What is Histrionic Personality Disorder (HPD)

Histrionic Personality Disorder

Histrionic Personality Disorder (HPD) is categorized by the American Psychiatric Association as a Cluster B personality disorder, which encompasses conditions marked by emotional, theatrical, and unpredictable behavior.

Individuals with HPD often exhibit an excessive display of emotions and a strong desire to be noticed and be at the center of attention. Their behavior can be described as overly dramatic, emotional, or erratic.

Egocentrism, self-indulgence, a constant desire for approval, and persistent manipulative behavior to achieve their own goals are all associated characteristics.

Signs of Histrionic Personality Disorder

Individuals with the condition may experience quickly changing emotions and a diminished capacity to recognize the emotions of others. They frequently fail to evaluate their own personal circumstances objectively, instead dramatizing and exaggerating their problems.

Others may see their emotions as shallow or overblown. The disorder has associations with extraversion, a low tolerance for frustration or delayed reward, and a willingness to try new things. People with histrionic personality disorder may exhibit minimal self-doubt and look egocentric.

Patients with HPD are typically high-functioning, both socially and professionally. They normally have good social skills, despite the fact that they like to be the focus of attention.

According to research, persons with histrionic personalities have a larger craving for social approval and reassurance and will seek it out continually, making them more susceptible to social media addiction. This disease is characterized by an oversensitivity to criticism or disapproval.

People suffering with this disorder frequently wear colorful attire, experiment with body alterations, and pretend to have medical concerns in order to attract the attention of others. They may engage in unwanted sexual provocation, flirtation, or exploitative behavior.

When their craving for attention is not addressed, their symptoms can become more severe. They are susceptible and readily persuaded, particularly by individuals they respect.

HPD can also have an impact on a person’s social and romantic connections, as well as their ability to deal with loss or failure. People with HPD are more likely to consider relationships closer than usual.

When romantic (or other intimate) relationships end, they may seek clinical depression treatment. Patients with histrionic personality disorder are more likely to suffer from substance use disorders, such as alcoholism or opiate addiction.

They may change jobs frequently since they become bored easily and wish to avoid frustration. Because they crave novelty and excitement, they may put themselves in dangerous circumstances. All of these factors may contribute to an increased risk of developing clinical depression.

Despite these characteristics, they can be proud of their own personality and may be resistant to change, considering any change as threatening. They may even attribute their personal shortcomings or frustrations to others.

Diagnostic Criteria

The current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) defines histrionic personality disorder as a pervasive pattern of excessive emotionality and attention-seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  • Discomfort when not the center of attention.
  • Inappropriately seductive or provocative behavior.
  • Rapidly shifting and shallow expression of emotions.
  • Using physical appearance to draw attention to oneself.
  • Impressionistic and vague speech.
  • Dramatic, theatrical, and exaggerated expression of emotions.
  • Suggestible, easily influenced by others or circumstances.
  • Considers relationships to be more intimate than they actually are.


There has been little research to determine the etiology of histrionic personality disorder. Although direct origins are inconclusive, different hypotheses and research propose multiple plausible causes, including neurochemical, genetic, psychoanalytic, and environmental factors.

Twin research have helped to break down the hereditary vs. environmental argument. A twin study done by the Department of Psychology at the University of Oslo sought to establish a link between heredity and Cluster B personality disorders.

With a test group of 221 twins, 92 monozygotic and 129 dizygotic, researchers examined the individuals using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and determined that histrionic personality disorder is hereditary (r = 0.67).

While genes set the stage, environmental factors often act as the catalyst for the display of HPD characteristics. Early childhood experiences and family dynamics heavily influence an individual’s temperament and behavior.

For instance, inconsistent parental reinforcement can lead to a child developing a distorted self-image and intense craving for attention—traits commonly observed in HPD. Additionally, cultural and societal norms, along with specific environmental stressors, can shape or trigger the expression of histrionic personality traits.

A different hypothesis implies a link between histrionic personality disorder and antisocial personality disorder. According to research, two-thirds of people diagnosed with histrionic personality disorder fulfill criteria similar to those for antisocial personality disorder, implying that both diseases based on sex-type manifestations may have the same underlying origin.

Impact on Relationships and Behavior

Individuals with HPD are often lively, engaging, and may initially charm new acquaintances. Their desire to be noticed frequently manifests in provocative behavior and dramatic expressions. Impressionistic speech—marked by vivid, but often vague and shallow details—is common.

While they may quickly form connections due to their enthusiastic and attention seeking nature, maintaining long-term friendships can be challenging due to a perceived lack of depth and authenticity in these interactions.

In intimate relationships, those with HPD may exhibit behaviors that are overly dramatic and seductive, sometimes well beyond what is appropriate for the context. They may expect their relationships to be more intimate than they truly are, and often require continual assurance of approval and acceptance. Due to their easily influenced nature, they might mirror their partners’ opinions and behaviors, which can lead to imbalanced or unhealthy dynamics within the relationship.

Treatment and Management

Psychotherapy is a cornerstone of treatment for histrionic personality disorder. Cognitive Behavioral Therapy (CBT) is commonly used to help patients identify and change maladaptive thought patterns and behaviors.

Another approach, known as Cognitive Analytic Therapy (CAT), has also been shown to be effective in treating HPD. According to a study evaluating CAT’s efficacy, patients experienced measurable improvements.

While medication does not cure HPD, it can help manage certain symptoms that often co-occur with this condition, such as depression or anxiety. The decision to use medication is carefully considered by psychiatrists on a case-by-case basis due to potential side effects and the necessity for monitoring. Other treatments, which may include group therapy or skills training, aim to enhance interpersonal relations and emotional regulation.

Prevalence and Demographics

According to data from the 2001-2002 National Epidemiological Survey, the prevalence of HPD in the general population.is 1.84%. This study also observed that the prevalence declines with age among males, while it remains relatively stable among females.  Women account for about 65% of HPD diagnoses, while men make up 35%.

In A Women’s View of DSM-III, Marcie Kaplan contends that women are overdiagnosed due to potential biases, and that even healthy women are frequently immediately diagnosed with HPD. It has additionally been argued that due to diagnostic bias, prevalence rates are equal for men and women.

Many of the symptoms listed in the DSM for HPD are exaggerations of typical feminine characteristics. A peer and self-review study found that femininity was associated with histrionic, dependent, and narcissistic personality disorders.

Most histrionics have further mental disorders. Comorbid problems include: depression, antisocial, dependent, borderline, and narcissistic personality disorders, anxiety disorders, panic disorder, somatoform disorders, anorexia nervosa, and substance use disorder.

Research shows a significant overlap between HPD and several other personality disorders. For example, narcissistic personality disorder shares traits of attention-seeking and desires for approval. It’s not uncommon for individuals to exhibit symptoms of both disorders.

There is also a notable link between HPD and borderline personality disorder; they may share symptoms such as intense emotional reactions and fears of rejection, despite differing core characteristics. HPD can co-occur with antisocial personality disorder and dependent personality disorder, though the exact prevalence rates can vary.

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Last Updated on March 4, 2024