Histrionic Personality Disorder

What is a Histrionic Personality Disorder?

Histrionic personality disorder (HPD) is a disorder that is marked with low self-esteem and attention-seeking behaviors. It falls within Cluster B of personality disorders in the DSM-5, each of which is described with dramatic and excessive emotionality responses.

Histrionic is a word that describes an action that is theatrical or melodramatic. Individuals with histrionic personality disorder tend to behave in ways that can be described as overly-dramatic in an attempt to demand attention. 

According to the DSM-5, a diagnosis of histrionic personality disorder requires at least five of the following:

  • Low or distorted self-esteem
  • Attention-seeking behaviors
  • Rapidly changing emotions
  • Strong desire to be the center of attention
  • Overly-sensitive to feedback or criticism
  • Increased attention to self-appearance
  • Highly influenced
  • Inability to finish projects
  • Rapid decision-making
  • Lack of empathy
  • Poor relationships
  • Often self-focused
  • Dramatized recount of events
  • Increased emotional response to relationships or stressful situations
  • Frequent patterns of self-dramatization

In addition to the traits, they must also cause disruption or impairment to the individual. But, diagnosing a histrionic personality disorder is not always easy. However, if you suspect that you, or a loved one, might have a histrionic personality disorder, consulting with a mental health professional is one of the best ways to receive a diagnosis and treatment to improve the disruptive symptoms.

What Causes Histrionic Personality Disorder?

There is often a lot of debate surrounding the cause of personality disorders. Personality disorders, including histrionic personality disorder, are often developed as a form of a coping mechanism to a difficult situation. Individuals might grow up in a family where they do not receive the attention that they desire and eventually, learn to demand this attention through dramatic behaviors. These same individuals may also develop repression or dissociation as coping mechanisms. 

While symptoms of HPD might not show up until late adolescence or early adulthood, it can be the events of childhood that contribute to the disorder. A stressful childhood, traumatic events, neglect, and abuse, can all lead to a histrionic personality disorder.

Other studies do show a genetic predisposition to histrionic personality disorder. Research is unclear whether this is due to the actual DNA or the environment in which a child is raised. Children and teens that grow up in a household with a parent or sibling who displays HPD symptoms can eventually learn these behaviors.

Other professionals believe that histrionic personality disorder is multifactorial. This means that the development of most personality disorders is likely due to both genetics and environment.

What Treatments Improve the Symptoms of Histrionic Personality Disorder?

Fortunately, if you or a loved one, is experiencing life difficulties due to the traits of a histrionic personality disorder, there are treatment options available. Talk therapy, or psychotherapy, is one of the most common treatment methods for histrionic personality disorder. During therapy, your counselor will assist with:

  • Recognizing the driving forces of the problematic behaviors
  • Encouraging awareness of unhelpful behavioral patterns
  • Improvement of social skills to better understand other’s feelings
  • Social and relationship skill-building
  • Reducing emotional difficulties and feelings of depression
  • Identifying irrational feelings and thought patterns to improve self-esteem
  • Education regarding histrionic personality disorder
  • Education and the practice of emotional regulation skills

Within psychotherapy, numerous techniques and theories may be applied until the counselor finds one that works. Psychodynamic therapy has been used frequently when working with clients with HPD. Other treatment options might include dialectical-behavioral therapy (DBT) and cognitive-behavioral therapy (CBT).

More recent treatment approaches have also tried techniques like biofeedback. Professionals believe that biofeedback can be used to help clients identify and control their internal feelings. In some cases, medications might be used in combination with psychotherapy. Medications like anti-depressants and anti-psychotics can be used to assist with treatment.

While treatment options can be beneficial for individuals with histrionic personality disorders, convincing the individual to seek therapy can be one of the biggest challenges. As with any personality disorder, the behaviors may seem reasonable and logical to the individual, making it difficult for them to understand a need for therapy.

It can also be more difficult to recognize histrionic personality disorder in individuals because those with HPD tend to be high-functioning. Clients with HPD may still attend college or maintain careers. However, they will often seek assistance following a break-up or estrangement of a friendship or close relative.

What Disorders are Similar to Histrionic Personality Disorder?

Histrionic personality disorder is just one of the listed Cluster B personality disorders. Other personality disorders similar to HPD include:

  • Borderline personality disorder
  • Narcissistic personality disorder
  • Dependent personality disorder
  • Somatic symptom disorder

Each of these disorders is also characterized as a personality disorder, meaning the symptoms and treatment methods are similar.

What Mental Health Disorders Often Co-Occur With Histrionic Personality Disorder?

Co-occurring disorders are not uncommon with personality disorders. Histrionic personality disorder often co-occurs with the following:

  • Depression: The constant feelings of isolation and need for attention that are common with histrionic personality disorder can lead to symptoms of depression. Intensified feelings following a breakup or a loss of friendship are one of the most common reasons for seeking therapy with histrionic personality disorder.
  • Anxiety: Fear of being rejected or ignored can lead to feelings of anxiety, or generalized anxiety disorder (GAD).
  • Drug and alcohol use: Individuals with personality traits that affect their social lives and relationships might turn to drugs and alcohol to self-cope.
  • Borderline personality disorder: Some studies estimate that HPD often co-occurs with BPD, in as much as 10% of individuals.

Because histrionic personality disorders often co-occur with other personality disorders or mental health conditions, it is important to treat symptoms with a multi-level approach. During psychotherapy, your therapist will identify the influence of each disorder on your life, while developing a treatment plan that relieves symptoms of each one.

Fast Facts About Histrionic Personality Disorder

Here are a few things that you might not know about histrionic personality disorder:

  • Histrionic personality traits begin to exhibit by adolescence, but it is often not diagnosed until after age 18.
  • While it is estimated that histrionic personality disorder primarily affects women, with women being diagnosed four times as often as men, some experts believe that it is under-represented in males. Reduced self-esteem or overly dramatic behavior is often recognized and determined problematic in women and ignored in men.
  • It is estimated that HPD affects between 2-3% of the population
  • Personality disorders, in total, affect up to 15% of the population

If histrionic personality disorder is affecting your ability to enjoy your career or your personal relationships, then you might find it useful to work with a mental health professional. Mental health professionals not only have the tools needed to diagnose a personality disorder, but to also treat and reduce the problematic symptoms that accompany them.