What is Histrionic Personality Disorder?

Do you know somebody who is super dramatic, exaggerates their emotions, and constantly needs to be the center of attention –– especially to an extent where it’s negatively affecting their life? If so, you may be dealing with someone who has histrionic personality disorder or HPD.

The definition of the word “histrionic” is “overly dramatic or emotional,” which certainly embodies the behavior of someone with HPD. While “histrionic symptoms” have been studied and discussed since ancient times, the diagnosis of histrionic personality disorder was not solidified and officially documented until 1968, in the second edition of the Diagnostic and Statistical Manual of Mental Disorders. Since then, mental health professionals have been able to better understand the characteristics of this personality disorder.

If you believe that your loved one, friend, or family member could have HPD, it’s helpful to educate yourself on the signs of histrionic personality disorder so you can identify problematic behavior, and ultimately help them get the treatment they need in order to improve their quality of life. 

Here’s what you need to know about histrionic personality disorder, its symptoms, common co-occurring disorders, causes, and treatment. 

What is histrionic personality disorder?

First, it’s important to understand what exactly a personality disorder is. According to the American Psychiatric Association, if someone is diagnosed with a personality disorder, it means they exhibit ways of thinking, feeling, or behaving which are outside of what’s culturally expected. These problematic behaviors and thought patterns cause the person distress and affect their functioning long-term. Relationships are often affected too. The signs of a personality disorder usually show up for the first time in the teen or young adult years, and a diagnosis typically isn’t made until someone is at least 18 years old. 

Three types, or clusters, of personality disorders have been identified. Histrionic personality disorder is considered a Cluster B personality disorder. Aside from HPD, the other Cluster B personality disorders are:

• Antisocial personality disorder
• Borderline personality disorder
• Narcissistic personality disorder ‍

The common thread through each of these disorders is that the person may be very erratic, dramatic, and emotional, acting unpredictably in many situations.

The prevalence of histrionic personality disorder is low, occurring in an estimated 1% of the general population. HPD is the most rare of the Cluster B personality disorders, with borderline personality disorder affecting 1.4%, antisocial personality disorder affecting up to 4%, and narcissistic personality disorder affecting up to 5%.

Histrionic personality disorder may be more common in women, who are four times as likely to receive an HPD diagnosis. However, researchers are still determining if this is due to women being over-diagnosed and men being under-diagnosed.

What are the symptoms of histrionic personality disorder?

Broadly speaking, symptoms of histrionic personality disorder include acting very dramatically, exaggerating emotions, and exhibiting attention seeking behavior. If someone has HPD, their dramatic emotions may come off superficial. They are desperate for validation, because they don’t have a solid sense of self or positive self-esteem on their own, so they need reassurance and approval from people around them to feel better about themselves. They may go to great lengths, including acting over-the-top or behaving inappropriately, in order to get attention, or even better, to be the center of attention.

So, how is histrionic personality disorder diagnosed? The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has specific diagnostic criteria for histrionic personality disorder.

According to the DSM-5, someone must have at least five of these traits in order to be diagnosed:

• Feeling uncomfortable if they aren’t the center of attention
• Acting provocatively or seductively 
• Displaying shallow emotions that can shift quickly
• Drawing attention to themself with their appearance
• Having speech that is vague or impressionistic
• Displaying exaggerated dramatic emotions
• Being easily influenced by other people
• Thinking their relationships are more intimate or closer than they actually are

Ultimately, this behavior becomes problematic and can cause problems with someone’s day-to-day life, functioning, and relationships. 

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Some additional histrionic personality disorder symptoms and characteristics include:

• Being very charming
• Behaving in over-the-top ways
• Acting impulsively
• Using sexuality to gain power
• Acting sexual in inappropriate situations
• Having trouble maintaining relationships 
• Seeking instant gratification rather than thinking long-term
• Needing approval and reassurance often

People with histrionic personality disorder are more likely to have co-occurring mental health conditions, including:

• Depression
• Substance use disorders
• Somatization disorder/somatic symptom disorder (SSD)
• Panic attacks
• Conversion disorders

Furthermore, due to their attention-seeking behavior, people with HPD may regularly make threats to attempt suicide, even if they aren’t actually thinking of doing it. 

