Histrionic Personality Disorder

Histrionic personality disorder is a psychiatric condition characterized by excessive attention-seeking behavior. When left untreated, the condition can significantly disrupt daily functioning and lead to unhappiness.

What Is Histrionic Personality Disorder?

Histrionic personality disorder (HPD) is a mental disorder that involves a pervasive pattern of hyper-emotional and extreme attention-seeking responses. People with this condition tend to behave and act in a highly dramatic and emotional way to attract attention from others. Individuals with HPD are usually enthusiastic, lively, flirtatious and cheerful. However, as they seek approval and attention excessively, they may engage in inappropriate seduction. Onset can be observed during early childhood.

The American Psychiatric Association explains that people with this disorder “may be uncomfortable when they are not the center of attention, may use physical appearance to draw attention to themselves or have rapidly shifting or exaggerated emotions.” HPD is a dramatic personality disorder that is categorized under Cluster B personality disorders due the patterns of exaggerated emotionality and attention-seeking behaviors. These personalities tend to be highly theatrical, volatile, erratic and excitable. They can also appear rather demanding, egocentric, dependent, shallow and inconsiderate.

According to the American Psychological Association (APA), the condition was previously known as hysterical personality disorder. The APA explains the condition as “a personality disorder characterized by a pattern of long-term (rather than episodic) self-dramatization in which individuals draw attention to themselves, crave activity and excitement, overreact to minor events, experience angry outbursts, and are prone to manipulative suicide threats and gestures.” People with histrionic personality disorder tend to be loud, seek stimulation and have exaggerated and inappropriate emotions & behavior. Although they can be easily influenced, they tend to be self-indulgent, manipulative and sexually provocative to accomplish their needs.

Research [mfn] Nestadt, G., Romanoski, A. J., Chahal, R., Merchant, A., Folstein, M. F., Gruenberg, E. M., & McHugh, P. R. (1990). An epidemiological study of histrionic personality disorder. Psychological medicine, 20(2), 413–422. https://doi.org/10.1017/s0033291700017724 [/mfn] indicates that the disorder affects around 2-3% of the population. Men and women are equally affected by the condition. However, hospital-based research indicates that women [mfn] Rienzi, B. M., & Scrams, D. J. (1991). Gender stereotypes for paranoid, antisocial, compulsive, dependent, and histrionic personality disorders. Psychological reports, 69(3 Pt 1), 976–978. https://doi.org/10.2466/pr0.1991.69.3.976 [/mfn] are four times more likely to be affected by it than men. Treatment based on different psychotherapeutic approaches can help someone overcome the symptoms of HPD and live a more fulfilling life.

History Of Histrionic Personality Disorder

Histrionic Personality Disorder is considered one of the most dubious and ambiguous personality disorders in psychiatry. One 2007 study [mfn] French JH, Shrestha S. Histrionic Personality Disorder. [Updated 2021 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542325/ [/mfn] states “Despite its familiar feel, HPD remains enshrouded in a degree of historical confusion and conceptual uncertainty that researchers have not yet resolved.” The condition was originally known as hysterical personality disorder. According to the Encyclopedia of Human Behavior, 2012, “HPD owes its historical origins to the early descriptions of ‘hysteria,’ although it gradually evolved into a more circumscribed diagnosis characterized by theatrical displays and interpersonal dysfunction.”

The term hysteria is derived from the Greek word “Hystera”, which means womb. The term has been widely used in texts by ancient Egyptians, Romans and Greeks. The term hysteria involves a wide range of psychopathological states. Ancient Romans also used the term “Histrione [mfn] Novais, F., Araújo, A., & Godinho, P. (2015). Historical roots of histrionic personality disorder. Frontiers in psychology, 6, 1463. https://doi.org/10.3389/fpsyg.2015.01463 [/mfn] ” which was used to describe actors who portrayed comic, dramatic and theatrical work. A 2015 study [mfn] Novais, F., Araújo, A., & Godinho, P. (2015). Historical roots of histrionic personality disorder. Frontiers in psychology, 6, 1463. https://doi.org/10.3389/fpsyg.2015.01463 [/mfn] reveals that HPD was first officially described in the Diagnostic and Statistical Manual of Mental Disorders II (DSM-II). Since the introduction of DSM-III, the condition is the only mental disorder which derives its name from the original concept of hysteria. The term histrionic means excessively theatrical or dramatic.

Understanding Histrionic Personality Disorder

People with this disorder tend to have poor sense of self-worth as their self-esteem largely depends on validation and approval from others. Due to their distorted self-images, these personalities experience unstable emotions and have an overwhelming need for attention. According to the APA, HPD can be described through the following clinical traits and domains:

• Volatile and fickle temperament and moods
• Dramatic behavioral acts
• Attention seeking interpersonal conduct
• Gregarious self-image
• Erratic & unstable cognitive style
• Disjointed psychic structure
• Shallow representations of others
• Regulatory mechanisms based on dissociation

People with HPD tend to feel disregarded, discomfort and underappreciated in social situations where they are not noticed or fail to gain the desired amount of attention. Generally, they tend to have a larger than life appearance and prove to be the life of the party. They are typically enchanting and vibrant individuals who tend to be overly seductive. They may wear bright colored or revealing clothes and use their physical appearance to draw attention to themselves. These personalities can behave in an inappropriately sexual manner with others, even though they may not be sexually, emotionally or physically attracted to that person. Histrionic people also display shallow, unbalanced and inconsistent emotions which may be considered insincere by others.

