Histrionic Personality Disorder

A pattern of elevated mood and attention-seeking behaviors characterizes the mental illness known as Histrionic Personality Disorder (HPD). People with HPD frequently exhibit flirty, seductive, charming, cunning, impulsive, and lively behaviors.

The prevalence of histrionic personality disorder in the general population ranges from 2 to 3%. HPD is four times more common in women than in men.

Last Updated: February 25, 2024

Studies about histrionic and other personality disorders have found several things that may lead to the development of these disorders, including genetics, a trauma in childhood, and parenting style. Histrionic personality disorder tends to run in families, so scientists think there may be a genetic (inherited) connection. Next, when a child goes through a traumatic event, like being abused or losing a family member, it can cause problems in their life as an adult and turn into a personality disorder. Lastly, children may be more likely to have histrionic personality disorder if their parents don't set limits, give them too much attention, or act differently. Also, children are more likely to get this condition if their parents act sexually in a dramatic, erratic, violent, or inappropriate way.

When they are not the focus of attention, those with HPD could feel unwanted or neglected. These individuals frequently have a "larger than life" presence and are the life of gatherings. Even when they are not attracted sexually to most of the individuals they meet, they may be exuberant, captivating, extremely seductive, or uncomfortably sexual. People with HPD may exhibit quickly changing, superficial emotions that others can see as fake. They wear bright colors or provocative attire to draw attention and may speak vaguely.

Additionally, they could be theatrical and overly expressive with their feelings, often humiliating friends and family with their outward displays of passion. They could be gullible, naive, suggestible, and prone to being easily swayed—especially by someone they look up to. They also think of relationships as being closer than they are.

Diagnosis requires meeting at least five of the following criteria:

  • Uncomfortable when not the center of attention
  • Seductive or provocative behavior
  • Shifting and shallow emotions
  • Uses appearance to draw attention
  • Uses artful and vague language
  • Exaggerated or dramatic feelings
  • Easily swayed by others
  • Sees relationships as being more personal than they are

Lastly, repression and dissociation are essential forms of protection for these individuals.

Treatment

 

Psychotherapy is the primary treatment option for histrionic personality disorder. Through careful and empathic listening, supportive psychotherapy tries to lessen emotional suffering, boost self-esteem, and strengthen the patient's coping mechanisms. This strategy is uplifting, comforting, and non-threatening.

HPD patients have also found improvement with psychodynamic psychotherapy, often known as insight-oriented treatment. This therapy aims to change a component of a patient's dysfunctional personality by integrating critical developmental milestones that a patient may have missed during earlier phases of emotional maturity. In this approach, individuals may better comprehend who they are and how they behave by resolving underlying, unconscious issues.

To promote better interpersonal communication, the patients are taught to replace overly emotional words with a more adaptable attitude or behavior. The therapy helps patients identify that attention-seeking, hypersexual behaviors are dysfunctional and find other, healthier methods to raise their self-esteem.

Antidepressants, mood stabilizers, and antipsychotics can be taken even though no medications have been authorized to treat HPD. Mood instability can be treated with the following:

  • Antidepressants like desipramine, fluoxetine, and amitriptyline;
  • Mood stabilizers like carbamazepine and lithium;
  • Antipsychotics like risperidone, aripiprazole, and olanzapine.

Therapy can help in dealing with triggering actions, ideas, and events. It allows people with HPD to understand their disease and improves their social skills. Patients who participate in counseling have better results, their behaviors become socially and professionally acceptable.

People with HPD are at increased risk of developing substance use disorders such as cannabis use disorder and alcohol use disorder. They can also have somatization disorder, panic attacks, and conversion disorders. That's why it is essential to attend and continue therapy sessions.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

French JH, Shrestha S. Histrionic Personality Disorder. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542325/

Cleveland Clinic (2022). Histrionic Personality Disorders. Retrieved October 22, 2022, from https://my.clevelandclinic.org/health/diseases/9742-histrionic-personality-disorder.

Last Updated: February 25, 2024