What causes histrionic personality disorder?

There is not a single known cause of histrionic personality disorder. Rather, mental health professionals and researchers believe there could be a variety of contributing elements that are both genetic and learned.

The following factors may play a part in developing HPD:

• Family history
  There may be a genetic component to histrionic personality disorder, meaning someone who has a family history of the disorder is more likely to develop it themselves. This is often the case with many mental health conditions. 
• Past trauma
  Trauma, particularly in childhood, can play a role in developing HPD. Examples of trauma could be physical abuse, sexual abuse, or losing a family member. The ways a child learns to cope or deal with this trauma can become behaviors that can eventually be related to a personality disorder. 
• Upbringing
  The way that someone was brought up by their parents or caregivers can contribute to a personality disorder developing. For example, this may include having a parent who is dramatic, sexually inappropriate, or lacks boundaries. 

What is the treatment for histrionic personality disorder?

There isn’t a “cure” for histrionic personality disorder, but treatment is available to manage symptoms and improve quality of life.

Due to the nature of personality disorders, someone with HPD might not think there’s anything wrong with them or anything problematic about their behavior. Because of this, they may not seek treatment on their own. 

Typically, someone with histrionic personality disorder will end up getting treatment for the disorder because they’re seeking help for a co-occurring mental health condition. Then, when the mental health professional evaluates them, they might notice signs of HPD and make the diagnosis of histrionic personality disorder. Therapists need to be especially gentle in their approach, as HPD patients may get defensive or offended if they feel like they’re being attacked in any way. 

There isn’t a one-size-fits-all treatment for HPD. However, some form of long-term psychotherapy is the main type of histrionic personality disorder treatment. Therapy can help someone with HPD gain insight into their minds, understand what thoughts and behaviors are unhealthy and unhelpful, and learn healthier ways to think and act.

Some common types of therapy for personality disorders are:

• Cognitive behavioral therapy (CBT)
• Dialectical behavior therapy (DBT)
• Psychoanalytic therapy
• Psychodynamic therapy
• Transference-focused psychotherapy

In some cases, group therapy may be recommended, but oftentimes group therapy can prove to be difficult for people with HPD since they feel the need to be the center of attention, which can get in the way of their progress. 

There is no one medication specifically designed or approved for histrionic personality disorder treatment. However, since people with HPD often experience symptoms like depression, anxiety, and mood swings, their psychiatrist may prescribe medications such as antidepressants, mood stabilizers, or antipsychotics.

Treatment for someone with HPD will be highly individualized based on how their personality disorder presents and what other conditions they have. Oftentimes, a team of mental health professionals may collaborate on the treatment plan. For example, someone with HPD might see a psychologist, social worker, or counselor for their therapy, and a psychiatrist for  their medication management.

The symptoms associated with co-occuring disorders can amplify each other, which is why it’s so important to treat all mental health conditions and get their symptoms under control to best improve someone’s well-being. 

A mental health professional can help someone understand their diagnoses, what they mean, and what they can do to help.

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How can Charlie Health help young adults with histrionic personality disorder?

If you think a young adult in your life has histrionic personality disorder and/or struggles with any other mental health conditions, Charlie Health may be able to help. 

We know that every individual has their own unique mental health journey depending on what symptoms they have and the difficulties they face. Our personalized intensive outpatient program provides mental health treatment for teens, young adults, and families dealing with a variety of struggles, including histrionic personality disorder and any other co-occurring conditions. 

At Charlie Health, every client is matched with a therapist who fits their specific needs, and will also be matched with a group of peers who are from similar backgrounds with similar struggles. 

Coping with histrionic personality disorder can be challenging, but it certainly is possible for people with HPD to experience a healthier, higher quality of life and improved mental health –– help is here now.

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