Histrionic Personality Disorder

Classification according to ICD-10
F60.4	Histrionic Personality Disorder
ICD-10 online (WHO version 2019)

The histrionic personality disorder (HPS) is a form of personality disorder and is characterized by self-centered , dramatic theatrical, and manipulatives extrovert of behavior. Typical are extreme striving for attention , exaggerated emotionality and a staging of social interaction . The HPS is therefore to the "dramatic-emotional personality disorders" in Cluster B counted.

Concept history

The adjective histrionisch is a German word formation from the noun Latin histrio , which was a term borrowed from the Etruscan language for an actor in ancient Rome . The word, which is also derived from English histrionic , means in this context acting , theatrical and affected . The noun Histrioniker therefore describes a person who exhibits such behavior.

The term histrionic personality disorder was introduced in DSM-III in 1980. The HPS has thus been removed from the term hysteria , which is only used by the psychoanalytic school , and separated from the conversion disorder . This new terminology has proven necessary because the term hysteria is now considered out of date in medical jargon and has a derogatory tone attached to it.

description

The disorder is characterized by an exaggerated, unstable emotionality and an excessive need for attention , importance , confirmation as well as solidarity and reliability . Further characteristics are self-centeredness ( motives , perception , thinking , acting ), easy vulnerability of feelings and manipulative behavior. Sexually provocative and seductive behavior is also often characteristic of the clinical picture , which is sometimes very close to hidden, vulnerable narcissism , which is often diagnosed as a comorbidity .

Case descriptions describe the (despite often theatrical description or representation) seemingly superficial presentation of feelings in contact, combined with unexpected and spontaneous changes that are difficult to understand for the interlocutor and also go hand in hand with a low tolerance of tension and frustration , which is geared towards the immediate satisfaction of needs . "Even minor causes lead to seemingly extreme changes in feelings, which in turn contribute to a change in the affective experience, cognitive judgment and actions of others in the situation".

Histrionic traits in the clinically inconspicuous area are related to creativity . Thus, people with a histrionic tendency have better divergent thinking skills .

In addition to a thorough medical history and structured interview, the hypochondriac hysteria inventory (HHI) can be used as a diagnostic tool . With the help of this test procedure , interactional characteristics such as extraversion , informality and sociability or in stressful situations defense against guilt , self-pity or aggressive behavior can be demonstrated.

Classification

ICD-10

According to ICD-10 , at least four of the following characteristics or behaviors must be present:

1. Dramatic self-expression, theatrical demeanor, or exaggerated expression of feelings;
2. Suggestibility , easy influenceability by others or by events (circumstances);
3. superficial, unstable affects;
4. Constantly looking for exciting experiences and activities that keep them the center of attention;
5. inappropriately seductive in appearance and demeanor;
6. excessive preoccupation with appearing outwardly attractive.

Egocentricity , self-centeredness, constant need for recognition, lack of reference to others, easily vulnerable feelings and constant manipulative behavior complete the clinical picture - but these behaviors are not necessary for the diagnosis.

DSM-5

According to DSM-5 , HPS is characterized by a profound pattern of excessive emotionality or striving for attention. It starts in early adulthood, and the pattern shows up in different situations. At least five of the following criteria must be met:

1. Feels uncomfortable in situations where he / she is not the focus of attention.
2. Interaction with others is often characterized by inappropriately sexually seductive or provocative behavior.
3. Shows rapidly changing and superficial emotional expressions.
4. Consistently use physical appearance to attract attention.
5. Has an overly impressionistic , poorly detailed style of speech.
6. Shows self-dramatization, theatrics and exaggerated emotional expression.
7. Is suggestible (i.e. easily influenced by other people or circumstances.)
8. Understand relationships more closely than they actually are.

This article or the following section is not adequately provided with supporting documents ( e.g. individual evidence ). Information without sufficient evidence could be removed soon. Please help Wikipedia by researching the information and including good evidence.

Differential diagnosis

Help is generally not sought for HPS, but for depression or dissociative disorders (also known as conversion disorder). The symptoms can be similar to organ complaints, including blindness or paralysis . Since the complaints are subjective in nature, misdiagnosis can occur. In the diagnostic and therapeutic interaction, it must be taken into account that dissociative disorders are not simulations or conscious actions. Psychosomatic complaints that occur independently of personality and disorder and can be reactions to various inner-psychological conflicts must also be separated from this. Depressive complaints are in turn processed within the framework of the histrionic experience with the aim of secondary gain from illness.

