Histrionic Personality Disorder

Histrionic personality disorder, or HPD, is one of several types of personality disorders recognized by mental health professionals. Personality disorders are complicated and very serious mental illnesses characterized by abnormal, unhealthy, and distorted patterns of thought and behaviors that cause significant distress and impairment in one or more areas of a person’s life.

HPD causes individuals to seek attention from other people to an excessive degree. Someone with this personality disorder is often submissive, suggestible, and poor at self-direction. To get attention a person with HPD may act in inappropriate ways, display extreme emotions, and exhibit dramatic behaviors.

He or she may seem very charming and can become depressed when not the center of attention. It is common for someone with HPD to use their looks, flirtation, and sexual behaviors to get attention. Relationships are difficult for someone with this disorder.

There is only one kind of histrionic personality disorder, but it is one of 10 different types of personality disorder. They are grouped into three clusters, and HPD belongs to cluster B. The personality disorders in this group are similar in that they cause erratic, unpredictable, dramatic, and emotional behaviors. Other cluster B disorders include antisocial, borderline, and narcissistic personality disorders.

Many of the symptoms of these disorders are similar, but histrionic is a distinct type. For instance, both narcissistic and histrionic personality disorders cause attention-seeking behaviors, but people who are narcissistic want to be admired, while those who are histrionic are not as selective and will take almost any kind of attention. Borderline personality disorder similarly causes outsized and intense emotional reactions but also causes self-loathing, which is not typical with HPD.

Histrionic personality disorder is a serious condition that causes a lot of distress and impairs a person’s ability to function, especially in relationships.

• A National Institutes of Health survey study found that as much as 15 percent of the adult population meets the criteria for any personality disorder.
• The study found that the rate of histrionic personality disorder in the U.S. is just 1.8 percent, making it one of the rarer types.
• Most people with a personality disorder of any type do not get treated. Just 39 percent receive treatment.
• Histrionic personality disorder is more common in women than in men.
• The signs of HPD may be present earlier but are most often fully developed by the early 20s.

A mental health professional can diagnose histrionic personality disorder through interviewing the patient, through observations, and by talking with family members. A complete diagnosis should also include medical history and a physical exam to rule out other causes of symptoms as well as screening for other mental health conditions.

To be diagnosed with HPD a person must exhibit both attention-seeking behaviors and excessive emotional responses. These must persist in a regular pattern and be excessive when compared to normal behaviors. To show there is a pattern, five or more of the following must be observed:

• Distress when not getting enough attention or not being the center of attention
• Emotions that seem shallow and change quickly
• Inappropriate or provocative interactions with others
• Use of physical appearance for attention
• Dramatic emotional responses, theatrical behaviors
• Impressionistic, vague speech
• Interpreting relationships as more intimate than they really are
• Being easily influenced by others

These are the diagnostic criteria for histrionic personality disorder as outlined by the Diagnostic and Statistical Manual of Mental Disorders. There are other characteristic and more specific signs or symptoms that a person may exhibit, including:

• Being more concerned with physical appearance than is normal
• Needing and seeking out approval from others
• Being unusually gullible
• Acting and making decisions impulsively, without much thought
• Self-centered behaviors and thoughts, little concern for others
• Extreme sensitivity to criticism from others
• Getting bored easily, starting and not finishing projects or activities
• Difficulty keeping relationships and developing or maintaining intimacy
• Using suicidal threats for attention

What causes any personality disorder is not known for certain. Family history is a big risk factor, so there is some evidence that genetics could play an important role in the development of HPD. Environmental and social factors are also likely to influence the development of a personality disorder. Other contributing factors that may make someone more susceptible to any personality disorder include a family history of any mental illness, an experience of trauma during childhood, and having grown up in an unstable home or family.

Parenting style and behaviors may also contribute to a young person developing histrionic personality disorder. The way a parent behaves toward and reacts to a child can leave him or her confused about what it means to have self-worth, how to get positive attention, and earning approval from parents. If a parent’s attention toward a child is erratic, for instance, the child may learn to use extreme emotions or dramatic behaviors to get attention.

It is common for someone with any personality disorder to have co-occurring mental illnesses. Histrionic personality disorder is often diagnosed with another personality disorder, especially borderline, narcissistic, and antisocial. That these are so similar to HPD has led some experts to question whether it is really a distinct personality disorder or simply a different degree of another cluster B disorder. Other co-occurring disorders include depression, dysthymia, somatic symptom disorder, and conversion disorder.

Substance use disorders are also common with personality disorders. Living with these conditions can be extremely distressing. They can cause complications that affect multiple parts of a person’s life, making relationships difficult and impacting work, school, and other activities. The distress it causes often leads someone to use drugs or alcohol as an unhealthy coping mechanism. Substance use may also co-occur with personality disorders because they have risk factors in common, like trauma and a troubled childhood or home life.

An important and characteristic challenge of all personality disorders is that the individual exhibiting the symptoms often does not see that his or her thoughts and behaviors are abnormal. They often think that other people are to blame for their problems and that they are doing nothing wrong or unusual. Someone with HPD may end up seeking therapy for other issues, like depression or troubled relationships, and then get diagnosed with a personality disorder.

Psychotherapy is the main type of treatment used to manage histrionic personality disorder. The type used for an individual may depend on his or her needs, but behavioral therapies like cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are most common.

DBT was specifically developed from CBT to be used for treating patients with personality disorders. It helps give patients new skills for coping with and managing difficult feelings and for maintaining healthier relationships with others. DBT focuses on the practice of mindfulness to be more aware of emotions and behaviors in the present moment; tolerance of distress to help patients accept and feel negative emotions instead of escaping them; and regulating emotions to de-escalate responses that cause conflict and distress.

Medications are not typically used in the treatment of any personality disorder unless there are other co-occurring issues. For instance, a patient may be given antidepressants to manage depression or anxiety disorders. It is also important that while being treated for HPD an individual can/ may also be screened for and treated for other mental illnesses and any substance use disorders. If all issues are not addressed, the success of treatment will be minimal or only short-term.

The prognosis for someone living with histrionic personality is largely positive. While many people with HPD are resistant to treatment, most live well with this condition with minimal impairment or dysfunction. Relationships are the biggest challenges for those with HPD, and therapy can be very useful in helping them manage conflict and develop healthier attachments.

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