Histrionic personality disorder is one of a group of conditions called "cluster B" or "dramatic" personality disorders. People with these disorders have intense, unstable emotions and distorted self-images. For people with histrionic personality disorder, or HPD, their self-esteem depends on the approval of others and does not arise from a true feeling of self-worth. They have an overwhelming desire to be noticed, and often behave dramatically or inappropriately to get attention. The word histrionic means "dramatic or theatrical."
This disorder is more common in women and people assigned female at birth, but researchers think that might reflect bias in how the condition is diagnosed. It's usually is evident by adolescence or early adulthood.
Histrionic vs. borderline personality disorder
Borderline personality disorder (BPD) is another "cluster B" condition. Like people with histrionic personality disorder, people with BPD have strong emotions that change rapidly. If you have BPD, you're very worried about people abandoning you.
A major difference between these two personality disorders is that people with BPD feel more despair and show more suicidal behaviors.
Histrionic vs. narcissistic personality disorder
Narcissistic personality disorder (NPD) is also a "cluster B" condition. If you have NPD, you feel superior to other people and think you're entitled to praise and special treatment. A major difference between the histrionic and narcissistic disorders is that someone with NPD is very focused on how special they are, something experts call "grandiosity."
Symptoms of Histrionic Personality Disorder
In many cases, people with histrionic personality disorder have good social skills; but they tend to use these skills to manipulate others so that they can be the center of attention.
If you have this condition, you might:
- Be uncomfortable unless you're the center of attention
- Act seductively or dress provocatively – or both
- 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 a hard time maintaining relationships, often seeming fake or shallow in dealings with others
- Threaten or attempt suicide to get attention
Causes of Histrionic Personality Disorder
The exact cause of histrionic personality disorder is not known, but many mental health professionals believe that both learned and inherited things play a role.
For example, the tendency for histrionic personality disorder to run in families suggests that a genetic cause might exist. But the child of a parent with this disorder might simply be repeating behavior they learned at home.
Other things that experts think might play a role:
- Not being criticized or punished as a child
- Getting positive feedback from parents only when you show certain behaviors that they approve of
- Inconsistent, unpredictable attention from parents
- Confusion about what behaviors will get approval from parents
Your temperament, psychological style, and the way you learn to cope with stress while growing up all can play a role in the development of a personality disorder.
Histrionic Personality Disorder Diagnosis
Your personality continues to change and develop as you grow up, so it's unusual for a doctor to diagnose histrionic personality disorder before you're 18 years old.
Personality disorders are tough to recognize, and if you have one, you may not think there's anything wrong with you. Often, someone with histrionic personality disorder seeks help because their condition has caused problems in their life, such as relationship issues, leading to depression or anxiety.
If you show signs of HPD, your doctor may do a complete medical and psychiatric history. The doctor might do a a physical exam and laboratory tests (such as neuroimaging studies or blood tests) to make sure a physical illness is not causing your symptoms.
If the doctor finds no physical ailment, they might refer the person to a psychiatrist, psychologist, or other licensed behavioral health professional who may use specially designed interview and assessment tools to evaluate a person for a personality disorder.
A mental health professional will ask questions about your:
- Work history
- Impulse control
If you have HPD, you might not be aware of your behaviors, so family members or others close to you could be asked for their input.
You may find quizzes and self-assessments online, but there's no exact histrionic personality disorder test. Only a mental health professional can make a diagnosis.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders spells out the criteria for an HPD diagnosis. The most recent version of this handbook, published in 2013, is called DSM-5.
If you have HPD, you'll show five or more of these behaviors on a regular basis:
- You're uncomfortable unless you're the center of attention
- You behave seductively or provocatively
- Your emotions are shallow and shift easily
- You use your appearance to draw attention
- Your speech is vague
- You think your relationships are closer than they really are
- You're easily influenced by others
- Your emotions are dramatic or exaggerated
Histrionic Personality Disorder Treatment
If you have histrionic personality disorder, you might not think you need therapy. Your dislike of routine might make following a treatment plan difficult.
Psychotherapy (a type of counseling) is generally the treatment of choice for histrionic personality disorder. The goal of treatment is to help you uncover the motivations and fears linked to your thoughts and behavior, and to help you learn to relate to others in a more positive way.
Types of therapy that might help include:
- Group therapy, which involves meeting with people who have the same diagnosis, supervised by a mental health professional. If you have HPD, it can give you a window into what your own behavior looks like to other people.
- Psychodynamic psychotherapy tries to get at the root of your emotions and behaviors.
- Supportive psychotherapy focuses on improving your symptoms and developing coping skills.
- Cognitive behavioral therapy is a goal-oriented approach that helps you unlearn negative patterns and substitute healthier ones.
Complications of Histrionic Personality Disorder
Histrionic personality disorder can affect your social, professional, or romantic relationships and how you react to losses or failures. You're also at higher risk than the general population for depression and substance abuse.
Extreme attention-seeking can include threats of suicide.
If you have HPD, you're more likely to have certain other psychological conditions. They include:
- Somatic symptom disorder. When you have this, you get very focused on a physical symptom you have and overly upset about it. You may not realize that the symptom itself is not serious, and you might have unnecessary medical tests and procedures trying to treat it.
- Panic attacks are brief, strong feelings of fear and a physical reaction to an ordinary situation that isn't threatening.
- Conversion disorders are also called functional neurological symptom disorder. When you have this, your mental health condition causes physical symptoms such as seizures, paralysis, loss of sight, or loss of hearing. The symptoms are real, but they are caused by your mental health disorder disrupting your brain and central nervous system.
What Is the Outlook for People With Histrionic Personality Disorder?
Many people with this disorder are able to function well socially and at work. But if your case is severe, you might have significant problems in your daily life without treatment.
Can Histrionic Personality Disorder Be Prevented?
HPD can't be prevented. But treatment can help you manage your condition and learn healthier ways to deal with your emotions and relationships.
Histrionic personality disorder, or HPD, is a "cluster B" personality disorder. When you have it, you have an overwhelming need for attention, and you try to get it through dramatic or inappropriate behavior. Researchers aren't exactly sure what causes it, but they think it may result both from genetic factors and patterns in your childhood. There's no specific drug for HPD, but several types of therapy are available. You might take medication to treat anxiety or depression, which can also affect people with HPD. In fact, depression or anxiety may be the trigger for your seeking help. People with this condition often don't believe their behaviors are a problem.
Histrionic Personality Disorder FAQs
Is histrionic personality disorder a form of narcissism?
HPD and narcissistic personality disorder are closely related, but they aren't the same. Both are "cluster B" personality disorders, which involve dramatic and impulsive behaviors. If you have narcissistic personality disorder, you have a sense that you're superior to other people and deserve special treatment.
How common is histrionic personality disorder?
Experts believe about 1% of people have HPD.
What happens if you ignore someone with histrionic personality disorder?
It's important to keep your emotions level when dealing with someone who has HPD. Don't match the intensity of their emotions. But if you ignore them, they might escalate their behavior to get your attention.