Definition

Personality reflects deeply ingrained patterns of behavior and the manner in which individuals perceive, relate to, and think about themselves and their world. Personality traits are conspicuous features of personality and are not necessarily pathological, although certain styles of personality may cause interpersonal problems.

Personality disorders denote rigid, inflexible, and maladaptive patterns of thinking and behaving, leading to impairment in functioning and/or significant internal distress. Most personality disorders have their onset in adolescence or early adulthood, are stable over time, and lead to significant inner turmoil or impairment.

Individuals with histrionic personality disorder exhibit excessive emotionality—a tendency to regard things in an emotional manner—and are attention seekers. People with this disorder are uncomfortable or feel unappreciated when they are not the center of attention. Typical behaviors may include the constant seeking of approval or attention, self-dramatization, and theatricality. People with histrionic personality disorder may act self-centeredly or sexually seductive in inappropriate situations, including social, occupational, and professional relationships, beyond what is appropriate for the social context. They may be lively and dramatic, and may initially charm new acquaintances with their enthusiasm, apparent openness, or flirtatiousness. They may also, however, embarrass friends and acquaintances with excessive public displays of emotion, such as embracing casual acquaintances with passion, sobbing uncontrollably over minor setbacks, or having temper tantrums.

People with histrionic personality disorder commandeer the role of “life of the party.” Their interests and conversation will be self-focused. They use their physical appearance to draw attention to themselves. They tend to believe that relationships are more intimate than they actually are. Their emotional expression may be shallow and rapidly shifting. Their style of speech is excessively impressionistic and lacking in detail. They may do well with jobs that value and require imagination and creativity, but will probably have difficulty with tasks that demand logical or analytical thinking.

Data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions estimate that the prevalence of histrionic personality disorder is 1.84 percent.

Symptoms

According to the DSM-5, for a diagnosis of histrionic personality disorder to be given, five or more of the following symptoms must be present:

• Self-centeredness, feeling uncomfortable when not the center of attention
• Constantly seeking reassurance or approval
• Inappropriately seductive appearance or behavior
• Rapidly shifting emotional states that appear shallow to others
• Overly concerned with physical appearance, and using physical appearance to draw attention to self
• Opinions are easily influenced by other people, but difficult to back up with details
• Excessive dramatics with exaggerated displays of emotion
• Tendency to believe that relationships are more intimate than they actually are
• Is highly suggestible (easily influenced by others)

In addition, the symptoms must cause significant impairment or distress in an individual.

Causes

The cause of histrionic personality disorder is unknown, but childhood events and genetics may both be involved. HPD occurs more frequently in women than in men, although some experts contend that it is simply more often diagnosed in women, because attention-seeking and sexual forwardness are less socially acceptable for women than for men.

People with this disorder are usually able to function at a high level and can do well in social and occupational environments. They may seek treatment for depression when their romantic relationships end. They often fail to see their own situation realistically, instead tending to overdramatize and exaggerate. Instead of taking responsibility for failure or disappointment, those with the disorder typically cast blame on others. Because they tend to crave novelty and excitement, they may place themselves in risky situations. Their behavior may lead to a greater risk of developing depression.

Treatment

The recommended form of treatment for histrionic personality disorder is psychotherapy. That said, therapy for people with this diagnosis is often challenging, because they may exaggerate their symptoms or ability to function. They may also be emotionally needy and challenge the behavioral boundaries set up by the therapist. Therapy should generally be supportive and solution-focused.

Because depression can be associated with failed romantic relationships, patients with histrionic personality disorder often seek treatment when they are experiencing symptoms of depression.