Histrionic Personality Disorder (HPD) is considered a dramatic personality disorder that is characterized by excessive and uncontrollable emotionality, inappropriate seductiveness and unnecessary attention seeking. Suggestive prevalence rates are about 2% to 3% and most cases occur among young adult females. People suffering from this disorder may act over-dramatically making a nuisance of themselves in social gatherings. Some of the associated features of this disorder include self-indulgence, egocentrism, manipulative and disruptive behavior. For instance, if a person suffering from Histrionic Personality Disorder does not get all the attention they want, they may do drastic and dramatic things to receive it. Most sufferers appear charming and friendly at first, but maybe highly demanding and insensitive in social relationships, in the long run.
The causes of the Histrionic Personality Disorder are unclear, but most psychodynamic theorists attribute it to childhood experiences with parents. According to Freud’s theories, if a child gets ‘fixed’ at the oral stage of psychosexual development, during which they learn dependency, they may show traits of egocentrism and may turn into demanding attention seekers. Some other theories state that histrionic behavior is modeled after parents or close relatives and/ or a result of long term neglectful parenting. Such children tend to draw attention by weeping, crying, anger tantrums and making up elaborate stories and these conditions may ultimately lead to personality disorders such as Histrionic Personality Disorder.
Genetics play a certain role in Histrionic Personality Disorder as well. Series of recent research studies have shown that such behaviors run in families, more prevalent among twins and also, people with this disorder show faulty emotional regulators in the brain. Even though, long term neglect can lead to the condition, being brought up in overly indulgent environments can also be a key cause for the disorder. Among sufferer of various personality disorders, histrionics are among the most difficult to associate with under regular circumstances. They tend to seek sexual gratification beyond their committed relationships, be insensitive to the needs of others and go to drastic extremes to get what they want and therefore, highly unsuccessful in relationships. Most histrionics are brought to therapy by family or friends, due to the fact that they are in denial. Nevertheless, while in therapy, they may try to win the affection of the therapists by bringing them gifts, admiring them excessively, dressing inappropriately, looking for compliments and appearing excessively emotional. These are in fact, the indicators and the confirmers of Histrionic Personality Disorder.
Symptoms and Types
Common symptoms of Histrionic Personality Disorder include;
- provocative behavior and clothing in inappropriate settings
- being overly concerned about appearance
- selfish, self-indulgent and egocentric behavior
- wanting to be the center of attention at all times
- constant need of reassurance and approval
- excessive sensitivity to criticism
- making rash decisions illogically
- rapid mood shifts
- being highly gullible
- markedly low tolerance for frustration, temper tantrums
- having difficulties in social relationships
- exaggerating stories or lying in order to receive attention
- dramatic display of emotions such as crying, laughing loud, talking loud, etc
- believing that relationships are more intimate than they actually are
- exhibitionist behavior
- somatic symptoms or complaining of imaginary physical illnesses
- threatening with self injury and suicidal attempts
The symptoms may vary from person to person but they should fit the diagnostic criteria as follows. There are numerous subtypes of Histrionic Personality Disorder, characterized by the most prevalent cluster of symptoms. Infantile Histrionic Personality Disorder, for example, is very much similar to the borderline personality disorder. Appeasing type shows more selfish behavior while disingenuous Histrionic Personality Disorder is characterized by antisocial behavior.
Diagnosis and Tests
The diagnostic criteria for Histrionic Personality Disorder include pervasive patterns of emotional, attention-seeking, self-indulgent, egocentric and seductive behavior, starting during young-adulthood (20’s to 30’s) and lasting for a prolonged period of time in a variety of contexts. Suffers of the disorder must show at least five of the following symptoms.
- seeking to be the center of attention at all times and severe discomfort when they are not
- social interactions primarily characterized by inappropriate provocative behavior and expression of sexuality
- rapidly shifting emotions and/or shallow display of emotions
- consider relationships to be more intimate than they actually are and maybe characterized by behavior such as hugging a stranger as they meet, unnecessary display of friendliness and inability to maintain professional/ formal relationships
- being highly suggestible or getting easily influenced by what others say
- impressionistic style of speech
- excessive self consciousness including paying unnecessary attention to personal appearance
- shows self-dramatization, theatricality and exaggerated emotionality
The symptoms of Histrionic Personality Disorder may overlap vastly with bipolar disorder and personality disorders such as borderline personality disorder, schizoid personality disorder and paranoia. But, only when at least five of the above listed symptoms are continuously displayed simultaneously, one can be eligible to be labeled as a histrionic and receive treatment for the condition.
Treatment and Care
Family therapy, cognitive and behavioral therapy and medication are some of the commonest and most successful treatment methods for those suffering from Histrionic Personality Disorder. Family therapy helps discover the dysfunctional behaviors of the family that brings about histrionic traits and also teaches each member to deal with a histrionic in the family. Medications including mood altering drugs/ antidepressants can be used temporarily and work best when paired with well-structured therapy. Cognitive psychotherapy helps individuals identify the underlying causes of their dramatic and attention demanding behaviors and alter thought patterns to fit social norms better.
Behavior therapy uses reinforces and punishments to treat the condition and is proven to be successful thought history. For example, due attention may not be given to attention seeking behavior. Social skills maybe improved both through individual counseling and through group therapy. However, working with several histrionics at once, maybe challenging because they may gratify one another. Like in the case of all other personality disorders, therapists need to be highly skilled and experienced to handle individuals with Histrionic Personality Disorder.
Thank You for this article. I’ve had to live through varied histrionic environments for a number of years. The two most common underlying factors fo
Thank You for this article. I’ve had to live through varied histrionic environments for a number of years. The two most common underlying factors for causation that have been consistent in my experiences are (1) a lack of ethical values in their childhood environment coupled with (2) an ‘almost innocent’ ability to manipulate for control. Often, the moral ‘front’ -that society willingly accepts- covers up the hidden unethical motives and philosophy. The ethos in and around their caregivers has been the need for control- almost, at any cost; and, manipulation techniques eventually become so subtle and ingrained that the individual, through intra-spection, easily accepts and approves them as his/her personality traits and eventual ‘secret’ identity; they ‘reap’ the benefits of their dishonesty but it is covered-up with ‘good moral standards’ and political correctness; it’s dangerous; and, it’s becoming prevelant in society. I suspect that is behind the reasoning to remove it from the next DSM. Everyone in such an environment is expected to ‘fall in line’ or be an outcast rebel. (I chose the later.) They do not come to a counselor until the process backfires. It’s a difficult chore but we have to reach back into childhood (and, even infancy) to grasp the small differences HPD folk have from other disorders.