Individuals with histrionic personality disorder may communicate in a vague manner and may be extremely emotionally expressive. They are also highly prone to public displays of emotion and affection. Histrionic people are often suggestible, gullible and impressionable and hence, can be easily influenced by people they like and admire. Moreover, they mistakenly believe certain relationships to be stronger and closer than what they may be in reality.

Comorbid Conditions

Histrionic personality disorder overlaps with some other psychiatric conditions, including –

• Borderline personality disorder
• Somatization disorder
• Antisocial personality disorder

However, all these disorders are unique and different from each other. Research [mfn] Lilienfeld, S. O., Van Valkenburg, C., Larntz, K., & Akiskal, H. S. (1986). The relationship of histrionic personality disorder to antisocial personality and somatization disorders. The American journal of psychiatry, 143(6), 718–722. https://doi.org/10.1176/ajp.143.6.718 [/mfn] indicates that men with HPD can develop antisocial personality disorder and women with HPD are highly likely to develop somatization disorder. Moreover, the researchers state that “all three conditions may represent alternative manifestations or different stages of the same underlying diathesis.”

According to The Merck Manuals, histrionic people may also possess traits of narcissistic personality disorder as well. It states that these related disorders “share a biologic vulnerability or casting doubt on whether histrionic personality disorder is a separate disorder.” Apart from these, patients with HPD may also experience “major depressive disorder, persistent depressive disorder, and conversion disorder” as these conditions may also coexist. Other comorbid conditions may include:

• Dependent personality disorder
• Anxiety disorders
• Panic disorder
• Eating disorders
• Conversion disorders
• Post traumatic stress disorder (PTSD), including dissociative disorders
• Attachment disorders, like reactive attachment disorder
• Body dysmorphic disorder
• Substance abuse
• Anorexia nervosa
• Other psychiatric disorders

Read More About Anorexia Nervosa Here

Types Of Histrionic Personality Disorder

Although the DSM identifies only one type of histrionic personality disorder, a 2004 study by American psychologist Theodore Millon and colleagues recognized 6 different types of HPD based on the specific traits and behaviors of the histrionic person. The 6 different HPD types are:

• Appeasing histrionic
• Vivacious histrionic
• Tempestuous histrionic
• Disingenuous histrionic
• Theatrical histrionic
• Infantile histrionic

Here is a brief look at the different types of HPD as identified by Millon:

1. Appeasing histrionic

The appeasing histrionic is characterized by dependent & compulsive traits. They are obsessed with making others like them and becoming friends with almost everyone they meet. They are prone to using praise and flattery to amuse others and may become desperate to gain attention when the other person appears indifferent. Their need for acceptance is so strong that they willingly surrender when conflict arises. This is perhaps due to their inner feelings related to helplessness, dependence, inferiority, guilt of the compulsion and emptiness. They are over eager to settle differences by compromising and making self-sacrifices. They are super-pleasures and may even appease and placate abusers. They are highly likely to tolerate neglect, abuse and violence from others for the sake of acceptance.

2. Vivacious histrionic

They are highly seductive and tend to have hypomanic energy. They may possess certain narcissistic traits and are exceptionally charming, spirited, vigorous and impulsive. They are more focused on gaining momentary attention and temporary gratification. Vivacious histrionics are energetic people who are playful and adventurous. However, they often fail to understand the consequences of their actions and behaviors. They are likely to engage in infidelity in relationships and tend to move on to the next relationship before ending the previous one. These individuals may fall prey to abusers even though they may possess narcissistic features themselves.

3. Tempestuous histrionic

This particular subtype of histrionic personality disorder is an amalgamation of “histrionic and negativistic personality [mfn] Hopwood, C. J., & Wright, A. G. (2012). A comparison of passive-aggressive and negativistic personality disorders. Journal of personality assessment, 94(3), 296–303. https://doi.org/10.1080/00223891.2012.655819 [/mfn] .” They tend to be pessimistic, critical and skeptical and may refuse to act on suggestions repeatedly. They are also highly moody, impulsive, impassioned, turbulent, out of control and prone to complaining and sulking. Tempestuous histrionics also tend to be emotionally variable, argumentative and confrontational. They may pretend to be superficially sociable and friendly, but they are socially immature, intolerant of frustration and sensitive to criticism.

4. Disingenuous histrionic

These personalities tend to possess both histrionic and antisocial characteristics. They tend to be manipulative, aggressive & hostile and are prone to violate social norms. Although they may appear charming and friendly initially, these personalities may exploit others after gaining their trust. These individuals are often described as deceitful, egocentric, scheming, guileful and insincere. As they don’t like being perceived as weak, they can resort to predatory behavior to create their preferred impression on others. Disingenuous histrionics may also have psychopathic characteristics and tend to combine the charm and adaptive social skills of the histrionic with the deliberate malevolence of the sociopath or psychopath. They tend to enjoy conflict and may be prone to homicidal behavior [mfn] Petherick, W., & Petherick, N. (2019). Psychological influences on homicide. Homicide, 49-79. https://doi.org/10.1016/b978-0-12-812529-8.00003-3 [/mfn].

