Histrionic personality disorder

Histrionic personality disorder (HPD) is characterized in the DSM-5 by a pervasive pattern of excessive emotionality and attention-seeking. Diagnostic criteria include discomfort when not the center of attention, inappropriately seductive or provocative interaction, shallow and rapidly shifting emotional expression, use of physical appearance to draw attention, excessively impressionistic and detail-lacking speech style, self-dramatization and theatricality, suggestibility, and considering relationships as more intimate than they actually are. It affects approximately 1.8% of the general population.

HPD has deep historical roots in the concept of hysteria, one of the oldest diagnoses in medicine. From Egyptian and Greek descriptions (the "wandering uterus") to the works of Charcot and Freud, hysteria was a central category in early psychology. The transformation of the diagnosis — from "hysteria" to "histrionic disorder" — reflects the effort to separate the construct from gender connotations and original psychoanalytic assumptions. Nevertheless, the diagnosis remains controversial: some authors argue that it pathologizes traits culturally associated with femininity.

Differential diagnosis is crucial. HPD shares features with borderline personality disorder (intense emotionality, impulsivity) but without the profound identity disturbance, self-harm, and chronic emptiness of BPD. It differs from narcissistic disorder in that histrionic attention-seeking is less selective and grandiosity is less prominent. Comorbidity with depression, somatoform disorders, and anxiety disorders is frequent. Treatment typically involves psychodynamic or cognitive psychotherapy focused on identifying the emotional needs underlying theatricality, developing more adaptive ways of seeking connection, and increasing tolerance for solitude and emotional self-regulation.