What Is Histrionic Personality Disorder?
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines histrionic personality disorder (HPD) as a mental illness with symptoms involving pervasive and excessive emotional and attention-seeking behavior. If you believe you or a loved one is experiencing symptoms of this mental health condition, understanding it in further detail can help you prepare for receiving treatment and support.
Criteria for a histrionic personality disorder diagnosis
For a diagnosis to be made, five or more of the following symptoms must be present in an individual:
- Discomfort in circumstances where a person is not the center of attention
- Inappropriate, sexually seductive, or provocative behavior in interactions with others
- Displays of rapidly shifting and shallow expression of emotions
- Consistent use of physical appearance to draw attention to self
- Style of speech that is impressionistic and lacking in detail
- Self-dramatization, theatrics, and exaggerated expression of emotions
- Easy suggestibility (quickly influenced by others or circumstances)
- Considering relationships to be more intimate than they are
Discomfort in situations in which they are not the center of attention
People with histrionic personality disorder may feel uncomfortable and unappreciated when the attention of others in social situations is not on them. They might try to draw attention to themselves by acting friendly and flirtatious. If this technique does not work, they may create scenarios to draw attention to themselves. For example, they might pretend to be sick, spill a drink on their clothes, or fall. This behavior may be used frequently across a broad range of personal and social events.
Inappropriate sexually seductive or provocative behavior in interactions with others
Individuals with histrionic personality disorder may behave in sexually provocative ways to incite sexual attention from others. This behavior might be directed not only to their sexual or romantic interests but at professionals, strangers, or people on social media.
Displays of rapidly shifting and shallow expression of emotions
People with histrionic personality disorder may show rapidly changing emotions in social situations. Changes in conversational topics are often accompanied by a corresponding emotional change to retain the conversational center. These rapid changes and seemingly intense emotions can lead to social challenges, difficulty making friends or maintaining relationships with family members, and other concerns. Because their displays are often proven to be shallow, a person with histrionic personality disorder may be seen as someone who is faking their emotions or lying about the stories they tell. For example, someone living with this condition might pretend to experience emotional distress (for example, by crying) to elicit emotional support from a group, even if they’re not sad.
Consistent use of physical appearance to draw attention to self
Individuals with this personality disorder may dress or present themselves in ways that pull attention to them in public. However, this action may not be done out of vanity or self-love, but in an effort to be looked at as much as possible.
Note that dressing in bright colors, unique styles, or revealing clothing alone is not a symptom of a personality disorder. Many people express their personality through unique clothing, hairstyles, and accessories, and it can be healthy and normal to do so. However, the motives behind specific actions and the connection of this symptom with the other symptoms in this list can indicate a potential underlying concern.
An impressionistic style of speech that is lacking in detail
People with histrionic personality disorder may engage in impressionistic and vague speech to achieve the attention of others. They might express certain opinions that would shock others to create a sense of interest in a group, even if the opinion is not one that they hold. They might also create false scenarios, stories, or ideas to shock others.
Self-dramatization, theatrics, and exaggerated expression of emotions
At times, those with this mental health condition may display exaggerated behavior, not in tune with their actual emotional state, such as crying loudly in public, arguing loudly with a friend or partner, or drawing attention to their emotions. If the behavior is not receiving attention, the individual might quickly switch expressions of emotion. For example, they might cry, laugh, or act angrily within a few minutes. These seemingly unstable emotions and behaviors can make relationships with others challenging.
It's important to note that being extremely emotionally expressive isn’t necessarily a personality disorder symptom. In histrionic personality disorder, it isn’t the expression itself that is a symptom but the urge behind the behavior, which is often to garner attention or impact the opinion of others. If an adult is having a public emotional challenge, they may be experiencing emotional or physical symptoms of an unrelated mental health condition. For this reason, diagnosing personality disorders can be challenging and should be done by a licensed therapist or medical doctor, like a psychiatrist.
It is also possible for those experiencing histrionic personality disorder to issue frequent suicidal threats. Whether these threats are serious or meant to garner attention, it's important to take any threats of suicide seriously and reach out for help immediately.*
*If you or a loved one is experiencing suicidal thoughts, it's essential to reach out for support immediately. The 24/7 988 Suicide and Crisis Lifeline can be reached by dialing 988.
Easy suggestibility
Those experiencing this personality disorder may be suggestible to the opinions, thoughts, and emotions of others. If they notice that a well-liked person holds a particular opinion, they might express the same opinion regardless of whether they believe in it. They may also be influenced by current trends and try to mimic a popular person’s social media presence or behavior in real life.
Considering relationships more intimate than they are
People with histrionic personality disorder may feel familiar with people they don’t know well or have just met. Their behavior may include quick romantic or sexual touching, calling someone a “best friend” immediately after meeting, or moving quickly in relationships.
The symptoms of histrionic personality disorder often begin in late adolescence or early adulthood. The condition is often diagnosed more often in women than men, unlike narcissistic personality disorder, which is more common in men than women. The symptoms discussed above may not be attributed to histrionic personality disorder if the individual has another mental health disorder that can have similar symptoms.
Histrionic personality disorder’s associated features
The above symptoms make up the diagnostic criteria for HPD. However, a few associated features may indicate the condition as well that are not listed as diagnostic requirements, including the following.
Difficulty developing long-term stable relationships
Because of their behavioral patterns, people living with histrionic personality disorder often find it difficult to have stable relationships. Others might tell them they are unauthentic or care “too much” about what other people think. Those with HPD may also ask for frequent reassurance out of fear.