5. Theatrical histrionic

These individuals tend to be highly dramatic and simulate desirable behavior and body languages. They are the perfect and purest variant of the primary histrionic pattern. They tend to “market” themselves as commodities and can change their personality and traits dramatically based on different social situations, like chameleons. They can easily transform their “self” based on the social demand and fabricate their appearance and characteristics to boost their appeal. The theatrical histrionic lacks depth in their inner identity as their prominent endeavor is being seductive, pleasing and attractive. Women with this condition may wear bright and appealing clothes and jewelry while men tend to be bodybuilders.

6. Infantile histrionic

These individuals have a combination of histrionic & borderline personalities. They often have severe dependency issues and tend to be demanding, labile and overwrought. They possess volatile emotions and experience childlike hysteria. Infantile histrionics prefer to attract powerful individuals and may use suxuality in relationships prematurely. Although they are highly indulgent, these types of personalities can be excessively clingy and have unhealthy attachment styles. They lack a solid sense of self and are more focused on seeking pleasure and attention. In relationships, they may be excessively demanding and dependent, seeking constant reassurance. They tend to be depressed when they do not get the required approval or external validation.

Symptoms Of Histrionic Personality Disorder

People with HPD are often overly dramatic, erratic and emotional. They can appear lively and vibrant and are usually described as seductive and “the life of the party.” Here are some of the most common symptoms of histrionic personality disorder:

• Persistently seeking attention from others
• Theatrical behavior with overdramatized emotions
• Attracting attention through physical appearance, provocative dressing and sexuality
• Feeling discomfort when they fail to attract expected attention
• Excessively focused on physical appearance
• Continuously seeking approval or reassurance
• Rapidly changing and shallow emotions
• Engaging in inappropriate sexual, provocative or seductive behavior
• Suggestible, overly trusting and easily swayed
• Lacking details in speech and speaking vaguely
• Being easily bored and seeking new experiences & relationships
• Sudden mood swings
• Feeling more attached to someone than they actually are
• Poor tolerance for frustration
• Highly sensitive to disapproval or criticism
• Making rash decisions and acting before thinking
• Self-centered and lacking concern for others
• Suicidal thoughts and behaviors when unable to gain attention

According to a 2018 study [mfn] Ritzl, A., Csukly, G., Balázs, K., & Égerházi, A. (2018). Facial emotion recognition deficits and alexithymia in borderline, narcissistic, and histrionic personality disorders. Psychiatry research, 270, 154–159. https://doi.org/10.1016/j.psychres.2018.09.017 [/mfn] , people with histrionic personality disorder may also be affected by alexithymia. This condition makes it difficult for the individual to identify or express emotions. They may also use dissociation and repression as a defense mechanism. They also have higher risk for developing depression. It is also difficult for histrionic people to experience healthy emotional or sexual intimacy. “Patients may, often without being aware of it, play a role (eg, victim). They may try to control their partner using seductiveness or emotional manipulations while becoming very dependent on the partner,” explains The Merck Manuals.

Usually, the symptoms of histrionic personality disorder tend to appear during early childhood. However, onset may also occur during early adulthood as well. If someone has some of these features but is able to function effectively in their daily life, then they might not necessarily be affected by HPD. Personality disorders cause long-term distress in the life of the sufferer and disrupt their ability to function normally. People with HPD do not behave this way deliberately and often find it difficult to change their behavior.

Histrionic Personality Disorder vs Borderline Personality Disorder

Categorized under cluster B personality disorders, both borderline personality disorder and histrionic personality disorder are characterized by overly emotional, dramatic, and erratic thinking & behavior. Both the disorders tend to have overlapping symptoms. Patients of both HPD and BPD have reactive and rapidly shifting emotions and usually depict impulsive behavior.

Research [mfn] Angstman, K. B., & Rasmussen, N. H. (2011). Personality disorders: review and clinical application in daily practice. American family physician, 84(11), 1253–1260. [/mfn] indicates that both these personality disorders involve overly strong expression of emotions. One study [mfn] Turner R.M. (1994) Borderline, Narcissistic, and Histrionic Personality Disorders. In: Hersen M., Ammerman R.T. (eds) Handbook of Prescriptive Treatments for Adults. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-1456-9_19 [/mfn] by Ralph M. Turner of the Department of Psychiatry in Lewis Katz School of Medicine at Temple University in Philadelphia, USA, states “These disorders appear to have many common features and often co-occur in patients. These are the disorders of the self.”

However, many experts argue that these symptoms often vary in their quality in HPD and BPD. For instance, the rapidly shifting emotions experienced by patients of BPD lack the depth and intensity of the same symptom experienced by people with HPD. Certain researchers tend to believe that although HPD and BPD may possess different features and traits, these may not necessarily be different disorders.

