Case Study: Marina Collins (DSM-5-TR: Histrionic Personality Disorder)

Demographics

• Name: Marina Collins

• Age: 29

• Occupation: Boutique retail associate / aspiring influencer

• Background: Lives alone; financially unstable; history of unstable romantic relationships

Clinical Presentation

Marina was referred to therapy after repeated conflicts at work and a recent breakup that left her feeling “humiliated, empty, and ignored.” She arrived to the intake session in dramatic attire, frequently shifting emotional tone, from tearful to flirtatious to animated within minutes. She spoke in a highly impressionistic style, often lacking detail (“Everyone is obsessed with me,” “My ex destroyed my life”).

Interpersonal Functioning

• Marina reports feeling deeply uncomfortable when not the center of attention, often escalating situations to reclaim focus (e.g., crying loudly during staff meetings).

• At work, coworkers describe her as “dramatic,” “flirtatious with customers,” and “constantly needing reassurance.”

• She interprets casual interactions as unusually intimate; she believed her boss was “secretly in love” with her after he complimented her outfit.

• Friendships are unstable. Friends report exhaustion from Marina’s emotional intensity and constant crises.

Emotional and Behavioral Features

• Emotions shift rapidly, often inconsistent with context.

• Speech is theatrical but vague and lacking specificity.

• She invests significant energy in physical appearance and becomes distressed if she feels unnoticed.

• She frequently uses provocative or sexually suggestive behavior in inappropriate contexts.

• She exaggerates closeness in relationships (“I’ve known him two weeks, but he’s my soulmate”).

DSM-5-TR Diagnostic Features Demonstrated

A pervasive pattern of excessive emotionality and attention-seeking behavior, beginning in early adulthood and present in multiple contexts, as indicated by five or more:

1. Uncomfortable when not the center of attention

   • Staff meetings and social gatherings trigger acute distress unless all focus is on her.

2. Interactions characterized by inappropriate sexually seductive or provocative behavior

   • Flirtation with customers; suggestive messaging to coworkers; misreading of professional boundaries.

3. Rapidly shifting and shallow expression of emotions

   • Emotional presentation fluctuates within minutes; tears quickly shift to smiling or flirtation.

4. Consistently uses physical appearance to draw attention to self

   • Excessive focus on appearance; distressed if unable to present herself dramatically.

5. Speech is excessively impressionistic and lacking in detail

   • Statements like “everyone loves me,” “my ex ruined my life,” without specific examples.

6. Self-dramatization, theatricality, exaggerated expression of emotion

   • Dramatic storytelling, crying spells, public scenes after minor frustrations.

7. Suggestible (easily influenced by others or circumstances)

   • Rapidly adopts others’ opinions; impulsively shifts career aspirations based on validation.

8. Considers relationships more intimate than they are

   • Describes new acquaintances as “best friends,” misinterprets colleagues’ politeness as romantic interest.

Marina meets clearly more than five criteria, supporting a DSM-5-TR diagnosis.

Differential Diagnosis

• Borderline Personality Disorder: She lacks core features such as chronic emptiness, self-harm, severe abandonment fears, or unstable identity.

• Narcissistic Personality Disorder: She seeks approval rather than admiration and displays dependency rather than entitlement.

• Bipolar II Disorder: Emotional lability is reactive rather than episodic; no hypomanic episodes.

• Dependent Personality Disorder: Though she seeks reassurance, her behavior is dramatic and attention-focused rather than submissive.

Functional Impairment

• Occupational: Performance issues, conflict with coworkers, boundary problems with customers.

• Interpersonal: Frequent romantic instability; friendships strained by emotional intensity.

• Emotional: Highly reactive, relies on external validation, distressed when perceived as ignored.

Precipitating Factors / Developmental History

• Childhood described as “chaotic but exciting”; reports being praised for performance and appearance but emotionally ignored otherwise.

• Early adolescent onset of attention-seeking behavior (dramatic storytelling, flirtation).

• Pattern intensified in adulthood as interpersonal and occupational stress increased.

Treatment Considerations

• Psychotherapy:

  • Long-term, insight-oriented therapy to build emotional awareness and reduce dramatization.

  • Focus on developing stable self-esteem not reliant on external validation.

  • Social skills training and boundary-setting.

• Therapeutic Challenges:

  • Risk of therapist-directed flirtation or demands for special attention.

  • Emotional exaggeration; difficulty tolerating slow therapeutic progress.

• Goals:

  • Improve emotional regulation.

  • Strengthen realistic interpersonal expectations.

  • Develop healthier patterns of intimacy and self-worth.