Short commitment spans
People with histrionic personality disorder may feel an overwhelming desire to leave relationships or situations that take a lot of time. They may feel excited about a new plan or concept through suggestibility and become upset if it doesn’t succeed. They may also quickly lose interest in jobs, relationships, and their degree path.
Other mental health conditions
Histrionic personality disorder is often associated with the following mental health conditions:
- Somatic symptom disorder
- Conversion disorder
- Major depressive disorder
- Borderline personality disorder
- Narcissistic personality disorder
- Antisocial personality disorder
- Dependent personality disorder
- Substance use disorders
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.
Causes of histrionic personality disorder
What causes of histrionic personality disorder is not well understood. However, researchers theorize that environmental and genetic factors, including traumatic events or family history of personality disorders, may cause HPD.
There are several schools of thought about the environmental factors that might cause this disorder. One such school of thought states that histrionic personality disorder may come about as a result of childhood trauma. Another school of thought says that an indulgent parenting style could increase the likelihood that a child develops histrionic personality disorder.
Treatment of histrionic personality disorder
Histrionic personality disorder is often treated with psychotherapy. Psychotherapy involves an individual talking and carrying out specific therapeutic activities under the guidance of a licensed therapist. Certain types of psychotherapy may be effective for managing histrionic personality disorder, including supportive therapy, cognitive-behavioral therapy, dialectical behavior therapy (DBT), and psychodynamic psychotherapy.
There is no medication for personality disorders. However, symptoms may be individually treated. Speak to a psychiatrist or medical doctor before starting, changing, or stopping medication for any condition or symptom.
Individuals with histrionic personality disorder may also benefit from self-care techniques, such as sleep hygiene, eating a balanced diet, exercising regularly, and practicing stress management. These techniques have been found to improve brain and emotional health.
Counseling options
Histrionic personality disorder can be manageable with the right treatment plan and professional support. Talking to a mental health professional can help you better understand your symptoms if you are worried about living with this mental health condition. In addition, there are multiple options for receiving support. If you experience barriers to in-person treatment, such as shame, cost, or fear of meeting a therapist, you may benefit from online therapy through a platform like BetterHelp.
Online therapy has been proven highly effective in treating numerous mental health conditions. One study found that it can be as effective as in-person therapy for treating personality disorders. When you work with an online therapist, you can use a nickname for treatment, choose between phone, video, and live chat sessions, and access educational materials on mental health that can assist you as you cope with symptoms.
Takeaway
If you are concerned you may have histrionic personality disorder or another mental health condition, you don’t have to navigate it alone. A licensed mental health professional can use their experience to help you gain insight into your condition and explore your concerns in a comfortable, nonjudgmental setting. Take the first step by reaching out to a therapist for guidance.
How does histrionic personality disorder affect daily life?
Histrionic personality disorder, diagnosed by mental health professionals, can be defined as a psychiatric disorder that often involves having low self-esteem, being overly concerned with attention and social approval, experiencing dramatic or exaggerated emotions, and displaying inappropriate sexual behavior.
HPD is generally considered a Cluster B personality disorder, and other disorders in this category usually include antisocial personality disorder, borderline personality disorder, and narcissistic personality disorder. It’s often possible to treat personality disorders with therapy.
A person with histrionic personality disorder may find themselves in risky situations due to their tendency to seek out excitement and new experiences. They may struggle with interpersonal relationships, change jobs frequently, and have trouble coping with failure.
What is it that a person with histrionic personality disorder wants the most?
Histrionic personality disorder is typically characterized by attention-seeking behaviors, and those with this disorder may seek social approval more than the average person.
Histrionic personality disorder, treated through talk therapy, can be managed so that the person with HPD can find fulfillment in life. They may display shallow emotions or exaggerated emotions less frequently and be able to develop closer relationships with others. Treating personality disorders can be a long process, but the results can be significant.
How do you cope with a personality disorder?
Learning about the personality disorder you live with, actively participating in treatment, avoiding alcohol and other substances, and maintaining a healthy lifestyle can all be helpful in managing a personality disorder.
Do people with histrionic personality disorder get better?
There’s not necessarily a “cure” for severe histrionic personality disorder, but talk therapy often helps those with this condition live a successful and fulfilling life. Therapists often treat histrionic personality disorder using behavioral therapy or psychodynamic therapy, among other options.
There can be several risk factors that increase the chances a person may develop histrionic personality disorder, such as a genetic susceptibility to personality disorders and being rewarded for attention-seeking behavior as a child.
Can people with histrionic personality disorder be easily influenced by others?
Yes, people with histrionic personality disorder can often be easily influenced due to their need for social approval and attention.
How should you interact with someone with histrionic personality disorder?
It can be helpful to communicate effectively and set healthy boundaries when interacting with someone who has histrionic personality disorder. In addition, do your best to remain calm. If you notice any attention-seeking or dramatic behaviors, try not to react strongly to them.
Which behavior would the nurse observe in a client who has a histrionic personality disorder?
A nurse might notice that a client with histrionic personality disorder demonstrates provocative behaviors and overreacts to things they find annoying or frustrating.
Does histrionic personality disorder get worse with age?
Similar to many other personality disorders, it can be likely that histrionic personality disorders may worsen with age.
Why do those with histrionic personality disorder often have difficulty maintaining personal relationships?
People with histrionic personality disorder may seem shallow or fake to others, and they may have a tendency to act out sexually. They may also seem dramatic and have a deep need for attention, which can also contribute to difficulty maintaining relationships.
Do people with histrionic personality disorder lack empathy?
In general, people with histrionic personality disorder do not lack empathy. The opposite may be true; many people with HPD tend to be very sensitive to the emotions of others.
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