Those who suffer from Histrionic personality disorder (HPD) crave being the center of attention, often seeking out novelty and excitement. The name Histrionic stems from an Etruscan word, histrio, meaning “an actor” and while the disorder itself has been reported as far back as Ancient Egypt, it wasn’t until Sigmund Freud that it was actually classified as a personality disorder. The disorder, also known as hysterical personality, first appeared in the DSM-II and was renamed to its current name in the DSM-III, possibly due to the negative connotations of the word ‘hysteria’. Those who suffer from HPD often display excessive attention-seeking behaviors, often delving into sexual or seductive behaviors to remain the center of attention. Although they usually have good social skills, people with HPD often have trouble viewing their own lives realistically. Instead, they dramatize or exaggerate things, sometimes getting into risky situations as they continue to chase after the excitement they crave. Due to these risky behaviors and the fact that HPD affects personal and romantic relationships, it’s not unusual for those who suffer from it to also suffer from depression.
In order to be diagnosed with Histrionic personality disorder, a patient needs to be diagnosed with at least five of the following symptoms.
1. Is uncomfortable when they’re not the center of attention.
2. Interactions with others are often characterized by inappropriate sexually seductive or provocative behaviors.
3. Displays rapidly shifting and shallow expression of emotions.
4. Consistently uses physical appearance to draw attention to self.
5. Has an excessively impressionistic style of speech or one lacking in detail.
6. Overdramatic, exaggerated, or theatrical expression of emotion.
7. Easily influence by others/suggestible.
8. Considers relationships to be more intimate than they actually are.
There has been little research done into the causes of HPD, though some studies have shown a possible relationship between HPD and Antisocial personality disorder (ASPD). According to this research, two-thirds of those diagnosed with HPD also meet similar criteria for a diagnosis of ASPD. Other studies have shown an extreme overlap between HPD and Borderline personality disorder (BPD). This overlap includes the rapidly shifting emotions and impulsive behaviors. Researchers believe that the hyper-sexualization of women in media may ingrain the idea that the only way for women to get attention is through physical means. The fact that men can be just as flirtatious and be seen as a more macho or Don Juan figure may also be why women are diagnosed with HPD four times more often than men are. Due to the overlaps with multiple disorders and the fact that the media influence may be shifting the behaviors of female patients, there was a debate going into the creation of the DSM-V of whether or not HPD should remain its own separate personality disorder. Despite these similarities, it did remain its own separate diagnosis for the DSM-V.
Like many of the cluster B personality disorders, most people with HPD seek out treatment not for the personality disorder, but for other symptoms. Depression is the most common disorder that those suffering from HPD seek treatment for, often coming at the end of a romantic relationship. While medication can be used to treat depression and other underlying conditions, at this moment there are no medications to specifically treat HPD. Rather, the most common form of treatment for HPD is psychotherapy. While some therapists use informal interview or self-reporting methods in therapy, these can prove to be unreliable as they rely on the patient to report symptoms accurately. Many people who suffer from HPD have a distorted view of themselves or their self-presentation which leads to issues when asking a patient if they believe they meet the criteria for this disorder. Rather, therapies such as functional analytic psychotherapy are more commonly used as treatments for this disorder. Functional analytic psychotherapy focuses on identifying the interpersonal problems a patient has both in and outside of therapy and using them to help a patient better handle these issues. By addressing these behaviors in real-time and offering improvements to them, the therapist can help a patient adjust and recognize their problematic behavior in order to correct it. As with any form of psychotherapy, this can take time to take effect so don’t feel discouraged if you don’t notice changes right away. Keep at it and these changes will start to appear.
