Living With Histrionic Personality Disorder

Do you know someone who is basically always overly dramatic, excessively emotional, and seems to need to be the center of attention in all situations? Maybe you’ve been told that you are like this multiple times or noticed this behavior in a friend or family member. Whatever the case, you’re probably wondering how and where this behavior stems from. The answer? Histrionic personality disorder (HPD).

Not everyone who tends toward drama and attention-seeking has a personality disorder but when taken to the extreme, sometimes these behaviors are signs of histrionic personality disorder. Want to learn more? Scroll down to find everything you need to know about HPD, including what it is, what it looks like, how it impacts people who have it, and how it can be treated and managed.

Understanding Histrionic Personality Disorder

Histrionic personality disorder “is a mental health condition characterized by intense emotionality and a strong desire to be the center of attention,” explains Stephanie Lewis, LICSW, LCSW, LSW, therapist and executive director of Epiphany Wellness Centers. “People with HPD may feel uncomfortable when they are not in the spotlight, so they often act in dramatic ways to draw attention.”

Like other personality disorders, histrionic personality disorder tends to be chronic, meaning that people live with the disorder throughout their lives. You may start to show signs in your teen years or when you are a young adult. People who have HPD are often described as dramatic, flirty, self-centered, and extremely extroverted. They may even be called narcissistic.

Origins and Background

Why is it called histrionic personality disorder? Its origin goes back to Greek and Roman times when people with intense, overly dramatic personalities were often called “hysterical.” Typically, this description was stereotypically given to women. The word “histrionic,” though it derives from a Latin root, has similar connotations. Sigmund Freud often discussed the idea of “hysteria” and women’s behaviors, but histrionic personality disorder, as we know it now, wasn’t formally recognized in the psychology world until 1980. Only then was it added to the Diagnostic and Statistical Manual of Mental Disorders as a condition and could be diagnosed.

HPD is a type of personality disorder—namely, a cluster B personality disorder. “Histrionic personality disorder is the third disorder in the Cluster B of personality disorders and has similar characteristics to narcissistic personality disorder (NPD) and borderline personality disorder (BPD),” explains Elisabeth Crain, PsyD, a licensed psychotherapist based in Southern California. Besides narcissistic personality disorder and borderline personality disorder, other cluster B personality disorders include antisocial personality disorder.

Symptoms and Diagnosis

The defining symptoms of HPD are being attention-seeking, dramatic, and hyper-emotional. “Some key signs include rapidly changing emotions, a tendency to use their appearance or flirtatious behavior to gain approval, and being easily influenced by others,” Lewis describes. Additionally, she says, a person who has HPD often experiences low self-esteem, or self-esteem that relies heavily on how much praise or attention they’re getting. This can make rejection very hard to handle.

According to Dr. Crain, some other common symptoms of HPD include:

Diagnosing Histrionic Personality Disorder

As Dr. Crain points out, it’s often difficult for people to get diagnosed with HPD. “People with personality disorders hardly seek treatment,” she shares. That said, if you think you may have HPD—or you are the friend or family member of someone who you suspect has it—it’s important to get evaluated by a mental health professional.

Diagnosis of HPD is based on the DSM-5 from the American Psychiatric Association. You must exhibit five of the following signs to be diagnosed with HPD:

• Feeling uncomfortable when you aren’t the center of attention
• Exhibiting sexually inappropriate or proactive behaviors
• Experiencing rapid and extreme emotional shifts
• Using your physical appearance to get attention
• Speaking in vague, undetailed manners
• Expressing yourself in dramatic or theatrical ways
• Easily influenced by others or the situations you find yourself in
• Often view a relationship as being more intimate than it actually is

Even if you display five or more of the symptoms above, it doesn’t mean you’re guaranteed to receive a diagnosis. Since personality continues to evolve, professionals don’t typically diagnose until after age 18. Furthermore, mental health professionals require a lot of information, from history to relationships and behaviors, to assess before making a proper diagnosis. This is not to say you can’t get diagnosed, but the process is much more complex.

Causes and Risk Factors

Similar to other personality disorders, it’s not fully known what causes histrionic personality disorders. Experts believe that it’s likely a combination of influences. These include genetic factors, early childhood experiences, and environmental impacts.

