Histrionic personality disorder

Last updated February 2020 | Next review due August 2021

Around 10% of the population is thought to have a personality disorder of some sort, however, there are no accurate or reliable figures on how many people in the UK may specifically have histrionic personality disorder (HPD). 

Part of the ‘Cluster B’ or ‘dramatic’ personality disorders group, those with HPD tend to have intense, unstable emotions; a distorted self-image; and their sense of self-esteem may depend on the approval of others, rather than stemming from any true sense of self-worth. 

We recognise that the system of personality disorder diagnosis can be considered controversial. It is completely your choice which term, if any, you want to use, knowing that your doctor or care team may use another. 

The terms used on Counselling Directory are those that are generally used in the UK at the time. We refer to these terms throughout, with the hope of reaching and supporting as many people as possible.

Characteristics of histrionic personality disorder include constant attention-seeking and discomfort from not being the centre of attention. Someone with HPD may often interrupt others to dominate the conversation, and may sometimes be referred to as a ‘drama queen’ due to their theatrical performances and gestures. Those with the disorder may dress provocatively to gain attention or may be sexually seductive in inappropriate situations.

Signs of histrionic personality disorder

Often seen as having good social skills, those with histrionic personality disorder may use these skills to manipulate those around them to make themselves the centre of attention. Other signs and symptoms of HPD can include:

  • exaggerated or rapidly shifting emotions
  • constantly seeking reassurance and approval
  • extreme sensitivity to disapproval and criticism
  • excessive dramatics, such as exaggerated emotions and expressions that appear to lack sincerity
  • self-centredness, often accompanied by a lack of concern shown for others 
  • inappropriate behaviour
  • low tolerance for frustration, easily bored by routines, or trouble finishing a project they have started 
  • extreme concern over physical appearance
  • difficulty maintaining relationships, or a tendency to believe relationships are more intimate than they are

As with many personality disorders, there is controversy and debate around how they are diagnosed, as well as the terms used to describe them. Those who are diagnosed with a personality disorder will often have symptoms of other disorders and may have multiple diagnoses.

What causes histrionic personality disorder?

As with all personality disorders, the specific cause of histrionic personality disorder is still unknown. There are a wide variety of factors that are believed to contribute to the disorder, while many believe a mixture of nature vs nurture may have an impact. 

HPD tends to run in families, however, expert opinion is divided on if this is a genetic factor, or a learned behaviour children pick up from repeating behaviour they have seen from family members. Other factors that may have an impact are thought to include a lack of criticism or punishment as a child, positive reinforcement that is only given for certain behaviours, and unpredictable attention from parents.

What treatment is available?

Individuals with histrionic personality disorder often seek treatment for depression when relationships dissolve. HPD is typically treated with psychotherapy, as with most personality disorders. Medication is sometimes prescribed, however, this should only be given for short periods of time. You may be prescribed antidepressants or antianxiety medication if you experience depression or anxiety as part of HPD. 

Depending on how severe your condition is and what is available in your local area, the form of treatment offered to you may vary. Typically, psychological therapy such as cognitive behavioural therapy (CBT) or psychotherapy is offered. This often lasts for six months or longer.

Working with a therapist or counsellor can help you to regulate your thoughts and emotions, as well as to better understand yourself. Working with a professional, qualified therapist can help you to work through any areas that may be causing you distress or concern, providing a safe space to speak without fear of judgement. 

For some people with HPD, they find that symptoms improve as they age, gain more life experience, and develop a better understanding of how to manage their responses and interactions with those around them.

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