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Histrionic personality disorder
From WikEM
Contents
Background
A pervasive pattern of excessive emotionality and attention seeking
Clinical Features
- Five (or more) of the following criteria, beginning by early adulthood and present in a variety of contexts:[1]
- Is uncomfortable in situations in which he or she is not the center of attention.
- Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
- Displays rapidly shifting and shallow expression of emotions.
- Consistently uses physical appearance to draw attention to self.
- Has a style of speech that is excessively impressionistic and lacking in detail.
- Shows self-dramatization, theatricality, and exaggerated expression of emotion.
- Is suggestible (i.e., easily influenced by others or circumstances).
- Considers relationships to be more intimate than they actually are.
Differential Diagnosis
- Other personality disorders
- Personality change due to another medical condition
- Substance use disorders
Evaluation
A clinical diagnosis; however if entertaining other organic causes may initiate workup below
General ED Psychiatric Workup
- Point-of-care glucose
- CBC
- Chem 7
- LFTs
- ECG (for toxicology evaluation)
- ASA level
- Tylenol level
- Urine toxicology screen/Blood toxicology screen
- EtOH
- Urine pregnancy/beta-hCG (if female of childbearing age)
- Consider:
- Ammonia (see Hepatic encephalopathy)
- TSH (hypo or hyperthyroidism may mimic mental illness)
- CXR (for Tb screen or rule-out delirium in older patient)
- UA (for rule-out delirium in older patients)
- Head CT (to rule-out ICH in patients with AMS)
- Lumbar puncture (to rule-out meningitis or encephalitis)
Management
Referral for outpatient psychiatric treatment, as psychotherapy is the primary treatment. Medication does little to affect the personality disorder but can be helpful with symptoms such as depression.
Disposition
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See Also
External Links
References
- ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
