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Mental Health

Histrionic Personality Disorder: Symptoms, Treatment, Causes, and More

Looking to learn more about the personality disorder known as histrionic personality disorder? This article offers symptoms, treatment, and more.

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Young Asian female looking at reflection
Jessica Ticozzelli

A personality is defined by the different patterns of thoughts, behaviors, and emotions a person uses to connect with and comprehend the world. When a person has a personality disorder, their personality traits or patterns of thinking, feeling, and behaving are “maladaptive” thus hindering them from having proper and fulfilling interactions within their personal and social lives. Most often, personality disorders are deemed as an “ego-syntonic” mental health condition, meaning the person suffering from the disorder is unaware that they have an issue and according to the Cleveland Clinic, it is estimated that upwards of 13% of the world’s population suffers from one or more personality disorders. Within the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are ten personality disorders classified into three groups (Cluster A, Cluster B, and Cluster C).

It’s common for a patient to have symptoms of more than one personality disorder for they tend to overlap. Doctors may struggle with attributing one disorder to a patient leading them to diagnose a “personality disorder not otherwise specified (PDNOS)” and carry forward with what is known as a “differential diagnosis“. Other mental illnesses that have commonalities with the histrionic disorder include narcissistic personality disorder due to the similar narcissism and attention-seeking qualities; borderline personality disorder due to the similar intense emotional landscape; dependent personality disorder due to the similar strong desire to be near others; and somatic symptom disorder and illness anxiety disorder due to the similar ways in which a patient may use physical ailments to gain attention.

Personality Disorder Categories

  • Cluster A: Personality disorders that fall within this category are often characterized by “odd, eccentric thinking or behavior”. The disorders within this category include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.
  • Cluster B: Personality disorders that fall within this category are often characterized by dramatic, attention-seeking thinking or behavior that defined as “excessive emotionality”. The disorders within this category include antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder.
  • Cluster C: Personality disorders that fall within this category are often characterized by fearful, paranoid, and/or anxious thinking or behavior. The disorders within this category include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder.

Histrionic Personality Disorder

Amongst the general population, it is known that between 2-3% of people suffer from what is known as “histrionic personality disorder” (HPD), with women designated four times as likely to be diagnosed. Histrionic personality disorder (HPD), otherwise known as “dramatic personality disorder”, is classified as a Cluster B personality disorder and is often characterized by a person’s habitual attention-seeking, dramatic, and erratic thoughts or behaviors. According to on the surface, people with this mental disorder often appear “flirtatious, seductive, charming, manipulative, impulsive, and lively,” in order to draw attention to themselves. Due to their emotional expression through emotional overreaction and dramatized, impulsive behavior, they are often deemed “the life of the party” and can be known to have a variety of unstable relationships that are primarily superficial.

Like many mental illnesses, HPD is known to be hereditary and puts the person suffering at a higher risk of developing another psychiatric disorder such as depression, anxiety disorder, and/or substance abuse or substance misuse disorder. As a result, a common symptom for those suffering from HPD is active suicidal thoughts, threats, or attempts along with self-harming behaviors such as cutting.

What Prompts Histrionic Personality Disorder?

While the causes of mental illness vary from person to person, the most common cause of histrionic personality disorder is childhood trauma. HPD’s origins are often described as a “conglomeration of both learned and inherited factors.” Inherited factors relate back to the earlier point that HPD can be hereditary. Meanwhile, learned factors refer to parenting styles that model consistent over-dramatized, erratic, and/or hypersexualized thought, emotion, or behavior that then puts their children at a heightened risk of developing HPD.

DSM-5 Diagnosis Requirments for HPD

According to the DSM-5 criteria for a patient diagnosed with a histrionic personality disorder, five of the following conditions must be met:

  • Uncomfortable feelings when not made to be the center of attention.
  • Commonly displaying seductive or provocative behavior.
  • Portraying illusive, shallow, or flighty emotions.
  • Utilizes their looks and appearances to attract attention.
  • Impressionistic and vague stories that lack many details.
  • Acting highly dramatic or displaying exaggerated emotion.
  • Suggestible, gullible, or easily persuaded.
  • Has the false sense of believing certain relationships are more intimate than they are in reality.

How is Histrionic Personality Disorder Treated?

The most common treatment for HPD involves a type of therapy known as “supportive psychotherapy” or “talk therapy”. It’s important to note that there are a variety of psychotherapy versions but often therapists use psychodynamic (psychoanalytic) psychotherapy to treat patients with HPD. According to GoodTherapy, a correct diagnosis of which personality disorder the patient has is crucial to their treatment. This is because a patient with HPD or another mental disorder, such as bipolar disorder, would respond well to cognitive behavioral therapy (CBT), meanwhile, someone with borderline personality disorder (BPD) would respond better to dialectical behavior therapy (DBT).

The reason that psychodynamic psychotherapy is the primary treatment for HPD patients is due to its goals for patients to “uncover the motivations and fears associated with his or her thoughts and behavior, and to…learn [how to] relate to others in a more positive way.” Although no medications are available to specifically treat HPD, during treatment it’s likely for the mental health professional to prescribe a mood stabilizer, antipsychotic, or antidepressant drug to aid patients with their “affective dysregulation effects“. These effects range from intense mood swings and anger to anxiety and/or overwhelming depression.

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