Histrionic Personality Disorder Causes, Symptoms, And Treatments
According to research made available by the National Library of Medicine, the prevalence of histrionic personality disorder (HPD) is estimated to be between 0.4% and 1.8%. HPD usually involves dramatic emotional displays meant to get others’ attention, as well as rejection sensitivity, a constant need to be the center of attention, and impulsive behavior. Genetic and environmental factors, such as childhood abuse and being raised by permissive parents, are thought to contribute to the development of histrionic personality disorder. Those with HPD can often benefit from attending regular therapy sessions to address symptoms.
What is histrionic personality disorder?
Histrionic personality disorder (HPD) is a cluster B personality disorder that is typically characterized by dramatic or theatrical displays of emotion that are usually intended to get attention from others.
It is estimated that women may be four times more likely than men to receive an HPD diagnosis. However, it has been suggested that women may be overdiagnosed with HPD, while men may be underdiagnosed.
Individuals experiencing this disorder often exhibit behavior that could be deemed inappropriate; for example, some may act in an overtly sexual or seductive manner in situations where these actions are improper or unsuitable. These behaviors and emotions can change rapidly, which could lead friends or acquaintances to view individuals with HPD as insincere. However, these are not the only symptoms an individual with HPD may experience.
Histrionic personality disorder symptoms
The symptoms of histrionic personality disorder may be difficult to recognize, as some could be interpreted as a person being outgoing or extroverted. Individuals living with HPD can also struggle to recognize that they could be experiencing a mental health disorder, which could make it more challenging for them to seek evaluation and treatment. Those with HPD may exhibit the following symptoms:
- Sensitivity to criticism or rejection
- A constant desire to be the center of attention
- Frequent changes in emotional state
- Easily influenced or manipulated
- Quick to frustration or boredom
- Difficulty maintaining relationships
- Consistent need to be reassured by others
- Impulsive behavior
- Exaggerated and impressionistic speech
- Shallow emotional expression
To better understand why these symptoms and behaviors can occur, exploring the factors that may cause a person to develop histrionic personality disorder can be helpful.
What causes histrionic personality disorder?
While research on HPD may be limited, a variety of factors appear to increase the likelihood of developing this disorder. These factors may include having a family history or genetic predisposition to HPD, environmental influences, and specific childhood experiences.
- Genetic predisposition: Research indicates that there may be a hereditary component to multiple personality disorders, including HPD. However, while these findings could suggest that genetics play a significant role, the specific mechanisms or genes involved have not yet been identified.
- Environmental influences: Medical conditions that damage the neurons can increase the likelihood of developing personality disorders, such as HPD. These may include, but aren’t limited to, endocrine disorders, heavy metal poisoning, Huntington’s disease, cerebrovascular diseases, cerebral tumors, epilepsy, multiple sclerosis, neurosyphilis, and head trauma.
- Specific childhood experiences: A 2023 study indicates that childhood trauma (specifically physical/emotional neglect and sexual abuse) can be a significant factor in the development of HPD. Childhood abuse and neglect can result in an individual developing unhealthy defense mechanisms (such as those related to HPD) to alleviate the cognitive discomfort associated with these events.
Certain parenting styles may also contribute to an individual developing HPD later in life, specifically permissive parenting. Permissive parents typically overindulge their children, rarely enforcing rules or boundaries while also refusing to establish any consequences.
This can be quite different from other parenting styles, such as authoritarian parenting (where parents usually maintain high or even unreasonable expectations while enforcing severe consequences) and authoritative parenting (a style that usually involves reasonable demands and fair consequences). While permissive parents could see their actions as nurturing, their children may sense they aren’t getting enough attention. This could, in turn, lead to seeking more attention through theatrical behavior as they grow older.
No matter the cause, it can be important to address HPD if you notice that you or a loved one are experiencing symptoms. In most cases, the best way to address this personality disorder is to seek the assistance of a medical or mental health professional. That way, you or your loved one can undergo an official assessment, receive a diagnosis, and start a treatment regimen to alleviate symptoms.
Histrionic personality disorder diagnosis and treatment
In order for someone with HPD to start treatment, it is typically necessary to receive a diagnosis. To do this, a person generally needs to schedule an appointment with a mental health or medical professional.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), a diagnosis may require an evaluation exploring an individual’s personal history and overall mental status. This evaluation may search for confirmation that the person is experiencing HPD by identifying the presence of at least five of the following eight symptoms:
- Shallow and rapidly shifting emotions
- Overly sexual, provocative, or inappropriate interactions with others
- Emotional expressions that may be considered self-dramatized or theatrical
- Discomfort when one is not the center of attention
- Susceptibility to influential individuals or circumstances
- Prone to using physical appearance to draw attention to oneself
- Misinterpretation of the intimacy level of certain relationships
- Speech that can be described as vague or impressionistic
In addition to looking for the presentation of these symptoms, doctors can rule out other personality disorders, as well as situations that could cause HPD-like symptoms. Once a diagnosis is confirmed, medical or mental health professionals may recommend treatments.
While the evidence for effective treatments for HPD may be limited, psychotherapy is cited as one of the primary treatment methods. Effective psychotherapeutic approaches can include the following:
- Cognitive behavioral therapy (CBT): CBT can help individuals living with HPD identify potentially harmful patterns of thought and behavior. With the assistance of a CBT provider, those with HPD can find ways to replace these thought patterns with more constructive ones.
- Group therapy: Individuals experiencing HPD can benefit from engaging in group therapy, which could allow them to discuss their challenges with others living with HPD. These sessions are typically guided by a therapist who can help those in the group learn effective coping skills.
- Interpersonal therapy (IPT): Interpersonal therapy can be beneficial for those whose HPD symptoms have negatively impacted their relationships. IPT sessions may help those with HPD understand how their behavior could affect their current relationships with others, as well as how it may have affected relationships in the past.
While therapy can be beneficial for those living with HPD, in-person therapy sessions may not be convenient or accessible for everyone. Some may struggle to discuss mental health-related subjects face-to-face, preferring instead to use other communication formats (such as online chat, video conference, or phone call). Others may not have the time to schedule or attend in-person appointments or could lack the transportation needed to commute to face-to-face therapy sessions. In these cases, online therapy may be a better fit.
According to a 2022 study, online therapy may reduce personality disorder symptoms. While not much research has been completed specifically on the efficacy of online therapy for histrionic personality disorder, existing evidence suggests that online and in-person therapy tend to produce the same client outcomes.
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