What Is Histrionic Personality Disorder & Can It Be Treated?

Histrionic personality disorder (HPD) is a mental health condition in which a person develops a distorted mental image of themselves.^{(1, 2, 3, 4)} The disorder is classified as being a part of a bigger group of psychological disorders that are known as Cluster B personality disorders. Cluster B disorders are typically categorized as displaying behavior that is overly emotional, erratic, or dramatic.^{(5, 6)} People with histrionic personality disorder tend to exhibit extreme attention-seeking behavior along with emotionality. This type of erratic behavior tends to begin by early adulthood and starts becoming evident in different situations.⁽⁷⁾ In fact, the term histrionic itself means to be dramatic or theatrical.

It is estimated that nine percent of the general population in the United States suffer from at least one type of personality disorder. Histrionic personality disorder is estimated to affect at least two to three percent of the general population.⁽⁸⁾

People with histrionic personality disorder tend to have a distorted image of themselves, and often their behavior is characterized by shallow emotions and being manipulative. Such people often base their self-esteem on seeking approval from others, creating a need to be noticed. Due to this, people with histrionic personality disorder often resort to dramatic antics.

More often than not, it is women who are diagnosed with this disorder as compared to men. This is perhaps because men report their symptoms less often than women.

Histrionic personality disorder is not a debilitating psychological disorder, and most people with this condition go on to function successfully not just at work but also in society. In fact, many people with this disorder have great people skills, which they, unfortunately, use to manipulate others.

In many cases, you might not realize that you have histrionic personality disorder because the way you think and behave seems to be natural to you. And what’s more, you are likely to blame others for the challenges you face.

According to the Diagnostic and statistical manual of mental Disorders (5th edition), people with histrionic personality disorder experience at least five or more of the following symptoms:⁽⁹⁾

• The person experiences discomfort in situations where they are not the center of attention.
• Interactions with others are characterized by inappropriate provocative or sexually seductive behavior.
• Shows rapid change and shallow expression of emotions.
• Experiences fleeting opinions, moods, and beliefs.
• Consistently uses their physical attention to draw attention to themselves.
• Have a style of speaking that lacks in detail and is excessively impressionistic.
• Displays self-dramatization, exaggerated and theatrical expression of emotion.
• Considers their relationships to be more intimate than they actually are.
• Behavior can be suggestible, that is, they can be easily influenced by others or by situations. They are quick to pick up fads.
• Have a need for others to witness their emotional displays in an attempt to gain attention or validation.

If you have histrionic personality disorder, you may also get easily frustrated or bored with your routine, make rash decisions before thinking things through, or threaten to commit suicide in order to gain everyone else’s attention.⁽¹⁰⁾

The exact cause of histrionic personality disorder remains unknown. Researchers believe that histrionic personality disorder is an outcome of both genetic and environmental factors.⁽¹¹⁾

It has been observed that certain families have a history of histrionic personality disorder, which gives credit to the theory that this disorder can partly be explained by genetics. On the other hand, children of parents who have histrionic personality disorder could simply be exhibiting behavior that they have learned from their parents. It is also very much possible that due to a lack of positive reinforcement or discipline of dramatic and erratic behaviors in childhood can also lead to histrionic personality disorder. A child is also prone to pick up behaviors of histrionic personality disorder as a way to seek attention from their parents.^{(12, 13)}

No matter what the cause of the disorder, this condition tends to typically present itself in early adulthood.

Some of the other factors associated with an increased risk of triggering or developing personality disorders like histrionic personality disorder include:

• Parents who model volatile or dramatic behaviors.
• Parenting style, especially being overindulgent or inconsistent in parenting.
• Having a family history of psychiatric disorders, personality disorders, or substance and/or alcohol abuse.
• Childhood trauma.

