Histrionic Personality Disorder

This article provides a comprehensive overview of histrionic personality disorder to help better understand this condition. The following sections cover the causes, symptoms, and effects of histrionic personality disorder, while also going over proper treatment and self-management.

Understanding Histrionic Personality Disorder

Histrionic personality disorder is a mental health disorder characterized by heightened emotionality and excessive attention-seeking behaviors across a wide variety of contexts. It typically develops around late adolescence or early adulthood. Individuals with histrionic personality disorder have a strong desire to be the center of attention or in the spotlight. Their actions may cause others to view them as lively, entertaining, flirtatious, narcissistic, or dramatic, depending on the exact behaviors and situation involved.^[1][2]

The roots of histrionic personality disorder go as far back as ancient Egypt and Greece. The Greeks identified certain people who were excessively emotional or attention-seeking as “hysterical”. This was based on their word “hystera”, meaning uterus, because they believed that the behaviors of excessive emotionality and attention-seeking were exclusive to women and resulted from disturbances in the uterus.^[1][3]

Over the years, many similar descriptions of hysteria were described, although with various beliefs behind the causes, based on the culture and time period. In the 19th century, psychologist Sigmund Freud suggested the concept of “hysteria” to describe these same behaviors of attention-seeking and emotionality.^[1][3]

An official category for hysteria was established in 1968 in theDiagnostic and Statistical Manual of Mental Disorders,2nd edition, (DSM-2). In this edition, it was called hysterical personality disorder. However, this was changed to histrionic personality disorder in theDSM-3in 1980, in part because many thought the initial name was too closely connected to the stereotypical notion of hysteria being only present in women.^[1][4]

Histrionic personality disorder is a part of cluster B personality disorders, which are characterized by dramatic, emotional, or erratic disorders. Other disorders within this cluster are antisocial, borderline, and narcissistic personality disorders.^[1]

Causes of Histrionic Personality Disorder

The exact causes of histrionic personality disorder are not completely identified, although there are many likely factors. This includes genetic predispositions, childhood events, environmental influences, and personality factors.

One of the most significant risk factors for histrionic personality disorder is child abuse and neglect. This damages self-esteem and promotes insecure attachment styles, which, among other factors, plays a role in the development of the common behaviors seen in this disorder.

Genetic factors, such as having a parent with histrionic personality disorder, also increase the risk of this disorder. However, no specific genes or mechanisms are known yet.^[1]

There are also possible environmental causes as well, such as inconsistent parenting styles, rewarding the child for attention-seeking behaviors, and a lack of appropriate punishment or criticism for negative behaviors. Additionally, if a parent exhibits dramatic, erratic, or inappropriate behavior, a child may learn to implement these behaviors as well.

Lastly, there are certain personality traits often found in individuals with histrionic personality disorder. These include:^[1]

• Low harm avoidance

• High novelty-seeking

• High reward dependence

• Low persistence

How Common Is It?

Histrionic personality disorder is a rare disorder, with a prevalence rate from 0.4 to 1.8%. Women are diagnosed around four times more often than men. However, this could be due to societal tendencies to overdiagnose women and underdiagnose men, as well as the general fact that more women than men seek professional help for treatment of any mental health disorder.^[1][4]

Symptoms of Histrionic Personality Disorder

The primary symptoms of histrionic personality disorder center around the need for attention and exaggerated displays of emotion. Some of the primary symptoms include:^[1][2][4]

• Heightened attention-seeking in social situations

• Desire to be the center of attention

• Dramatic or emotional speaking/gestures

• Express strong opinions, but not with many facts or supporting details

• Seductive and provocative behavior, including in inappropriate settings

• This also includes wearing seductive or provocative clothing

• Deep concern for one’s physical appearance

• Want to impress people with how they look

• Exaggerated emotions

• Rapidly changing and shallow emotions

• They may come off as insincere to others

• Bored very easily

• Require immediate satisfaction and instant gratification

• Easily influenced by other people and circumstances, such as current trends

• Quick to trust authority figures

• High levels of flirtatiousness and liveliness

• They also try to charm new acquaintances right away

• Tend to change jobs frequently

• Tend to move on from old friends easily (want to make new ones)

Overall, individuals with histrionic personality disorder need to structure their lives so that they are the center of attention and are able to receive immediate rewards/gratification. As a result, they can get easily frustrated or even depressed when these needs aren’t met.

Diagnosing Histrionic Personality Disorder

Diagnosing histrionic personality disorder is more challenging than some other mental health disorders, especially given that the symptoms can overlap with many other disorders. For example, individuals with narcissistic personality disorder also desire and seek attention, and people with borderline personality disorder experience intense emotions.