Irrespective of the controversy and debate, HPD is a unique and specific diagnosis in the DSM-5. It has also been observed that histrionic personality disorder and borderline personality disorder frequently co-occur [mfn] Bakkevig, J. F., & Karterud, S. (2010). Is the diagnostic and statistical manual of mental disorders, fourth edition, histrionic personality disorder category a valid construct? Comprehensive Psychiatry, 51(5), 462-470. https://doi.org/10.1016/j.comppsych.2009.11.009 [/mfn] in some patients. As most of the symptoms overlap, it can often be difficult to diagnose the conditions in someone properly. Further studies [mfn] Tomko, R. L., Trull, T. J., Wood, P. K., & Sher, K. J. (2014). Characteristics of borderline personality disorder in a community sample: Comorbidity, treatment utilization, and general functioning. Journal of Personality Disorders, 28(5), 734-750. https://doi.org/10.1521/pedi_2012_26_093 [/mfn] have revealed that around 10% of individuals with BPD also tend to meet the diagnostic criteria for HPD.

Causes Of Histrionic Personality Disorder

The exact cause for the development of histrionic personality disorder is currently not known. However, it is believed that a combination of different factors, like genetics and environmental factors, may lead to the onset of this psychiatric condition. Childhood abuse or traumatic childhood experiences and learned behavior may also influence the development of HPD. The condition may also be caused by excessive stress and anxiety during developing years.

Many researchers claim that biopsychosocial factors can also play a significant role. This means that the condition is caused by a complex combination of biological, genetic and social factors. Psychological factors refer to how a person’s environment shapes their temperament and personality and what coping skills they have learned to deal with anxiety and stress. Social factors may refer to how an individual interacts with their family, friends and peers during their early childhood.

Here are some of the most common factors that are believed to result in the development of HPD:

1. Genetics

Cluster B personality disorders may run in families. According to a 2013 study [mfn] Torgersen, S., Myers, J., Reichborn-Kjennerud, T., Røysamb, E., Kubarych, T. S., & Kendler, K. S. (2012). The heritability of Cluster B personality disorders assessed both by personal interview and questionnaire. Journal of personality disorders, 26(6), 848–866. https://doi.org/10.1521/pedi.2012.26.6.848 [/mfn] , personal interview and questionnaire assessment has revealed that cluster B personality disorders, like HPD and BPD, may have a strong heritability. The authors of the study state that “When Cluster B PDs are assessed by interview as well as by questionnaire, the heritability is high, just as high as it is for schizophrenia.” If you suffer from HPD then it is highly likely that the condition may be passed down to your children. If you have a first-degree family member or relative with HPD, then it is likely that multiple members of your family, including you, may develop the disorder.

According to the American Psychological Association (APA), researchers may have identified certain malfunctioning genes that may cause certain personality disorders. Moreover, “researchers are exploring genetic links to aggression, anxiety and fear – traits that can play a role in personality disorders,” states the APA. Moreover, twin studies [mfn] Torgersen, S., Lygren, S., Øien, P. A., Skre, I., Onstad, S., Edvardsen, J., Tambs, K., & Kringlen, E. (2002). A twin study of personality disorders. ScienceDirect.com | Science, health and medical journals, full text articles and books. https://www.sciencedirect.com/science/article/abs/pii/S0010440X00982841?via%3Dihub [/mfn] conducted by Oslo University have revealed an association between Cluster B personality disorders and genetics. The study revealed a 0.67 correlation that HPD is hereditary.

2. Parenting styles

Parenting styles can also play a crucial role in the development of histrionic personality disorder. When a child observes [mfn] Sulz S. (2010). Hysterie I: Histrionische Persönlichkeitsstörung. Eine psychotherapeutische Herausforderung [Hysteria I. Histrionic personality disorder. A psychotherapeutic challenge]. Der Nervenarzt, 81(7), 879–888. https://doi.org/10.1007/s00115-010-3016-6 [/mfn] their parent or primary caregiver displaying inappropriate, volatile, dramatic, erratic or oversexualized attitudes and behavior, then it is highly likely that the child may have a histrionic personality. The child may display behavior that they have learned from their caregivers or parents. Children may also learn and exhibit HPD behaviors in order to gain attention from their parents.

A recent scientific analysis on HPD reveals that “Parenting which lacks boundaries is over-indulgent or inconsistent may predispose children to develop histrionic personality disorder.” Overindulgent parenting may also lead to the development of this condition in early adulthood. As such neglectful caregiving fails to establish any boundaries, it affects the healthy psychological and emotional development of a child. “Moreover, parents who role model dramatic, erratic, volatile, or inappropriate sexual behavior put their children at high risk for developing this personality disorder,” adds the scientific analysis.

3. Traumatic experiences

Childhood “abuse, trauma or neglect” can also increase the risk of developing HPD. Excessive stress, such as financial problems or the loss of a loved one can also be a contributing factor. Family dynamics and frequent issues in the family can also influence the onset. For instance, if a child is rewarded for dramatic or theatrical behavior or if there is a lack of discipline, it is likely that they will become a histrionic person.

