- Histrionic Personality Disorder; Causes, Symptoms & Treatment
- What are the symptoms of histrionic personality disorder?
- What are the complications of histrionic personality disorder?
- Teen Drama vs. Histrionic Personality Disorder
- What Is Histrionic Personality Disorder (HPD)?
- Histrionic Personality Disorder vs. Other Personality Disorders
- Borderline Personality Disorder (BPD)
- Antisocial Personality Disorder (ASPD)
- Narcissistic Personality Disorder (NPD)
- What Causes Histrionic Personality Disorder?
- Can Histrionic Personality Disorder Be Treated?
- What is Histrionic Personality Disorder?
- How common is histrionic personality disorder?
- What causes histrionic personality disorder?
- How is histrionic personality disorder diagnosed?
- Related psychological issues to histrionic personality disorder
- What treatment is suggested for histrionic personality disorder?
- Well-known people with histrionic personality disorder
- Get Help for Histrionic Personality
- Treatment for Histrionic Personality
- How to Help a Loved One with Histrionic Personality
Histrionic Personality Disorder; Causes, Symptoms & Treatment
In a person with histrionic personality disorder, self-esteem depends on the approval of others. People with this disorder have an overwhelming desire to be noticed, and often behave dramatically or inappropriately to get attention. Histrionic Personality Disorder
Histrionic personality disorder is one of a group of conditions called dramatic personality disorders.
People with these disorders have intense, unstable emotions and distorted self-images. For people with histrionic personality disorder, their self-esteem depends on the approval of others and does not arise from a true feeling of self-worth. They have an overwhelming desire to be noticed, and often behave dramatically or inappropriately to get attention.
The word histrionic means “dramatic or theatrical.”
This disorder is more common in women than in men and usually is evident by early adulthood.
The exact cause of histrionic personality disorder 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 histrionic personality disorder to run in families suggests that a genetic susceptibility for the disorder might be inherited.
However, the child of a parent with this disorder might simply be repeating learned behavior.
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 behaviors, and unpredictable attention given to a child by his or her parent(s), all leading to confusion about what types of behavior earn parental approval.
What are the symptoms of histrionic personality disorder?
In many cases, people with histrionic personality disorder have good social skills; however, they tend to use these skills to manipulate others so that they can be the center of attention.
A person with this disorder might also:
- Be uncomfortable unless he or she is the center of attention
- Dress provocatively and/or exhibit inappropriately seductive or flirtatious behavior
- 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, often beginning projects without finishing them or skipping from one event to another
- Not think before acting
- 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
If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests to rule out physical illness as the cause of the symptoms.
If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist, healthcare professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder.
In general, people with histrionic personality disorder do not believe they need therapy. They also tend to exaggerate their feelings and to dis routine, which makes following a treatment plan difficult. However, they might seek help if depression—possibly associated with a loss or a failed relationship—or another problem caused by their thinking and behavior causes them distress.
Psychotherapy (a type of counseling) is generally the treatment of choice for histrionic personality disorder. The goal of treatment is to help the individual uncover the motivations and fears associated with his or her thoughts and behavior, and to help the person learn to relate to others in a more positive way.
Medication might be used to treat the distressing symptoms—such as depression and anxiety—that might co-occur with this disorder.
What are the complications of histrionic personality disorder?
Histrionic personality disorder can affect a person’s social or romantic relationships, and how a person react to losses or failures. People with this disorder are also at higher risk than the general population to have depression.
Although prevention of the disorder might not be possible, treatment can allow a person who is prone to this disorder to learn more productive ways of dealing with situations.
Many people with this disorder are able to function well socially and at work. Those with severe cases, however, might experience significant problems in their daily lives.
Last reviewed by a Cleveland Clinic medical professional on 01/22/2018.
- Janowsky D. Chapter 30. Personality Disorders. In: Ebert MH, Loosen PT, Nurcombe B, Leckman JF. eds. CURRENT Diagnosis & Treatment: Psychiatry, 2e. New York, NY: McGraw-Hill; 2008.
- Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Copyright © 2000, American Psychiatric Association.
- Hales RE, Yudofsky SC, Gabbard GO. The American Psychiatric Publishing Textbook of Psychiatry. American Psychiatric Pub; 2008.
