What Is… Histrionic Personality Disorder

In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is histrionic personality disorder.

Histrionic personality disorder (HPD) falls within the DSM-5‘s cluster B of dramatic/emotional/erratic personality disorders. The primary characteristic is a pathological level of need for attention.

People with this disorder are often charming and enthusiastic, and people may view them as the life of the party. They crave novelty and don’t do well with delayed gratification. They tend to have difficulty establishing healthy relationships, and they may become dependent or act manipulatively due to a lack of more adaptive skills.

Histrionic personality disorder symptoms

Histrionic personality disorder symptoms include:

• Has a longstanding pattern of excessive emotionality and attention-seeking; unlike narcissism, where people specifically seek ego-boosting attention, in HPD, it’s the attention itself that matters more than what it’s for
• Experiences discomfort when they’re not the centre of attention
• Acts in an excessively provocative or seductive manner to gain attention, even when there is no sexual attraction involved
• Has rapidly shifting emotions that don’t have much substance to them
• Uses physical appearance to gain attention
• Dramatic, exaggerated expression of emotions, e.g claiming to have intense depression when feeling a bit low
• Is highly suggestible, gullible, and easily influenced, especially when it comes to people they admire
• Believes relationships are closer than they actually are

Like any personality disorder symptom list, or list of symptoms for most mental disorders for that matter, many of us do some of these things some of the time. For it to rise to the level of a disorder, the symptoms need to clearly go above and beyond what’s “normal” and cause functional impairment.

HPD, just like other personality disorders, doesn’t just pop up out of nowhere in adulthood; it starts early and is pretty well-developed by early adulthood. It involves inflexible, maladaptive patterns of behaviour and inner experiences that are pervasive and tend to be consistent over time and across situations.

Prevalence and other characteristics

HPD occurs in about 2-3% of the population. It’s diagnosed more commonly in females, but it’s not clear if that actually represents the disorder being more common in females, as opposed to just more commonly detected. Like any personality disorder, causation is multifactorial, with both biology and childhood circumstances (including trauma) playing a role. Poor boundaries and overindulgence on the parents’ part may increase the risk of developing HPD.

People with HPD often have another cluster B diagnosis as well (antisocial, borderline, or narcissistic personality disorder). Other disorders that may occur concurrently are somatic symptom disorder (experiencing physical symptoms due to a mental disorder), major depressive disorder, persistent depressive disorder (previously known as dysthymia), and functional neurological symptom disorder (previously known as conversion disorder).

HPD Treatment

Psychodynamic psychotherapy is one option for the treatment of histrionic personality disorder, as it gets into the childhood issues that may have contributed to the development of the disorder. Group or family therapy can be counterproductive.

Medications may help to provide some symptomatic relief by improving emotional self-regulation, but they don’t address the underlying issues. SSRI antidepressants, tricyclic antidepressants, mood stabilizers, and atypical antipsychotics may provide some benefit, with mood stabilizers helping with impulse control in addition to mood regulation.

In general, though, personality disorders can be hard to treat because the patterns are so deeply ingrained, and lack of insight can pose challenges.

Stigma

Personality disorders are also the target of a great deal of stigma, including those who question whether it’s an actual illness at all. I think histrionic personality disorder may be either rare enough or not high profile enough that there don’t seem to be as many stereotypes attached to it, and on a superficial level, behaviours related to the disorder may not be viewed in a negative light by others.

Have you known anyone with HPD?

References

• Merck Manual Professional Version
• StatPearls