Histrionic Personality Disorder (HPD): Symptoms, Treatment and Diagnosis

A skewed sense of self and extreme, erratic emotions are symptoms of histrionic personality disorder (HPD). One definition of histrionic is “dramatic or theatrical”. “Individuals suffering with histrionic personality disorder have an inflated sense of self-worth that is based on the opinions of others rather than their own internal values” (Novais et al., 2015). To satisfy their insatiable need for attention, they frequently act in an outrageous or improper manner. A common symptom of histrionic personality disorder is a lack of self-awareness on the part of the affected individual. Histrionic personality disorder is included in the Cluster B personality disorders, which is characterised by extremely out-of-control behaviour.

Symptoms

Anxieties set in when they aren’t the focus of attention are common symptoms of histrionic personality disorder. They can be charming to new acquaintances since they are often outgoing, dramatic, energetic, and flirty. Regardless of the setting (e.g., job, school), these patients frequently display sexually suggestive and provocative behaviour that is not suitable. They fixate on their looks because they want to make a good impression on other people.

An excessive or superficial display of emotion is possible. They speak passionately and assertively, yet they don’t back up their claims with evidence. The patients suffering from histrionic personality disorder are more susceptible to the persuasive power of others and societal trends. They have a tendency to put too much faith in people in positions of power, who they mistakenly believe can fix all their issues. They have a tendency to overestimate the proximity of relationships (French & Shrestha,2019). They get bored easily and desire new experiences. Therefore, they might switch employment and social circles quite a bit. Their activities are frequently driven by the desire for rapid satisfaction, as they find delayed gratification annoying.

Sometimes it’s hard to become close to someone on an emotional or sexual level. Unfortunately, patients frequently unwittingly play a part (e.g., victim). While growing emotionally and sexually dependent on their spouse, they may attempt to exert control over them through manipulation of their emotions or seduction.

Causes

1. Neurochemical/physiological

Hormone and neurotransmitter function is very correlated with Cluster B personality disorders like HPD, according to studies. This appears to be particularly true when it comes to catecholamines. A highly responsive noradrenergic system, which synthesises, stores, and releases the neurotransmitter norepinephrine, is present in individuals diagnosed with HPD. Excessive amounts of norepinephrine cause extroversion, reliance, anxiety, and a desire for novelty (Lengel,2020).

2. Genetic

Research using identical twins has helped dismantle the heritability vs. environmental argument. In an effort to determine if Cluster B personality disorders are heritable, researchers from the University of Oslo’s Department of Psychology undertook a twin study. Using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II), researchers interviewed 221 twins (92 monozygotic and 129 dizygotic) and found a correlation of 0.67, indicating that histrionic personality disorder is genetic.

3. Psychoanalytic theory

Despite claims that they lack scientific backing, psychoanalytic theories accuse parents—often the mother—of being distant or dictatorial and of loving their children conditionally on meeting expectations that they would never be able to fulfil. Freud theorized in psychoanalysis that lustfulness reflected a patient’s emotional shallowness, cognitive immaturity, and inability to love unconditionally (Dawood et al., 2020). He theorised that a person’s inability to love might stem from a form of childhood trauma, such as the loss of a close relative or the false perception of commitment caused by parental divorce. A person’s ability to develop genuine and loving relationships with other individuals is severely impaired after experiencing the painful loss of a close friend or family member, whether through abandonment or death.

Related: Sigmund Freud’s 5 Most Important Contributions to Psychology

4. HPD and Antisocial Personality disorder

There is an alternative idea that proposes a link between antisocial personality disorder and histrionic personality disorder. The fact that two-thirds of people with antisocial personality disorder also fit the criteria for histrionic personality disorder implies that the two diseases may share the same origin, as they both centre on sex-type expressions.

Histrionic, borderline, and antisocial personality disorders all seem to run in families, according to some family history research; however, the exact proportion of hereditary vs environmental components remains unknown (Blagov et al., 2007). Both cases highlight the possibility that a person’s genetic makeup or environmental factors play a role in the development of histrionic personality disorder, but research into the exact nature of this disorder remains limited. The biological causes of this illness, if any, have not been the subject of much investigation.