- Young JQ. Chapter 26. Personality Disorders. In: Feldman MD, Christensen JF. eds. Behavioral Medicine: A Guide for Clinical Practice, 3e. New York: McGraw-Hill; 2008.
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Teen Drama vs. Histrionic Personality Disorder
Teens can be dramatic, and they are often preoccupied with themselves.
But at what point is such behavior normal and understandable, and at what point does it become a disorder? Disorders do not characterize or differentiate annoying from acceptable behavior, and part of the process of going through adolescence includes mood swings, identity changes, irritability, and a tendency towards hyperbole.
But certain behaviors fall outside the scope of “normal,” hinting at a developing problem that may be better managed in later life if addressed and treated early.
Histrionic personality disorder, for example, is a lifelong mental health condition characterized by excessive dramatization, constant attention-seeking, and inappropriate behavior. Its onset tends to coincide with early adolescence.
Despite similarities to normal teen behavior, specific characteristics tend to be blown proportion in teens with histrionic personality disorder.
What Is Histrionic Personality Disorder (HPD)?
Histrionic personality disorder (HPD) is one of ten major personality disorders identified and characterized in the Diagnostic and Statistical Manual of Mental Disorders (5th edition), under a cluster of personality disorders centered around dramatic and attention-seeking behavior (cluster B). At its root, it is defined by overly dramatic and theatrical (i.e., histrionic) behavior. This disorder’s history is long and varied.
Its early meaning has little to do with modern psychiatry, dating back to when male doctors blamed “unmanageable” female behaviors on “hysteria.” For a time, HPD was known as hysterical personality.
We have since learned that the causes and contributing factors in most personality disorders are varied and complex, from environmental agents to genetics and early childhood experiences, and have nothing to do with uteri or most other believed causes of hysteria.
Where teens might exaggerate for the sake of calling attention to themselves or experiment with boundaries, a teen with histrionic personality disorder will consistently engage in outrageous and inappropriate behavior to remain in the center of attention at all times, and they may be visibly upset if they aren’t the center of attention. Some characteristic behaviors for teens with a potential histrionic personality disorder include:
- Intentionally provocative or seductive behavior.
- Rapidly shifting and changing emotions.
- Overtly shallow expressions (i.e., acting).
- Consistently alters and uses physical appearance to draw attention.
- Jumps from relationship to relationship, quickly consider relationships to be more intimate than they are.
- Extreme self-dramatization, exaggerated storytelling and expressions, and a shallow style of speech.
- May resort to extreme statements to draw attention, including repeatedly threatening suicide and very rash decision-making.
- Very susceptible to suggestion, easily influenced by others.
- Symptoms are consistent across settings, i.e., displays the same behavioral issues at home, at work, and elsewhere.
A teen with HPD may not necessarily be consistently disruptive. Many grow up to remain “high-functioning” in the sense that they can hold a job and get through life. Yet, their behavior remains odd and can negatively impact relationships, friendships, and more. To be diagnosed according to the DSM-5, a teen would have to display at least five or more of the following signs:
- Discomfort when not the center of attention.
- Seductive behavior.
- Shifting emotions.
- Using appearance to draw attention.
- Vague, impressionistic speech.
- Exaggerated emotions.
- Considers relationships more intimate than they are.
It is also important to note that identifying and diagnosing a personality disorder is not a simple process.
Individual cases rarely fit neatly into textbook definitions, and only a trained mental health professional can make a diagnosis and prescribe treatment if needed.
There may also be co-occurring mental health issues such as irritability or “affective dysregulation,” which can complicate the diagnosis with depression and anxiety symptoms.
Part of the process also involves ruling out any other potential explanations or causes for a teen’s symptoms. Teens with histrionic personality disorder may be very reluctant to consider anything “wrong” with their behavior and may sometimes dissociate from their actions or words as a defense mechanism.
Histrionic Personality Disorder vs. Other Personality Disorders
The main characteristic that sets histrionic personality disorder apart from other personality disorders in its cluster focuses on overly dramatized speech and behavior and the need to remain the center of attention. Other similar personality disorders include:
Borderline Personality Disorder (BPD)
Borderline personality disorder is characterized by unstable and rapidly changing moods and self-image.