According to the recent scientific analysis on HPD, trauma experienced during childhood can result in the condition. It states “Children may endure their trauma by coping with their environment in ways that may ultimately lead to a personality disorder.” Personality disorders in childhood may be a manifestation of a traumatic situation or traumatic environment in childhood and may develop as a coping mechanism.

The APA explains that the role of childhood experiences can be more significant than expected, according to studies. It states “One study [mfn] Yen, S., Shea, M. T., Battle, C. L., Johnson, D. M., Zlotnick, C., Dolan-Sewell, R., Skodol, A. E., Grilo, C. M., Gunderson, J. G., Sanislow, C. A., Zanarini, M. C., Bender, D. S., Rettew, J. B., & McGlashan, T. H. (2002). Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: findings from the collaborative longitudinal personality disorders study. The Journal of nervous and mental disease, 190(8), 510–518. https://doi.org/10.1097/00005053-200208000-00003 [/mfn] found a link between the number and type of childhood traumas and the development of personality disorders.” Physical, emotional, verbal and sexual abuse can also increase the risk for developing personality disorders in adulthood.

Read More About Post-Traumatic Stress Disorder Here

4. Brain structure

Sometimes brain anatomy and functioning may also affect our personality & behavior leading to the development of certain mental and personality disorders. The human brain produces and releases certain chemicals that significantly affect our thoughts, emotions & actions. When these brain chemicals are out of balance, then it may adversely affect how we feel, behave, think and act. A person suffering from histrionic personality disorder may behave in a certain way due to a disbalance in brain chemicals.

Studies reveal that people with HPD tend to have “highly responsive noradrenergic systems, the mechanisms surrounding the release of a neurotransmitter called norepinephrine.” The excessively emotional behavior exhibited by patients with HPD can be attributed to disbalance in a type of neurotransmitters known as catecholamines [mfn] Goldstein D. S. (2010). Catecholamines 101. Clinical autonomic research : official journal of the Clinical Autonomic Research Society, 20(6), 331–352. https://doi.org/10.1007/s10286-010-0065-7 [/mfn] .

5. Personal factors

Apart from genetics, parental styles, childhood experiences and brain anatomy, personal variables may also influence the onset of histrionic personality disorder. Researchers have found an association between HPD behaviors and age of the person. Although HPD symptoms tend to be long-term, certain characteristic traits of the condition may vary depending on the age of the patient.

For instance, a young person with HPD may be more prone to use their physical appearance and sexuality to attract attention and praise from others than an older adult. Older adults with HPD may use their intellect, social status and paternal/maternal seductiveness to gain attention. Moreover, the intensity of attention-seeking behavior may also vary with the age of the individual with HPD.

Complications Of Histrionic Personality Disorder

Histrionic people can experience certain complications, when the symptoms related to the condition are left untreated. For instance, persistently engaging in an oversexualized behavior may not only affect their social reputation, but also prevent them from experiencing a long-term, committed romantic relationship. Moreover, they may also be prone to angry outbursts when faced with negative feedback or criticism. This can make it difficult for them to survive in certain challenging work environments and interact properly with colleagues and employers in a socially acceptable manner.

Moreover, individuals with cluster B disorders, like histrionic personality disorder, also tend to seek new experiences and adventures constantly. This can make them engage in reckless behavior and take unnecessary risks, like substance use. These people are also likely to experience high levels of anxiety and depression. A person with a cluster B personality disorder may experience the above mentioned additional symptoms along with those of HPD.

When To Consult A Doctor

As histrionic personalities can often function normally in social and professional settings, some patients may believe that there is nothing wrong with them and they don’t need to seek treatment. However, when the symptoms of histrionic personality disorder begin to negatively affect their quality of life, personal relationships and their ability to pursue education and career successfully, then it may be imperative to visit a mental healthcare professional.

Moreover, when the intensity of comorbid conditions increases, then it may become necessary to seek treatment as well. The American Psychiatric Association states “More severe or long lasting symptoms may require a team approach involving a primary care doctor, a psychiatrist, a psychologist, social worker and family members.”

Diagnosis Of Histrionic Personality Disorder

The diagnosis of HPD can be a complicated process as it may simultaneously occur with other personality disorders, like BPD. Diagnosis is often based on the patient’s behavior, history and semi-structured or unstructured interviews. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the diagnostic criteria for Histrionic Personality Disorder requires the presence of at least 5 of the following:

• The histrionic person feels discomfort in situations where they are not the center of attention
• They often engage in inappropriate sexually seductive or provocative behavior while interacting with others
• They present shallow and rapidly shifting expression of feelings
• They constantly utilize their physical appearance to attract attention
• They have excessively impressionistic style of speech which lack detail
• They display theatricality, self-dramatisation and intense expression of emotions
• They are suggestible and easily influenced by other people or situations
• They believe relationships are more intimate than they are in reality

According to Healthdirect Australia, HPD can only be diagnosed “in an adult, not a child, and should be made only by a psychiatrist or clinical psychologist who gets to know the person over a period of time.” Personality disorders are usually diagnosed by trained and experienced mental health professionals, like a psychiatrist, a psychologist or a therapist. General practitioners and family physicians are typically not trained to diagnose psychological conditions and personality disorders. So even though a patient may consult a general physician for the initial consultation, they need to visit a mental health professional for accurate diagnosis & treatment.