There are certain factors that may put you at higher risk of having HPD. These include:

• A history of child abuse and neglect
• A history of childhood sexual abuse
• A family history of HPD or other personality disorders
• A history of neurological damage
• A history of head trauma, stroke, epilepsy, endocrine issues, heavy metal poisoning, Huntington’s disease, or multiple sclerosis

Impact on Life and Relationships

Having HPD not only impacts the person who has the condition but also affects those around them.

HPD can shake up your personal relationships, says Lewis. “Someone with HPD might seek constant attention, which can make it challenging to maintain long-term, stable relationships,” she explains. This behavior doesn’t just impact your friendly and familial connections but also your relationships in the workplace, as attention-seeking and acting out are usually frowned upon in work environments.

Folks with HPD often have issues with confidence and identity, too. “Their self-image and self-esteem are often fragile since they depend so much on outside approval,” Lewis shares.

Dr. Crain agrees, noting that low self-esteem is one of the cornerstones of HPD. “People with HPD tend to struggle with self-esteem issues, which stem from their difficulty maintaining relationships,” she says. One area that can be particularly affected by this is romantic relationships, Dr. Crain adds. That’s because it’s very difficult to get close to or trust someone who constantly desires reassurance and displays attention-seeking behaviors.

Treatment and Management

The sad truth is that the majority of people with HPD don’t get treatment for their disorder, often because they don’t recognize they need the help, or aren’t able to see that their behaviors are problematic. Furthermore, people with HPD don’t like to be criticized, and admitting that something may be wrong can feel like too much of a critique.

There aren’t any formal treatment plans for HPD, though it’s typically treated with psychotherapy. “Therapy is often the most effective way to help someone with HPD manage their behaviors and work towards healthier relationships,” Lewis describes. Unfortunately, it’s often thought that HPD treatment is only minimally effective because it’s a life-long personality trait, rather than a problem that can be isolated and treated.

That said, many people with HPD and their loved ones find relief with therapy. “The go-to treatment for HPD is therapy, especially cognitive behavioral therapy (CBT), which helps individuals identify and change unhealthy thought patterns and behaviors,” Lewis explains. “Dialectical Behavior Therapy (DBT) can also be helpful, focusing on managing emotions and improving relationships.”

And what about medication? There are no approved HPD medications. But it’s possible to treat some of the symptoms you may experience if you have HDP. “While medication does not directly treat HPD, it can help if there are co-occurring issues like anxiety or depression,” Lewis offers.

Living with Histrionic Personality Disorder

Living well with histrionic personality disorder can be challenging, but it’s possible. According to Lewis, some coping strategies include:

Lewis emphasizes the importance of therapy for people with HPD, and shares a successful story of an HPD client she worked with. “One client felt a constant need for attention, which led to dramatic behavior that pushed people away,” she describes. “Through therapy, she learned to develop deeper connections and reduce her reliance on external validation.”

As time went on, Lewis’s client was able to find fulfillment in more authentic relationships and was able to learn healthier coping mechanisms where she was not the center of attention. “It was not an easy journey, but it was gratifying for her,” says Lewis.

Use Friends and Family for Support

Having support from friends and family members is also vital when someone has HPD. Lewis shared thoughts on how you can support a loved one who has HPD:

• Set clear boundaries with them
• Offer emotional support
• Model healthier coping mechanisms and relationship skills
• Try to be patient and understanding, acknowledging that their behavior you see comes from a deep need for validation
• Encourage your loved one to seek therapy
• Offer helpful resources, such National Alliance on Mental Illness (NAMI), which offers free, online information about mental health and coping

The Bottom Line

People with histrionic personality disorder are often misunderstood. Their behaviors of being overdramatic, attention-seeking, impulsive, and volatile can be off-putting and relationship-ruining. But it’s important to understand that people who display these behaviors aren’t doing this to intentionally harm others—in some cases, they are dealing with a personality disorder.

Remember: never try to diagnose histrionic personality disorder yourself, even if you are convinced you or a loved one has it. Always seek advice and care from a licensed mental health professional if you are showing signs of histrionic personality disorder.