Blank Checklist - Historionic Personality Disorder
Blank Checklist - Historionic Personality Disorder
Blank Checklist - Historionic Personality Disorder
Personal Information:
Name: ____________________________________ Age: ______________________ Sex: ________
Date & Time of Assessment: ___________________________
This is a checklist to help one understand Histrionic Personality Disorder (HPD). All information is
taken from the DSM-5.
Instruction:
Please check “yes” criteria that are evident in the client’s inner experiences and behaviors.
4. Impulse control.
*Note: The client must meet the minimum number of symptoms to be diagnosed of histrionic
personality disorder.
Diagnostic Features:
Recommendation:
Evaluated
by: Date: