Histrionic Personality Disorder: Symptoms, Treatments, Causes

[David Baxter PhD]

What is Histrionic Personality Disorder? Symptoms, Treatments, Causes​

by Tori Morales, ADDitudeMag.com
August 8, 2022

What is Histrionic Personality Disorder?​

Histrionic Personality Disorder (HPD) is psychiatric condition associated with a pattern of attention-seeking behavior, inappropriate sexually seductive behavior, and discomfort with being outside the center of attention. People with HPD are overly dramatic and display exaggerated emotions¹.

HPD is one of the rarest personality disorders, occurring in only 0.83% of the population².

HPD is one of 10 personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Along with borderline, antisocial, and narcissistic personality disorders, HPD is a Cluster B disorder, which causes affected individuals to appear erratic, emotional, or dramatic.

What are the Symptoms of Histrionic Personality Disorder?​

People with histrionic personality disorder exhibit at least five of the following symptoms in a variety of situations:

• Experiences discomfort when he or she is not the center of attention
• Frequently displays inappropriate sexually provocative or seductive behaviors
• Has shallow and fleeting emotions
• Uses appearance to draw attention
• Vague but highly emotional speech
• Displays dramatized and exaggerated emotions
• Is highly suggestible
• Behaves as if relationships were more intimate than they are³

Other Signs of HPD​

People with HPD may struggle to form and maintain relationships, both platonic and romantic. They may alienate friends with inappropriate sexual behavior. They crave novelty and stimulation and are prone to becoming bored with their usual routine. Starting a project may feel invigorating, but they will often have trouble finishing, as they struggle with delayed gratification. HPD is also associated with low self-esteem, which leads to the need for approval and attention⁴.

Causes of HPD​

HPD has no known definitive cause, however preliminary studies have shown potential roots of the disorder, including:

• Genetics. HPD runs in families, so researchers theorize that there may be an underlying genetic link.
• Trauma. Trauma can change the way a child perceives the world, and therefore the way they interact with it, potentially resulting in HPD.
• Parenting. Most research into the cases of HPD has centered on parenting. HPD is correlated with permissive, over-indulgent parenting5.

HPD and ADHD​

Though HPD is uncommon, it is frequently comorbid with ADHD, with up to 35% of adults with ADHD meeting HPD criteria. HPD is the most common personality disorder among ADHD adults6. HPD and ADHD have similar effects, such as difficulty with interpersonal relationships and delayed gratification. However, theatricality and inappropriate sexuality are unique to HPD, while hyperfocus points primarily to ADHD.

Treating HPD​

Like many personality disorders, HPD is egosyntonic, meaning that HPD sufferers often do not realize they have a problem. Egosyntonic disorders are more difficult, though not impossible, to diagnose and treat.

HPD is most often treated with supportive psychotherapy that aims to improve self-esteem and coping skills in a patient, encouraging environment. Psychodynamic therapy, which aims to resolve unconscious conflicts and help patients understand themselves, is also effective. Some patients also benefit from cognitive behavioral therapy (CBT), which aims to help them unlearn negative patterns of thought and adopt healthier ways of thinking and interacting with the world.
Though there is no approved pharmacological treatment for HPD, antidepressants, mood stabilizers, and antipsychotics may be helpful to reduce emotional dysregulation⁷.

Histrionic Personality Disorder: Next Steps​

• Read: Is It Just ADHD? Comorbidities That Unlock an Accurate Mental Health Diagnosis
• Listen: Complex ADHD – The New Approach to Understanding, Diagnosing, and Treating Comorbidities in Concert
• Read: When It’s Not Just ADHD – Symptoms of Comorbid Conditions

Sources:​

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 667 Psychiatry Online
2. Volkert, J., Gablonski, T., & Rabung, S. (2018). Prevalence of personality disorders in the general adult population in Western countries: Systematic review and meta-analysis. The British Journal of Psychiatry, 213(6), 709-715. Prevalence of personality disorders in the general adult population in Western countries: systematic review and meta-analysis | The British Journal of Psychiatry | Cambridge Core
3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 667 Psychiatry Online
4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 667 Psychiatry Online
5. Batool, N., Shehzadi, H., Riaz, M. N., & Riaz, M. A. (2017). Paternal malparenting and offspring personality disorders: Mediating effect of early maladaptive schemas. The Journal of the Pakistan Medical Association, 67(4), 556–560.
6. Jacob, C. P., Romanos, J., et al. (2007). Co-morbidity of adult attention-deficit/hyperactivity disorder with focus on personality traits and related disorders in a tertiary referral center. European archives of psychiatry and clinical neuroscience, 257(6), 309–317. https://doi.org/10.1007/s00406-007-0722-6
7. French JH, Shrestha S. Histrionic Personality Disorder. [Updated 2021 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: Histrionic Personality Disorder - StatPearls - NCBI Bookshelf