It can happen that histrionics are wrongly diagnosed with ADHD ( attention deficit / hyperactivity disorder ) due to their manipulative or provocative behavior and that treatment with methylphenidate (e.g. Ritalin), which is contraindicated in HPS , is initiated. Such a misdiagnosis can also occur with a possible narcissistic deflection of the HPS or a narcissistic comorbidity, since in both cases there may be a lack of ability or willingness to listen. The same applies to dissociative disorders of consciousness (dissociative forgetting, dissociative hearing loss). Since children can often show clear histrionic deflections even at school age, they are at particular risk of misdiagnosis.

therapy

Histrionics are difficult to treat: it is slow and difficult for them to change their behavior; they often lack the necessary insight. You can manipulate your therapist and thus steer the treatment in the wrong direction. This should clarify the psychological cause of his complaints to the patient and act dynamically and supportively on him. A clear limitation of the patient with regard to his manipulative behavior makes sense here.

See also

• Dissociative Identity Disorder
• Borderline personality disorder
• Narcissism , Narcissistic Personality Disorder

literature

• Histrionic Personality Disorder. In: Aaron Beck , Arthur Freeman: Cognitive Therapy of Personality Disorders. Beltz, 1995, ISBN 3-621-27155-4 , pp. 183-203.
• Elisabeth Bronfen : The knotted subject. Hysteria in the modern age. Volk und Welt, Berlin 1998, ISBN 3-353-01125-0 .
• Peter Fiedler , Sabine C. Herpertz: Personality disorders . 7th edition, Beltz Verlag, Weinheim 2016, ISBN 978-3-621-28013-6 .
• Annegret Eckhardt-Henn, Otto F. Kernberg , Peter Buchheim, Birger Dulz: The hysterical, histrionic personality disorder. In: Personality Disorders, Theory and Therapy. Issue 3, Schattauer, Stuttgart / New York 2000, ISBN 3-7945-1907-8 , pp. 127-175.
• Rainer Sachse : Clarification-oriented psychotherapy of histrionic personality disorder . Hogrefe Verlag, Göttingen 2012, ISBN 978-3-8017-2428-3 .

Web links

• Hysteria. Volker Faust : Psychosocial Health , accessed April 6, 2012 . 
• Dual Diagnosis and the Histrionic Personality Disorder (HPD). Sharon C. Eklery, archived from the original on April 27, 2006 ; Retrieved April 6, 2012 . 

Individual evidence

1. ↑ ^{a b c} Peter Falkai, Hans-Ulrich Wittchen (Ed.): Diagnostic and statistical manual of mental disorders DSM-5 . Hogrefe, Göttingen 2015, ISBN 978-3-8017-2599-0 , pp. 914-917 .
2. ↑ Wolfgang Tress: Personality Disorders: Guideline and source text. Schattauer Verlag, 2002, ISBN 3-7945-2142-0 , pp. 169f.
3. ↑ Histrione. In: Dtv-Lexikon. Munich 2006.
4. ↑ Volker Faust: Hysteria - Hysterical Neurosis - Histrionic Personality Disorder - Dissociative Disorders - Conversion Disorders - Conversion Hysteria. In: Psychiatry Today. Working Group on Psychosocial Health. (PDF; 130 kB), January 12, 2011, (archive)
5. ↑ hysterical character. In: Uwe Henrik Peters : Dictionary of Psychiatry and Medical Psychology. 1999, ISBN 3-86047-864-8 , pp. 244f.
6. ↑ 11.3.4 Histrionic Personality Disorder. In: James N. Butcher, Susan Mineka, Jill M. Hooley: Clinical Psychology . Pearson Verlag, 2009, ISBN 978-3-8273-7328-1 .
7. ^ Rainer Sachse: Histrioniker: With drama, manipulation and egocentricity to success. Klett-Cotta Verlag, 2017, ISBN 978-3-608-96171-3 .
8. ↑ ^{a b c} Peter Fiedler : Personality disorders . 6th edition. Beltz, Weinheim / Basel 2007, ISBN 978-3-621-27622-1 , p. 190-199 .
9. ↑ Adrian Furnham: The Bright and Dark Side Correlates of Creativity: Demographic, Ability, Personality Traits and Personality Disorders Associated with Divergent Thinking . In: Creativity Research Journal . tape 27 , no. 1 , 2015, p. 39-46 ( tandfonline.com ).
10. ^ Fritz Süllwold: Das Hypochondrie-Hysterie-Inventory (HHI). Concept, theory, construction, measurement-theoretical quality criteria, standards and possible applications . In: Works from the Psychological Institute . No. 6 , 1994.
11. ^ Stephan Doering, Susanne Hörz: Manual of structural diagnostics: concepts, instruments, practice. Schattauer Verlag, 2012, ISBN 978-3-7945-2793-9 .
12. ↑ AWMF : Old S2 guidelines on personality disorders (valid from 2008 to 2013) ( Memento from January 23, 2013 in the Internet Archive ), p. 10.

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