Working with someone with histrionic personality disorder

What Is Histrionic Personality Disorder (HPD)?

Histrionic personality disorder (HPD) is a psychological disorder in which a person has a pattern of extreme emotionality and attention-seeking behavior. Its name comes from the word histrionic, which means “dramatic or theatrical."

In addition to displaying attention-seeking behavior, histrionic personality disorder is characterized by shallow emotions and manipulative behavior. It begins in early adulthood (when personality begins to form) and is obvious in different situations.

Histrionic personality is one of 10 personality disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a manual used by mental health professionals to diagnose mental health conditions. Roughly 9% of the U.S. population has a personality disorder, with histrionic personality disorder appearing in somewhere between slightly less than 1% and 3% of Americans.

Histrionic personality disorder is classified as a Cluster B personality disorder. This classification of personality disorders is characterized by the person being dramatic, overly emotional, and/or erratic.

Symptoms of Histrionic Personality Disorder 

If you're wondering whether you or someone you know may have histrionic personality disorder, its symptoms can include:

• Being very suggestible and quick to respond to fads
• Displaying exaggerated symptoms of weakness or illness
• Displaying excessive, shallow emotions
• Engaging in attention-seeking behaviors (i.e., constantly “performing”)
• Experiencing fleeting moods, opinions, and beliefs
• Needing others to witness the person's emotional displays for validation or attention
• Using sexually provocative behaviors to control others or gain attention
• Using threats of suicide to manipulate others

In some cases, someone may have histrionic personality disorder and not realize it because their way of thinking and behaving seems natural to them. They may also blame others for the challenges they face.

Diagnosis of Histrionic Personality Disorder

Many histrionic personality disorder symptoms are similar to those experienced with other psychiatric disorders and medical illnesses. Therefore, a health provider will likely first make a differential diagnosis to rule out other disorders or medical conditions that may be causing the person's symptoms.

There is no stand-alone histrionic personality test that a provider can use to diagnose this condition. Instead, the DSM-5 indicates that a person must have five or more of the following signs or symptoms to be diagnosed with histrionic personality disorder:

• Discomfort in situations in which the person is not the center of attention
• Interaction with others that is often characterized by inappropriate sexually seductive or provocative behavior
• Rapidly shifting and shallow expression of emotion
• Consistently uses physical appearance to draw attention to one's self
• Using a style of speech that is excessively impressionistic and lacking in detail
• Displays self-dramatization, theatricality, and exaggerated expression of emotion
• Is easily influenced by others or by circumstances
• Considers relationships to be more intimate than they actually are

Related Conditions

Histrionic personality disorder tends to co-occur with a few other mental health disorders. Related or co-occurring conditions include:

• Borderline personality disorder
• Dependent personality disorder
• Eating disorders
• Narcissistic personality disorder
• Substance use disorder
  

Histrionic Personality Disorder vs. BPD

There is a great deal of overlap between the features of histrionic personality disorder and borderline personality disorder (BPD). For instance, the conditions share similarities such as:

• Rapidly shifting and reactive emotions
• Being associated with impulsive behavior
• Characterized by a strong expression of emotion

Because of these similarities, some experts believe that HPD may not actually be distinguishable from BPD. Yet, the DSM-5 disagrees.

According to the DSM-5, "although borderline can also be characterized by attention-seeking, manipulative behavior, and rapidly shifting emotions, it is distinguished by self-destructiveness, angry disruptions in close relationships, and chronic feelings of deep emptiness and identity disturbance".

Some clinicians also argue that the qualities of symptoms are different in histrionic personality disorder versus borderline personality disorder. Specifically, the rapidly shifting emotions in HPD are not experienced with the same depth and intensity as those in BPD.

Despite predictions that the HPD diagnosis would be dropped in the DSM-5, it remains its own specific and unique diagnosis.

Causes of Histrionic Personality Disorder

There is no singular or precise cause of histrionic personality disorder. It is believed that this mental health condition is more so the result of a combination of genetic and environmental influences.

• Genetics: Certain personality traits may be passed on to you by your parents through inherited genes. These traits, also sometimes called your temperament, may make you more vulnerable to developing HPD.
• Environment: Your environment involves the surroundings you grew up in, events that have occurred, and relationships with family members and others. These surroundings, events, and relationships may trigger the development of histrionic personality disorder.

Risk Factors

Several factors have been found to increase a person's risk of developing a personality disorder. Some of these risk factors include:

• Being verbally abused
• Experiencing childhood trauma
• Having a higher sensitivity to environmental stimuli (light, noise, etc.)

Treatment for Histrionic Personality Disorder

There is currently no cure for histrionic personality disorder. However, individuals with this condition can lead productive lives and their outlook is good, particularly if they engage in psychotherapy (talk therapy). Treatment may also include medications, along with lifestyle changes.

Psychotherapy

Psychotherapy can be effective in treating histrionic personality disorder. For instance, one study of 159 patients with HPD found that clarification-oriented psychotherapy helped reduce patients' symptoms and improved their relationship processes.

Group therapy and family therapy are generally not recommended for people with histrionic personality disorder. This is because some of their symptoms—such as seeking attention and exaggerating symptoms—may be triggered or worsened in a group atmosphere.

Medication

There are no FDA-approved medications for the treatment of histrionic personality disorder. Although, some medicines may be used to treat affective dysregulation that can accompany this disorder, including mood swings, anger, tearfulness, anxiety, and depression.

Alternative Therapies

Mindfulness techniques such as yoga, tai chi, and biofeedback may also help people with personality disorders. They work by making it easier to control their inner feelings, also providing positive effects for impulsivity and emotional reactivity.

Complications of Histrionic Personality Disorder

People with histrionic personality disorder can have trouble maintaining close relationships with others due to their behaviors. HPD is also associated with higher rates of bullying behaviors and internet addiction.

People with a personality disorder don't always recognize the effects of their behaviors on others. This can lead to distress in various areas of their life beyond their relationships, negatively impacting them socially as well as in the workplace.

At the same time, not all effects of histrionic personality disorder are negative. Males with HPD often report better sexual functioning, for example, and this condition may also provide beneficial effects such as lower levels of loneliness and social anxiety.

Coping With Histrionic Personality Disorder

Histrionic personality disorder often goes underdiagnosed and is undertreated. So, perhaps the best way to improve symptoms is to first identify them. Then, with appropriate treatment, you can learn to manage the symptoms and come up with a self-care plan to improve your quality of life.

Ways to cope with histrionic personality symptoms include:

• Establishing consistent eating and sleeping schedules
• Exercising on a regular basis
• Avoiding drugs and alcohol
• Enlisting the help of trusted friends and family to keep you on track

For Loved Ones

If a friend or family member has histrionic personality disorder, it is important to encourage that person to seek help. Without professional treatment, it is unlikely that the symptoms (and their related impacts on relationships) will improve.

It can also be helpful to learn as much as you can about HPD. This can help you better understand histrionic personality, also giving you the information you need to better support your loved one.

Frequently Asked Questions

• Does histrionic personality disorder get worse with age?

  It might. Some studies suggest that histrionic personality disorder remains stable throughout the lifespan while others indicate that it may increase. There is limited research on personality disorders in older adults so the answer to this question is not quite clear.

• Do people with histrionic personality disorder lack empathy?

  When compared to people without histrionic personality disorder, someone with this condition tends to have a harder time recognizing emotions in others and in themselves. This could potentially make it more difficult for them to be empathetic.

• What are histrionic personality traits?

  Suggestible, emotionally unstable, attention-seeking, seductive, and trouble paying attention to detail are all histrionic personality traits. Egocentric, shallowness, and theatrical are a few others.

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