What is Histrionic personality disorder (HPD)?

A histrionic personality disorder is characterized by extreme emotionality and attention-seeking that begins in early adulthood and manifests itself in various situations.

HPD is one of 10 personality disorders recognized in the DSM-5. It is classified as one of the Cluster B disorders characterized as dramatic, overly emotional, and erratic. The word ”  theatrical”  means “dramatic or theatrical.”

Approximately 9% of the US population suffers from at least one personality disorder, and Histrionic personality disorder affects around 2-3% of the general population. The disease is characterized by superficial emotions, attention-seeking, and manipulative behavior.

Histrionic personality disorder


Histrionic personality disorder Symptoms

In some cases, you may not realize that you have a histrionic personality disorder because your way of thinking and behaving seems natural to you. And you can blame others for the problems you face.

People with Histrionic personality disorder can:

  • Display exaggerated symptoms of weakness or illness and may use suicide threats to manipulate others.
  • Show excessive but superficial emotions and attention-seeking behavior (i.e., they constantly “act” to get attention)
  • Experience fleeting moods, opinions, and beliefs; they are also highly suggestible and react quickly to quirks.
  • It takes others to witness their emotional manifestations to gain recognition or attention.
  • Use sexually provocative behavior to control others or gain attention.


Histrionic personality disorder Diagnosis

Because Histrionic personality disorder can have symptoms similar to other mental disorders and medical conditions, your doctor will likely make a differential diagnosis first to rule out other diseases or medical conditions causing the symptoms.

According to the DSM-5, a person must have five or more of the following signs or symptoms to be diagnosed with HPD:

  • Discomfort in situations where you are not the center of attention
  • Interaction with others is often characterized by inappropriate sexual seduction or provocative behavior.
  • Fast-changing and superficial expression of emotions
  • Consistently uses his appearance to draw attention to himself
  • Overly impressionistic and lacking in detail style of speech.
  • Demonstrates self-drama, theatricality, and exaggerated expression of emotions.
  • Easily influenced by others or circumstances
  • Beliefs relationships are closer than they are



There are many similarities between the features of Histrionic personality disorder (HPD) and borderline personality disorder (BPD), so much so that some experts believe that HPD cannot be distinguished from BPD.

According to the DSM-5, “although the borderline state can also be characterized by attention-seeking, manipulative behavior, and rapidly changing emotions, it is characterized by self-destruction, angry breakdowns in intimate relationships, and chronic feelings of deep emptiness and personality disorder.” …

The terms and conditions have standard features, including:

  • Share the traits of fast-paced and reactive emotions
  • Associated with impulsive behavior
  • A powerful expression of emotion characterizes it.

Some clinicians argue that the quality of these symptoms differs in HPD from BPD, particularly that rapidly changing emotions in HPD are not experienced with the same depth and intensity as in BPD. Other experts, however, have argued that HPD and BPD are not necessarily separate disorders.

However, despite the predictions that the diagnosis of HPD will be excluded in the DSM-5, this did not happen, and therefore it remains a separate, specific, and unique diagnosis.


Causes and risk factors

Although the exact cause of Histrionic Personality Disorder is unknown, it is believed to be caused by a combination of genetic and environmental factors. Your genes can make you vulnerable to developing a personality disorder, and your life situation can trigger the actual development.

  • Genes: some personality traits can be passed on to your parents through inherited genes; these traits are sometimes referred to as your temperament.
  • Environment: Your environment includes the environment in which you grew up, past events, and relationships with family members and others.

Other factors associated with an increased risk of developing or Histrionic personality disorders include:

  • