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.
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.
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.
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?