What Is Histrionic Personality Disorder?

Histrionic personality disorder (HPD) is a mental disorder characterized by exaggerated emotions and attention-seeking behaviors. HPD is classified within cluster B personality disorders (described as dramatic, excitable, erratic, or volatile) in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Other conditions in this group include narcissistic personality disorder, borderline personality disorder, and antisocial personality disorder.

It has been estimated that up to 9% of the general population is affected by at least one personality disorder, and about 2% of the general population has HPD.

Traits

The main characteristic of people with HPD is that they often act in a very emotional and dramatic way that draws attention to themselves. It may be hard to recognize someone with this personality disorder because they are often high-functioning individuals who perform well at work and in school.

A person with HPD may:

• Be uncomfortable unless they are the center of attention
• Dress provocatively or exhibit inappropriately seductive or flirtatious behavior
• Shift emotions rapidly
• Act very dramatically, as though performing before an audience, with exaggerated emotions and expressions, yet appear to lack sincerity
• Be overly concerned with physical appearance
• Constantly seek reassurance or approval
• Be gullible and easily influenced by others
• Be excessively sensitive to criticism or disapproval
• Have a low tolerance for frustration and be easily bored by routine, often beginning projects without finishing them or skipping from one event to another
• Not think before acting
• Make rash decisions
• Be self-centered and rarely show concern for others
• Have difficulty maintaining relationships, often appearing fake or shallow in their dealings with others
• Threaten or attempt suicide to get attention

Histrionic personality disorder may affect a person’s social or romantic relationships. A person with HPD may be unable to cope with losses or failures. They may change jobs often because of boredom and not being able to deal with frustration. They may also crave new things and excitement, which can lead to risky situations. All of these factors may lead to a higher chance of depression or suicidal thoughts.

Causes

The causes of HPD are unknown, but researchers believe it is the result of a number of factors, biological and environmental.

Histrionic personality disorder tends to run in families, suggesting that a genetic susceptibility for the disorder may be inherited. However, it is also possible for a child to learn behaviors characteristic of HPD from a parent with this disorder.

Adaptation to traumatic environments and parenting styles that lack boundaries or are overindulgent or inconsistent may predispose children to HPD.

Diagnosis

A healthcare provider will likely begin the diagnosis process by asking about symptoms and medical history, and performing a physical exam. They will also order blood tests to rule out other medical conditions. 

Histrionic personality disorder usually begins by late teens or early 20s.

According to the DSM-5, HPD is diagnosed if a person has five or more of the following:

• Uncomfortable when not the center of attention
• Seductive or provocative behavior
• Shifting and shallow emotions
• Uses appearance to draw attention
• Impressionistic and vague speech
• Dramatic or exaggerated emotions
• Suggestible (easily influenced by others)
• Considers relationships more intimate than they are

Treatment 

Histrionic personality disorder can be particularly difficult to treat because people with this personality disorder may experience it as ego-syntonic, meaning they tend to view these emotional patterns as normal. If you view your thoughts, feelings, and behaviors as normal, and especially when you may alter reactions to gain acceptance from others, you will be less likely to accept there is a potential problem.

People with HPD tend to seek treatment when they have depression or anxiety from failed relationships or other conflicts with people.

Psychotherapy is the best treatment for the disorder, while medications may help with certain symptoms.

Supportive Psychotherapy

Supportive psychotherapy is an encouraging, reassuring, and non-threatening method of treating histrionic personality disorder. 

Primary goals include:

• Reducing emotional distress
• Improving self-esteem
• Establishing and enhancing coping skills

Psychodynamic Psychotherapy

Also known as insight-oriented therapy, psychodynamic psychotherapy serves to help HPD patients recognize underlying motivations for maladaptive behaviors and help them develop healthier ways of improving and sustaining self-esteem.

Other goals include:

• Resolving underlying, unconscious conflicts that drive unhealthy behavior
• Promoting less dramatic behavior and developing better communication skills

Medications

While people with HPD should not rely on medication as their first line of treatment, they can ask their healthcare providers how certain medications—including antidepressants and anti-anxiety medications—can help reduce symptoms of depression and anxiety, which commonly co-occur with personality disorders.

Coping

Research has shown that incorporating mindfulness practice can help reduce symptoms common to those with histrionic personality disorder, including emotional reactivity and impulsivity.

Some mindfulness practices people with HPD can try include:

• Mindfulness meditation: This involves training the brain to focus and calm itself.
• Mindfulness-based stress reduction (MBSR): This takes place over an eight-week period and includes weekly group sessions and daily at-home mindfulness exercises. Yoga and meditation are involved.

A Word From Verywell

One of the biggest hurdles of histrionic personality disorder is admitting you have a problem. While you may have developed certain coping mechanisms that have helped you survive, you can develop healthier ways of living and managing daily stresses as an adult. 

The ups and downs of constantly feeling the need for external validation and reassurance can be detrimental to your overall quality of life. If you have the signs and symptoms of HPD, talk to your healthcare provider and ask for help. Ask your friends and family for support while you work through things by getting professional treatment. With some help, you can establish internal self-confidence and enhance your relationships with others.