Histrionic Personality Disorder

Histrionic Personality Disorder (HPD) interferes with emotional stability. People with HPD are prone to emotional overreaction in a wide variety of situations, and from the viewpoint of others they may seem constantly on edge. When they do react, it is usually from a self-centered perspective, and the needs of others are seldom their priority.

In addition to their emotional sensitivity and reactivity, men and women with Histrionic Personality Disorder have a strong need to be the center of attention and frequently exhibit a range of attention-seeking behavior. They also want instant satisfaction and are easily frustrated or overwhelmed by obstacles or criticism.

People with HPD usually have good communication skills and are often quite charismatic, projecting a “life of the party” or “larger than life” image. But beyond good initial first impressions they have a difficult time establishing and maintaining close and satisfying relationships.

Despite their self-absorption, people with HPD are subsumed by insecurity, which usually leaves them frustrated and miserable and seeking answers for their feelings of inadequacy.

HPD is classified as a Cluster B personality disorder, along with borderline personality disorder, narcissistic personality disorder, and antisocial personality disorder. People with Cluster B conditions are known to be highly emotional, erratic in their feelings and behavior, and self-centered in their approach to socializing and building relationships.

Nearly 15% of the American population meet the diagnostic criteria for one or more of 10 recognized personality disorders. Histrionic personality disorder is one of the least common of these disorders, affecting about 1.8% of the population, but that still represents about four million people.

Histrionic Personality Disorder is diagnosed more frequently among women, who comprise about two-thirds of the known cases. This may not reflect the true incidence of the disorder, but could relate to the willingness of women (or unwillingness of men) to seek assistance for the symptom of HPD when they manifest.

The seeds of Histrionic Personality Disorder are likely sown in childhood, but its symptoms don’t normally become apparent until late adolescence. The severity of the condition may then escalate during early adulthood and become a dominant factor from that point on.

Personality disorders in general are marked by an obsessive concern for the self, rigid and uncompromising attitudes, and an inability or unwillingness to adapt to the needs and desires of others. They function as a cover for deep-seated self-esteem issues, representing a form of overcompensation for feelings of insecurity and inferiority.

HPD is prototypical of the personality disorder category in every way. An accurate histrionic definition focuses on the distinctive symptoms HPD produces. Histrionic Personality Disorder symptoms may include:

• Strong and volatile emotions, both negative and positive
• Rapid shifts in mood, often triggered by seemingly benign events
• Self-centeredness, in conversation and behavior
• Exaggerated gestures or words designed to draw attention
• Expressions of sentiments toward others that seem shallow or insincere, as if meant to manipulate or create a certain impression
• A lack of patience, often accompanied by childish reactions
• Tendency to become flustered or frustrated when things go wrong
• Extreme sensitivity to criticism or perceived rejection
• Constant approval-seeking behavior
• Flirtatious or sexually suggestive behavior that may violate interpersonal boundaries
• Obsessive concern with physical appearance
• A tendency to become bored or distracted, making it difficult to finish tasks or projects
• Lack of empathy, no capacity to read the emotions of others or correctly interpret their words and actions
• Inability to maintain satisfying relationships due to self-centered tendencies and emotional outbursts

Many of these symptoms are common to other personality disorders, which inevitably interfere with personal, social, and professional functioning.

Under standards established by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Histrionic Personality Disorder can be diagnosed if:

1. Feelings of discomfort are experienced if the person’s need to be the center of attention is frustrated.
2. Inappropriate sexual innuendo or otherwise provocative behavior frequently causes interpersonal conflicts.
3. Rapid changes in emotion are experienced, although feelings often lack depth or texture.
4. Physical appearance is often carefully crafted to attract attention.
5. A person’s conversation style is self-centered, impressionistic, and lacking in descriptive detail.
6. During interpersonal encounters, exaggerated expressions of emotion are the norm.
7. The person is highly suggestible and easily influenced by others.
8. The person has a habit of misinterpreting the feelings and intentions of others, believing their relationships to be more intimate than they actually are.

At least five of these eight signs of HPD must be detected before an official diagnosis can be made.

Mental health experts believe that personality disorders like HPD usually develop as a result of stress, anxiety, and trauma experienced during childhood. Young people who are subjected to neglect or abuse must rely on limited resources and life experiences to cope with haunting memories and the feelings of shame, inadequacy, or weakness that accompany them, and personality disorders may develop as a form of adaptation or compensation.

Overindulgent or inconsistent parenting can also lead to HPD later in life. This type of neglectful caregiving doesn’t set boundaries and can therefore interfere with a child’s healthy emotional and psychological development.

Having a family history of personality disorders, and other mental health conditions, is a risk factor for Histrionic Personality Disorder. There are genetic factors involved that help explain the connection, but negative role modeling by parents with mental health issues can undoubtedly play a part in the development of HPD as well.

It is possible for a person to exhibit the symptoms of more than one personality disorder.

Among people diagnosed with HPD, borderline personality disorder, dependent personality disorder, and narcissistic personality disorder are also frequently diagnosed. Borderline personality disorder is the most commonly detected of these conditions, and some mental health professionals actually classify HPD as a borderline personality disorder subtype.

Some of the other mental and behavioral health disorders routinely diagnosed in people with histrionic personality disorder include:

• Depression. HPD creates strong emotional responses, and when rejection or disappointment is experienced people with histrionic personalities can easily slip into clinical depression.
• Anxiety disorders. In one study, between 35% and 52% of those with various anxiety disorders also met the diagnostic criteria for a personality disorder, usually of a type that affects emotion and stress responses (such as HPD).
• Eating disorders. About one-third of eating disorder sufferers also have one or more co-occurring personality disorders, often including HPD.
• Substance use disorders. While different studies have produced varying results, most research has shown as least some relationship between histrionic personality disorder and addiction. However, the association is not as strong as with several other types of personality disorder.

When an additional mental or behavioral health condition is diagnosed in people with HPD, treatment plans must be developed that focus equally on each disorder.

If those who have them are truly determined to change their emotional and psychological reactions, personality disorders are amenable to treatment.

Inpatient or intensive outpatient treatment programs in mental health treatment facilities are ideal for people diagnosed with HPD, who require peace, quiet, and ample social and psychological support in the early stages of recovery.

Psychotherapy is the preferred method of intervention for Histrionic Personality Disorder. Some of the therapies that have proven effective for this condition include:

• Cognitive Behavioral Therapy (CBT). Through CBT people with histrionic personalities can begin to think and act more calmly and with more deliberation and contemplation. CBT is also effective against depression and anxiety disorders, which can co-occur with HPD.
• Psychodynamic therapy. The goal in psychodynamic therapy is to decrease emotional reactivity by identifying and demystifying the underlying reasons for the development of HPD.
• Group therapy. By participating in group discussions and role-playing sessions with peers, men and women with HPD can work at improving their social behavior and interpersonal relationships.
• Family and couples therapy. Family relationships of all types are affected by histrionic personality disorder, and all the issues that arise as a result of HPD can be addressed in a cooperative, solution-oriented environment during family or couples therapy.
• Holistic mind-body practices. Mindfulness techniques acquired through meditation, yoga, Tai Chi, biofeedback, and other holistic therapies have much to offer people with HPD, who need to reprogram their minds to more effectively control their hair-trigger emotional reflexes.

With careful and compassionate intervention that extends from initial treatment through aftercare, people with histrionic personality disorder can learn to minimize the condition’s influence on their lives. HPD cannot be cured, but over time its capacity to control emotional reactions can be reduced to a manageable level.

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