It’s thought that between 0.4% and 1.8% of the general population have histrionic personality disorder (HPD). People with HPD base their sense of self-worth on the approval of others to an extreme degree. This often results in behavior that is overly dramatic, exaggerated, or inappropriate as a way to gain attention.
If you or someone you care about experiences HPD symptoms, understanding the condition can help you access the right support. In this guide, we’ll explain what HPD is and explore common treatment options.
Understanding Histrionic Personality Disorder
Histrionic personality disorder is a Cluster B personality disorder. It leads people to behave in ways that appear overly emotional, erratic, or dramatic in order to draw attention from others.
HPD is sometimes attributed to public figures in popular commentary and true-crime coverage. Diagnosing someone from a distance, or after their death, isn’t clinically valid. A personality disorder diagnosis requires direct assessment by a qualified professional who has evaluated the person over time.
Women are more likely to receive an HPD diagnosis than men, though the condition may be underdiagnosed in men. People with HPD often display observable symptoms by the time they reach young adulthood.
Symptoms and Traits
The symptoms of HPD are generally oriented toward generating attention. Common signs include:
- Experiencing emotions that shift rapidly from one extreme to the other
- Constantly seeking reassurance for things they’ve done
- Being extremely concerned about their appearance
- Being overly sensitive to criticism, even when justified and delivered in a non-threatening way
- Acting in a dramatic or overly expressive way
- Being easily influenced by others, which results in constantly shifting decisions
- Not being comfortable in any situation unless they’re the center of attention
- Becoming easily bored by routine
- Beginning a project but then dropping it when it requires attention or effort
- Having a low tolerance for frustration
Dr. Beau A. Nelson, DBH, LCSW, FHE Health’s Chief Clinical Officer, points out that “histrionic relationship cycle issues with flare ups and intense emotional outbursts can create friction with the support systems of the patient needing support and help. Lashing out or having a negative emotional reaction can push people away and this often makes loneliness and desperation increase, it is a vicious cycle.”
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Causes and Risk Factors
Researchers don’t know what causes HPD, but genetic and environmental factors both appear to play important roles. If HPD runs in several generations of a family, a genetic susceptibility may exist among its members. A child of a parent with HPD who begins to exhibit the same behaviors may also be repeating what they’ve observed at home.
Environmental factors may include a lack of consistent boundaries around difficult behavior, unpredictable attention from caregivers, or praise given only for particular behaviors. As a result, a child may feel uncertain about how to behave and how to earn genuine approval. In adulthood, this sometimes leads to dramatic behavior designed to generate attention, because the person isn’t sure of the appropriate way to gain approval from their peers.
Over time, these patterns can strain relationships with family, friends, and partners. The need for constant reassurance, and difficulty coping when someone else receives more attention, can wear down the people closest to them.
Co-Occurring and Related Conditions
HPD can interfere with everyday life on its own, and it can also raise the risk of other conditions, including depression, alcohol use disorder, and substance use disorder.
Conditions that commonly co-occur with HPD include:
- Conversion disorder. Conversion disorder occurs when a person loses some or all function of part of the nervous system without physical or structural damage. It’s understood to have a psychological origin but presents with physical symptoms.
- Panic disorder. Panic disorder involves an acute fight-or-flight response to a non-threatening or only mildly threatening situation.
- Somatic symptom disorder. Somatic symptom disorder happens when a person focuses obsessively on minor physical ailments to the point that it interferes with daily living.
- Other personality disorders. Meeting criteria for more than one personality disorder is relatively common. Borderline personality disorder (BPD) may co-occur with HPD; BPD involves a negative self-image and emotions felt more intensely than other people experience them. Narcissistic personality disorder (NPD) can also appear alongside HPD, and is characterized by attention-seeking behavior aimed at admiration rather than reassurance.
Suicidal thoughts, threats, and gestures can occur in HPD, often in the context of relationship distress. Any expression of suicidal intent should be taken seriously and evaluated by a mental health professional.
If you or someone you know is in crisis, call or text 988 to reach the Suicide & Crisis Lifeline, available 24 hours a day.
Diagnosis
If a doctor suspects HPD, they will typically begin with a complete physical examination and a thorough review of the person’s medical history. No lab test can detect HPD, but testing can rule out a medical cause for the person’s symptoms.
If medical testing comes back negative, the doctor will usually recommend a consultation with a psychiatrist or psychologist. This is the more productive path, because these mental health care professionals have the assessment tools designed to identify HPD and distinguish it from other personality disorders.
Treatment Options
HPD is most often treated with the help of a psychologist or psychotherapist. Recognizing the need for help can be difficult, and once a person does, following a treatment plan or attending regular appointments can be a challenge, because routine tends to feel boring and frustrating.
Once someone commits to the process, mental health professionals can help them work with their diagnosis. Talk therapy that helps a person recognize unhelpful behavior patterns and build healthier coping strategies is the most common treatment approach. Where appropriate, a prescriber may also use medication to address co-occurring depression or anxiety.
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Living With and Supporting Someone With HPD
Living with histrionic personality disorder, or supporting a loved one who has it, can be difficult. With the right strategies in place, people with HPD can live full, productive lives.
If you have an HPD diagnosis, identifying what triggers your behavior patterns and building self-validation skills can help. Some people find that mindfulness and grounding techniques help them regulate emotional reactions. A licensed mental health professional can help you find the strategies that work for you.
Friends and family members can help by understanding what drives these behaviors, offering steady emotional support, and encouraging their loved one to seek professional care. Protecting your own mental health matters too. Clear, consistent boundaries often do more to keep a relationship healthy than accommodation does.
How FHE Health Can Help
There’s no permanent cure for histrionic personality disorder, but the condition responds to therapy and, where indicated, medication. Patients who follow an effective treatment plan can build better relationships and a more stable sense of self.
If you’re concerned about your ability to form solid relationships, your behavior feels out of control, or you think you may be dealing with a mental illness, we can help. Contact us to speak with a team member and take the next step toward recovery.
Frequently Asked Questions
The FHE Health team is always ready to answer questions about histrionic personality disorder. Here are our answers to the most common ones.
