What Is Histrionic Personality Disorder? Symptoms & HPD Treatment

What Is Histrionic Personality Disorder?

Histrionic personality disorder is a personality disorder defined in the DSM-5 as an ongoing pattern of excessive emotionality and attention-seeking behavior that typically develops early in life and continues across a wide range of different contexts.[1] Like all other personality disorders, HPD reflects deeply ingrained thought, emotional, and relationship patterns that are ego-syntonic in nature, which makes developing a clear understanding of the condition and engaging in treatment particularly challenging.

HPD is classified as a Cluster B personality disorder along with others known for their dramatic, emotional, or erratic presentations, such as borderline personality disorder (BPD), narcissistic personality disorder (NPD), and antisocial personality disorder.[2] HPD is estimated to affect around 1-3% of the general population, and affects men and women equally.[3]

People diagnosed with histrionic personality disorder are high-functioning: they have social skills, charisma, and can be engaging and fun to be around. However, the distress associated with HPD is most observable in the context of intimate relationships or when their need for attention or reassurance is not being met.

What Causes HPD?

As with the other personality disorders, HPD develops through a combination of biological factors and early life experiences, and can be influenced by the following factors:

• Genetic and temperamental factors — Histrionic personality disorder is believed to involve a combination of genetic and environmental factors, with inherited personality traits contributing to risk.[4]
• Developmental and relational factors — Early life experiences, including lack of consistent or emotionally available caregiving, environments where attention and emotional validation were conditional or unpredictable, and being neglected or emotionally invalidated, are all associated with an increased risk for developing a personality disorder, including HPD.[5]
• Learned patterns of relating — The attention-seeking patterns that were used at a young age to satisfy needs become ingrained patterns and continue into adulthood, even if they are no longer effective.[6]
• Other mental health disorders — HPD commonly co-occurs with mood disorders, anxiety disorders, other personality disorders, or substance abuse, and can complicate the clinical presentation and require integrative treatment.[7]

Symptoms of Histrionic Personality Disorder

HPD symptoms cluster around two key themes: excessive need to be the center of attention and emotional expressions that are rapidly shifting and dramatic in nature. HPD symptoms may include the following:

• Experiencing significant discomfort when not the focus of attention in social situations
• Consistently using one’s appearance or seductive behavior to gain attention
• Rapid changes in emotional expression that may seem theatrical or exaggerated to others
• Speaking in an impressionistic manner that is emphatic in delivery but often vague in context
• Being easily influenced by others or one’s environment
• Perceiving social relationships as being more intimate than they are
• Overly dramatic or theatrical self-expression that appears disproportionate to the situation
• A high need for affirmation and acceptance from other people
• Difficulty focusing on the needs of others or the perspectives of others in relationships

Not everyone who exhibits attention-seeking behavior has HPD. That is why it is important to distinguish HPD from the ordinary human desire for connection and recognition. An HPD diagnosis reflects long-standing patterns that are persistent and that cause significant distress or functional impairment.

When to Seek Professional Help

Because features are ego-syntonic (they feel acceptable and natural and are consistent with self-image), many people with histrionic personality disorder have difficulty recognizing how problematic their behavior is.[8]  As a result, most do not seek help.

However, professional help is typically sought after or recommended when:

• The pattern of relationship difficulties has become painful and persistent
• Emotional pain, anxiety, or depression has developed along with HPD
• Co-occurring conditions, including substance use, are present
• Behavior is causing significant impairment in work, school, or in daily life.
• A loved one expresses concern for their well-being, and the person shows an openness to exploring what treatment may provide

Patients often have questions about the possibility of being “cured” of HPD. It is more effective to frame treatment as something that can bring meaningful change to HPD patterns. Many people experience a significant improvement in self-awareness, relationships, and overall well-being over the course of treatment.

Histrionic Personality Disorder Treatment at Helios West Palm

Patients with HPD benefit from clinically appropriate treatment that addresses both the surface behaviors and the underlying emotional needs and self-image issues that drive them. At Helios West Palm, treatment begins with an extensive psychiatric evaluation that provides clinicians with a complete picture of how they will structure the individualized treatment plan. Individual therapy is foundational to HPD treatment. Through ongoing, one-on-one therapy with an experienced licensed clinician, the patient can develop emotional depth, self-awareness, and more authentic interpersonal patterns. 

Psychodynamic approaches are especially valuable because, through the exploration of early experiences, the clinician and patient will have a better understanding of how those experiences impacted the development of current patterns.

Benefits of HPD Treatment

With the right treatment approach and therapist, many people with HPD can see meaningful and lasting change. The following are some of the benefits of evidence-based treatment:

• Increased self-awareness — Develop a clearer, more stable understanding of your emotional needs and patterns and how they affect other people.
• More authentic, lasting relationships — Relationships will no longer be characterized by attention-seeking behavior. They will be built on genuine connection.
• Improved self-esteem — Develop a more internally based self-esteem that does not rely on constant external validation.
• Better emotional regulation — Learn to feel and express your emotions without the dramatic intensity that puts strain on your relationships.
• Less distress in non-attention-seeking situations — Reduced distress in situations where you cannot be the center of attention.
• Better daily functioning and a more consistent sense of self — A more coherent sense of self and ability to function.

Better management of co-occurring conditions — Many people with HPD have co-occurring conditions like depression and anxiety. By addressing both conditions together, patients can benefit from improved coping skills to meet all their emotional needs.