Antisocial Personality Disorder (ASPD)
Antisocial personality disorder is characterized by a lack of empathy and constant manipulation of others.
Narcissistic Personality Disorder (NPD)
Narcissistic personality disorder is characterized by self-grandeur, often accompanied by the need to put others down.
What Causes Histrionic Personality Disorder?
The causes of histrionic personality disorder are varied, depending on the teen’s circumstances and history. Genetics seem to play at least some role, as does gender – while the prevalence for histrionic personality disorder is less than two percent in the general population, it is four times more common in women than men.
While identities and behaviors evolve, temperament is mostly determined early on and may play a role in how the disorder develops. Upbringing may also be necessary – children who were only awarded affection and attention in specific ways after performing certain tasks may learn to behave that way into their teen years.
Can Histrionic Personality Disorder Be Treated?
Yes, although it cannot be “cured.” most personality disorders, histrionic personality disorder can be treated and managed through therapy, specifically by helping teens differentiate between maladaptive thinking and their other thoughts, identifying the condition before it translates into behavior and action. It can take time for a patient to learn the difference.
Various approaches may be utilized to get to that point, including group therapy, dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), and family therapy.
In cases where histrionic personality disorder is also accompanied by severe mood issues or an anxiety disorder, medication can help alleviate significant symptoms to make therapy more effective.
There may be evidence that some personality disorders – particularly ones in the same cluster as HPD – generally improve with age, especially with treatment.
What is Histrionic Personality Disorder?
By: Alyssa L. Miller
A personality disorder is a consistent and long-term pattern of thinking, behaving, and relating that leaves someone unable to match or manage the norms of the culture they are in.
Histrionic personality disorder (HPD) sees an individual living with an overwhelming need to constantly be the centre of attention, often using seductive and manipulative behaviour to achieve this. With their sense of esteem only coming from the approval of others, they tend to be dramatic and self-centred.
It’s important not to assume that just because someone is an attention seeker or ‘drama addict’ means they have histrionic personality disorder.
A personality disorder is a diagnosis that is only made if the behaviour has existed since at least early adulthood and pervades most if not all areas of an individual’s life, causing them distress and confusion.
Un many other personality disorders, though, those with HPD can be highly functioning with successful lives despite often often struggling with relationships.
How common is histrionic personality disorder?
It’s thought that around 10% of the population suffers from a personality disorder of some sort. But there are no accurate or reliable figures of how many people in the UK suffer from histrionic personality disorder in particular.
American statistics, however, claim that HPD affects up to three per cent of the general population, and up to 15 per cent of those attending mental health institutions.
Histrionic personality disorder is known for affecting more women then men, with a suggested ratio of four women to every one male diagnosed. Interestingly, research also shows that HPD is usually found in those with an above-average appearance, making it the only personality disorder to be linked to physical attributes.
What causes histrionic personality disorder?
As with all personality disorders, exact causes are unknown. But theories abound and tend to be a mix of nature vs nurture.
With histrionic personality disorder there is a leaning towards seeing the cause as learned behaviour, often in response to inconsistent parenting.
If a child receives no sensible punishment and boundaries from parents, receives attention sporadically, or is given love only if they meet certain changing requirements, they can be left to believe that one must seek out and earn any attention or affection one requires.
Freud in particular was interested in how children grow up to be shallow adults who lack an understanding of unconditional love. He suggested that it could stem from a trauma that leaves a child feeling abandoned and they can’t rely on others affections, such as a loved one dying or parents divorcing.
By: Cat Sacdalan
Freud also created a theory of defence mechanisms – that a stressed out child will develop ways of distorting or denying reality to protect themselves from stress. Those who decide to use the defense mechanisms of denial, repression, and disassociation (disconnecting from one’s experience), might very well grow up to have histrionic personality disorder.
As for genetics, HPD does seem to run in families. But this could again be down to learned patterns of behaviour.
Research has also found some biological connections with histrionic personality disorder. Some individuals with HPD were discovered to have a malfunction in a group of neurotransmitters which include norepinephrine, affecting one’s impulses.
How is histrionic personality disorder diagnosed?