The mental disorder cannot be diagnosed using any specific laboratory or blood test. However, a healthcare professional may use the DSM-5 criteria and ask the patient about their symptoms to assess the condition. Moreover, the person also must experience extensive and regular signs of emotional dysregulation.

A doctor may:

• Analyze the patient’s medical and family history
• Assess mental status through a comprehensive interview
• Ask about the thoughts and feelings of the patient
• Ask about their relationships with family members, friends and peers
• Conduct a family session to evaluate consistent behavior patterns
• Conduct a personality test

The doctor may also conduct certain lab tests to determine if the symptoms are caused by any other medical or psychological problems, medications or substance and alcohol abuse. Unfortunately, most people with HPD are reluctant to seek treatment as they do not believe that they have a personality disorder, making diagnosis more difficult. However, once the condition starts to affect their daily functioning, they may be compelled to consult a mental health professional.

Treatment Of Histrionic Personality Disorder

Generally, individuals with HPD are reluctant to seek treatment and they believe that they do not need therapy. However, if a patient is determined to change their psychological and emotional state, then personality disorders can be effectively treated. “General treatment of histrionic personality disorder is the same as that for all personality disorders,” explains The Merck Manuals.

Although more research is needed, clinicians and experts believe that a patient can successfully overcome the symptoms of HPD with psychotherapy and medications. If the patient has symptoms for other mental conditions, like anxiety, depression, borderline personality disorder or other comorbid conditions, then these disorders should also be addressed and treated as well.

Typically, treatment for HPD primarily includes long-term psychotherapy under the supervision of a trained therapist experienced with treating personality disorders. A doctor may also prescribe certain medicines for specific troubling symptoms, such as stress, anxiety, depression, drug and alcohol use erc.

Here are some of the most effective treatment options available for histrionic personality disorder:

1. Psychotherapy

Therapy is perhaps the most recommended type of treatment for this personality disorder. Psychotherapy [mfn] Gabbard G. O. (2000). Psychotherapy of personality disorders. The Journal of psychotherapy practice and research, 9(1), 1–6. [/mfn] is a form of counseling that enables the patient to gain insight and understand the fears, anxieties and motivations related to their own thoughts, emotions and behaviors. This can help them to better cope with difficult emotions and connect with other people in a more positive way. It can also encourage the patient to talk more openly about their thoughts and feelings. The American Psychiatric Association states “Psychotherapy can help a person understand the effects of their behavior on others and learn to manage or cope with symptoms and to reduce behaviors causing problems with functioning and relationships.”

However, therapy can often be challenging for people with HPD as they tend to exaggerate and over-dramatize their symptoms or their functioning ability. Therapy and the therapist must be solution-focused and supportive as the patient is likely to defy the behavioral boundaries established by their therapist and act in an emotionally needy way. Here are some common and effective psychotherapy options available for people with HPD:

A. Cognitive behavioral therapy (CBT)

CBT is an efficient way to help histrionic personalities to identify and modify their unconscious thoughts and perspectives regarding themselves, others and the world in general. It can also help them become more aware of negative and unhealthy patterns of impulsive and erratic behavior. Cognitive-behavioral therapy can enable patients to think, behave and react in a calmer and more considerate way with deliberation & contemplation.

A 2010 study [mfn] Matusiewicz, A. K., Hopwood, C. J., Banducci, A. N., & Lejuez, C. W. (2010). The effectiveness of cognitive behavioral therapy for personality disorders. The Psychiatric clinics of North America, 33(3), 657–685. https://doi.org/10.1016/j.psc.2010.04.007 [/mfn] by Alexis K. Matusiewicz and colleagues states “Research generally supports the conclusion that CBT is an effective treatment modality for reducing symptoms and enhancing functional outcomes among patients with PDs (personality disorders), thereby making it a useful framework for clinicians working with patients with PD symptomatology.”

CBT for HPD patients may involve specific techniques, like assertiveness training and modeling behavior which can help individuals manage their theatrical and dramatic behavior in a social or professional setting. Another 2006 study [mfn] Davidson, K., Norrie, J., Tyrer, P., Gumley, A., Tata, P., Murray, H., & Palmer, S. (2006). The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial. Journal of personality disorders, 20(5), 450–465. https://doi.org/10.1521/pedi.2006.20.5.450 [/mfn] claims that “CBT can deliver clinically important changes in relatively few clinical sessions in real clinical settings,” for patients with personality disorders, like HPD. CBT can also help in coping with anxiety and depression as well.

Read More About Cognitive behavioral therapy (CBT) Here

B. Cognitive analytic therapy (CAT)

This is a form of talking therapy that aims to improve how the patient feels, thinks, behaves and acts. One 2007 study [mfn] Kellett S. (2007). A time series evaluation of the treatment of histrionic personality disorder with cognitive analytic therapy. Psychology and psychotherapy, 80(Pt 3), 389–405. https://doi.org/10.1348/147608306X161421 [/mfn] reveals that cognitive analytic therapy (CAT) can be effective in the treatment of histrionic personality disorder. It states “analysis of the general measures illustrated clinically significant change, indexing personality integration and reductions to depression.” Research also indicates that CAT can significantly help to alleviate the severity of the symptoms of histrionic personality disorder. However, more research is required to analyze the effectiveness of this form of psychotherapy.

