What is histrionic personality disorder?

The word “histrionic” means theatrical and it is a mental health disorder that is marked by the instability of emotions, a distortion in self-image, and the intense and overwhelming desire to be noticed by everyone. People with this disorder are often very dramatic and act inappropriately just to get attention. Histrionic personality disorder belongs to a class of mental health conditions known as “Cluster B” personality disorders. The disorders in this category are marked by similar characteristics like being erratic, emotional, and dramatic. People in this category also have their self-esteem dependent on the approval of other people without any feeling or sense of self-worth which creates a need to be noticed. They constantly want to be noticed, and they often resort to dramatic and inappropriate antics when trying to get the attention they desire.

Most of the time, people who have this disorder are unaware that their behavior and thought processes can be perceived as dramatic and problematic. Statistics also indicate that women are diagnosed with this disorder at a higher rate than men. Others, however, assert that this might be the case because men report symptoms less frequently than women.

Histrionic personality disorder (HPD) tends to occur in tandem with other personality disorders like borderline personality disorder (BPD), narcissistic personality disorder, and dependent personality disorders. There are lots of similarities between the symptoms of borderline personality disorder and histrionic personality disorder, to the point that experts at times find it difficult to differentiate between the two.

Borderline and Histrionic personality disorder

There aren’t many studies to show that the two disorders can co-occur but a study found that 10% of people with a borderline personality disorder also showed symptoms of histrionic personality disorder.

There are few similar and overlapping symptoms between the two. They are both characterized by the rapid shifting of emotions, extreme reactive emotions, strong expressions of emotion, and impulsive behavior.

However, there are arguments concerning the acclaimed similarities in these mental health conditions. For example, the rapid emotional changes in histrionic disorder are not the same in terms of intensity as in bipolar disorder.

Antisocial personality disorder and histrionic personality disorder

Similar to borderline personality disorder, antisocial personality disorder has a relationship with a histrionic personality disorder. Recent research found that two out of three patients diagnosed with a histrionic personality disorder also show symptoms and meet criteria similar to that of antisocial personality disorder. Based on this research, it has been suggested that both disorders might have similar underlying causes. Further studies on family history also showed that both disorders tend to run in families but it still isn’t clear whether these occurrences were based on genetics or environmental factors.

Symptoms of histrionic personality disorder

The main symptom of histrionic personality disorder is the display of excessive, extreme, and superficial emotions and sexuality to get attention from others. A person who is experiencing histrionic personality disorder may experience some or all of the following:

  • Feeling of underappreciation
  • Depression is when they are not getting the attention they desire.
  • Unstable and shallow emotions.
  • Dramatic, theatrical, and extreme emotional expression to the point of embarrassment to others around them.
  • Unnecessary and persistent use of charm and flirtation.
  • Extreme concern with physical appearance.
  • Wearing bright-colored, revealing, or extravagant clothing to draw attention to their physical appearance.
  • Inappropriate and provocative sexual advances towards people they are not sexually attracted to.
  • Speak loudly, in an impressionistic and dramatic manner.
  • Express strong opinions with little to no facts or details to back them up.
  • Gullible and easily influenced by people they admire.
  • Believe their relationships with others are more important than they usually are.
  • Inability to maintain meaningful relationships and often engage in fake and shallow interactions with others.
  • Enjoy and desire instant gratification and easily get bored and frustrated.
  • Constantly desire reassurance or approval of others.
  • Use of their social skills to manipulate others into making them the center of attention.
  • Not thinking their actions through and making rash decisions.
  • Discomfort in situations or events where they are not the center of attention could lead to not following through with events.
  • Attempt suicide to get attention.
  • Excess sensitivity to corrections, criticisms, or disapproval.

Other symptoms like extravagance, vanity, and seductiveness are also common in women diagnosed with this disorder. These symptoms typically do not surface completely until the age of 15 and diagnosis and treatment only averagely occur at the age of 40.

Causes of histrionic personality disorder

There is only a little research as to what causes histrionic personality disorder. Even though there are no direct causes, there are various theories and studies that suggest various possible causes like neurochemicals, genetics, psychoanalytic, and environmental problems.

Neurochemical/physiological Causes

There is a correlation between Cluster B disorders like histrionic personality disorder and the function of neurotransmitters. This theory is based on the fact that individuals diagnosed with this disorder also had highly responsive noradrenergic systems. This is responsible for the production, storage, and release of norepinephrine in neurotransmitters. High levels of this norepinephrine are what result in anxiety and extreme sociability.