Personality disorders are both controversial and debatable. They are, after all, only terms that were created by mental health professionals to describe groups of individuals outside the norm, as opposed to illnesses that can be seen under a microscope.
And often, an individual who seems to qualify for one personality disorder will have symptoms of other mental disorders (comorbidity). So then how useful are the labels, then?Some healthcare professionals see personality disorders as stigmatising and limiting, and prefer to see clients as having ‘personality difficulties’.
The health systems of different countries can thus approach personality disorders differently, with America being the most ‘diagnosis friendly’. The American Diagnostic and Statistical Manual of Mental Disorders (DSM-V) lists the most personality disorders, dividing them into three categories.
Histrionic personality disorder comes under cluster B, the ‘dramatic’ disorders, which all involve having a distorted sense of self and unstable very intense emotions.
The UK mental health profession, however, does not prescribe completely to the DSM, although mental health care professionals often use it as a reference.
The World Health Organisation (WHO) put out a medical health classification list, the ICD- 10, which is more regarded in the UK, and mental health care professionals also follow guidelines for treatment put forward by the National Institute of Health and Care Excellence (NICE).
In the UK the National Institute for Health and Care Excellence (NICE) does not offer diagnostic guidance for histrionic personality disorder, but only for the often similar diagnosis of borderline personality disorder. Nor does the NHS have a page devoted to histrionic personality disorder – it receives a mention only on the main page about personality disorders.
By: Jakub Zeke
As for the ICD-10, as well as an individual matching the general criteria for a personality disorder, at least four of the following must be present for a diagnosis:
“(1) Self-dramatisation, theatricality, or exaggerated expression of emotions.
(2) Suggestibility, easily influenced by others or by circumstances.
(3) Shallow and labile affectivity.
(4) Continually seeks excitement and activities in which the subject is the centre of attention.
(5) Inappropriately seductive in appearance or behaviour.
(6) Overly concerned with physical attractiveness.”
Related psychological issues to histrionic personality disorder
As mentioned above, histrionic personality disorder often occurs alongside other personality disorders. These are dependent personality disorder, borderline personality disorder, antisocial personality disorder, and narcissistic personality disorders.
Histrionic personality disorder also often occurs alongside alcoholism, sleep problems, and depression.
What treatment is suggested for histrionic personality disorder?
Psychotherapy is recommended for those with histrionic personality disorder. And, un sufferers of many other personality disorders, those with HPD do sometimes put themselves forward for therapy. This is usually when a relationship ends and leaves them anxious and depressed.
Psychodynamic therapy is suggested as a potential treatment for HPD as it helps individuals gain awareness of their behaviour and social interactions.
Cognitive-behavioural therapy (CBT) can be helpful as it can teach individuals with HPD to identify automatic thoughts and impulsive behaviour, and to develop better problem-solving skills that can reduce emotional overreaction.
Group therapy might work in some cases, offering a way to explore relating to others and manage personal drama. But the person with HPD can be prone to dominate in a group situation, so the leader of the group must be able to handle this.
Well-known people with histrionic personality disorder
One of the most known cases of histrionic personality disorder was Jerry Sandusky, an American football coach who during his trial for abusing children had his psychiatrist testify he had HPD.
Otherwise, there are no publicly confirmed cases, although certainly many modern day celebrities seem to obsessively crave attention and are happy to use seductive behaviour to gain it.
But again, unless the behaviour has been consistent since early adulthood and we know someone’s life history, such behaviours do not mean the disorder is present, so it would be pure speculation.
Do you have a question about histrionic personality disorder? Or want to share your experience with HPD? Share below.[contact-form-7 404 "Не найдено"]
Get Help for Histrionic Personality
Histrionic personality (HPD) is most often recognized by dramatic behavior, rapid shifts in emotion, high suggestibility, and attention-seeking acts. People with this condition feel uncomfortable or otherwise distressed when they are not the center of attention. They may try to draw the attention of others with flirtatious behavior, tantrums, enthusiastic outbursts, or gushing praise.
The actions of a person with HPD can confuse their family and friends. Rapid changes in emotion can seem shallow. Flirtatious behavior can negatively affect professional bonds and friendships.
