Histrionic Personality Disorder

Individuals with Histrionic personality disorder (HPD) often exhibit dramatic and highly emotional behaviors, as their self-worth is largely dependent on the approval and validation of others. Although the theatrical nature of HPD can sometimes appear charming, it often masks a distorted self-image and can lead to significant difficulties in personal relationships and daily life. It’s one of several “Cluster B” personality disorders, which are known for dramatic and erratic behaviors.

What Is Histrionic Personality Disorder?

Histrionic personality disorder is a condition where a person’s emotions are intense and unstable, and they have an overwhelming desire to be noticed. The word “histrionic” itself means dramatic or theatrical, which perfectly captures the core of the disorder. People with HPD often feel uncomfortable and unappreciated when they’re not the focus of a conversation or a group. This constant need for validation can lead them to behave in ways that are inappropriate, flirtatious, or even manipulative to ensure they remain in the spotlight. Unlike a healthy sense of self-worth that comes from within, their self-esteem is built on external approval, making them highly dependent on others’ reactions.

Symptoms of Histrionic Personality Disorder

The key feature of histrionic personality disorder is a pattern of excessive emotionality and attention-seeking behavior. A person with HPD may exhibit a range of symptoms, including:

• Feeling uncomfortable when not the center of attention: They may get visibly upset or even depressed if they feel ignored or underappreciated.
• Rapidly shifting, shallow emotions: Their emotional expressions can be very dramatic, but they often lack depth and sincerity, changing quickly from one mood to another.
• Being overly dramatic and theatrical: They might act as if they are performing for an audience, often embarrassing friends and family with exaggerated emotions and expressions.
• Using physical appearance to draw attention: Individuals with HPD often dress in a provocative or flamboyant manner to ensure all eyes are on them.
• Having a “larger than life” presence: They can be persistently charming and flirtatious, using their social skills to capture and hold the attention of others.
• Speaking dramatically but vaguely: They may express strong opinions with great conviction but lack the facts or details to back them up.
• Being easily influenced by others: Because they crave approval, they can be gullible and highly susceptible to the suggestions and opinions of people they admire.
• Thinking relationships are more intimate than they are: They often believe their casual acquaintances are closer friends than they actually are.
• Seeking constant reassurance or approval: They are constantly fishing for compliments and validation from those around them.

What Causes Histrionic Personality Disorder?

The exact causes of histrionic personality disorder are not fully understood, but it is believed to be a combination of genetic, environmental, and psychological factors. Here are some of the potential contributing factors:

• Genetics: HPD seems to run in families, suggesting a possible genetic link. A person may inherit a predisposition to developing the disorder.
• Childhood trauma: Experiencing childhood trauma, such as abuse or neglect, can play a significant role. A child might develop attention-seeking behaviors as a way to cope with or respond to the trauma.
• Parenting styles: Inconsistent or over-indulgent parenting can contribute to the development of HPD. When a child receives attention only for certain dramatic or emotional behaviors, they may learn to continue these patterns into adulthood. Additionally, growing up with parents who display dramatic or erratic behaviors can model the same behavior for the child.

Histrionic Personality Disorder Diagnosis

Diagnosing histrionic personality disorder can be challenging because individuals with the condition often don’t see their own behavior as problematic. Instead, they typically seek help for related issues, such as depression or anxiety, which arise from relationship failures or other life problems caused by their disorder. 

Since a person’s personality continues to evolve through their teens, a diagnosis is not usually made before the age of 18. A mental health professional, such as a psychiatrist or psychologist, will conduct a comprehensive evaluation, including a review of the person’s past and current relationships, work history, and impulse control. Because the individual may lack insight into their own behaviors, the professional might also gather information from family and friends. 

Histrionic Personality Disorder Treatment

Treatment for histrionic personality disorder is primarily focused on helping the individual gain insight into their behaviors and develop healthier ways of interacting with others. The biggest challenge in treatment is that those with HPD often dislike routine and may exaggerate their feelings, which can make sticking to a plan difficult. However, many people find relief and improved functioning when they commit to a treatment plan.

Psychotherapy

Psychotherapy, also known as talk therapy, is the most effective form of treatment for HPD. The main goal is to help the individual explore the underlying fears and motivations behind their attention-seeking behaviors and learn to build more meaningful, stable relationships.

• Psychodynamic Psychotherapy: This approach helps the individual examine the psychological roots of their emotional distress and identify problematic patterns in their relationships.
• Cognitive Behavioral Therapy (CBT): CBT is a goal-oriented therapy that helps a person identify and change negative thought patterns and behaviors, replacing them with healthier coping mechanisms.
• Group Therapy: Group sessions can be particularly beneficial. By interacting with others who have similar diagnoses, an individual with HPD can see their own behavior reflected back at them, which can foster a new level of self-awareness.

Medications

A healthcare provider may prescribe medication to treat co-occurring conditions like depression or anxiety. Treating these symptoms can make it easier for the person to engage in therapy and work on their HPD behaviors.

Mental Health Care Tailored to You

All personality traits have both benefits and drawbacks themselves. It does not mean you have to change all of your personality once you are diagnosed with. A patient is able to

keep their good parts along with recognizing the parts that should be improved. In my

experience, histrionic personality patients are smart to notice people’s emotion, and try to support them. However, they do not realize their emotions until they show some unpleasant behavior and suffer from them. Supporting the patients to gently know the

bad parts is the best ways to let them adapt their behavior later

Living with histrionic personality disorder doesn’t mean you can’t have a productive and fulfilling life. With the right support, you can learn to manage your emotions, build genuine relationships, and find a sense of self-worth that isn’t dependent on the approval of others. 

Therefore, seeking professional help is the first step toward a healthier, more balanced life. If you’re ready to take that step, a qualified psychiatrist in Bangkok can provide the specialized care you need.

Contact Bangkok Mental Health Hospital today.

• Phone: 02-589-1889
• Line: @bmhh
• Mail: [email protected]
• Location: Bangkok Mental Health Hospital

Article By

Pathamabhorn Thongsookdee, M.D.
Child and Adolescent Psychiatry
Bangkok Mental Health Hospital (BMHH)