Histrionic personality disorders is a mental health condition listed in the DSM-5 that is characterized by pervasive and uncontrolled emotionality and attention-seeking behavior. It often begins in late adolescence or young adulthood and is more common in women than men. Recent evidence affirms that treatment approaches like psychotherapy are effective in mitigating the symptoms of histrionic personality disorder.
What Are The Signs And Symptoms Of Histrionic Personality Disorder?
An individual may be living with histrionic personality disorder if they consistently experience five or more of the following symptoms:
- Discomfort in circumstances where they are not the center of attention
- Sexually promiscuous or provoking behavior in most interactions with others
- Displays of briskly moving and superficial emotional expression
- Consistent use of physical features to attract attention to one's self
- Highly impressionistic speech that is insufficient in detail
- Self-dramatization, theatrics, and extreme expression of emotions
- Easy persuasion by others or situations
- Feeling that relationships are closer than they are
What Treatments Are Available For Histrionic Personality Disorder?
Compared to treating other personality disorders like borderline personality disorder, there have been fewer studies on treating histrionic personality disorder. There is, however, substantial evidence that some psychotherapy techniques may reduce symptoms.
Effective Types Of Psychotherapy For HPD
Below are descriptions of some of the most effective types of psychotherapy for those living with HPD.
Supportive therapy is a type of therapy developed to help clients cope with long-term or chronic illnesses. People with histrionic personality disorder who participate in supportive therapy show improvement in self-esteem, emotional regulation, stress management, and healthy coping mechanisms. Supportive therapy achieves its results by using the following features.
Trusting Therapeutic Relationships
Supportive psychotherapy can create a trusting relationship between the therapist and the client. Since managing the symptoms may take a long time, the therapist may focus on forming a trusting and safe professional relationship. When individuals with HPD feel they can trust and rely on their therapist, they may be more open to honestly discussing their symptoms and experiences.
In supportive therapy, the focus is on actively listening to and hearing the client's point of view. Concerns are taken seriously, and they have the therapist's full attention. This process may reduce the social worries a person with histrionic personality disorder might experience.
Information And Advice
Accurate information and advice may be given to individuals with histrionic personality disorder to build trust. The information may be well-timed and fitted for situations where self-reflection occurs. The information is given in a way that is not overwhelming but at the pace preferred by the individual. For example, the therapist might remind the client of their diagnosis or how their behaviors might negatively impact them.
In therapy, people with histrionic personality disorder are encouraged to express themselves. Their emotional outbursts are not discouraged and may be accepted within the confines of the session as long as they do not breach ethical boundaries.
In supportive therapy, people with histrionic personality disorder are given hope and reassurance that their situation can improve. The reassurance given is specific and offered in a way that the individual may understand.
Those living with histrionic personality disorder may be encouraged to learn skills to support the long-term management of their condition. They might also be persuaded to take necessary actions in their relationships, career, or educational life.
As therapy proceeds, people with HPD may be encouraged to support themselves with the skills they have learned in therapy. Doing so enables them to transfer the progress made during therapy to their outside lives and full-time self-management.
Cognitive-Behavioral Therapy (CBT)
As a mental illness, HPD can have both cognitive and behavioral components. Cognitive-behavioral therapy (CBT) helps clients change maladaptive behaviors and cognitive processes by teaching them unique coping mechanisms and ways to restructure their beliefs.
To understand histrionic personality disorder's cognitive and behavioral aspects, an individual may be encouraged to keep a journal describing each symptom and its impacts as they move throughout their day. The individual may also be encouraged to record the behaviors, thoughts, and emotions. The therapist can help them identify the causes of their behaviors through activities and worksheets. In this type of therapy, the individual might experience the following elements.
The individual with histrionic personality disorder may be encouraged to take an active role in therapy, with the therapist acting as a guide to help them come to conclusions.
Beliefs, behaviors, and thoughts that are thought to be maladaptive may not be challenged directly. First, questions might be asked in ways that help the individual conclude that the behaviors are maladaptive themselves.
Attention To Provoking And Maintaining Factors
The therapist may use the information from journals kept by the individual with histrionic personality disorder to pick out provoking factors that maintain the symptoms of the mental health condition.
Coping Skills And Strategies
In therapy sessions, coping skills and strategies are often taught to help clients manage histrionic personality disorder's cognitive and behavioral symptoms.
People with histrionic personality disorder may be encouraged to try techniques the therapist suggests in social situations and on their own. These techniques may improve the social lives of people living with this condition.
Psychodynamic therapy attempts to treat people with histrionic personality disorder to uncover the condition's origins. In this type of therapy, treatment focuses on early life experiences, which may lead to unconscious factors that account for maladaptive thoughts and behaviors in adulthood. The therapist may begin by explaining the aim of the therapy and then ask the client about their treatment goals.
The individual with histrionic personality disorder may be encouraged to explore ideas and fantasies that were previously hidden or shameful to them. Expression of ideas, feelings, and emotions is often encouraged. They may also be asked to review their part in the challenges they might place on others. They are encouraged to try out new responses when they realize their roles in each challenge.
Ineffective Forms Of Treatment
Group or couples therapy is not often used for people with histrionic personality disorder due to the attention-seeking behaviors of those diagnosed. When people with histrionic personality disorder begin to respond positively to individual therapy, they may be referred to group therapy by their therapist. Group therapy may allow them to practice skills learned in individual therapy.
