Histrionic Personality Disorder
Overview of Diagnosis, Prevalence and Treatment of HPD
Many of us desire the admiration of others, but Histrionic personalities have an unhealthy need for constant attention and engage in outrageous behavior to get it.
What is Histrionic Personality Disorder?
To be histrionic is to behave melodramatically—over the top. People with the psychological disorder HPD, have a personality based on histrionic behavior; constantly displaying an excessive level of emotionality.
Histrionics crave the limelight and constantly seek attention and approval. They tend to dominate conversations using grandiose language and frequent interruptions. Those with HPD can be manipulative—negative attention being better than no attention at all (Dobbert 2007, Horowitz 2001).
Diagnosis of HPD
There are currently 10 conditions considered to be personality disorders, some of which have very little in common. Mental health professionals typically group those PDs that share characteristics into one of three clusters. Histrionic is a Cluster B Personality Disorder, a class which also contains Antisocial, Borderline and Narcissistic PD; all three distinguished by dramatic, emotional or erratic behavior.
HPD is only diagnosed when the characteristic behaviors are pervasive and disabling. According to the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders), a patient must fit at least five of the following criteria in order to be diagnosed with Histrionic Personality Disorder:
- uncomfortable in situations when not the center of attention
- social interactions often characterized by inappropriate sexually provocative behavior
- rapidly shifting and shallow expression of emotions
- consistently uses physical appearance to draw attention to self
- style of speech that lacks detail and is excessively emotional
- shows self-dramatization, theatricality, and exaggerated expression of emotion
- easily influenced by others or circumstances
- considers relationships to be more intimate than they actually are
Prevalence of Histrionic Personality
HPD has been estimated to occur in 2% to 3% of the general population and is more common among women (NESARC 2002).
Cause and Course of HPD
While the exact cause is not yet known, the disorder is exacerbated during increased times of stress and interpersonal difficulties. As is the case with most personality disorders, Histrionic Personality Disorder usually begins in early adulthood, and has a chronic course (Dobbert 2007, Horowitz 2001.
Treatment of Histrionic Disorder
Psychotherapy
Because personality is such an integral part of what defines our identity, PDs are characteristically difficult to treat. Individual psychotherapy, focused on increasing coping mechanisms and interpersonal skills appears to be the most effective course of treatment. Group therapy is generally not recommended for Histrionic patients, since their attention-seeking behavior can monopolize the session.
Suicidal gestures and self-mutilation, as attention-seeking behaviors, are often associated with HPD. Even if death is not the patent’s intention, it may be the result, so any expressed thoughts or plans of suicide should be taken very seriously.
The characteristic emotional neediness of Histrionics can result in an over-reliance on the therapist and reluctant to terminate therapy. Long-term psychotherapy can be financially prohibitive and is unlikely to resolve the deep-rooted issues of personality. The recommended course of treatment is short-term and focused on dealing with immediate stressors and difficulties within the person's life.
HPD and Medication
Psychiatric medications are not typically used to alleviate the personality disorder itself, but may be used to treat associated disorders such as anxiety or depression. Physicians should be cautious when prescribing to those with Histrionic Personality Disorder due to the possibility that the patient may use the medication inappropriately in the commission of self-destructive, harmful behaviors (Dobbert 2007, Horowitz 2001).
Information on Personality Disorders
There are numerous on-line and in print resources with additional information on personality disorders, including: Psychology Prof Online, PsychCentral and the article Types of Personality Disorders: Borderline, Narcissistic, Obsessive-Compulsive & Associated Clusters.
This article is a brief summary of the personality disorder HPD. The contents of this article are not meant to be used for diagnosis and are not a substitute for professional help and counseling.
Additional HPD Sources
American Psychiatric Association APA (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).
Dobbert, D. (2007) Understanding Personality Disorders: An Introduction. Greenwood Press.
Horowitz, M. J. (2001) Hysterical Personality Style and Histrionic Personality Disorder. Aronson.
National Epidemiologic Survey on Alcohol and Related Conditions - NESARC (2002) Journal of Clinical Psychiatry, 65.
