An Integrated Approach to Young Adult Mental Health Rehab

What Is Histrionic Personality Disorder and How Is It Treated?

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Histrionic personality disorder (HPD) is a mental health condition characterized by over-dramatizing feelings and situations. People with HPD tend to overreact emotionally and have poor impulse control. Because they struggle with their self-esteem, they constantly seek attention and affirmation.

HPD has become known as the “Amber Heard personality disorder” as a result of the 2022 trial in which Heard’s ex-husband, actor Johnny Depp, sued her for defamation. A psychologist testified in court that Heard has both histrionic personality disorder, as well as borderline personality disorder. 

As a result, viral posts and memes about Amber Heard and histrionic personality disorder have increased the public’s awareness about this condition. However, HPD is relatively rare compared to other personality disorders, such as borderline personality disorder or obsessive-compulsive disorder. Only between 2 and 3 percent of the general population is diagnosed with HPD, and females are more frequently diagnosed with the disorder than males.

Know the Facts

Women are 4x as likely as men to be diagnosed with histrionic personality disorder.

What Is Histrionic Personality Disorder? 

Histrionic personality disorder (HPD) was first identified in 1968 in the Diagnostic and Statistical Manual of Mental Disorders II. It is one of 10 personality disorders in the DSM, and is classified as one of the Cluster B personality disorders, sometimes referred to as “dramatic” personality disorders. These Cluster B disorders also include antisocial personality disorder, borderline personality disorder, and narcissistic personality disorder. 

The word histrionic means “dramatic” or “theatrical,” and derives from the word “hysteria.” In ancient Greece and Rome, “hysterical disorders” in women were thought to be related to the womb, or uterus. Today, HPD is the only modern diagnosis that still uses this outdated terminology. In fact, some mental health experts believe that the term histrionic personality disorder should be deleted from the DSM. Instead, the disorder could be classified as an exhibitionistic subtype of narcissism. 

What’s the Difference Between Histrionic Personality Disorder and Typical Young Adult Drama? 

Some of the histrionic personality disorder symptoms are similar to typical young adult behavior. Young adults are in a period of life that is particularly volatile. People in this age group are typically experiencing new things all the time: starting college, traveling, moving to a new town, starting a new job, forming new friendships or relationships. All of that change can lead to intense emotions and dramatic behaviors.

Moreover, the brain is not fully mature until a person is in their mid-20s. And the parts of the brain that develop last are the areas related to emotional regulation and impulse control. Therefore, young adults tend to have more extreme emotional reactions and experience more dramatic highs and lows. 

Because HPD typically develops during adolescence or early adulthood, it might be difficult to distinguish between HPD symptoms and normal young adult emotions. However, there is usually a clear difference between typical young adult drama and the ongoing attention-seeking behavior associated with histrionic personality disorder symptoms.

Histrionic Personality Disorder Symptoms

To receive an HPD diagnosis, an individual must exhibit specific symptoms and experience significant impairment or distress as a result of those symptoms. Their HPD typically has a negative impact on their relationships, daily functioning, and work or academic performance

A specific set of criteria defines HPD, which was used to determine the Amber Heard histrionic personality disorder diagnosis. When diagnosing HPD, a mental health professional looks for five or more of these histrionic personality disorder symptoms: 

  1. Being excessively dramatic, with exaggerated displays of intense emotion 
  2. Self-centeredness—uncomfortable when not the center of attention
  3. Dramatic and vague manner of speaking
  4. Inappropriately seductive appearance or behavior
  5. Rapidly shifting emotional states that appear shallow to others
  6. Overly concerned with physical appearance, and using physical appearance to draw attention to oneself
  7. Easily influenced by other people 
  8. Tends to believe that relationships are more intimate than they actually are.

Mental healthcare providers usually do not diagnose HPD in people under the age of 18. That’s because personality is still developing as an adolescent matures. So it’s usually not clear whether an individual has histrionic personality disorder until their personality becomes more defined.

Histrionic Personality Disorder Character Traits

People with HPD crave attention. Therefore, they can be energetic, lively, and extroverted, and are often described as “the life of the party.” In fact, they may have good social skills. But they often use these skills to manipulate others and to place themselves in the spotlight. 

In order to gain attention, people with HPD may exhibit behaviors such as talking loudly and interrupting other people’s conversations, dressing provocatively, and generally acting as if they are performing for an audience. They may take on a particular role, such as the victim or the diva. 

In people with HPD, these attention-seeking behaviors are ongoing, and continue over a long period of time. Moreover, individuals with the disorder may even threaten or attempt suicide in order to get attention.

What Is Histrionic Personality Disorder Behavior?

Many high achievers believe that without anxiety and fear of failure, they wouldn’t be motivated to perform or to get People with histrionic personality disorder lack a sense of self and self-worth. Hence, their self-esteem depends on gaining the approval of others. When they are not in the spotlight, people with HPD feel uncomfortable and unappreciated. Therefore, they will do whatever is necessary in order to be the center of attention. This could include a variety of dramatic and inappropriate behaviors, such as:

  • Making impulsive decisions 
  • Not thinking before acting
  • Constantly seeking reassurance or approval
  • Being excessively sensitive to criticism or disapproval
  • Getting frustrated by situations that involve delayed gratification; constantly seeking immediate satisfaction
  • Beginning and abandoning projects; easily bored in general
  • Blaming failure or disappointment on others
  • Getting into risky situations as a result of craving novelty
  • Having difficulty maintaining relationships
  • Seeming fake or superficial.

What Is Histrionic Personality Disorder’s Effect on Relationships?

