Histrionic personality disorder — structured clinical viva

This presentation is consistent with a histrionic personality disorder pattern if general PD criteria and ≥5 of 8 DSM features are met longitudinally (need to be centre of attention, theatrical/shallow affect, provisional intimacy, impressionistic style, suggestibility, appearance or seductive attention bids). State that HPD is a pointer diagnosis with contested construct validity — Bakkevig and Blagov-type work question coherence and reorganise many cases toward borderline or hysterical subtypes. Sex bias exists in clinical labelling; male presentations are real and under-recognised if examiners only expect seductive female stereotypes.[1][2]

Differentials. BPD (abandonment, emptiness, self-harm regulation), NPD (admiration/status, envy), mania (episodic energy, reduced sleep need), substance disinhibition, somatic pathways. Dual diagnosis when thresholds are met.[1][2]

Treatment. Firm frame and structured psychotherapy targeting externalised self-worth and interpersonal strategies; change-process research supports treatability of HPD presentations. Schema therapy has multicentre RCT support for personality disorders (Bamelis). Medication does not cure personality; SSRIs treat comorbid depression/anxiety with named dose and review. Countertransference literacy (Betan) and supervision prevent boundary failures around flirtation.[3][4][5]

Risk. Never dismiss self-harm as mere drama; full formulation, means safety, rapid access after rejection/public shame.[1]