C. Functional analytic psychotherapy (FAP)

This is another successful way to treat certain personality disorders, like narcissistic and histrionic personality disorder behaviors. According to one 2003 study [mfn] Callaghan, G.M., Summers, C.J. & Weidman, M. The Treatment of Histrionic and Narcissistic Personality Disorder Behaviors: A Single-Subject Demonstration of Clinical Improvement Using Functional Analytic Psychotherapy. Journal of Contemporary Psychotherapy 33, 321–339 (2003). https://doi.org/10.1023/B:JOCP.0000004502.55597.81 [/mfn] , functional analytic psychotherapy “treatment produced significant changes in these behaviors both statistically and qualitatively.” This form of therapy enables the therapist and the patient to recognize the interpersonal problems as they occur during and out of therapy sessions. The goals of the therapy are usually set by the therapist based on the patient’s behaviors and their need for improvement. FAP [mfn] Functional Analytic Psychotherapy: Creating Intense and Curative Therapeutic Relationships [/mfn] is different from conventional psychotherapy as here the therapist directly observes, analyzes and communicates the patterns of behavior of the histrionic person as it happens in-session.

In their 2010 study, researcher Alexis K. Matusiewicz and colleagues explain “As target behaviors occur in session, the therapist blocks or reinforce them using natural contingencies (e.g., sharing feelings that the patient has evoked in the therapist), with the goal of creating behavioral change that generalizes to daily life.” The researchers claim that functional analytic psychotherapy is a “radical behavioral approach,” where the therapist utilizes reinforcement principles to change and improve the behavior of the patient.

D. Psychodynamic psychotherapy

This form of therapy has been found to be effective in treating patients with a histrionic personality disorder. Also known as insight-oriented therapy, this form of therapy focuses on identifying and revealing the underlying causes for the onset of HPD to reduce the emotional reactivity of the patient. According to a recent scientific analysis on HPD, “Psychodynamic psychotherapy aims to resolve underlying, unconscious conflicts in an effort for patients to understand themselves and their behaviors better.”

It aims to change certain aspects of the individual’s dysfunctional personality by incorporating important developmental accomplishments that may have not been accounted for during their previous emotional maturation stages. Psychodynamic therapy [mfn] Gonzalez-Torres M. A. (2018). Psychodynamic psychotherapies for borderline personality disorders. Current developments and challenges ahead. BJPsych international, 15(1), 12–14. https://doi.org/10.1192/bji.2017.7 [/mfn] motivates patients to replace intense dramatic behaviors with more adaptive behaviors and encourages enhanced communication with others. The Merck Manuals explain “The therapist may start by encouraging patients to substitute speech for behavior, and thus, patients can understand themselves and communicate with others in a less dramatic way.” It can also help them realize that attention-seeking behaviors can be damaging and enable them to build their self-esteem in healthier ways.

E. Holistic therapies

Apart from therapy, certain relaxation techniques and practices like yoga, meditation, breathing techniques, biofeedback, Tai Chi and other holistic mind-body practices can also prove to be highly helpful for someone with a histrionic personality. These practices can help to manage their stress, anxiety and depression and enable them to control their emotional reflexes by reprogramming their thoughts and mindset.

Studies [mfn] Crescentini, C., Matiz, A., Cimenti, M., Pascoli, E., Eleopra, R., & Fabbro, F. (2018). Effect of Mindfulness Meditation on Personality and Psychological Well-being in Patients with Multiple Sclerosis. International journal of MS care, 20(3), 101–108. https://doi.org/10.7224/1537-2073.2016-093 [/mfn] claim that mindfulness-oriented meditation can substantially help to improve a person’s mental health and positively influence their personality profiles. Another 2009 study [mfn] Dakwar, E., & Levin, F. R. (2009). The emerging role of meditation in addressing psychiatric illness, with a focus on substance use disorders. Harvard review of psychiatry, 17(4), 254–267. https://doi.org/10.1080/10673220903149135 [/mfn] found that Buddhist meditation, transcendental meditation and mindfulness-based meditation can be effective in addressing mental conditions, particularly the ones involving substance use disorders. It states “In addition to evidence-based medical uses, meditation may have psychiatric benefits.”

F. Other therapy techniques

Apart from these, some other therapy techniques may also be recommended for a person affect with histrionic personality disorder, such as:

• Talk therapy
• Behavior therapy
• Group therapy
• Family and couples therapy
• Supportive psychotherapy
• Psychoeducation

Read More About Group Therapy Here

2. Medications

There is no specific medication for the treatment of histrionic personality disorder. But as HPD may result in affective dysregulation leading to tearfulness, anger, mood swings, depression and anxiety in the patient, medication may be helpful for recovery. Although medication may not be typically recommended, a doctor may prescribe certain medicines to manage symptoms associated with comorbid conditions, like major depressive disorder or panic disorder. Even though the United States Food and Drug Administration (FDA) has not approved any specific medication for the treatment of this psychiatric condition, doctors may prescribe mood stabilizers, antipsychotics, antidepressants or antianxiety medication for treating affective dysregulation.