Related: It’s Important to Understand the Complexities of Borderline Personality Disorder

Diagnosis of Histrionic Personality Disorder

Patients with a chronic pattern of extroverted displays of emotion and need for attention are considered to have histrionic personality disorder (Nalini & Panneerselvam,2018). The existence of at least five of the following indicates this pattern:

• Feeling awkward or threatened when not the focus of attention
• Engaging in sexually suggestive or provocative interactions with others
• Feelings that are fleeting and unsubstantiated
• Use of one’s physical attractiveness as a means of self-promotion on a consistent basis
• Very impressionistic and nebulous speech
• Extreme displays of emotion, theatricality, and self-dramatization
• Believing in a deeper level of intimacy in relationships than what actually exists
• Being readily swayed by other people or circumstances
• Additionally, symptoms should have started in the early adult years.

Distinguishing traits

A number of distinguishing traits set histrionic personality disorders apart from others

• Narcissistic personality disorder: People who suffer from narcissistic personality disorder also crave attention, but their goal is to feel esteemed rather than admired, in contrast to people who suffer from histrionic personality disorder, who are less particular about the type of attention they receive and are content to be considered charming or foolish.
• Borderline personality disorder: While those with borderline personality disorder have a negative self-image and suffer from powerful and profound emotions, individuals with histrionic personality disorder have a positive self-image and rely less on the approval of others, which may be a result of low self-esteem.
• Dependent personality disorder: Both histrionic and dependent personality disorder patients seek out social interactions, but the former are more reserved and submissive due to their fears of rejection, while the latter are more outgoing and flashier (Blashfield et al., 2012).

Histrionic personality disorder has somatic symptom disorder and sickness anxiety disorder as possible differential diagnoses.

Related: Personality Disorder: Types, Cause and Symptoms

Treatment and Prognosis

Personality disorders can be treated if the patient is really committed to altering their emotional and psychological responses. Patients with HPD, who need a lot of social and psychological assistance while they get back on their feet, are best treated in an inpatient or intense outpatient program at a mental health facility.

The most effective treatment for Histrionic Personality Disorder is psychotherapy. Among the treatments that have shown promise for this illness are

• Process-Based Approach (PBA): People who tend to act impulsively and without thinking things through can learn to control their emotions and thoughts through cognitive behavioural therapy. Since HPD and anxiety disorders often occur together, CBT is useful for treating both conditions (Babl et al., 2023).
• Treatment of psychodynamic disorders: Reducing emotional reactivity is one of the main goals of psychodynamic therapy, which seeks to uncover and explain the origins of HPD.
• Therapy in a group setting: Men and women with HPD can enhance their social conduct and interpersonal interactions through engaging in group talks and role-playing sessions with peers.
• Counselling for families and couples: Histrionic personality disorder (HPD) impacts all kinds of family connections, but the good news is that couples and family therapy provide a safe space where everyone may work together to find solutions to the problems that HPD causes.
• Holistic mind-body practices: People with high-power emotional dysregulation (HPD) can benefit greatly from practising mindfulness through holistic therapies such as biofeedback, yoga, Tai Chi, meditation, and other forms of holistic practice.

Read More: What Is Couples Therapy, And How Does It Work?

Complications of Living With HPD

HPD causes a plethora of problems and functional outcomes. The ups and downs of life with HPD, as well as significant relationship problems, are inevitable.

Living with histrionic personality disorder may come with the following complications:

• You might expect relationships that are passionate and intense, but short-lived and disappointing.
• Homosexual dysfunction is strongly associated with somatic symptom disorder. A variety of physical health problems may affect these individuals.
• A panic attack may occur if you’re very anxious or stressed out (Perrotta, 2021).
• Individuals suffering from conversion disorder may encounter physical health issues associated with HPD; this condition is now known as functional neurological symptom disorder.
• Individuals with HPD and those around them are both impacted by the condition’s ups and downs, which can lead to feelings of despair and low mood. As a result, hostile and bullying tendencies may emerge.

