Personality Disorders

Personality disorders are a group of mental health conditions characterized by enduring patterns of behavior, cognition, and inner experience that deviate markedly from the expectations of the individual’s culture. These patterns are inflexible and pervasive across a broad range of personal and social situations, causing distress or impairment in functioning. There are different types of personality disorders, such as borderline personality disorder, narcissistic personality disorder, and obsessive-compulsive personality disorder, each with unique features and symptoms.

If you or someone you know is struggling with potential symptoms of a personality disorder, seeking professional help is crucial for diagnosis and treatment.

See Personality Disorders for more on this topic

History of Histrionic Personality Disorder

The term ‘histrionic’ is derived from the Latin word ‘histrio,’ meaning ‘actor.’ HPD is linked to the early concept of hysteria. We can trace the term back to ancient times when the Egyptians attributed hysteria to a wandering womb in women. In the seventeenth century,

Richard Mead wrote:

“There is no disease so vexatious to women as that called hysterical. It is common to maids, wives, and widows; and although it may not be attended with great danger, yet it is frequently very terrifying; and moreover, it sometimes deprives them of their senses as effectually as if they had been seized with an epileptic fit” (Veith, 1977).

Of course, as a physician running a very large practice, he should have seen past the biased gender perceptions of the time and recognize that many men were afflicted by the same symptoms. This recognition would come in the late nineteenth century. Thomas Sydenham, a distinguished English Physician, recognized that symptoms of hysteria were experienced by men and women.

Nineteenth Century Insights

Sydenham described the disorder as the “incurable despair of patients, their belief that they must suffer all the evil that befalls mankind, their presentiment of further unhappiness.” In addition, he pointed out the characteristics of a “propensity to anger, jealousy, and suspicion” They also experience occasional intervals of joy, hope, and cheerfulness.

According to Sydenham, “their daytime moods, mirrored by their dreams, were haunted by sad forebodings.” Sydenham punctuated these remarks with: “They love without measure those whom they will soon hate without reason” (Veith, 1977, p. 24).

In the 19th century, notable figures like Jean-Martin Charcot and Sigmund Freud studied hysteria, with Charcot considering it a neurological disorder and Freud associating it with psychological trauma. The modern concept of HPD emerged in the 20th century with the creation of the Diagnostic and Statistical Manual of Mental Disorders (DSM). HPD was first included in the DSM-II and has been part of subsequent editions, with evolving criteria reflecting the understanding of the disorder as characterized by dramatic, attention-seeking behaviors and emotional instability.

Symptoms and Behaviors

Histrionic personality disorder exhibits a pattern of excessive emotion and attention seeking. People with histrionic personality disorder often experience discomfort when they are not the focus of attention, may use physical appearance as a means to draw people’s attention or have rapidly shifting and exaggerated emotions.

People with HPD may exhibit the following symptoms and behaviors:

• Attention-Seeking: They often go to great lengths to be the focus of attention in social settings, using dramatic and flamboyant gestures to capture the spotlight.
• Seductive Behavior: Individuals with HPD may engage in overly flirtatious or provocative behavior in an attempt to draw attention to themselves.
• Shifting Emotions: Their emotions can be unstable, with sudden and dramatic shifts in mood. A small event can lead to an exaggerated emotional response (see Emotional Lability).
• Need for Approval: Those with HPD often seek reassurance and validation from others, and may feel uncomfortable or anxious when not in the spotlight.
• Impulsivity: They may make impulsive decisions without considering the consequences, driven by their desire for immediate gratification and attention.

A Therapist Description of a Histrionic Patient

Barbara Flemming described the Histrionic patient this way:

Unlike people with dependent personality disorder, they actively pursue the attention of others through dramatic, attention seeking behavior. They are overly concerned with physical attractiveness, often overtly seductive, and most comfortable when they are the center of attention. Their emotionality seems to be inappropriately exaggerated, labile, and shallow, and they tend to have a global, impressionistic style of speech. They are seen by others as self-centered and lacking the ability to delay gratification. These patients are lively, dramatic, and, as the diagnosis implies, histrionic in style. Their behavior is overly reactive and intense. They are emotionally excitable and crave stimulation, often responding to minor stimuli with irrational, angry outbursts or tantrums. Their interpersonal relationships are impaired, and they are perceived by others as shallow, lacking in genuineness, demanding, and overly dependent (Beck, 1990, p. 210).