In addition, medication has not been proven effective in treating histrionic personality disorder. Medications can, however, be used to treat co-morbidities like anxiety or depression. Mood stabilizers can treat some impulsive behaviors seen in people with personality disorders. However, consult a medical professional before starting, changing, or stopping a medication.
Alternative Counseling Options For HPD
For some individuals with HPD, finding a therapist in person can be difficult. As personality disorders are often rarer than other types of mental illness, finding a specialist in these conditions can be challenging. In these cases, it may be beneficial to try online therapy.
Online therapy has shown significant promise in treating people with personality disorders. In a recent systematic literature search of 11 internet-delivered personality disorder interventions, patient satisfaction ranged from moderate to high and several studies demonstrated significant reductions in personality disorder symptoms. More research is needed in this area, particularly as treatment pertains to histrionic personality disorder on its own.
There are many reasons why online therapy from platforms like BetterHelp may be advantageous to people living with histrionic personality disorder. For example, people can schedule appointments from home, eliminating the possibility of having to commute and potentially mitigating the compulsion to behave maladaptively in public. Additionally, online therapy can be more cost-effective than face-to-face options.
What is the best treatment for histrionic personality disorder (HPD)?
While medications are sometimes used for treating symptoms of co-occurring conditions such as anxiety and depression, the most effective treatment for HPD is psychotherapy.
Common types of psychotherapy used to treat HPD include:
Cognitive-Behavioral Therapy (CBT)
CBT is used for treating personality disorders of all types. This therapy focuses on helping the patient identify and change the unhealthy thought patterns and behaviors that contribute to their symptoms. It can also help them develop healthier coping mechanisms.
Dialectical Behavior Therapy (DBT)
DBT focuses on improving emotional regulation, interpersonal effectiveness, and distress tolerance. It can be beneficial for individuals with HPD who struggle with impulsive behavior and intense emotions.
Psychodynamic Therapy (PDT)
This type of talk therapy delves into the underlying causes of the individual's behavior. It helps them understand and work through unresolved issues in the subconscious that may contribute to histrionic traits. Transference-focused and mentalization-based treatment are two types of psychodynamic psychotherapy often used to treat HPD.
Interpersonal Therapy (IPT)
While similar to CBT, IPT focuses on improving relationships and communication skills-- which can be particularly relevant for individuals with HPD who have difficulty maintaining stable and healthy relationships.
Group therapy can be beneficial for individuals with HPD as it provides an opportunity to practice interpersonal skills, gain insight into their behavior, and receive feedback from others in a supportive environment.
Clarification-Oriented Therapy (COP)
A growing body of recent research suggests that COP is an effective method for treating symptoms of HPD. This therapy cultivates the patient's self-knowledge and motivations that account for their experiences and behaviors. This type of therapy often focuses on increasing the patient's awareness and understanding of how their behavior impacts interpersonal interactions.
Can histrionic personality disorder be cured?
HPD cannot be cured. However, it is possible to manage its symptoms with therapy (and medication if necessary), allowing individuals to lead more balanced, productive lives.
Can histrionic personality disorder be treated with medication?
No specific medications are approved for the treatment of HPD, but medications may help symptoms of histrionic personality disorder diagnosed with comorbid mental conditions such as anxiety and depression.
What happens when you ignore a histrionic?
Ignoring someone with histrionic personality disorder often increases its problematic symptoms. It may reinforce insecurity, leading to feelings of abandonment, loneliness, and extreme emotional distress (trademark symptoms of HPD). Individuals with HPD may seek to retaliate personally or socially when ignored.
Does histrionic get worse with age?
Individuals are more likely to develop histrionic personality disorder in their late teens and early twenties, but current studies indicate that the frequency and intensity of HPD may worsen with age.
This is also typical of mental disorders like avoidant, borderline, and dependent personality disorder.
Do people with HPD lack empathy?
Common symptoms such as self-centered and constant attention-seeking behaviors may make it appear that an individual with HPD cannot experience empathy. Even though they may seem overly concerned about themselves, there is no evidence to suggest that people with HPD lack empathy and cannot show concern for others.
Is histrionic worse than narcissistic?
Determining which condition is "worse" is challenging because each person's perspective and experiences differ. The two share some characteristics, such as a preoccupation with physical appearance and social status, emotional instability due to low self-esteem, and impaired interpersonal relationships. But while people with HPD may have issues with emotional intimacy and difficulty maintaining relationships, people with NPD are more likely to emotionally hurt others intentionally without remorse.
How serious is histrionic personality?
HPD can be very serious, particularly if left untreated. People with severe histrionic personality disorder are at risk for several comorbid mental health conditions and symptoms:
- Substance Use Disorders
- Depressive Disorders
- Conversion Disorders
- Somatic Symptom Disorder
- Panic Attacks
- Self-Harm And Suicidal Ideation
Because of their impulsivity, need for attention, and dramatic or exaggerated emotions, people with HPD may be easily influenced by others in destructive ways. Inappropriate sexual behavior for attention is also a common symptom of HPD, which may increase the likelihood of self-destructive behaviors and unhealthy relationships. Histrionic personality disorder treated early can help reduce these risk factors.
Is histrionic personality disorder lifelong?
HPD is a chronic disorder whose symptoms are typically lifelong. With therapeutic support and patient commitment, it is possible to treat histrionic personality disorder and improve or eliminate symptoms.
Can a histrionic person change?
If an individual with HPD is self-aware and committed to treatment, it is possible for them to change.
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