Attempts to manipulate others to get attention can also cause harm to romantic relationships. People with HPD are often aware their actions have negative effects on themselves and others, but they might struggle to effectively manage emotions and make different choices.
Depression can develop as a result of problems with work or relationships.
There is help for histrionic personality. Professional support from a counselor or therapist can lead to improvement of symptoms.
In therapy, you can also learn new skills to manage emotions and deal with situations in different ways. Therapy can also help treat depression and other co-occurring conditions.
It’s especially important to reach out if you have severe depression or thoughts of suicide. Begin your search for a counselor here.
Treatment for Histrionic Personality
The support of a therapist or counselor can be beneficial for people with HPD. Therapy can help people understand the reasons for their thoughts and behavior. Individuals in therapy can begin working toward positive changes, such as finding new ways to relate to other people.
For therapy to be successful, an individual usually has to desire help. This generally means recognizing that what they experience is a mental health issue.
With personality disorders, this often happens when the condition has strongly impacted a person’s life.
For example, a person’s emotional outbursts may end a long-term friendship, forcing them to realize the negative consequences of their behavior.
Certain traits of histrionic personality can offer challenges in therapy. A person with HPD may try to flatter or flirt with the therapist to get approval. Because people who have HPD often become bored easily, it may be difficult to stick to something that follows a routine, counseling.
Depression occurs commonly with HPD, especially if people have a pattern of relationship difficulties or failed friendships. People who have histrionic personality and another condition, such as depression, may be more ly to seek help.
Types of therapy that can help with HPD include:
- Psychodynamic therapy: This approach helps people explore conflicts in their relationships. People can then work to change these conflicts to improve their relationships.
- Group therapy: Working with other people who have similar mental health challenges can help people learn new ways of relating to others. They can also practice social and interpersonal skills.
- Family counseling: When a person’s mental health affects family members and partners, family and relationship counseling may be recommended. In counseling, partners and family members can also learn more about the mental health issue and how to offer support.
- Mindfulness practices: While mindfulness practices shouldn’t replace professional support, learning to be more mindful can help people manage emotions. Practicing mindfulness can be helpful when trying to keep from reacting in a certain way.
How to Help a Loved One with Histrionic Personality
Personality disorders are mental health issues involving fixed patterns of thinking and behavior. These patterns can create difficulties at school, work, or in relationships. Even though a person’s actions may cause problems for them and other people in their lives, they might have a hard time making changes that lead to healthier interpersonal dynamics.
When a loved one has HPD, it may sometimes be difficult to relate to them. It can be hard to understand their need to be the center of attention. If they lie or use manipulation to get sympathy, you may feel hurt or worried.
It can help to remember that HPD is a mental health condition. A person’s HPD symptoms may be upsetting to you, but they also cause your loved one distress. While a diagnosis is not an excuse for any hurtful actions, it can explain why your loved one behaves a certain way.
You can offer support to a loved one who has HPD by:
- Setting boundaries. Have a discussion with the person about how you will respond to certain behaviors from now on. You might say something , “I care about you, but I feel uncomfortable when you make scenes in public. If you throw a tantrum in public, I’ll go home.”
- Knowing when to distance yourself. It can be difficult to deal with histrionic personality issues on an ongoing basis. It is okay to take a break on occasion and spend some time caring for yourself.
- Telling them you care for them. It may help the person to know that even when you can’t give them your full attention, you still care for them.
- Encouraging them to evaluate their actions. Impulsivity and suggestibility are common traits in HPD. If your loved one tries to act on impulse (or another person’s suggestion), you can encourage them to consider what they’re doing and why. This can help them learn to think through their decisions.
- Keeping calm when they become excited or act in dramatic ways. It can help to offer a distraction if your loved one is considering an impulsive action.
- Communicating. Be honest about your feelings. If your loved one upsets you, let them know calmly. If you have expressed a boundary about that action, stick to it. This can help your loved one know their actions affect others.
- Offering to go to couples counseling or family therapy. If your loved one wants to get help, show them you support their decision by offering to go with them.
While support from friends and family can be invaluable, it cannot replace professional therapy. If your loved one’s histrionic personality is affecting their daily life, chances are they need treatment. A compassionate counselor can provide your loved one guidance.
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