Individuals with histrionic personality disorder may have difficulty achieving emotional in- timacy in romantic or sexual relationships. Without being aware of it, they often act out a role (e.g., ”victim” or ”princess”) in their relationships to others. They may seek to control their partner through emotional manipulation or seductiveness on one level, while display- ing a marked dependency on them at another level. Individuals with this disorder often have impaired relationships with same—sex friends because their sexually provocative inter- personal style may seem a threat to their friends’ relationships. These individuals may also alienate friends with demands for constant attention. They often become depressed and up- set when they are not the center of attention. They may crave novelty, stimulation, and ex- citement and have a tendency to become bored with their usual routine. These individuals are often intolerant of, or frustrated by, situations that involve delayed gratification, and their actions are often directed at obtaining immediate satisfaction. Although they often ini- tiate a job or project with great enthusiasm, their interest may lag quickly. Longer-term re- lationships may be neglected to make way for the excitement of new relationships.
The actual risk of suicide is not known, but clinical experience suggests that individu- als with this disorder are at increased risk for suicidal gestures and threats to get attention and coerce better caregiving. Histrionic personality disorder has been associated with higher rates of somatic symptom disorder, conversion disorder (functional neurological symptom disorder), and major depressive disorder. Borderline, narcissistic, antisocial, and dependent personality disorders often co—occur.
Data from the 2001—2002 National Epidemiologic Survey on Alcohol and Related Condi- tions suggest a prevalence of histrionic personality of 1.84%.
Norms for interpersonal behavior, personal appearance, and emotional expressiveness vary widely across cultures, genders, and age groups. Before considering the various traits (e.g., emotionality, seductiveness, dramatic interpersonal style, novelty seeking, sociabil- ity, charm, impressionability, a tendency to somatization) to be evidence of histrionic per- sonality disorder, it is important to evaluate whether they cause clinically significant impairment or distress.
In clinical settings, this disorder has been diagnosed more frequently in females; however, the sex ratio is not significantly different from the sex ratio of females within the respective clinical setting. In contrast, some studies using structured assessments report similar prev- alence rates among males and females.