Clinical presentation and behavior
The core syndrome of this disorder is demonstrativeness. Patients with histrionic (histrionic) disorder cannot tolerate situations where they remain unnoticed.
External manifestations of emotions are always florid and vivid, and gestures are hyperbolized. Behavior is marked by extreme lability and directly depends on the current audience. To gain attention or elicit pity, a patient may demonstrate emphasized modesty, but in another situation easily switch to brazenness, shocking behavior, and bohemian manners. An extreme manifestation of attention-seeking is demonstrative suicide attempts.
Character and communication features
The foundation of the personality in histrionic disorder is deep egocentrism. Patients are characterized by extraversion: they easily and gladly make new acquaintances. However, communication has a number of specific traits:
- Superficiality of contacts. Patients often talk about close relationships with celebrities, yet are incapable of forming deep attachment to real friends.
- Loss of interest. As soon as the company's attention shifts away from their person, they quickly lose interest in their interlocutors.
- Inconstancy. They easily forget their own words of love and tend to cruelly ridicule the flaws of those they called friends just recently.
- Pseudologia. Patients lie with self-absorption, sometimes resorting to self-incrimination, and the logic of their judgments is built solely on momentary emotions.
Related pathology: Borderline personality disorder (F60.31)
To understand the spectrum of personality disorders, it is important to distinguish histrionic disorder from emotionally unstable (borderline) disorder. In Russian psychiatry prior to ICD-10, borderline disorder was not diagnosed, and the closest term was explosive psychopathy (often equated to "nuclear psychopathy").
According to ICD-10, this is one of the most severe forms of behavioral pathology, bordering on psychosis. Unlike histrionic disorder, the foreground features here are:
- Gross antisocial acts and pronounced conflict behavior.
- Inability to conceal feelings and adapt to others.
- Unpredictable shifts in plans and alogical behavior with preserved intellect.
- Possible short-term psychotic episodes.
Differential diagnosis of borderline disorder often has to be made with schizotypal disorder (formerly sluggish schizophrenia). Such patients usually end up seeing doctors due to severe conflicts, forensic psychiatric evaluation against a background of aggression, or due to alcohol abuse.
Clinical case: emotional instability and alcohol abuse
A characteristic behavioral pattern in emotionally unstable disorder can be traced through the example of a typical clinical case complicated by alcoholism.
Anamnesis: The patient demonstrated disciplinary violations as early as the army (AWOL, alcohol). Marriage was early, due to pregnancy. In college, requirements for him were lowered due to having a child. At work, adaptation periods were quickly replaced by aggression (fights) and dismissals. Domestic violence amidst intoxication reigned in the family, leading to the wife's departure. An attempt to run a business collapsed due to conflicts with partners (suspicions of deceit) and daily alcohol consumption.
Hospitalization: Upon admission, the patient is gloomy, his face is flush (hyperemia), tachycardia and shortness of breath are observed. He swears to completely give up alcohol. Already by the 3rd day, his somatic state and sleep improve, after which a sharp shift of the affect pole occurs: euphoria, sociability, and courting of the staff appear. The patient demands immediate discharge. Having received a refusal from the doctor and from his wife (who did not want to pick him up for the weekend), he commits an impulsive act — jumps out of a second-story window, sustaining a femur fracture.
In follow-up: his wife never returned, and the patient continued to abuse alcohol.
Briefly: answers to topical questions
What are the diagnostic criteria for histrionic personality disorder (F60.4) identified in ICD-10?
ICD-10 identifies the following clinical manifestations of histrionic personality disorder:
- Core syndrome — demonstrative, theatrical behavior designed for an external effect, and an overwhelming desire to be constantly the center of attention.
- Emotional disorders — vividness and floridity of emotional expression, hyperbolization of gestures, high behavioral lability.
- Communication features — egocentrism, extraversion, superficiality of contacts, quickly forgetting words of love.
- Pathological lying (pseudologia) — self-absorbed lying and self-incrimination.
- Suicidal behavior — demonstrative suicide attempts solely to attract attention.
- Thinking features — the logic of judgments is based exclusively on emotions.
Which psychotherapy methods have the highest efficacy in histrionic personality disorder?
For histrionic personality disorder, a specific most effective method of psychotherapy is not indicated in the cited sources. Suggestive methods are indicated for hysteria, and directive methods (suggestion in the waking state, hypnosis, narcohypnosis) are described for hysterical psychoses.
A hysterical personality is easy to remember by the formula "Three E's": Egocentrism, Emotionality, Épatage.
Class and exam questions
What is the main difference between histrionic and borderline disorders?
In histrionic disorder, behavior is aimed at attracting attention (demonstrative, shocking), whereas in borderline disorder, true explosiveness, an inability to control aggression, and antisocial acts come to the fore.
What is pseudologia?
This is self-absorbed lying in which the patient may start believing the fiction themselves. In histrionic disorder, it is often accompanied by self-incrimination to create a dramatic image.
Why do patients with histrionic disorder rapidly change their social circle?
Their contacts are superficial. As soon as new acquaintances stop paying them maximum attention and admiring them, patients lose interest in this company.
What else to study on this topic
- Mechanisms of formation of pseudologia and pathological lying.
- Differential diagnosis of borderline and schizotypal disorders.
- Historical evolution of the term "explosive psychopathy".
- Impact of chronic alcohol intoxication on the dynamics of personality disorders.
- Principles of stopping short-term psychotic episodes in borderline disorder.
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