Histrionic Personality Disorder
The clinical presentation described is most consistent with Histrionic Personality Disorder (HPD) as classified in DSM-5-TR.
Diagnostic Rationale
The patient demonstrates the hallmark features of HPD through multiple converging clinical characteristics:
- Excessive emotionality and attention-seeking behavior manifested by feeling she is not receiving enough attention from co-workers and her associated person based on her work performance 1, 2
- Provocative dress, heavy makeup, and exaggerated gestures which represent the preoccupation with outward appearance and theatrical presentation characteristic of HPD 2
- Workplace dysfunction where her behavior has become so disruptive that others cannot perform their work, reflecting the dramatization and need to take center stage that defines this disorder 2
- Overwhelming emotions that impair her ability to function, consistent with the superficial and rapidly changing affects seen in HPD 2
Differential Diagnosis Considerations
Why not the other options:
Bipolar II Disorder would require distinct episodes of hypomania and depression with clear mood elevation, decreased need for sleep, and increased goal-directed activity—none of which are described here 3
Conduct disorder applies only to individuals under age 18 and involves a repetitive pattern of violating others' rights or societal norms, not attention-seeking through appearance and emotional displays 3
Exhibitionistic paraphilic disorder involves sexual arousal from exposing genitals to unsuspecting strangers over at least 6 months, which is fundamentally different from the attention-seeking presentation described 3
Obsessive-compulsive disorder requires time-consuming obsessions (intrusive, unwanted thoughts) and compulsions (repetitive behaviors to neutralize anxiety), typically taking more than 1 hour per day—features entirely absent from this presentation 3
Key Clinical Features of HPD
The disorder is characterized by a compensatory attitude resulting from important childhood relationships and includes 2:
- Dramatization and theatrical behavior
- Suggestibility and impressionist cognitive style
- Superficial, rapidly changing affects
- Seductive or provocative behavior
- Excessive need for attention and approval
- Discomfort when not the center of attention
Clinical Pitfalls to Avoid
Do not confuse HPD with:
- Narcissistic personality disorder (though comorbidity is common)—narcissism focuses on grandiosity and entitlement rather than emotional expressiveness 2, 4
- Borderline personality disorder—which involves identity disturbance, self-harm, and fear of abandonment not present here 4
- Normal attention-seeking behavior—HPD requires significant functional impairment and pervasive pattern across contexts 1
The low prevalence of HPD (0.4-1.8% in clinical samples) means it may be underrecognized, but when the full constellation of features is present as in this case, the diagnosis is appropriate 1, 4.