There is a lot of overlap and similarities between the symptoms and features of histrionic personality disorder and borderline personality disorder. In fact, there is so much in common that some medical experts often believe that histrionic personality disorder might not actually be different from borderline personality disorder.^{(14, 15)}

According to the Diagnostic and Statistical Manual of Mental Disorders – 5 (DSM-5), even though borderline personality disorder can sometimes also be characterized by manipulative behavior, attention-seeking, and rapid change in emotions, it is primarily recognized by angry disruptions in close relationships, self-destructiveness, and persistent feelings of identity disturbance and emptiness.

Both the conditions share many symptoms, including:

• Both are associated with impulsive behavior.
• Both share the characteristics of rapidly shifting and reactive feelings.
• Both can be characterized by a very strong and sudden expression of emotion.

There is a debate amongst some clinicians that the qualities of these symptoms are often different in histrionic and borderline personality disorder, especially the rapid shift of emotions in histrionic personality disorder, which is not experienced with the same intensity and depth in people with borderline personality disorder. Other doctors, though, argue that histrionic personality disorder and borderline personality disorder are not different disorders.⁽¹⁶⁾

However, despite several doctors predicting that the diagnosis of histrionic personality disorder would eventually be dropped from being included in DSM-5, it has not been excluded, and histrionic personality disorder remains its own unique and specific diagnosis.

There is no specific diagnostic test that can diagnose histrionic personality disorder. If you feel your symptoms interfere with your daily life and you want to seek medical care, your doctor will first begin by taking a complete medical history. They will also carry out a physical exam to rule out any physical condition that may cause your symptoms.

If your doctor does not find any physical cause that might be behind your symptoms, they are likely to refer you to a mental health professional. Psychiatrists are specially trained to recognize and treat all types of psychological disorders. They will ask you specific questions to get a clear view of the history of your behavior and your symptoms. An accurate assessment of your behaviors is necessary so that your doctor can make a correct diagnosis.

However, as has been seen, most people with histrionic personality disorder do not believe that they need any help or therapy, which makes diagnosis a challenging affair. Many people with this disorder usually receive a diagnosis after going to therapy for anxiety or depression, usually because of a failed relationship or other personal conflicts in their life.

Treatment can be challenging for people with histrionic personality disorder. Like most people with this condition, you are likely to believe that there is no need for treatment, or you may feel that the routine of a treatment or therapy program is unappealing. However, therapy, and medications, if needed, can help you cope with your condition and also better manage the symptoms of histrionic personality disorder.

Some of the treatment options for histrionic personality disorder include:

• Psychotherapy: Psychotherapy is the most common treatment option for people with histrionic personality disorder. It is also the most effective treatment. Psychotherapy is also referred to as talk therapy. In this type of therapy, you talk to a professional therapist about your experiences, feelings, and symptoms. Such talks can help you, and your therapist understand what is the reasoning behind your behaviors and actions, and your therapist might be able to help you understand how to better relate with people in a positive way instead of trying to continuously seek attention.
• Medication: You may need to take certain prescription medications if you also suffer from depression or anxiety as part of your histrionic personality disorder. Your doctor may prescribe antidepressants or antianxiety medication.^{(17, 18)}

Lots of people with histrionic personality disorder live very full and normal lives and are able to be a part of society and continue working as well. It has been seen that many people with this disorder tend to do very well in casual settings. Most of them only face problems when they are in more intimate relationships. Depending on your individual case, your disorder may affect your ability to maintain a relationship, stay focused on your goals, or hold down a job. Histrionic personality disorder may also cause you to constantly seek adventure, even by putting yourself in risky situations.

People with histrionic personality disorder are at a greater risk for developing anxiety and depression. The disorder affects how you deal with failure and loss in your life, and it can often leave you feeling frustrated and overwhelmed when things don’t go your way. If you notice symptoms of histrionic personality disorder, you should make an appointment with your primary care provider, especially if these symptoms begin to interfere with your day-to-day life, work, or your ability to live a fulfilling life.

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