DSM Diagnosis of Histrionic Personality Disorder

Diagnostic and Statistical Manual of Mental Disorders identifies ten personality disorders that it organizes into three different clusters. The American Psychiatric Association centered each cluster around similar symptoms. The Histrionic Personality Disorder is in cluster ‘B’ with Antisocial Personality Disorder, Borderline Personality Disorder, Narcissistic Personality Disorder. These disorders share are characterized by dramatic, emotional, and erratic behavior.

According to DSM V, a person must possess five or more of these characteristics in order for a clinician to diagnose them with HPD:

• uncomfortable when not the center of attention
• inappropriate sexual/seductive behavior
• rapidly shifting and shallow emotions
• uses physical appearance for attention
• excessively expressionistic speech lacking details
• exaggerated emotional expression
• suggestibility
• misperceives intimacy in relationships (Wright & Carbajal, 2021).

Impact of Histrionic Personality Disorder on Relationships and Daily Life

Histrionic Personality Disorder (HPD) is characterized by excessive emotionality and attention-seeking behavior.

• Emotional Instability: Individuals with HPD often experience intense emotions that can change rapidly. This instability may lead to difficulties in managing stress, which can affect work performance and personal responsibilities.
• Attention-Seeking Behaviors: Those with HPD frequently seek validation and approval from others, which may result in dramatic or provocative behaviors. This need for attention can strain relationships as friends, family, or colleagues may feel overwhelmed or manipulated.
• Interpersonal Relationships: Relationships tend to be superficial; individuals with HPD may struggle to form deep connections due to their focus on being the center of attention. They might exaggerate emotions or situations to keep the spotlight on themselves, leading others to feel unvalued.
• Difficulty Handling Criticism: People with HPD are often sensitive to criticism and rejection, which can lead to conflicts in both personal and professional settings. Their reactions might be disproportionate, causing misunderstandings or further alienation.
• Impulsivity: Impulsive decision-making related to spending habits, sexual behavior, or other activities is common in individuals with HPD. Such impulsivity can create financial issues or complications within romantic partnerships.
• Dependence on Others for Self-Esteem: Individuals with this disorder frequently rely on external sources for self-worth rather than developing a stable sense of identity internally. This dependence can make them vulnerable during times of social isolation or when they perceive a lack of support from others.
• Inconsistent Communication Styles: The tendency toward dramatic expression means that those suffering from HPD may exaggerate or use theatrical expressions in communication rather than straightforward—a factor that could confuse listeners and hinder clear understanding among peers.

Overall, while people with Histrionic Personality Disorder have the capacity for meaningful relationships and experiences, their behaviors often complicate interactions and contribute to challenges in sustaining long-term connections both personally and professionally.

Causes of Histrionic Personality Disorder

Research and professionals have not identified the exact cause of histrionic personality disorder (HPD). Like all personality disorders, professionals believe that a variety of factors combine to cause the disorder:

• Genetics: There may be an inherited predisposition to the disorder, as it sometimes runs in families.
• Environmental Factors: Childhood experiences, such as a lack of criticism or punishment, or traumatic events like the death of a close one or parental divorce, may contribute to the development of HPD.
• Psychological Factors: Many researchers believe that issues with self-esteem and self-worth, along with a desire for approval and attention,also play a role in the development of the disorder.

Aaron Beck emphasized a cognitive component to the disorder. He hypothesized that personality orders are identified by “dysfunctional beliefs and maladaptive strategies (that) make individuals susceptible to life experiences that impinge on their cognitive vulnerability.” He continues to explain that for the histrionic this stress is caused “by failure to manipulate others to provide attention and support” (Beck, 1990).

It’s important to note that these factors can vary greatly among individuals, and having one or more of these factors does not necessarily mean a person will develop HPD. A healthcare provider can offer more personalized insights based on an individual’s history and circumstances.

Diathesis Stress Model and Epigenetics

According to the diathesis stress model, many disorders develop as a result of interactions between pre-dispositional vulnerabilities (the diathesis), and stress caused by life experiences. Basically, predispositions interact with stressful experiences creating the disorder.

Epigenetics is the science of gene expression. Research has discovered that environments can alter gene expressions. Robert M. Sapolsky, Ph.D., professor of biology and neurology at Stanford University, explains that research shows that mothering style “altered the on/off switch in a gene relevant to the brain’s stress response.” By stimulating environments, “harsh parents, good neighborhoods, uninspiring teachers, optimal diets—all alter genes in the brain” (Sapolsky, 2018).

Most likely the cause of histrionics lies somewhere in the complex intertwining of genetic predispositions and environmental exposures. Perhaps, a behavioral feedback loop may also contribute to the developing and magnifying of symptoms. However, scientists can not positively identify any one of these possible causes in the lab. Consequently, the causes of the disease remain highly subjective and as Robyn Dawes stated about these diagnoses they “have the largest amount of fuzz in their fuzzy boundaries” (Dawes, 1996).

