequently in females (2)

Etiology and Pathophysiology

• Both genetic and environmental factors play a role in development of HPD.
  • Heritability estimated to be 31–63% (3)
  • Adverse childhood experiences, particularly emotional neglect, are a risk factor for development (4).
• Biosocial learning theory: According to the biosocial model in psychology, persons might develop HPD from inconsistent or inappropriately low parental attention. For example, a parent might respond only when the child has intense emotional affect, eventually leading the individual to unconsciously learn to be excessively emotional to draw attention to themselves.

Commonly Associated Conditions

• Depression, anxiety, panic disorder
• Bipolar disorders (5)[A]
• Somatic symptom disorder
• Body dysmorphic disorder
• Anorexia
• Posttraumatic stress disorder
• Dissociative disorders
• Substance use disorder
• HPD can co-occur with other PDs, particularly other cluster B PDs (antisocial, borderline, narcissistic) (2).