Is the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, histrionic personality disorder category a valid construct?
published online 08 January 2010.
Abstract
Purpose
The study investigated crucial aspects of the construct validity of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) histrionic personality disorder (HPD) category.
Material and methods
The study included 2289 patients from the Norwegian Network of Psychotherapeutic Day Hospitals. Construct validity was assessed by means of prevalence, comorbidity with other personality disorders, internal consistency among HPD criteria, severity indices, as well as factor analyses.
Results
The prevalence of HPD was very low (0.4 %). The comorbidity was high, especially with borderline, narcissistic, and dependent personality disorders. The internal consistency was low. The criteria seemed to form 2 separate clusters: the first contained exhibitionistic and attention-seeking traits and the other contained impressionistic traits.
Conclusion
The results indicated poor construct validity of the HPD category. Different options for the future of the category are discussed. The authors suggest the HPD category to be deleted from the DSM system. However, the clinical phenomena of exhibitionism and attention-seeking, which are the dominant personality features of HPD, should be preserved in an exhibitionistic subtype of narcissism.
aDepartment of Personality Psychiatry, Ulleval University Hospital, 0407 Oslo, Norway
bDivision Mental Health Services, Akershus University Hospital
cFaculty of Psychiatry, University of Oslo, Oslo, Norway
Corresponding author. Department of Personality Psychiatry, Ulleval University Hospital, 0407 Oslo, Norway. Tel.: +47 40218580.
ABSTRACT