Treatment and Support

Seeking professional help is crucial for managing Histrionic Personality Disorder. Treatment typically involves psychotherapy, particularly cognitive-behavioral therapy (CBT), which can help individuals understand and modify their behavior patterns. Most professionals use behavioral therapies to help individuals diagnosed with HPD uncover the motivations and fears associated with their thoughts and behaviors. 

Medical professionals may prescribe medications to address co-occurring conditions like depression or anxiety. However, medications typically are not the primary course of treatment for HPD.

Support from friends and family members is also valuable. Building a strong support network can help individuals with HPD feel more secure and less reliant on seeking attention from others.

It’s important to note that the understanding and treatment approaches for HPD and other personality disorders continue to evolve as research in psychology and psychiatry advances.

See Different Therapy Style for other methods of treatment

Associated Concepts

• Attachment Theory: This is a psychological framework that helps explain how human beings form emotional bonds and connections with others, particularly in early childhood. British psychologist John Bowlby developed this theory in the 1950s. Mary Ainsworth and others expanded on Bowlby’s original work.
• Neurosis: This refers to a maladaptive behavior or thinking process adopted to relieve negative affects. Typically, the neurosis relieves anxiety in the present without regard to future impact on self and others.
• Dependent Personality Disorder: American Psychiatric Association characterizes this personality disorder by the patients excessive need to be taken care of, which leads to submissive and clinging behavior, fear of separation, and an inability to make everyday decisions. Individuals with Dependent Personality Disorder often have difficulty expressing disagreement or disagreeing with others due to fear of losing their support.
• Relationship Drama: This refers to interpersonal conflicts, disagreements, or emotional turmoil within a romantic relationship or between partners. This can encompass a wide range of issues such as jealousy, insecurity, communication breakdowns, infidelity, or differing expectations, all of which can lead to heightened emotions and tension within the relationship.
• Rejection Sensitive Dysphoria: Psychologists and physicians may use this term to describe when a person experiences an intense emotional sensitivity and pain triggered by their perception of others rejecting or criticizing them. The psychiatric literature commonly associates this with certain mental health conditions.
• Separation-Individuation Theory: This theory, proposed by Margaret Mahler, describes the process through which a child develops a sense of individual identity and separates from their primary caregivers. According to the theory, children go through different stages of development, gradually becoming more autonomous and independent while establishing a separate sense of self from their caregivers.

A Few Words by Psychology Fanatic

Histrionic Personality Disorder can be a deeply challenging experience for those who live with it, often leading to feelings of isolation and misunderstanding. The intense emotions and constant need for attention may create significant barriers in forming meaningful relationships, which can further exacerbate feelings of loneliness. However, it’s important to recognize that individuals suffering from HPD are not defined solely by their disorder; they have unique strengths and qualities that deserve acknowledgment and appreciation. With compassion and understanding from both themselves and those around them, individuals can begin to navigate the complexities of their emotions more effectively.

There is hope for recovery through proper support systems, including therapy tailored specifically to address the needs associated with Histrionic Personality Disorder. Engaging in therapeutic practices allows individuals to explore their emotional landscapes and develop healthier coping mechanisms while fostering self-awareness. As they embark on this journey toward healing, it’s vital for loved ones to offer unwavering support—encouraging open communication without judgment. With dedication, patience, and professional guidance, people diagnosed with HPD can learn how to manage symptoms effectively, cultivate fulfilling relationships, and ultimately lead lives filled with purpose and joy.

Last Update: March 4, 2026

References:

Beck, Aaron T. (1990) Cognitive Therapy for Personality Disorders. The Guilford Press. ISBN: 9780898624342; APA Record: 2014-50109-000
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Dawes, Robyn (1996). House of Cards. Psychology and Psychotherapy Built on Myth. Free Press; 1st edition. ISBN-10: 0029072050; APA Record: 1994-97431-000
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Sapolsky, Robert (2018). Behave: The Biology of Humans at Our Best and Worst. Penguin Books; Illustrated edition. ISBN-10: 1594205078
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Veith, Ilza (1977). Four Thousand years of Hysteria. In: Mardi Jon Horowitz (ed.), Hysterical Personality, edited by . New York : J. Aronson. ISBN: 9780876685464
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Wright, M., & Carbajal, A. (2021). Personality disorders. Journal of the American Academy of Physician Assistants, 34(10), 49-50. DOI: 10.1097/01.jaa.0000791516.70522.f8
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