Histrionic personality disorder: Common characteristics and effective treatment

What Is Histrionic Personality Disorder? Understanding Histrionic Personality Disorder

Histrionic personality disorder is a personality disorder characterized by dramatic behavior, mood swings, and an unstable self-image. Histrionic personality disorder is a “Cluster B” personality disorder, meaning it involves dramatic and erratic behaviors and emotional dysregulation. Symptoms and characteristics include: 

• Mood swings
• An exaggerated desire to be the center of attention
• Acting seductively or provocatively despite social norms
• Being overly concerned with physical appearance
• Difficulty with criticism
• Being easily influenced
• Seeking constant reassurance or approval from others
• Impulsive behavior

Typically, someone with histrionic personality disorder requires and demands attention at all costs, in any situation, and will sacrifice their personal morals and social customs to meet their need for attention. They can often be called selfish, and their outward symptoms may resemble those of narcissistic personality disorder, though they are two distinct disorders.

Criteria Used to Diagnose Histrionic Personality Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), histrionic personality disorder is a pattern of excessive emotionality and attention-seeking behavior that begins in early-adulthood and is indicated by five or more of the following symptoms:

• Feels uncomfortable in situations where they are not center of attention.
• Interactions with others usually involve inappropriately seductive or provocative behavior.
• Displays rapidly shifting and shallow expressions of emotions.
• Uses physical appearance to attract attention from others.
• Consistently uses a vague or impressionistic style of speech, lacking in detail.
• Shows self-dramatization and exaggerated expression of their emotions.
• Being very suggestible or easily influenced by others or circumstances.
• Considers relationships to be more intimate than they are.

Histrionic personality disorder usually isn’t diagnosed until after someone is 18, as one’s personality is still developing. Because people with this disorder frequently don’t see a problem with their behavior, it is often a co-occurring condition, like anxiety or depression, that brings them in for treatment.

Histrionic personality disorder may make it difficult for individuals to achieve emotional intimacy in their romantic relationships and cause rifts with friends due to their provocative nature. It is common, too, for these individuals to become easily frustrated with situations that don’t result in direct or immediate gratification and satisfaction for them.

However, it’s important to note that an excessive sensitivity and desire for attention do not automatically lead to a diagnosis of histrionic personality disorder. Specific criteria must be met, which is why one should consult a mental health professional about their symptoms before making any assumptions.

What Causes Histrionic Personality Disorder? Psychological, Cultural, and Social Factors

Histrionic personality disorder does not have a specific, direct cause, but it can be influenced by a number of environmental and genetic factors. 

For example, someone with a family history of personality disorders might be genetically predisposed to developing histrionic personality disorder. Individuals raised in a household where parents are either overly indulgent or inconsistent in their attention and discipline. The child may learn to use dramatic and attention-seeking behaviors to receive validation and care. 

Additionally, cultural and social influences can play a significant role. For example, in societies or social circles that reward or emphasize expressive and flamboyant behavior, individuals may adopt these traits to fit in or stand out. 

Childhood experiences, such as trauma or neglect, can also impact personality development, leading individuals to develop maladaptive coping mechanisms like those seen in histrionic personality disorder to handle feelings of insecurity or low self-esteem.

What Are Common Characteristics of Histrionic Personality Disorder?

Characteristics of histrionic personality disorder vary between each person, so it’s important to understand the individuality of each case of the condition. However, there are some common characteristics that many who have this disorder share, such as: 

• Needs to be the center of attention
• Extreme attention-seeking behavior, no matter the setting 
• Focus on appearances
• Unstable mood 
• Dramatic expression
• Easily influenced to fit in
• Misreads relationships
• Shallow emotions, quickly changing
• A constant need for acceptance, praise, and reassurance from others
• A low threshold for criticism and feedback
• Impulsive decision-making processes
• Seductive, provocative, or inappropriate behaviors

The common goal of those with histrionic personality disorder is, again, to gain attention, which they see as validation and acceptance. They use this as a way to reduce the inner distress and conflict they are often feeling.

Histrionic Personality Disorder vs. Narcissistic Personality Disorder: What’s the Difference?

While the two personality disorders can look very similar, they do have distinct differences and diagnostic criteria that can be used to separate the disorders. 

Those with histrionic personality disorder typically have less impulse control and more rapid, severe mood swings than those with narcissistic personality disorder (NPD). Further, those with NPD are not as singularly focused on getting the attention of others. They also desire to obtain wealth, power, and influence over others through their behavior. 

Those with NPD have an ultimate goal of power, control, and influence, while those with histrionic personality disorder largely aim to be the center of attention and gain acceptance and praise from others. While similar, the motivations that exist within the disorders differentiate.

Effective Treatment Approaches for Histrionic Personality Disorder

While histrionic personality disorder can indeed be treated, many individuals with the disorder do not seek treatment or even believe they need treatment. For those who do, these treatments are the most promising:

• Psychotherapy: Counseling is one of the best ways to treat histrionic personality disorder. Its primary purpose is to help the clients discover the motivations and fears driving their thoughts and behaviors.
• Medication: Medication is another treatment option for histrionic personality disorder sufferers. It can be used to treat difficult symptoms, like depression or anxiety, that may occur alongside the disorder.

Counseling and supportive therapy services are not only recommended, but effective for the treatment of histrionic personality disorder. Cognitive behavioral therapy (CBT) can be a great tool for helping clients identify, challenge, and replace negative automatic thoughts and gain insight into the effects of their behaviors on themselves and others. 

Mindfulness training is also helpful in increasing insight and accountability and decreasing the propensity to engage in impulsive behavior patterns. Finally, dialectical behavioral therapy (DBT) can provide additional insight and structure for clients, allowing them to learn about their own processes and motivations behind their actions.