What is 'histrionic personality disorder'?

Few outside the psychiatric community knew about "histrionic personality disorder" until it was reported that attorneys for former Penn State assistant football coach Jerry Sandusky would bring it up in his defense on child sex abuse charges.

Today, the condition took center stage as a psychologist who evaluated Sandusky took the stand. The condition is defined in the American Psychiatric Association's diagnostic manual (called the DSM, short for Diagnostic and Statistical Manual of Mental Disorders) as "a pervasive pattern of excessive emotionality and attention seeking."

Psychiatrists familiar with such disorders aren't convinced such a claim will help Sandusky.

"That doesn't make any sense at all," says psychiatrist Carl Bell of Chicago, who has been in practice for 45 years. "He may have a histrionic personality, but I'm not sure it's going to do him very much good. I would never walk into court for a defense with a personality disorder because the courts don't recognize it. Personality disorders are rarely, if ever, a reason not to find somebody guilty of a crime."

The DSM says histrionic personality disorder is indicated by five or more of eight potential characteristics that include being "uncomfortable in situations in which he or she is not the center of attention." Among others: "interaction with others is often characterized by inappropriate sexually seductive or provocative behavior," "consistently uses physical appearance to draw attention to self," and "considers relationships to be more intimate than they actually are."

Experts who are editing the diagnostic manual, which is being revised for publication next year, propose to delete it as a separate disorder; it probably will be placed in the appendix, which suggests further study is warranted, says Renato Alarcon of Oakland, an emeritus professor of psychiatry and a consultant for the Mayo Clinic in Rochester, Minn.

Bell and Alarcon are among those on the personality disorders panel, which is recommending the revision for all such disorders, not just histrionic personality disorder.

"The whole issue of personality disorders is being reviewed," Alarcon says. "It will be considered mostly a trait or a feature and not a type and may be called something different, such as exhibitionism or grandiosity."

Psychiatric Ryan Shugarman, who teaches at Georgetown University and at Saint Elizabeths Hospital in Washington, D.C., says histrionic personality disorder has been recognized since 1968, and the percentage of people who meet criteria for it is low compared with that for mood or anxiety disorders.

"I see a few patients per year that meet that criteria," he says.

Estimates suggest that almost a quarter of Americans have some sort of psychiatric condition in their lifetime, and histrionic personality disorder affects about 10% to 15% of those who have received psychiatric care, Shugarman says. Some suggest the disorder is more common in women, but he says the research isn't clear on that point.