Impact on Daily Life and Functioning

Personality disorders like histrionic personality disorder (HPD) can make it hard for a person to handle their relationships, work, and mental health.

Challenges in Relationships

It might be hard for people with HPD to stay in solid relationships and be happy in them. It’s hard for them to make real friends because they want praise, approval, and attention so much. It could be hard for them to get along with family, friends, coworkers, and sexual partners as they like to act out when they want attention.

People with HPD care more about short-term thrills and happiness than they do about long-term emotional ties (Pelz,2017). This could make someone look fake or uninterested in social settings. People who are constantly reassuring and backing them may find it stressful, which can lead to relationship problems and fights. It can be even harder for people with HPD to set good limits in relationships because they may find it hard to accept and follow other people’s rules. They may not be able to be close to other people even though they want to because they are afraid of being turned down or left alone.

Related: 15 of the Best Couples Therapy Techniques to try

Occupational and Academic Difficulties

It might be hard to do well at school or work if you have HPD signs. It may be hard for them to concentrate because they are excited and want to stand out. What if they can’t finish their work on time? It might get in the way of how well they do at school or work. Also, people with HPD might find it hard to follow the rules because they think they limit their freedom. This makes them more likely to fail school or get in trouble with their bosses or coworkers. Putting short-term pleasures ahead of long-term goals can make people act in risky and impulsive ways that could hurt their work or school performance (Hughes et al., 2020).

Co-occurring Mental Health Disorders

When combined with other mental health conditions, HPD significantly impairs quality of life and daily functioning. Anxiety, depression, substance addiction, and additional personality disorders frequently coexist. Insufficiency or feelings of rejection in the context of a marital dispute can contribute to the development of melancholy. Chronic appearance-related self-consciousness can result in anxiety disorders such as GAD and SAD.

Individuals diagnosed with HPD may potentially develop substance use disorders as a means of alleviating emotional distress or fulfilling their desire for exhilaration. Impulsivity and risky behaviour increase the likelihood that patients with HPD will develop an addiction to substances.

Due to the similarity of symptoms to those of other personality disorders, HPD can be challenging to diagnose and treat. Personal relationships, daily functioning, and emotional well-being can all be impacted by HPD. Patients with HPD must comprehend their conditions in order to obtain the necessary treatment and answers that will enable them to lead satisfying lives.

Coping Strategies and Management Techniques

There are some unique problems that come with having Histrionic Personality Disorder (HPD), but people can deal with their symptoms and make their lives better by using coping strategies and management methods.

Developing Self-Awareness

A self-awareness is essential for effectively managing HPD. Self-awareness is the capacity to recognize the influence that one’s thoughts, emotions, and behaviours have on others. Individuals who have HPD can better manage their symptoms and comprehend the reasons for their behaviour if they have a greater understanding of themselves. Talk therapies, like DBT and CBT, can help you learn more about yourself. The point of these treatments is to help people better deal with their issues, think about ideas that aren’t helpful, and discover their feelings and thoughts (Candel, 2019).

Practices that make you more aware of and open to the present moment, such as meditation and deep breathing, can help you learn more about yourself. Some ways to learn more about yourself and grow are to write in a journal or do other types of self-reflection, like self-assessment.

Building Healthy Relationships

This is important for people with HPD because it helps their health and lets them make friends who can help them. Know and care about each other, set healthy boundaries, and talk to people better. This will help your relationships grow. People with HPD should get care that helps them understand relationships and get better at socialising. This is especially true for relational or interpersonal care. People go to therapy to learn how to talk about their wants and needs in a strong way, how to fix problems in a healthy way, and how to build relationships based on trust and respect (Dawood et al., 2020).

Forums and support groups run by other people with HPD can also help, validate, and give people a way to talk about their journey. People may feel less alone and more accepted when they talk about their experiences with other people who have had the same ones.

