Histrionic Personality Disorder (HPD) is a condition marked by emotion dysregulation, distorted self-image, and an overwhelming desire to be noticed. People with HPD often behave in what would be considered dramatic or inappropriate with the intent to seek validation. These behaviours do not arise from a true feeling of self-worth.
HPD is categorized as a “Cluster B” personality disorder. Often, those with HPD do not realize their behaviour and way of thinking may be problematic. In many cases people with HPD have good social skills; however, they tend to use these skills to manipulate others so that they can be the center of attention.
Symptoms and Causes:
The exact cause of HPD is not known but many mental health professionals believe that both learned and inherited factors play a role in its development. For example, the tendency for HPD to run in families suggests that a genetic susceptibility for the disorder might be inherited. In other words, the child of a parent with this disorder might simply be repeating learned behaviour.
Other environmental factors that might be involved include a lack of criticism or punishment as a child, positive reinforcement that is given only when a child completes certain approved tasks, and unpredictable attention given to a child by their parent(s); all leading to confusion about what types of behaviour earn parental approval. Personality disorders also usually develop in relation to individual temperament and psychological styles and ways people learn to cope with stress while growing up.
A person with HPD may:
- Be uncomfortable unless they are the center of attention
- Dress provocatively and/or exhibit inappropriately seductive or flirtatious behaviour
- Shift emotions rapidly
- Act very dramatically, as though performing before an audience with exaggerated emotions and expressions, yet appears to lack sincerity
- Be overly concerned with physical appearance
- Constantly seek reassurance or approval
- Be gullible and easily influenced by others
- Be excessively sensitive to criticism or disapproval
- Have a low tolerance for frustration and be easily bored by routine
- Make rash decisions
- Be self-centered and rarely show concern for others
- Have difficulty maintaining relationships, often seeming fake or shallow in their - Dealings with others
- Threaten or attempt suicide to get attention
- Display obsessive behaviour
Development:Personality disorders, including HPD, are the most misunderstood mental health conditions. Studies about HPD have identified several factors that may lead to its development:
Genetics: HPD tends to run in families; studies show there may be a genetic (inherited) link.
Childhood Trauma: coping with trauma as a child (ex. child abuse or the death of a family member) that later as an adult can lead to the development of a personality disorder.
Parenting Styles: children who experience parenting styles that lack boundaries, are over-indulgent, or inconsistent may be more likely to develop HPD. In addition, parents who display erratic, volatile or inappropriate sexual behaviour put their children at risk for developing this condition.
Mental health providers base a diagnosis of HPD on the criteria for the condition in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Diagnostic criteria for Histrionic Personality Disorder require meeting five (or more) of the following persistent behaviours:
- Uncomfortable when not the center of attention
- Seductive or promiscuous behaviour
- Shifting and shallow emotions
- Uses appearance to draw attention
- Impressionistic and vague speech
- Consistently exaggerating emotions
- Easily influenced by others
- Considers relationships to be more intimate than they are
People with HPD are also more likely to have:
Somatic Symptom Disorder: Somatic Symptom Disorder is a disorder in which individuals feel excessively distressed about a physical symptom they have, to a level that results in major distress and/or problems functioning.
Panic Attacks: A panic attack causes sudden, brief feelings of fear and strong physical reactions in response to non-threatening situations.
Conversion Disorders: Conversion Disorder is a disorder in which a person experiences blindness, paralysis, or other symptoms affecting the nervous system that cannot be explained solely by a physical illness or injury. Your brain and body believe that a part of your nervous system isn't functioning when there's no evidence of structural damage.
Extreme attention-seeking behaviour people with HPD may involve frequent suicidal threats.
In most cases, people with HPD do not see their behaviour as problematic. They tend to dislike routine, which makes following a treatment plan difficult. However, they might seek help if depression — associated with a loss or a failed relationship — or another problem causes them distress.
CBT, DBT, Group Therapy, and/or Psycho-Dynamic Psychotherapy is generally included as part of treatment for histrionic or other personality disorders. The goal of treatment is to help the person uncover triggers and fears to get to the root of emotional suffering, restore or improve self-esteem, and develop healthy coping skills.