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Histrionic Personality Disorder (HPD)

By Robert M. A. Hirschfeld, MD, DeWitt Wallace Senior Scholar and Professor, Department of Psychiatry, Weill Cornell Medical College

Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking.

  • People with histrionic personality disorder continually demand to be the center of attention and often try to do so by dressing and acting in inappropriately seductive and provocative ways and by expressing themselves very dramatically.

  • Doctors diagnose histrionic personality disorder based on specific symptoms, including discomfort due to not being the center of attention, inappropriately seductive or provocative interaction with others, and dramatic behavior and expression of emotion.

  • Psychotherapy that focuses on underlying conflicts may help.

Personality disorders are long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or impair the person's ability to function.

People with histrionic personality disorder use their physical appearance and act in inappropriately seductive or provocative ways to gain the attention of others. They often behave in submissive ways to retain the attention of others.

Histrionic personality disorder occurs in about 1.5 to 3% of the general population. It is more common among women.

Other disorders are also often present. They include one or more of the following:

Symptoms

Need for attention

People with histrionic personality disorder continually attempt to be the center of attention and often become depressed when they are not. They are often lively, dramatic, enthusiastic, and flirtatious and sometimes charm new acquaintances.

People with this disorder often dress and act in inappropriately seductive and provocative ways, not just with potential romantic interests, but in many contexts, including work and school. They want to impress others with their appearance and so are often preoccupied with how they look.

Problems with emotions

Emotions may be turned off and on quickly and thus may seem shallow to others . A the same time, emotions are often expressed in an exaggerated way. People with this disorder speak dramatically, expressing strong opinions, but with few facts or details to support their opinions.

Achieving emotional or sexual intimacy may be difficult. People may, often without being aware of it, play a role (such as that of a victim). They may try to control their partner using seductiveness or emotional manipulations while becoming very dependent on the partner.

Other symptoms

People with histrionic personality disorder are easily influenced by others and by current trends. They are highly suggestible. Also, they tend to be too trusting, especially of authority figures who, they think, may be able to solve all their problems.

These people often believe that their relationships are more intimate than they are.

People with this disorder crave novelty and tend to bore easily. Thus, they may change jobs and friends frequently. They are easily frustrated by having to wait for rewards, so their actions are often motivated by obtaining immediate satisfaction.

Diagnosis

  • A doctor's evaluation, based on specific criteria

Doctors usually diagnose personality disorders based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5—see Classification and Diagnosis of Mental Illness), published by the American Psychiatric Association.

For doctors to diagnose histrionic personality disorder, people must persistently exaggerate their emotions and seek attention, as shown by at least five of the following:

  • They feel uncomfortable when they are not the center of attention.

  • They interact with others in inappropriately sexually seductive or provocative ways.

  • Their emotions shift rapidly, making them seem shallow.

  • They consistently use their physical appearance to call attention to themselves.

  • Their speech that is extremely vague, lacking detail.

  • They express their emotions in a dramatic, theatrical, and extravagant way.

  • They are easily influenced by others or situations.

  • They view relationships as more intimate than the relationships are.

Also, symptoms must have begun by early adulthood.

Treatment

  • Psychotherapy

General treatment of histrionic personality disorder is the same as that for all personality disorders.

Little is known about how effective cognitive-behavioral therapy and drugs are for histrionic personality disorder.

Psychodynamic psychotherapy may be used. This type of psychotherapy focuses on underlying conflicts. The therapist may start by encouraging people to substitute speech for behavior and thus understand themselves better. This approach helps people with this disorder communicate with others in a less dramatic way. Then, the therapist can help them realize how their histrionic behaviors are an ineffective and inappropriate way to attract the attention of others and to make them feel better about themselves.