The debate on whether the occurrence of disorders in families is due to genetics or environment has been aided by twin studies. One was conducted by psychologists at Oslo University with 221 twins. Interviews, using the Structured Clinical Interview for personality disorders, were carried out and the conclusion was that there’s a 67% correlation between heredity and histrionic personality disorder.

The psychoanalytic theory

Though this theory has been criticized for having no scientific evidence, it points to the authoritative or distant attitudes of parents and expectations a child could never meet. With the use of psychoanalysis, Freud proposed that lustfulness was merely a projection of the inability of the patient to show unconditional love and this had cognitively developed with them to maturity, thus, making them emotional. He also thought that a traumatic event, such as the loss of a loved one or an early parental divorce, could have contributed to their inability to love. They might have had the wrong idea about committed relationships after their divorce experience. He continued by demonstrating how regular exposure to numerous instances of these traumatic events in other people’s families could demonstrate abandonment as a component of relationships, which has the effect of impairing their capacity to develop sincere and affectionate connections with others.

Childhood trauma

Just as the psychoanalytical theory has explained, children handle trauma like child abuse or death in a way that can later be disruptive and problematic as adults resulting in a personality disorder.

Parenting styles

Children who grew up with parenting styles that lacked boundaries and were over-indulgent are more likely to develop a histrionic personality disorder. Also, growing up with parents who displayed dramatic, erratic, and inappropriate sexual behavior in the presence of their children put them at the of developing a histrionic personality disorder. Also, some problems between parents and their children can result in low self-esteem which is also a characteristic symptom of histrionic personality disorder.

Treatment of histrionic personality disorder

During diagnosis, if the doctor finds the signs of histrionic personality disorder present, the doctor will start to evaluate the patient by performing a complete psychiatric and medical history. In cases where physical symptoms are discovered during physical examinations, the doctor may also advise laboratory tests, such as neuroimaging studies or blood tests, to ensure that the symptoms are not caused by other physical illnesses. A psychiatrist, psychologist, or therapist may be consulted if the results of all these tests indicate that there is no physical explanation for the patient’s symptoms. These professionals may then use specialized interview and assessment techniques to aid in the disorder’s treatment.

The treatment of histrionic personality disorder, just like other personality disorders, can be difficult. Many people with the disorder do not even realize they have a disorder talkless of needing treatment. Those who get treatment might also find their treatment program unappealing. However, an early histrionic personality disorder test and treatment of this disorder are important to be able able to cope with it. Here are a few treatment options available:

2. Therapy

Just like other personality disorders, psychotherapy is the most common and effective treatment option and it involves talking to a therapist about their feelings and experiences the therapist uses these conversations to evaluate and determine the thoughts behind the actions and behaviors of the patient. The therapist also shows the patient the appropriate manner to relate with people without constantly trying to be the center of attention.

3. Functional analytic psychotherapy

This is another type of therapy used to treat histrionic personality disorder after it has been diagnosed. A functional analytic psychotherapist identifies a patient’s interpersonal problems during and outside of therapy sessions. Functional analytic psychotherapy is different from traditional psychotherapy because the therapist can directly address the patient’s behavioral patterns immediately after they occur during therapy.

4. Interviews and self-report methods

General clinical practice’s popular method of assessment of personality disorders is an unstructured interview. However, the most preferred method is al the semi-structured interview but this seems impractical which is why it is hardly used. It is preferred to the unstructured interview because it is more comprehensive and objective. Even though unstructured interviews are used more, they are unreliable and susceptible to errors that can mislead the patient.

5. Medication

If the patient is experiencing depression or anxiety as a part of their symptoms, they might put you on antidepressants or antianxiety medication.


A lot of people with histrionic personality disorder live regular lives. They work and function as part of society. They even thrive well in social settings. However, they encounter different and so many problems in intimate and important relationships. Depending on the intensity and level of this disorder, the symptoms might impair their ability to maintain professional relationships and also focus on pressing life goals because they are constantly seeking instant gratification.  They are also at risk of depression since this disorder affects the way they handle criticism and failure. Histrionic personality disorder can generally disrupt the course of a person’s life which is why earlier detection and treatment are required. Ignoring someone with histrionic personality disorder is not recommended as they usually do not realize they have a mental health