It’s usually not hard for young adults with HPD to make new friends. They’re able to win over new acquaintances easily with their outgoing, flirtatious, and energetic behavior. However, they often have difficulty establishing and maintaining authentic connections

One problem is that they tend to alienate their friends over time with their constant demands for attention. In addition, their tendency to engage in excessive displays of emotion can be difficult for others to handle. This might include temper tantrums or breakdowns when they encounter minor obstacles, or being loud and intrusive in social situations. These behaviors often end up embarrassing their friends and acquaintances. 

Moreover, because they are easily bored with routine, people with histrionic personality disorder often neglect long-term relationships in favor of new ones. Hence, they have difficulty achieving emotional intimacy and long-term stability in friendships or romantic relationships. people with HPD seek treatment for depression when their romantic relationships fail. But they don’t recognize the larger implications of their disorder.

Causes of Histrionic Personality Disorder

Understanding the basics of what is histrionic personality disorder includes an overview of what causes this personality disorder. However, the exact causes of HPD are unknown. Experts believe it may be triggered by a combination of genetic, social, and psychological factors. Studies suggest that children of people with HPD may have a slightly increased risk of also developing the disorder.

As with other mental health disorders, what happens in an individual’s early life may affect their likelihood of developing histrionic personality disorder. Specifically, childhood trauma that impacts brain development and emotional regulation could lead to HPD. In order to cope with a trauma, children may be forced to adapt in unhealthy ways that ultimately lead to a personality disorder. 

Related Mental Health Issues

People with HPD also have a higher risk of developing additional mental health issues, including:

  • Anxiety
  • Depression
  • Panic attacks
  • Other personality disorders, such as borderline personality disorder or narcissistic personality disorder
  • Conversion disorder, in which mental health issues manifest as physical problems
  • Co-occurring issues, including substance abuse and disordered eating.

How to Treat Histrionic Personality Disorder

Often, people with HPD don’t seek treatment until the disorder begins to significantly affect their life. They often decide to get histrionic personality disorder treatment not for the HPD itself. Instead, they seek help for anxiety or depression created by the disorder and its impact on their lives and relationships. 

Talk therapy is the most effective histrionic personality disorder treatment. Therapy can help people with HPD uncover the motivations and fears associated with their thoughts and behavior. Moreover, therapy can help individuals with HPD person learn to form more positive and mutually beneficial relationships. 

The Most Effective Therapy for Histrionic Personality Disorder

Therapy for histrionic personality disorder may include the following modalities:

  • Group therapy with other people with HPD, which can be helpful in allowing individuals to see their behaviors more clearly when they are reflected in others. However, group therapy with other clients who do not have HPD may not be effective, as the individual with HPD may distract from the therapeutic goals by attempting to be the center of attention. 
  • Supportive psychotherapy that focuses on restoring self-esteem and building healthy coping skills
  • Cognitive Behavioral Therapy, in which clients can look at how their thoughts and emotions influence their behaviors, and being shifting negative thought patterns and habits
  • Additional forms of therapy to address co-occurring issues, such as anxiety, depression, and conversion disorder

Treatment for Histrionic Personality Disorder at Newport Institute

At Newport Institute, we address personality and mood disorders through the lens of trauma and attachment issues. By uncovering and addressing early trauma, young adults come to understand the origins and impact of their past experiences. They expand their self-awareness and learn to recognize their own triggers for problematic behaviors. Moreover, they build a toolkit of healthy coping mechanisms, including self-compassion and self-acceptance.

Furthermore, authentic connection is key to our approach to histrionic personality disorder treatment. Our team of highly experienced clinicians utilizes evidence-based clinical and experiential modalities to engage young adults in connecting with self, family, and a supportive community of peers. Contact us today to learn more about our clinical model and our nationwide locations.

Key Takeaways

  • Histrionic personality disorder (HPD) is a Cluster B personality disorder that is characterized by dramatic, attention-seeking behaviors.
  • To be diagnosed with HPD, an individual must be over 18 and meet five of eight specific criteria.
  • People with HPD are at higher risk of other mental health issues, like anxiety, depression, conversion disorder, other personality disorders, and substance abuse.
  • Unhealthy adaptations as a result of childhood trauma may lead to histrionic personality disorders, in addition to other genetic, social, and psychological factors.
  • Talk therapy can be effective in helping young adults address underlying trauma, shift negative thought patterns, and manage histrionic personality disorder symptoms.

Frequently Asked Questions About Histrionic Personality Disorder

What are histrionic personality traits?

People with HPD are typically charming, manipulative, seductive, demanding, energetic, and impulsive.

What are three symptoms of histrionic personality?

Three of the most common HPD symptoms are being excessively dramatic, always needing to be the center of attention, and constantly seeking reassurance or approval.

What triggers histrionic personality disorder?

HPD is caused by a combination of genetic, social, and psychological factors. An individual’s personality and temperament also contribute to the likelihood of developing the disorder.

What is an example of histrionic behavior?

In social situations, people with HPD tend to talk loudly, act as if they are performing for an audience, and interrupt others in order to stay in the spotlight.

Do histrionics have empathy?

People with HPD may have difficulty recognizing and identifying emotions in others (as well as in themselves). This may appear as lack of empathy.

Does histrionic PD get worse with age?

No, the opposite is true. Histrionic personality disorder, like most personality disorders, decreases in intensity with age. 

Sources

Front Psychol. 2015; 6: 1463. 

Nervenarzt. 2010 Jul;81(7):879–87. 

Compr Psychiatry. 2010 Sep-Oct; 51(5):462–70. 

National Epidemiologic Survey

Mental Health / September 9, 2022

Newport Institute

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