Histrionic Personality Disorder in Women
Histrionic personality disorder (HPD) is a psychiatric condition characterized by highly dramatic and/or emotional attention-seeking conduct that disrupts a person’s ability to participate fully in everyday life. It belongs to a larger group of conditions commonly referred to as Cluster B personality disorders. Women develop histrionic personality disorder roughly four times more frequently than men. However, a number of questions surround the ways in which doctors apply HPD diagnoses to women, and not all mental health professionals believe that women actually develop the disorder at such high rates. For these and other reasons, HPD will likely be removed from the official list of mental illnesses in 2013.
As with all other forms of mental illness, the standard definition for histrionic personality disorder in the US comes from a professional organization called the American Psychiatric Association. According to this definition, a doctor can diagnose HPD in people who have at least five of eight specific symptoms. These symptoms include use of shallow forms of expression that move rapidly between different emotional states; exaggerated, theatrical or self-dramatizing displays of emotion; use of inappropriate, sexually provocative or seductive conduct when interacting with others; a strong tendency to talk in vague, general terms meant to impress others; a tendency to exaggerate the level of intimacy in personal relationships; ongoing, exaggerated use of personal appearance as a way to attract attention; easy susceptibility to the influence of others; and clear displays of discomfort when someone else acts as the center of attention. Roughly 1 percent of American adults qualify for an HPD diagnosis.
No one knows why people develop histrionic personality disorder, according to the US National Library of Medicine’s PubMed Health. However, factors that may contribute to its onset include genetic predisposition and the presence of certain destabilizing events during childhood. As with all other forms of personality disorder, doctors don’t usually attempt to diagnose HPD in people who haven’t reached full adulthood; in most cases, symptoms of the disorder first appear between a person’s very late teens and mid 20s. Unlike people with certain other personality-related illnesses, people with histrionic personality disorder typically retain a high degree of social functionality and successfully maintain ongoing personal and work-oriented relationships.
Controversies in Diagnosing Women with HPD
As stated previously, many mental health professionals inside and outside the psychiatric community question the unusually high rate of histrionic personality disorder diagnoses in women. In part, this questioning attitude stems from the language used to identify HPD symptoms during diagnosis. For instance, use of terms such as “provocative” and “seductive” is sometimes strongly associated with negative moral or social judgments on female conduct, and some mental health professionals believe that these terms are sometimes used to officially stigmatize women’s behavior rather than to draw medically significant conclusions about any given person’s state of mental health.
In addition, some mental health professionals believe that doctors who diagnose HPD in women sometimes fundamentally misunderstand the long-term effects that childhood sexual abuse, childhood physical abuse, rape, and other forms of trauma can have on women’s psyches. Where these doctors see pathological, unhealthy reactions that damage a woman’s ability to function in society, others may reasonably see intelligent adaptations to social and personal reality that actually protect and support a woman’s functional abilities. While not all women who display provocative or seductive behaviors-or any other symptom of HPD-have adjusted in healthy ways, it’s likely that at least some women with these behaviors function as well as anyone else.
As stated previously, the American Psychiatric Association will probably remove HPD from the list of official psychiatric conditions in 2013, when it will issue new guidelines for all forms of mental illness. In all likelihood, these new guidelines will group histrionic personality traits under a larger heading of conditions known as “antisocial/psychopathic type personality disorders.” In part, this redefinition probably stems from complaints about HPD diagnoses both inside and outside the medical/psychiatric community. Other potential motivations for the move include a general desire to streamline existing definitions of mental disorders; a desire to eliminate unnecessary overlap between symptoms used to identify different types of personality disorder; and a desire to streamline the ways in which doctors who make mental health diagnoses interact with the insurance companies that pay for the treatments stemming from these diagnoses.