Quick reference
- When to use
- Use F60.4 when the client demonstrates a pervasive, inflexible, and enduring pattern consistent with Histrionic Personality Disorder that deviates from cultural expectations, causes distress or impairment, and is stable over time. Do not assign based on a single clinical encounter.
- Duration
- Personality disorders are enduring patterns — symptoms should be traceable to adolescence or early adulthood. Minimum of several sessions recommended before diagnosing. Reassess periodically as treatment may modify traits.
- Session codes
- Pair with CPT 90834/90837 for individual therapy. DBT programs: 90853 (group), 90834 (individual), plus phone coaching. 90791 for comprehensive evaluation. Long-term treatment is typical.
- Key indicators
- Enduring pattern of inner experience and behavior • Deviates from cultural expectations • Pervasive across situations • Onset in adolescence/early adulthood • Stable and long-standing • Distress or impairment
What F60.4 represents
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts.
Key diagnostic criteria
5+ of 8 criteria:
- Uncomfortable when not center of attention
- Inappropriately sexually seductive/provocative
- Rapidly shifting, shallow emotions
- Uses physical appearance to draw attention
- Impressionistic, vague speech
- Self-dramatization, exaggerated emotion
- Suggestible
- Considers relationships more intimate than they are
Documentation essentials
Document specific criteria met across multiple contexts. Note the pervasive, longstanding nature.
Differential diagnosis
Distinguish from BPD, NPD, somatic symptom disorder, and normal personality variation.
Treatment planning
Psychodynamic psychotherapy, CBT, group therapy. Address underlying emotional needs.
Insurance & billing
Personality disorder codes may face treatment authorization challenges.
Updates & changes
May be reconceptualized in future DSM editions using dimensional model.
Documentation pitfalls
Avoid gender bias in diagnosis. Ensure cultural considerations are addressed.
References
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).