Questioning the Coherence of Histrionic Personality Disorder

Department of Psychology, Emory University, Atlanta, Georgia 30322, USA.
The Journal of nervous and mental disease (Impact Factor: 1.69). 12/2008; 196(11):785-97. DOI: 10.1097/NMD.0b013e31818b502d
Source: PubMed


After the introduction of histrionic personality disorder (HPD), nosologists struggled to reduce its overlap with borderline personality disorder and other PDs. We studied the coherence of HPD in adults and adolescents as part of 2 larger studies. Clinicians described a random patient with personality pathology using rigorous psychometrics, including the SWAP-II (a Q-sort that captures personality and its pathology in adults) in study 1 and the SWAP-II-A (the adolescent version) in study 2. Using DSM-IV-based measures, we identified patients who met HPD criteria with varying degrees of diagnostic confidence. Central tendencies in the SWAP-II and SWAP-II-A profiles revealed that both the most descriptive and most distinctive features of the patients included some features of HPD but also many features of borderline personality disorder. Q-factor analyses of the SWAP data yielded 3 types of patients in each of the 2 samples. The HPD diagnosis may not be sufficiently coherent or valid.

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    • "The SWAP instruments (the original SWAP-200 and revised SWAP-II for adults, and the SWAP-200-A and revised SWAP-II-A for adolescents) have been used to develop an empirically based classification of personality disorders (PDs; Shedler & Westen, 2007; Westen & Shedler, 1999a, 1999b; Westen, Shedler, Bradley, & DeFife, in press; Westen, Waller, Shedler, & Blagov, in press), to refine current diagnostic constructs by identifying richer diagnostic criterion sets more faithful to the clinical syndromes observed in practice as well as in the lab (Blagov & Westen, 2008; Russ, Bradley, Shedler, & Westen, 2008; Shedler & Westen, 2004a; Zittel & Westen, 2005), to identify clinically important personality dimensions via factor analysis that are absent from other dimensional models of personality (Shedler & Westen, 2004b; Westen, Shedler, Bradley, & DeFife, in press), to link SWAP-assessed dimensions to etiological and outcome variables (including, e.g., genetic history , psychosocial history variables, and treatment response to both psychotherapy and pharmacological interventions; Westen & Shedler, 2007), to develop dimensional prototype models for personality diagnosis as an alternative to the categorical approach of Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; Shedler & Westen, 2004a; Spitzer, First, Shedler, Westen, & Skodol, 2008; Westen, Shedler, & Bradley, 2006; Westen, Shedler, et al., in press), to explore subthreshold forms of personality pathology currently absent from the diagnostic manuals (Blagov, Bradley, & Westen, 2007), to assess subtypes of Axis I and Axis II disorders (e.g., DiLallo, Jones, & Westen, 2009; Russ et al., 2008), and to assess change in psychotherapy (Lingiardi, Shedler, & Gazillo, 2006). "
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