Histrionic Personality Disorder

Overview

What is histrionic personality disorder?

Histrionic personality disorder (HPD) is a mental health condition marked by intense, unstable emotions and a distorted self-image. The word “histrionic” means “dramatic or theatrical.”

For people with histrionic personality disorder, their self-esteem depends on the approval of others and doesn’t come from a true feeling of self-worth. They have an overwhelming desire to be noticed and often behave dramatically or inappropriately to get attention.

People with histrionic personality disorder often don’t realize their behavior and way of thinking may be problematic.

Histrionic personality disorder is one of a group of conditions called “Cluster B” personality disorders, which involve dramatic and erratic behavior.

Who does histrionic personality disorder affect?

Histrionic personality disorder usually begins in your late teens or early 20s.

People assigned female at birth (AFAB) are more commonly diagnosed with histrionic personality disorder than people assigned male at birth (AMAB), but researchers think that people AMAB may be underdiagnosed.

How common is histrionic personality disorder?

Histrionic personality disorder is relatively rare. Researchers estimate that about 1% of people have the condition.

Symptoms and Causes

What are the signs and symptoms of histrionic personality disorder?

The main feature of histrionic personality disorder is displaying excessive, superficial emotionality and sexuality to draw attention to themselves.

A person with histrionic personality disorder may:

  • Feel underappreciated or depressed when they’re not the center of attention.
  • Have rapidly shifting and shallow emotions.
  • Be dramatic and extremely emotionally expressive, even to the point of embarrassing friends and family in public.
  • Have a “larger than life” presence.
  • Be persistently charming and flirtatious.
  • Be overly concerned with their physical appearance.
  • Use their physical appearance to draw attention to themselves by wearing bright-colored clothing or revealing clothing.
  • Act inappropriately sexual with most of the people they meet, even when they’re not sexually attracted to them.
  • Speak dramatically and express strong opinions but with few facts or details to support their opinions.
  • Be gullible and easily influenced by others, especially by the people they admire.
  • Think that their relationships with others are closer than they usually are.
  • Have difficulty maintaining relationships, often seeming fake or shallow in their interactions with others.
  • Need instant gratification and become bored or frustrated very easily.
  • Constantly seek reassurance or approval.

What causes histrionic personality disorder?

Personality disorders, including histrionic personality disorder, are among the least understood mental health conditions.

Studies that have been done about histrionic and other personality disorders have identified several factors that may lead to the development of histrionic or other personality disorders:

  • Genetics: Histrionic personality disorder tends to run in families, so scientists think there may be a genetic (inherited) link.
  • Childhood trauma: Children may cope with trauma, such as child abuse or the death of a family member, that later as an adult may be disruptive or problematic in their life and become part of a personality disorder.
  • Parenting styles: Children who experience parenting styles that lack boundaries, are over-indulgent or inconsistent may be more likely to develop histrionic personality disorder. In addition, parents who display dramatic, erratic, volatile or inappropriate sexual behavior put their children at risk for developing this condition. Some researchers think that problems in parent-child relationships lead to the characteristic low self-esteem in people with HPD.

Diagnosis and Tests

How is histrionic personality disorder diagnosed?

Personality continues to evolve throughout child and adolescent development. Because of this, healthcare providers don’t typically diagnose someone with histrionic personality disorder until after the age of 18.

Personality disorders, including histrionic personality disorder, can be difficult to diagnose since most people with a personality disorder don’t think there’s a problem with their behavior or way of thinking.

When they do seek help, it’s often due to conditions such as anxiety or depression due to the problems created by their personality disorder, such as divorce or lost relationships, and not the disorder itself.

When a mental health professional, such as a psychologist or psychiatrist, suspects someone might have histrionic personality disorder, they often ask broad, general questions that won’t create a defensive response or hostile environment. They ask questions that will shed light on:

  • Past history.
  • Relationships.
  • Previous work history.
  • Reality testing.
  • Impulse control.

Because a person suspected of having histrionic personality disorder may lack awareness of their behaviors, mental health professionals might ask to collect information from the person’s family and friends.

Mental health providers base a diagnosis of histrionic personality disorder on the criteria for the condition in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

Diagnosis criteria for histrionic personality disorder require meeting five (or more) of the following persistent behaviors:

  • Uncomfortable when not the center of attention.
  • Seductive or provocative behavior.
  • Shifting and shallow emotions.
  • Uses appearance to draw attention.
  • Impressionistic and vague speech.
  • Dramatic or exaggerated emotions.
  • Suggestible (easily influenced by others).
  • Considers relationships more intimate than they are.

