Histrionic Personality Disorder
Cluster B — Dramatic / Emotional / Erratic · Table 7.2 [1]
Pervasive, excessive emotionality and attention-seeking; uncomfortable when not the center of attention.
Characteristics (Table 7.2) [1]
| Triggering Event(s) | Situations in which the person is not the center of attention |
|---|---|
| Behavioral Style |
|
| Interpersonal Style |
|
| Cognitive Style |
|
| Affective Style |
|
| Temperament |
|
| Attachment Style | Preoccupied |
| Parental Injunction | “I'll give you attention when you do what I want.” |
| Self-View | “I need to be noticed.” |
| World-View | “Life makes me so nervous, so I'm entitled to special care and consideration.” |
| Maladaptive Schemas |
|
| Optimal Diagnostic Criterion | Is uncomfortable in situations in which he or she is not the center of attention. |
DSM diagnostic criteria
A pervasive pattern of excessive emotionality and attention-seeking, beginning by early adulthood.
- Is uncomfortable in situations where they are not the center of attention.
- Interaction is often characterized by inappropriate sexually seductive or provocative behavior.
- Displays rapidly shifting and shallow expression of emotions.
- Consistently uses physical appearance to draw attention to self.
- Has a style of speech that is excessively impressionistic and lacking in detail.
- Shows self-dramatization, theatricality, and exaggerated expression of emotion.
- Is suggestible (easily influenced by others or circumstances).
- Considers relationships to be more intimate than they actually are.
- Borderline PD (adds identity disturbance, self-harm, abandonment terror)
- Narcissistic PD (attention sought to confirm superiority, not approval)
- Dependent PD (clinging without the dramatic display)
- Somatic symptom disorder
Treatment
- Develop attention to detail and reflective (vs. impressionistic) thinking
- Build tolerance for not being the center of attention
- Identify and pursue genuine, internally defined goals and relationships
Provide structure that counters the global, impressionistic cognitive style; gently slow the patient down and ask for specifics. Maintain professional boundaries in the face of seductive or dramatized relating, reframing the wish for attention as a wish to be valued.
- Cognitive therapy (systematic, detail-focused)
- Group therapy (interpersonal feedback)
- Psychodynamic / interpersonal therapy
- Slow the narrative and ask for concrete detail to build reflective capacity.
- Set and maintain clear boundaries around seductive or dramatized relating.
- Use here-and-now feedback (especially in group) on the impact of attention-seeking.
- Help articulate authentic preferences and longer-term goals.
- Seductive or dramatized relating that tests boundaries
- Superficial engagement; difficulty staying with emotionally specific material
- Approval-seeking that shapes responses to please the therapist
Fair to good; many patients respond to structured therapy, especially when attention-seeking and superficial relating are addressed in the relationship.
Practise this presentation
For training only. Diagnostic criteria are summarised — consult the full sources [1,2] for the complete text; see References. Not a substitute for supervised clinical assessment.