What Does It Mean To Have A Histrionic Personality Disorder Diagnosis?

Personality disorders are mental illnesses that impact one’s personality and behavior in ways that often cause disruption in relationships and difficulty practicing healthy behavioral patterns. One such disorder is histrionic personality disorder (HPD). Exploring the signs and symptoms of this condition can shed insight into how this disorder can affect a person and how to find the treatment options available.

What is histrionic personality disorder (HPD)? 

Personality disorders affect approximately 9% of the population, with histrionic personality disorder accounting for between 0.4% and 1.8%. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies histrionic personality disorder as a cluster B personality disorder. 

The cluster B category also includes: 

• Antisocial personality disorder 
• Borderline personality disorder 
• Narcissistic personality disorder

People with cluster B personality disorders tend to demonstrate erratic or dramatic behaviors. In the case of histrionic personality disorder, individuals often have a pervasive pattern of attention-seeking, which may significantly affect their relationships. 

Possible causes of histrionic personality disorder

Researchers believe that a combination of genetic and environmental factors may cause histrionic personality disorder. In some cases, childhood trauma may contribute to the development of the disorder, as can a family history of mental illness or substance use. Another risk factor may be childhood caregivers who show inconsistent care or lack boundaries. Despite these possible risk factors, their presence does not guarantee that a person will develop the disorder.

Symptoms of HPD 

The DSM-5 lists eight criteria for a clinician to make a histrionic personality disorder diagnosis. Individuals must fulfill at least five of the following eight criteria to be diagnosed with the disorder:

1. Discomfort in situations in which they are not the center of attention
2. Interactions that are inappropriately provocative or sexually seductive
3. Rapidly shifting and superficial emotions
4. Use of physical appearance to attract attention
5. Speech that is overly impressionistic with little detail
6. Dramatic or exaggerated displays of emotion
7. A tendency to be easily influenced by others or by circumstances
8. A tendency to believe that relationships are more intimate than they are

The role of differential diagnosis

Histrionic personality disorder can lead to symptoms that are similar to those of other personality disorders. For this reason, clinicians may focus on various factors during the differential diagnosis process. 

A person with narcissistic personality disorder may also engage in attention-seeking behavior. However, those with NPD often crave admiration. By contrast, a person living with histrionic personality disorder may seek any type of attention, even if it means being perceived as fragile. Similarly, individuals with dependent personality disorder may desire praise and acceptance from others, but they don’t tend to exhibit dramatic or exaggerated behavior, which are symptoms common in histrionic personality disorder.

Individuals may be diagnosed with more than one personality disorder. Thus, the diagnostic process may not always conclude with the clinician ruling out disorders with similar symptoms. During the assessment process, a clinician may also consider the possibility of functional neurological symptom disorder or somatic symptom disorder. In some cases, a person with HPD may use physical symptoms to express distress. 

Another factor to consider during the diagnostic process is culture. Different cultures can have different norms for what behavior is considered acceptable. For example, what is considered normal in one culture may be considered attention-seeking behavior in another. Specifically, in one culture, dressing a certain way may be customary, whereas the same outfit might be considered seductive in another. For this reason, mental health professionals may consider a person’s cultural background during assessment. 

Finally, some people may display histrionic traits yet not have histrionic personality disorder. According to the DSM-5, to diagnose histrionic personality disorder, a clinician must observe traits that “are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress.” 

How histrionic personality disorder can affect daily life

Individuals living with histrionic personality disorder (HPD) may experience significant challenges in their relationships—both personally and professionally. Their attention-seeking behavior may lead others to maintain distance. 

Rapidly changing emotions can make it difficult for others to assess their relationship with a person living with this disorder. For example, in a romantic relationship, a person living with HPD might show overt interest at first and then become distant without any apparent cause. This behavior could leave the other person confused about the status of the relationship.

Friendships can also be impacted by HPD. Friends who don’t understand the nature of HPD may interpret symptoms as hostility or a lack of interest. They may choose to distance themselves from the friendship. If several friends do the same, the person with HPD may experience a lack of social support, which research shows is vital for mental health—especially for those living with a mental health condition.

In addition to friendships and romantic relationships, professional relationships can become challenging for people with HPD and their coworkers. A person who experiences a strong desire for attention may engage in inappropriate seductive behavior with coworkers, which could lead to disciplinary action. In some cases, a person living with HPD may have difficulty keeping a job if attention-seeking behavior crosses boundaries. 

Treatment options

Histrionic personality disorder treatment may be challenging, and individuals may not recognize that they have a disorder. However, talk therapy may reduce symptoms and improve relationships. Mental health professionals often use various therapy modalities to treat histrionic personality disorder, including but not limited to the following. 

Cognitive-behavioral therapy (CBT)

CBT may help an individual with HPD challenge their inaccurate or negative thoughts. This process may lead to behaviors that improve personal relationships, which can be challenging for people living with HPD and other personality disorders. 

Internal family systems therapy (IFS) 

Other options 

In addition to therapy, a person living with HPD may be prescribed medication for comorbid mental disorders, such as anxiety or depression. Other support options might include support groups, dialectical behavior therapy, and intensive outpatient mental health services. 

The BetterHelp platform is not intended for any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. Do not take any action without consulting a qualified medical professional. 

Finding support for histrionic personality disorder 

If you think you may be experiencing symptoms of histrionic personality disorder, speaking with a licensed mental health professional may help you gain clarity. However, alternative options are also available if you’re hesitant to see a therapist in person. 

Online therapy through a platform like BetterHelp allows clients to communicate with a therapist via video, audio, or live chat at a time that fits their schedule. With online therapy, clients can also contact their therapist at any time via messaging, receiving a response as soon as they are available. This option may be helpful if a person experiences emotional challenges or interpersonal difficulties between therapy sessions. 

Peer-reviewed studies have shown that online therapy is effective in supporting individuals with mental disorders. One study found online therapy effective in treating anxiety, depression, and bipolar disorder, which may be co-occurring with personality disorders.