Is the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, histrionic personality disorder category a valid construct?
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Bakkevig
Jonas F
JF
Department of Personality Psychiatry, Ulleval University Hospital, 0407 Oslo, Norway. jonas.bakkevig@hotmail.com
Karterud
Sigmund
S
D000328:Adult; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005163:Factor Analysis, Statistical; D005260:Female; D006677:Histrionic Personality Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D009664:Norway / Q000453:epidemiology; D015995:Prevalence; D015203:Reproducibility of Results; D017678:Sex Distribution