Histrionic Personality Disorder

Histrionic personality disorder symptoms may vary with sociocultural influences, circumstances, and individual traits. However, according to the Fifth Edition Text Revision (DSM-5-TR), individuals must meet five of the following eight criteria to be diagnosed with HPD:

• Discomfort when not the center of attention. A central feature of HPD is typically a constant need for attention. Individuals with HPD may speak dramatically or engage in other attention-grabbing behaviors to maintain the focus on themselves.
• Inappropriately seductive or provocative behavior. Individuals with HPD may use their sexuality to draw attention and gain favor with others, often inappropriately. This behavior may go beyond romantic interests and extend to professional or social contexts.
• Shallow and labile emotions. People living with HPD may have emotional expressions that are shallow and rapidly changing. They might be enthusiastic one moment and despondent the next without any apparent reasons.
• Use of physical appearance to gain attention. Individuals living with HPD may spend a lot of time and money on clothing and appearance. They may be highly sensitive to criticism about the way they present themselves. 
• Speech that is overly impressionistic and lacks detail. Individuals with HPD may express dramatic opinions but then be unable to substantiate them.
• Excessive emotionality. Individuals with HPD may display strong emotions in a dramatic and theatrical manner. They may perform excessive displays of emotions in public, such as hugging acquaintances inappropriately.
• High suggestibility. People with HPD may be easily influenced by others and may adapt their behavior or opinions to gain approval.
• Overvaluation of relationships. People living with HPD may assume relationships are more intimate than they are. They may also quickly become infatuated with others, only to lose interest once the initial excitement diminishes.

Having some of these traits doesn't necessarily mean a person has histrionic personality disorder. For an HPD diagnosis, the DSM-5 states that: 

• The individual must consistently display five or more of the above symptoms. 
• Symptoms must begin by early adulthood.
• Symptoms must be persistent and occur often.
• Symptoms must cause significant distress or impairment in various areas of life.
• Symptoms must not be better explained by another mental health condition.

It can be important to recognize that the behaviors of people with HPD are symptoms of their disorder and not personal choices.

The exact causes of HPD are complex and not fully understood, but it is believed to result from a combination of genetic, social, and psychological factors. However, due to its developmental variability and patterns of emergence, researchers believe a combination of environmental, biological, and genetic factors may contribute to the onset of histrionic personality disorder (HPD). 

Environmental factors

Research indicates that childhood trauma is strongly connected to HPD, particularly in the form of sexual abuse and neglect.

Other environmental causes may include:

• Erratic patterns of attention from caregivers
• Reinforcement of attention-seeking behavior as a child
• Lack of healthy boundaries and consequences for unacceptable behavior
• Exposure to HPD behaviors from a parent or caregiver
• Withholding of approval from a parent or caregiver

Heritability

Scientists believe there may be a link between genetics and HPD due to its strong connection within families. 

Collective use of current family and twin studies may yield more conclusive connections, but based upon the research available, experts believe the symptoms of HPD are interwoven within families where members have a pre-existing mental illness, creating a case for both genetic factors and adverse environment.

Currently, there is no cure for histrionic personality disorder (HPD), but there are multiple therapeutic methods for treatment.⁴ Treatment for HPD aims to alleviate distressing symptoms, improve social and personal functioning, and empower individuals with coping strategies through a personalized therapeutic approach.

Medication

While not a standard treatment for the disorder, medications may be also be helpful in treating symptoms of common comorbidities like anxiety and depression. Do not start, stop, or change medications without consulting with a physician or other qualified health professional.

Other treatment options

Depending on the severity of symptoms, people with HPD may sometimes experience difficulties maintaining close, stable relationships. They may also have trouble with productivity at work, at school, and in other areas of daily life. As a result, treatment for individuals with HPD may include communication skills training and other forms of practical support.

Self-care

Self-care techniques, such as maintaining a healthy lifestyle through diet, exercise, and mindfulness practice, may also be helpful but should typically be used in conjunction with psychotherapy as a form of treatment for HPD.

Engaging consistently in therapy and building meaningful social relationships can be crucial for those managing HPD, as ongoing treatment and community support can enhance treatment outcomes.

Once they've committed to treatment, people with HPD may see improvement in their symptoms and become more comfortable in daily interactions. How long this takes may depend on the individual, the support they receive from others, and the availability of treatment. 

If you or someone you know may have HPD, plenty of resources are available to help. For example, many federal agencies offer resources for finding local mental health care providers and low- to no-cost mental health services:

• Health Resources and Services Administration (HRSA)
• National Alliance on Mental Illness (NAMI)
• Substance Abuse and Mental Health Services Administration (SAMHSA) 

For those with scheduling challenges, there are many online platforms dedicated to matching individuals to therapists experienced in treating personality disorders. Some people with HPD may find virtual therapy to be more comfortable than in-person treatment. This may be particularly true for those with comorbid disorders, such as anxiety, depression, and other personality disorders.

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988. Please also see our Get Help Now page for more immediate resources.

Emerging research on histrionic personality disorder yields important insights that may help mental health professionals treat it and prevent symptoms from interfering with the individual's’ relationships and quality of life. 

For example, a 2019 study published in the Journal of Mental Health and Addiction developed a hypothetical model of the relationship between HPD, narcissistic personality disorder, and social media disorder. In the study, 305 adolescents were administered four self-assessments: the Personality Belief Questionnaire-Short Form, the Need for Social Approval Scale, the Desire for Being Liked Scale, and the Social Media Disorder Scale. 

According to the researchers’ findings, the need for social attention and approval (prevalent in many with HPD) drove social media addiction within the study population. Also, histrionic personality belief influenced the need for social approval and the desire to be liked. Furthermore, researchers found a positive link between social media addiction and those with narcissistic personality disorder. Although more quantitative research is required for a definitive connection, the findings suggest that clinicians might help patients living with social media addiction by focusing on their personality beliefs. 

Another 2022 study measured the effectiveness of clarification-oriented psychotherapy (COP) on a group of 159 patients diagnosed with HPD. Specific therapeutic sessions were video-recorded and surveyed using the Process-Content-Relationship Scale, and therapy outcomes were assessed using symptom measurements during intake and discharge. 

The study found that COP reduced symptoms of people living with HPD and that improvement in the client-therapist relationship was systematically related to therapeutic outcome.  These findings may have a significant impact on how the disorder is treated in the future.

Here are some key statistics on histrionic personality disorder and other personality disorders: 

• HPD has a prevalence rate of less than 2.1% of the general population.
• Between 34.8% and 73.0% of patients treated for addictions have a co-occurring personality disorder, such as HPD.
• Studies suggest that approximately 83% of people with B cluster personality disorders, such as HPD, also have Axis I comorbidities like anxiety and depression.
• According to one study, approximately 52% percent of patients who continued to participate in therapy for more than one year no longer fulfilled all of the criteria for a personality disorder when they were evaluated during post-treatment follow-up sessions (after receiving an average of 1.3 years of therapy). This finding perhaps underscores the importance of treatment adherence for those with HPD.