Understanding Histrionic Personality Disorder: A Closer Look at HPD

In the vast landscape of human psychology, personality disorders are some of the most intriguing yet challenging conditions to understand and manage. Among these, Histrionic Personality Disorder (HPD) stands out with its colorful array of symptoms and behaviors. Characterized by a persistent pattern of excessive emotionality and attention-seeking. HPD can lead to significant distress and impairment in an individual’s life. This disorder often paints a picture of vibrant, charismatic individuals who are, paradoxically, grappling with deep-rooted insecurities and a constant need for validation.

In this blog, we’ll embark on a journey to unravel the complexities of HPD. It will exploring the theatrical yet often misunderstood world of those who live with this condition, their struggles, triumphs, and the myriad ways they navigate their social tapestry.

What is Histrionic Personality Disorder?

Histrionic Personality Disorder (HPD) is a type of personality disorder, defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) as a pervasive pattern of excessive emotionality and attention-seeking behavior. It begins by early adulthood and is present in a variety of contexts.

Individuals with HPD often display a high degree of emotional expression. It is combined with a need for approval and discomfort when they are not the center of attention. Their behavior can be viewed as excessively charming or flirtatious and can often be inappropriate for the situation.

Symptoms of Histrionic Personality Disorder

HPD is distinguished by a constellation of symptoms, which include but are not limited to:

• They like to dress in a way that gets them noticed in a flirty way.
• They feel good when everyone is paying attention to them at a party or event.
• Their emotions can change very quickly.
• They always need people to tell them they’re doing well or are liked.
• They get upset easily if someone criticizes them.
• They tend to go along with what other people say or suggest.
• They act in a way that’s over-the-top, like they’re putting on a show.
• They don’t always seem to mean what they say or do.
• They find regular daily activities dull and lose interest quickly.
• They often start new things without finishing what they’re already doing.
• They struggle to pause and think before doing something.
• They make choices in a hurry, which can seem rash.
• They find it hard to put up with what other people do or how they act.
• They don’t have steady relationships with people.
• If they feel ignored, they might say they will hurt themselves.

Causes of Histrionic Personality Disorder

The exact cause of HPD, like other personality disorders, is not fully understood. But it is concidered as a combination of genetic and environmental factors is believed to play a role. Some possible causes include:

• Genetics: A family history of personality disorders or HPD may increase the risk.
• Childhood experiences: Early childhood events, such as neglect or a lack of criticism during pivotal developmental stages, could contribute to the disorder.
• Brain biology: Some studies suggest differences in brain structure or chemistry may be involved.

Diagnosis of Histrionic Personality Disorder

Diagnosing Histrionic Personality Disorder (HPD) requires a mental health professional to assess. Statistical Manual of Mental Disorders (DSM) is a criteria of assessment, which is published by the American Psychiatric Association. As of my last update in April 2023, the DSM-5 provides the latest criteria for the diagnosis of HPD. Here’s a general overview of the process:

Clinical Assessment

The process typically begins with a comprehensive clinical interview where the mental health professional assesses the patient’s history, symptomatology, and overall functioning. This can include discussions about the patient’s interpersonal relationships, emotional expression, and behavior patterns.

Diagnostic Criteria

For a diagnosis of HPD to be made, the DSM-5 requires that a patient demonstrate a pervasive pattern of excessive emotionality and attention-seeking behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following criteria:

1. Is uncomfortable in situations in which he or she is not the center of attention.
2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
3. Displays rapidly shifting and shallow expression of emotions.
4. Consistently uses physical appearance to draw attention to self.
5. Has a style of speech that is excessively impressionistic and lacking in detail.
6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.
7. Is suggestible, i.e., easily influenced by others or circumstances.
8. Considers relationships to be more intimate than they actually are.

