Insights into Psychology

What Is… Histrionic Personality Disorder

histrionic personality disorder symptoms

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. Like any personality disorder, it doesn’t just pop up out of nowhere in adulthood; it starts early and is pretty well-developed by adulthood. There are inflexible, maladaptive behaviour patterns that are relatively consistent over time and across situations.

Like any personality disorder symptom list, or most mental disorders for that matter, many of us do some of these things some of the time. For it to actually be a disorder, the symptoms need to clearly go above and beyond what’s “normal” and cause functional impairment. Someone might be described as having histrionic traits if they don’t meet the full criteria for the disorder.

Symptoms

HPD symptoms include:

  • a longstanding pattern of excessive emotionality and attention-seeking; unlike narcissism, where specifically ego-boosting attention is sought, 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
  • has rapidly shifting emotions that don’t have much substance to them
  • uses physical appearance to gain attention
  • dramatic, exaggerated expression of emotions, such as claiming they’re very depressed when they feel a bit low
  • highly suggestible, gullible, and easily influenced, especially when it comes to people they admire
  • believes relationships are closer than they actually are

People with this disorder are often charming and enthusiastic, and may be considered 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 may become dependent or act manipulatively due to lack of more adaptive skills.

Prevalence and other characteristics

HPD is estimated to occur in about 2-3% of the population. It’s more commonly diagnosed 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 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, and conversion disorder.

Treatment

Psychodynamic psychotherapy is one option for treatment, as it gets into the childhood issues that may have contributed to the development of HPD. Group or family therapy can be counterproductive. Medications may help to provide some symptomatic relief by improving emotional self-regulation. In general, though, personality disorders can be hard to treat because the patterns are so deeply ingrained.

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 either rare enough or not high profile enough that there aren’t 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 this disorder?

Sources

The Psychology Corner: Insights into psychology and psychological tests

The Psychology Corner page includes an index of the terms that have been covered in the What Is… (Insights into Psychology) series, as well as a collection of scientifically validated psychological tests.

14 thoughts on “What Is… Histrionic Personality Disorder”

  1. I worked with a girl who had hpd and her behavior made me extremely uncomfortable. She befriended me when I first started and two weeks after I wish I had never spoke to her. She would expect me to back her up when she sought attention and finally I just had to make her not like me so she would leave me alone. At that point I became a target for her behavior but that only lasted about a week.

  2. Interesting! I always thought actor Robin Williams had some histrionic traits (but not necessarily the full disorder). His acting style seemed to be histrionic in the sense that he’d ham it up way more than necessary. Mrs. Doubtfire comes to mind. It’s like the script wasn’t that funny, but he went full-throttle in it, if that makes sense. And then my general, overall sense of him was that he was a great person who left a lot of people devastated by his death. 🙁

    Someone I knew who was histrionic in a way that was definitely bad, though, was Dr. Satan at my college, and he definitely had the co-occuring narcissism. He was both narcissist and histrionic. He had this wild dramatic flair, he had to be the center of attention, and he had to make every interaction all about him. He mumbled so that people would lean in and hang on his every word, which is a very egocentric thing to do. He’d also give these reactions where, like, I’d be up the hallway and I’d hear him explode with forced laughter over something that wasn’t all that funny, like, look at me, I’m so easily entertained over here! Yeah. [Eyeroll.]

    So that’s the good and the bad of it! And may Robin Williams rest in peace. (Sadness.)

  3. I am not sure this qualifies but I had a close friend in my youth who was extremely uncomfortable not being in the center of attention. Whenever we were in a small or somewhat small group, she seemed to like to “perform” rather than “relate.” It seemed to me to be about getting attention.

  4. Interestingly, I’ve known MEN who have fit this description somewhat. Always craving attention of any kind. Can be charming to excess or cruel, and switch in a blink. It’s exhausting to be around…

  5. I worked with a very damaged young female who had schizophrenia and HPD. She was always “running away” from the ward in her own inimitable dramatic way — making sure we all knew she was “running” and was “going to kill herself”.

    As I followed her one day she skipped up onto a low brick wall saying “I’m going to jump now and there’s nothing you can do to stop me!” I had to stop myself from laughing and told her the worst she would do would be to sprain an ankle. She stormed off to find a higher place to jump from, a low level branch of a large tree and enjoyed the commotion she was causing as people passed by. I could go on – she was adorable.

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