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Histrionic Personality Disorder (HPD)

Histrionic Personality Disorder (HPD) is characterized by overly dramatic behavior, a desire to seek attention and an obsession with appearance and looks. Patients are often ‘over the top’ in their emotional and verbal expression, but are emotionally superficial. Many patients will behave in a childish manner and public behavior is always targeted toward receiving sympathy and attention, most especially sexual attention, from others. Social and intimate relationships are typically superficial and short-lived. Even the most minor situation can cause wild emotional swings in the histrionic patient. They are bored with normal routines, and demand excitement in their lives at all times, seeking new relationships and putting themselves in new and different situations in order to remain interested in life. The patient with Histrionic Personality Disorder has a distorted self-image. Their self-esteem depends entirely upon approval from and they have an overpowering desire to be noticed, behaving dramatically and inappropriately to get attention. Patients typically blame any failure or disappointment they may experience on other people. Most HPD patients do not recognize their own behavior and they are rarely the ones that initiate treatment. The cause of this disorder is not known, but childhood experiences and heredity may contribute. HPD is usually diagnosed by the early adult years, no later than the mid-twenties. Though it is often reported more frequently in women than in men, some doctors feel that the disorder occurs equally but is reported more frequently in women because sexually forward and publicly inappropriate behavior are less acceptable in women than in men. Environmental factors may also predispose a patient to HPD. The absence of criticism or punishment during childhood, or positive reinforcement provided by parents only when the child exhibits certain behaviors, or unpredictable response from a parent all lead to confusion about what type of behavior will earn approval, and this confusion can translate into HPD adult behaviors.

What are the symptoms?

• Good social skills; typically used to manipulate others so that the patient can be the center of attention at all times.
• Very dramatic, as if performing in front of an audience, exaggerated emotions and expressions, appears to lack sincerity
• Rapidly shifting emotions
• Needs constant reassurance and approval
• Extreme sensitivity to criticism and disapproval
• Tends to believe that relationships are more intimate than they are
• Self-centered with no genuine concern or empathy for others
• Threatens or attempts suicide or self-harm to get attention
• Dresses provocatively or exhibits inappropriate seductive, flirtatious behavior and language, even in non-sexual situations
• Low tolerance for frustration, always wants to ‘get his/her own way’, easily bored by routine and by other people after a short duration of exposure
• Does not think before acting
• Can be gullible, easily influenced by others
• Uncomfortable unless he/she is the center of attention
• Begins projects and does not finish them, skips from one event or task to another
• Cannot maintain relationships, seems fake or shallow in dealing with others
• The patient’s ability and willingness to structure events, projects or life in general often falls short on detail and is poorly planned though the patient may be very excited about the ideas

How is it diagnosed and treated?

Doctors will take a complete medical history and perform a physical examination to rule out other health or mental disorders. Most patients with histrionic personality disorder do not believe they have a problem, so they don’t often initiate treatment. However, a patient may seek treatment for depression following a failed romantic relationship, or perhaps another medical problem and HPD may be diagnosed during that examination. Where there is no physical ailment, a psychiatrist or psychologist will typically diagnose and treat the personality disorder. HPD is typically diagnosed where at least 3 of the following characteristics appear:

• dramatization, theatricality, exaggerated emotions
• manipulative behavior to achieve his or her own needs
• rapidly shifting, shallow expression of emotion
• suggestibility, easily influenced by others
• continuously seeks excitement, appreciation by others, and activities where the patient is the center of attention
• inappropriate seductiveness in appearance or behavior
• abnormal behavior is long-standing, not limited to episodes
• overly concern with physical attractiveness
• egocentricity, self-indulgence

Treatment(s) can include:

• Psychotherapy
• Medication as appropriate for depression, anticonvulsant medication to suppress impulsive or aggressive behavior, antipsychotic medication in severe cases, anti-anxiety medication if appropriate

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