Differential Diagnosis

The mental health professional will also seek to differentiate HPD from other mental health disorders with overlapping symptoms, including other personality disorders (like Borderline, Narcissistic, or Dependent Personality Disorder), mood disorders, and anxiety disorders. This is a critical step to ensure that the correct diagnosis is made.

Psychological Testing

In some cases, the clinician may also utilize psychological tests that can help in the assessment of personality structure and pathology.

Collateral Information

Information from third-party sources such as family members or close friends can also be valuable for the diagnosis to understand the consistency of the individual’s behavior across different contexts.

Treatment for Histrionic Personality Disorder

Treating HPD can be challenging, but various approaches can help manage the condition. The primary treatment is psychotherapy, with the goal of helping individuals understand their emotions and needs and learn to relate more authentically with others. Therapy can also teach coping skills for dealing with distress and improving interpersonal functioning. No medications specifically treat HPD, but they may be prescribed for associated symptoms like depression or anxiety.

Cognitive-Behavioral Therapy (CBT)

CBT focuses on identifying and changing unhealthy, irrational beliefs that may underlie attention-seeking behaviors.

Psychodynamic Psychotherapy

This approach aims to delve into past experiences and unresolved conflicts that may be contributing to the current behavior.

Group Therapy

Group therapy can be particularly beneficial for HPD, as it offers a social context to observe and change interactions with others.

Challenges Faced by Individuals with HPD

Individuals with Histrionic Personality Disorder (HPD) face a multitude of challenges that often pervade and complicate various aspects of their lives. Interpersonally, they may struggle to form genuine, deep connections with others due to their pattern of seeking attention and approval, which can come off as insincere or manipulative. Their emotional responses can be perceived as over-the-top or theatrical, leading to difficulties in being taken seriously by peers and authorities when genuine distress or needs are present.

Professionally, the impulsive behaviors and the need for constant validation associated with HPD can undermine their reliability and the quality of their work, potentially stalling career progression and fulfillment. Moreover, their tendency to seek excitement and engage in risk-taking behaviors without considering the long-term consequences can lead to legal troubles or financial instability.

Psychologically, the inner world of someone with HPD can be turbulent. The constant search for validation and fear of being ignored or unloved can result in chronic feelings of emptiness and low self-esteem. These individuals may experience depression and anxiety when they are not the center of attention or when they face rejection. The exaggerated expression of emotions, although often deemed shallow by observers, can be deeply exhausting for the person with HPD, who may feel a sense of loss or confusion about their true self and personal values.

Treatment itself presents a challenge, as individuals with HPD may find it difficult to engage in the introspective and consistent work required in psychotherapy due to their desire for immediate results and their fluctuating focus on the therapeutic process. Addressing these challenges requires a nuanced approach, tailored to the individual’s needs, and often necessitates a long-term commitment to personal growth and self-understanding.

A note from Known_Psychchology

HPD is a complex personality disorder that can profoundly affect an individual’s life. While attention-seeking and dramatic flair are hallmark characteristics, it’s essential to remember that they stem from a place of insecurity and a deep-seated need for acceptance. With proper diagnosis and treatment, individuals with HPD can lead fulfilling lives. As we learn more about the disorder, it is crucial for the stigma surrounding HPD to be dismantled, allowing those affected to seek help without fear of judgment. Through understanding and support, individuals with HPD can learn to navigate their world with a stronger sense of self and healthier interpersonal dynamics.

References

• French JH, Shrestha S. Histrionic Personality Disorder (https://www.ncbi.nlm.nih.gov/books/NBK542325/).
• Merck Manual: Professional Version. Histrionic Personality Disorder (HPD) (https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/histrionic-personality-disorder-hpd).
• National Institutes of Health, National Library of Medicine. Histrionic Personality Disorder (https://medlineplus.gov/ency/article/001531.htm).
• Weissman SH. Personality Disorders. In: Ebert MH, Leckman JF, Petrakis IL, eds. Current Diagnosis & Treatment: Psychiatry, 3e. McGraw Hill; 2019.