Diagnostic and Statistical Manual of Mental Disorders, 5th Ed, Text Revision (DSM-5) criteria for a diagnosis of histrionic personality disorder (1), patients must have a persistent pattern of excessive emotionality and attention seeking. This pattern is shown by the presence of ≥ 5 of the following:
- Discomfort when they are not the center of attention
- Interaction with others that is inappropriately sexually seductive or provocative
- Rapidly shifting and shallow expression of emotions
- Consistent use of physical appearance to call attention to themselves
- Speech that is extremely impressionistic and vague
- Self-dramatization, theatricality, and exaggerated expression of emotion
- Suggestibility (easily influenced by others or situations)
- Interpretation of relationships as more intimate than they are
Also, symptoms must have begun by early adulthood.
Histrionic personality disorders can be distinguished from other personality disorders based on characteristic features:
Narcissistic personality disorder: Patients with narcissistic personality disorder also seek attention, but they, unlike those with histrionic personality disorder, want to feel admired or elevated by it; patients with histrionic personality disorder are not so picky about the kind of attention they get and do not mind being thought cute or silly.
Borderline personality disorder: Patients with borderline personality disorder consider themselves bad and experience emotions intensely and deeply; those with histrionic personality disorder do not see themselves as bad, even though their dependence on the reaction of others may stem from poor self-esteem.
Dependent personality disorder: Patients with dependent personality disorder, like those with histrionic personality disorder, try to be near others but are more anxious, inhibited, and submissive (because they are worried about rejection); patients with histrionic personality disorder are less inhibited and more flamboyant.
Differential diagnosis for histrionic personality disorder also includes somatic symptom disorder and illness anxiety disorder.
Diagnosis reference
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR). Washington, DC, American Psychiatric Association, 2022, pp. 757-760.