Clinical trials [mfn] Sulz S. (2010). Hysterie I: Histrionische Persönlichkeitsstörung. Eine psychotherapeutische Herausforderung [Hysteria I. Histrionic personality disorder. A psychotherapeutic challenge]. Der Nervenarzt, 81(7), 879–888. https://doi.org/10.1007/s00115-010-3016-6 [/mfn] have shown that mood stabilizers, such as lithium, valproate, topiramate, carbamazepine and lamotrigine, can be especially helpful in managing impulse control and behavior regulation problems commonly experienced by patients with histrionic personality disorder. Moreover, antipsychotics, such as haloperidol, olanzapine, aripiprazole and risperidone can also help in relieving affective dysregulation symptoms. Antidepressants [mfn] Morrison, J. (1989). Histrionic personality disorder in women with Somatization disorder. Psychosomatics, 30(4), 433-437. https://doi.org/10.1016/s0033-3182(89)72250-7 [/mfn] , like fluvoxamine, amitriptyline, fluoxetine and desipramine, have proven effective for treating symptoms of HPD.

Apart from therapy and medication, doctors may also recommend intensive outpatient or inpatient treatment programs in mental health hospitals or treatment facilities for certain HPD patients, especially those who seek mental peace and psychological & social support during the initial phases of recovery.

Read More About Antidepressants Here

Can Histrionic Personality Disorder Be Prevented?

There is no such technique or strategy to prevent the onset or development of this psychiatric condition. However, early diagnosis and seeking professional treatment can enable a person with HPD to learn helpful and productive ways of coping with their negative thoughts and behaviors in different situations.

Coping Strategies For Histrionic Personality Disorder

Certain self-help strategies, in addition to treatment, can prove effective in relieving symptoms for individuals with personality disorders. Here are some helpful self-care and coping strategies for people with HPD:

1. Educate yourself about HPD

Learning, gaining knowledge and properly understanding your condition can motivate and empower you.

2. Learn stress management skills

Practice relaxation techniques like meditation and deep breathing every time you feel too anxious or stressed. Do things that you enjoy like eating good food, reading, watching movies, listening to music, or simply taking a walk outside.

3. Be physically active

Taking care of your physical health is crucial when trying to overcome mental health conditions. Get physically active and exercise regularly as it can manage symptoms of anxiety and depression.

4. Improve your health

Eat a nutritious and balanced diet. Moreover, you should get at least 7 to 9 hours of undisturbed sleep every day. Restrict your consumption of caffeine and nicotine by avoiding drinking coffee or smoking frequently.

5. Avoid drugs and alcohol

“Alcohol and illegal drugs can worsen symptoms or interact with medications,” warns the American Psychiatric Association. Try to quit drinking or at least avoid it as much as possible and stay away from drugs and other substances.

6. Follow your treatment plan

Strictly follow your routine medical care. Do not miss your therapy sessions and take your medications properly. If you take other medicines and supplements for different conditions, then talk to your doctor openly about it. Moreover, make sure not to skip regular checkups.

7. Seek support

Connect with your family and friends and talk to them honestly and openly. Instead of seeking attention from others, give them your undivided attention and focus on building emotional connections. Do not isolate yourself and avoid social withdrawal. Seek immediate emergency care or talk to a trusted loved one in case you have suicidal or homicidal thoughts.

Prognosis For Histrionic Personality Disorder

Some patients with HPD can live normal lives and function effectively at work and in social settings. However, most people with severe and intense symptoms may experience substantial problems which can affect their career and relationships. Although some histrionic personalities tend to behave and act normally in casual settings, it is highly likely that they face challenges in romantic relationships due to their attention-seeking and overly seductive behavior. They are also prone to seeking unnecessary risks and having difficulties with focusing on life goals.

Even though there is no specific cure for HPD, therapy, medications and support from family and friends can certainly help histrionics manage their symptoms and reduce the disorder’s impact on their daily lives. “Family members can be important in an individual’s recovery and can work with the individual’s health care provider on the most effective ways to help and support,” suggests the American Psychiatric Association. The condition may not be cured, but a patient can develop the ability to regulate their emotional reactions and live a satisfying, independent life.

Histrionic Personality Disorder At A Glance

1. Histrionic personality disorder (HPD) is a mental disorder which involves a pervasive pattern of hyper-emotional and extreme attention-seeking responses.
2. Histrionic Personality Disorder is considered one of the most dubious and ambiguous personality disorders in psychiatry.
3. People with HPD are often overly dramatic, erratic and emotional.
4. The exact cause for the development of histrionic personality disorder is currently not known.
5. Histrionic people can experience certain complications, when the symptoms related to the condition are left untreated.
6. Certain self-help strategies, in addition to treatment, can prove effective in relieving symptoms for individuals with personality disorders.
7. Some patients with HPD can live normal lives and function effectively at work and in social settings.