Is Treatment For Histrionic Personality Disorder Treatment Effective?

Histrionic personality disorder is a mental health condition listed in the DSM-5 that is characterized by pervasive and uncontrolled emotionality and attention-seeking behavior. It often begins in late adolescence or young adulthood and is more common in women than men. Recent evidence affirms that treatment approaches like psychotherapy are effective in mitigating the symptoms of histrionic personality disorder.

What are the signs and symptoms of histrionic personality disorder?

An individual may be living with histrionic personality disorder if they consistently experience five or more of the following symptoms: 

• Discomfort in circumstances where they are not the center of attention
• Sexually promiscuous or provoking behavior in most interactions with others
• Displays of briskly moving and superficial emotional expression
• Consistent use of physical features to attract attention to one's self
• Highly impressionistic speech that is insufficient in detail
• Self-dramatization, theatrics, and extreme expression of emotions
• Easy persuasion by others or situations
• Feeling that relationships are closer than they are 

What treatments are available for histrionic personality disorder?

Compared to treating other personality disorders like borderline personality disorder, there have been fewer studies on treating histrionic personality disorder. There is, however, substantial evidence that some psychotherapy techniques may reduce symptoms. 

Effective types of psychotherapy for HPD

Below are descriptions of some of the most effective types of psychotherapy for those living with HPD. 

Supportive therapy

Supportive therapy is a type of therapy developed to help clients cope with long-term or chronic illnesses. People with histrionic personality disorder who participate in supportive therapy show improvement in self-esteem, emotional control, stress management, and healthy coping mechanisms. Supportive therapy achieves its results by using the following features. 

Trusting therapeutic relationships 

Supportive psychotherapy can create a trusting relationship between the therapist and the client. Since managing the symptoms may take a long time, the therapist may focus on forming a trusting and safe professional relationship. When individuals with HPD feel they can trust and rely on their therapist, they may be more open to honestly discussing their symptoms and experiences. 

Active listening 

In supportive therapy, the focus is on actively listening to and hearing the client's point of view. Concerns are taken seriously, and they have the therapist's full attention. This process may reduce the social worries a person with a histrionic personality disorder might experience. 

Information and advice 

Accurate information and advice may be given to individuals with a histrionic personality disorder to build trust. The information may be well-timed and fitted for situations where self-reflection occurs. The information is given in a way that is not overwhelming but at the pace preferred by the individual. For example, the therapist might remind the client of their diagnosis or how their behaviors might negatively impact them. 

Emotional release 

In therapy, people with histrionic personality disorder are encouraged to express themselves. Their emotional outbursts are not discouraged and may be accepted within the confines of the session as long as they do not breach ethical boundaries.

Reassurance 

In supportive therapy, people with histrionic personality disorder are given hope and reassurance that their situation can improve. The reassurance given is specific and offered in a way that the individual may understand. 

Skill development 

Those living with histrionic personality disorder may be encouraged to learn skills to support the long-term management of their condition. They might also be persuaded to take necessary actions in their relationships, career, or educational life. 

Self-help 

As therapy proceeds, people with HPD may be encouraged to support themselves with the skills they have learned in therapy. Doing so enables them to transfer the progress made during therapy to their outside lives and full-time self-management.

Cognitive behavioral therapy (CBT)

As a mental illness, HPD can have both cognitive and behavioral components. Cognitive-behavioral therapy (CBT) helps clients change maladaptive behaviors and cognitive processes by teaching them unique coping mechanisms and ways to restructure their beliefs. 

To understand histrionic personality disorder's cognitive and behavioral aspects, an individual may be encouraged to keep a journal describing each symptom and its impacts as they move throughout their day. The individual may also be encouraged to record the behaviors, thoughts, and emotions. The therapist can help them identify the causes of their behaviors through activities and worksheets. In this type of therapy, the individual might experience the following elements. 

Active partnership 

The individual with histrionic personality disorder may be encouraged to take an active role in therapy, with the therapist acting as a guide to help them come to conclusions.

Socratic questioning

Beliefs, behaviors, and thoughts that are thought to be maladaptive may not be challenged directly. First, questions might be asked in ways that help the individual conclude that the behaviors are maladaptive themselves.

Attention to provoking and maintaining factors 

The therapist may use the information from journals kept by the individual with histrionic personality disorder to pick out provoking factors that maintain the symptoms of the mental health condition. 

Coping skills and strategies

In therapy sessions, coping skills and strategies are often taught to help clients manage histrionic personality disorder's cognitive and behavioral symptoms. 

Practice 

People with histrionic personality disorder may be encouraged to try techniques the therapist suggests in social situations and on their own. These techniques may improve the social lives of people living with this condition. 

Psychodynamic therapy

Psychodynamic therapy attempts to treat people with histrionic personality disorder to uncover the condition's origins. In this type of therapy, treatment focuses on early life experiences, which may lead to unconscious factors that account for maladaptive thoughts and behaviors in adulthood. The therapist may begin by explaining the aim of the therapy and then ask the client about their treatment goals.

The individual with histrionic personality disorder may be encouraged to explore ideas and fantasies that were previously hidden or shameful to them. Expression of ideas, feelings, and emotions is often encouraged. They may also be asked to review their part in the challenges they might place on others. They are encouraged to try out new responses when they realize their roles in each challenge. 

Ineffective forms of treatment

Group or couples therapy is not often used for people with histrionic personality disorder due to the attention-seeking behaviors of those diagnosed. When people with histrionic personality disorder begin to respond positively to individual therapy, they may be referred to group therapy by their therapist. Group therapy may allow them to practice skills learned in individual therapy. 

In addition, medication has not been proven effective in treating histrionic personality disorder. Medications can, however, be used to treat co-morbidities like anxiety or depression. Mood stabilizers can treat some impulsive behaviors seen in people with personality disorders. However, consult a medical professional before starting, changing, or stopping a medication. 

Alternative counseling options for HPD 

For some individuals with HPD, finding a therapist in person can be difficult. As personality disorders are often rarer than other types of mental illness, finding a specialist in these conditions can be challenging. In these cases, it may be beneficial to try online therapy. 

Online therapy has shown significant promise in treating people with personality disorders. In a recent systematic literature search of 11 internet-delivered personality disorder interventions, patient satisfaction ranged from moderate to high, and several studies demonstrated significant reductions in personality disorder symptoms. More research is needed in this area, particularly as treatment pertains to histrionic personality disorder on its own. 

There are many reasons why online therapy from platforms like BetterHelp may be advantageous to people living with histrionic personality disorder. For example, people can schedule appointments from home, eliminating the possibility of having to commute and potentially mitigating the compulsion to behave maladaptively in public. Additionally, online therapy can be more cost-effective than face-to-face options.