Management and Treatment

How is histrionic personality disorder treated?

In most cases, people with histrionic personality disorder (HPD) don’t believe their behaviors are problematic. They also tend to exaggerate their feelings and dislike routine, which makes following a treatment plan difficult. However, they might seek help if depression — possibly associated with a loss or a failed relationship — or another problem caused by their thinking and behavior causes them distress.

Psychotherapy (talk therapy) is generally the treatment of choice for histrionic or other personality disorders. The goal of treatment is to help the person uncover the motivations and fears associated with their thoughts and behavior and to help the person learn to relate to others more positively.

Types of psychotherapy that may benefit people with histrionic personality disorder include:

  • Group therapy: This is a type of psychotherapy in which a group of people meets to describe and discuss their problems together under the supervision of a therapist or psychologist. Group therapy may be of particular benefit to people with HPD, especially if it’s with other people with HPD. It can help someone with HPD see their own behavior reflected back at them.
  • Psychodynamic psychotherapy: This type of therapy focuses on the psychological roots of emotional suffering. Through self-reflection and self-examination, the person undergoing therapy looks into problematic relationship patterns in their life.
  • Supportive psychotherapy: This type of therapy aims to improve symptoms and maintain, restore or improve self-esteem and coping skills. Supportive psychotherapy involves the examination of relationships and patterns of emotional response or behavior.
  • Cognitive-behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. A therapist or psychologist helps you take a close look at your thoughts and emotions. You’ll come to understand how your thoughts affect your actions. Through CBT, you can unlearn patterns of negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.

While there’s currently no medication that can treat personality disorders, there is medication for depression and anxiety, which people with histrionic personality disorder may also have. Treating these conditions can make it easier to treat histrionic personality disorder.

Prevention

Can histrionic personality disorder be prevented?

While histrionic personality disorder generally can’t be prevented, treatment can allow a person who's prone to this condition to learn more productive ways of dealing with triggering behaviors, thoughts and situations.

Outlook / Prognosis

What are the possible complications of histrionic personality disorder?

People with histrionic personality disorder (HPD) are at a higher risk of developing depression and substance use disorders, such as cannabis use disorder and alcohol use disorder.

People with HPD are also more likely to have:

  • Somatic symptom disorder: Somatic symptom disorder is a disorder in which individuals feel excessively distressed about a physical symptom they have. They may also have abnormal thoughts, feelings and behaviors in response to their symptoms.
  • Panic attacks: A panic attack causes sudden, brief feelings of fear and strong physical reactions in response to ordinary, nonthreatening situations.
  • Conversion disorders: Conversion disorder, also called functional neurological symptom disorder, is a medical problem involving the loss of function of a part of your nervous system. More specifically, your brain and body believe that a part of your nervous system isn't functioning when there's no evidence of structural damage.

Extreme attention-seeking behavior in people with HPD may involve frequent suicidal threats and gestures.

What is the prognosis (outlook) for histrionic personality disorder?

While there’s no cure for histrionic personality disorder (HPD), many people who have the condition often have productive lives. People with HPD who participate in talk therapy tend to have better outcomes as they gain insight into their condition and function better socially.

However, people with severe histrionic personality disorder may experience frequent problems at work and in social and/or romantic relationships.

A note from Cleveland Clinic

It’s important to remember that histrionic personality disorder is a mental health condition. As with all mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions to your life. Mental health professionals can offer treatment plans that can help you manage your thoughts and behaviors.

The family members of people with histrionic personality disorder often experience stress, depression, grief and isolation. It’s important to take care of your mental health and seek help if you’re experiencing these symptoms.

Last reviewed by a Cleveland Clinic medical professional on 04/29/2022.

References

  • French JH, Shrestha S. Histrionic Personality Disorder. (https://www.ncbi.nlm.nih.gov/books/NBK542325/) [Updated 2021 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Accessed 4/29/2022.
  • Merck Manual: Professional Version. Histrionic Personality Disorder (HPD). (https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/histrionic-personality-disorder-hpd) Accessed 4/29/2022.
  • National Institutes of Health, National Library of Medicine. Histrionic Personality Disorder. (https://medlineplus.gov/ency/article/001531.htm) Accessed 4/29/2022.
  • Weissman SH. Personality Disorders. In: Ebert MH, Leckman JF, Petrakis IL. eds. Current Diagnosis & Treatment: Psychiatry, 3e. McGraw Hill; 2019.

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