In addition, many individuals with this disorder often don’t view their behaviors as problematic. Thus, they may not seek out treatment unless it is initiated by a family member, or if they experience other resulting mental issues, such as anxiety or depression.^[1][4]

If histrionic personality disorder is suspected, your doctor will refer you to a psychiatrist, psychologist, or other qualified mental health professional for a comprehensive mental health evaluation. These professionals evaluate your behaviors across various contexts and circumstances to ensure they gain a complete picture of your overall functioning. This requires long-term observation and multiple sessions with the patient. Otherwise, the diagnosis is not deemed accurate.^[1]

Official diagnosis is made using the diagnostic criteria found in theDSM-5. The criteria are:^[1]

• A pervasive pattern of excessive emotionality and attention seeking, which begins by early adulthood and is found across various contexts, indicated by five or more of the following:

• Uncomfortable in situations where one is not the center of attention

• Often displays inappropriate sexually seductive or provocative behavior when interacting with others

• Exhibits rapid changing and shallow displays of emotion

• Consistently uses physical appearance to draw attention to oneself

• Uses excessively impressionistic and dramatic speech that lacks detail

• Displays self-dramatization, theatricality, and exaggerated emotional displays

• Easily influenced by other people or circumstances

• Believes that relationships are more intimate than they actually are

Is Histrionic Personality Disorder Still Diagnosed?

Histrionic personality is still recognized as a distinct mental disorder in theDSM-5and is thus still diagnosed.

Now, there are some concerns that the diagnostic criteria are still too centered on stereotypically feminine traits, such as being sexually provocative and being overly dramatic. This not only may contribute to a greater diagnosis in women compared to men, it also potentially results in stereotyping men who are diagnosed with this disorder. That is, men who receive a histrionic personality disorder diagnosis may be stigmatized by others as feminine or dramatic.^[4]

Histrionic Personality Disorder Tests and Assessment

Accurate diagnosis of histrionic personality disorder requires lengthy observation of behavior patterns and symptoms, while also going over personal history details and evaluating overall mental status.

A number of tests and assessments may be used to diagnose histrionic personality disorder. Firstly, symptoms are compared to the diagnostic criteria in the DSM-5 as mentioned just above. This is the most important diagnostic tool and is essential for an official diagnosis.

In addition, psychological tests may also be implemented to help further understand the individual’s personality traits, emotional functioning, and thought patterns in order to further support the diagnosis. Examples of possible assessments here include:

• Minnesota Multiphasic Personality Inventory (MMPI): This is one of the most commonly used tests designed to assess personality traits and psychiatric symptoms, such as depression, hysteria, and paranoia.

• Personality Diagnostic Questionnaire (PDQ): The PDQ consists of 54 statements that describe thought and behavior patterns. It’s often used to assess personality disorders.

• Eysenck Personality Inventory: This test consists of 57 questions specifically designed to measure extroversion vs introversion, and neuroticism vs stability.

Treatment for Histrionic Personality Disorder

The primary treatment for histrionic personality disorder is psychotherapy. Two of the most effective forms of psychotherapy for this disorder are psychodynamic therapy and cognitive behavioral therapy (CBT).

Psychodynamic therapy helps patients understand how their past experiences have shaped their current beliefs, thought patterns, and behaviors. Once these are identified, the goal is to develop healthier coping strategies and behaviors.^[2][5]

CBT helps individuals with this disorder identify and change any negative thoughts and behaviors that may be causing problems, such as low self-esteem, emotional instability, and a strong urge to seek attention.^[5]

Over time, both psychodynamic therapy and CBT may help individuals to:^[2]

• Communicate with others in a less dramatic, less emotional way

• Improve their self-esteem and sense of self/identity

• Discover and implement healthier alternatives to overly sexual or attention-seeking behaviors

• Explore areas of interest that act as healthier sources of pleasure/reward

Group therapy may also be considered when treating histrionic personality disorder. This form of therapy provides a supportive environment where individuals can work on their self-esteem, improve communication and relationship skills, and get a chance to see how their behaviors affect others. It is particularly beneficial when in a group of others with the same disorder.^[5]

Within therapy, it’s essential that a positive relationship is established between the therapist and client, especially since individuals with this disorder may be resistant to treatment. In order to establish this relationship, therapists should aim to create a positive alliance, while at the same time establishing firm, clear boundaries. The therapist should also create an environment that is consistent, safe, and supportive, yet without being overly accommodating.^[1][4]

Medication is generally considered ineffective for this disorder. With that said, antidepressants or anti-anxiety medications may be used to help resolve anxiety, depression, or other comorbid mental health concerns.^[1][5]

Self-Management for Histrionic Personality Disorder

Self-management should not be used in isolation for histrionic personality disorder since professional treatment is more beneficial. Nonetheless, there are many things you can implement on a daily basis to help better manage this condition. Just remember that these should be used in combination with professional treatment.

Such tips include:

• Practice mindfulness to gain greater awareness of your emotions and how they influence your behaviors

• Journaling to gain greater insight into your thoughts, feelings, desires, etc.

• Partake in activities you enjoy, which promotes self-confidence (and acts as a healthy reward)

• Implement stress-management techniques, such as yoga, meditation, or nature walks

• Set clear boundaries within relationships

• Take time to focus on your strengths and positive qualities

• Spend more time with people who are supportive and positive

• Let go of toxic relationships characterized by criticism, negativity, judgment, etc.

• Implement healthy lifestyle habits, such as adequate sleep, regular exercise, and a healthy diet

Final Thoughts

Histrionic personality disorder can often lead to significant difficulties with relationships, self-esteem, work, and overall mental well-being. These problems may all be magnified given that many people don’t understand this disorder and often attach negative labels to these individuals, which adds further distress.

However, many people with this disorder can still live enjoyable, fulfilling lives, especially if they receive professional treatment, communicate openly with others, and implement appropriate self-management techniques.