Stress Management and Emotional Regulation Techniques

To deal with their strong emotions and recklessness, people with HPD need to be able to handle stress and keep their feelings in check. Learning how to deal with stress in a healthy way can help people avoid acting and responding in unhealthy ways.

Histrionic Personality Disorder (HPD) sufferers, their families, and the community encounter several challenges. This research examined HPD symptoms, effects, and treatments. A complete understanding of HPD requires knowledge of its implications on relationships, career, and mental health. HPD patients need attention and acceptance so much that they struggle to maintain meaningful relationships. Linking up might be difficult and damage relationships. HPD may affect school and employment performance by making it hard to focus, relate to authority figures, and plan ahead. HPD patients with depression or substance dependence need a more holistic approach to treatment.

Also Read: Stress Management Strategies for Young Professionals

With the correct help, HPD patients can manage their symptoms and move on. HPD management needs self-awareness, healthy relationships, and stress and emotion control. Some HPD patients find relief through treatment, support groups, and lifestyle changes. Living a full life with Histrionic Personality Disorder is difficult, but treatment can help. Awareness, stigma reduction, and understanding can enhance HPD patients’ quality of life and hasten recovery.

Reference +

• Babl, A., Gómez Penedo, J. M., Berger, T., Schneider, N., Sachse, R., & Kramer, U. (2023). Change processes in psychotherapy for patients presenting with histrionic personality disorder. Clinical psychology & psychotherapy, 30(1), 64-72. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084191
• Blagov, P. S., Fowler, K. A., & Lilienfeld, S. O. (2007). Histrionic personality disorder. https://www.researchgate.net/profile/Stephanie-Mullins-Sweatt/publication/257619932_Histrionic_personality_disorder_Diagnostic_and_treatment_considerations/links/0046353a841b3cae89000000/Histrionic-personality-disorder-Diagnostic-and-treatment-considerations.pdf
• Blashfield, R. K., Reynolds, S. M., & Stennett, B. (2012). The death of histrionic personality disorder. https://books.google.co.in/books?hl=en&lr=&id=nqOBunfGoNgC&oi=fnd&pg=PP1&ots=MUadnbkwne&sig=49gSiMAOO64KPeyCEAfaSkt5xFE&redir_esc=y#v=onepage&q&f=false
• Candel, O. S. (2019). Review on the Present Condition of Histrionic Personality Disorder. Buletin de PsihiatrieIntegrativa, 82(3), 39-44. https://www.researchgate.net/publication/335796609_A_Review_on_the_Present_Condition_of_Histrionic_Personality_Disorder
• French, J. H., & Shrestha, S. (2019). Histrionic personality disorder. https://www.ncbi.nlm.nih.gov/books/NBK542325
• Hughes, A., Brewer, G., & Khan, R. (2020). Sexual coercion by women: The influence of pornography and narcissistic and histrionic personality disorder traits. Archives of sexual behavior, 49, 885-894. https://www.researchgate.net/publication/336325796_Sexual_Coercion_by_Women_The_Influence_of_Pornography_and_Narcissistic_and_Histrionic_Personality_Disorder_Traits
• Nalini, R., & Panneerselvam, S. (2018). Histrionic Personality Disorder. International Journal of Advances in Nursing Management, 6(4), 329-333. https://ijanm.com/HTMLPaper.aspx?Journal=International%20Journal%20of%20Advances%20in%20Nursing%20Management;PID=2018-6-4-14
• Novais, F., Araújo, A., & Godinho, P. (2015). Historical roots of histrionic personality disorder. Frontiers in psychology, 6, 1463. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4585318
• Pelz, B. (2017). Histrionic Personality Disorder. Abnormal Psychology. https://fscj.pressbooks.pub/abnormalpsychology/chapter/histrionic-personality-disorder
• Perrotta, G. (2021). Histrionic personality disorder: Definition, clinical profiles, differential diagnosis and therapeutic framework. Arch Community Med Public Health, 7(1), 001-005. https://www.researchgate.net/publication/348348700_Histrionic_personality_disorder_Definition_clinical_profiles_differential_diagnosis_and_therapeutic_framework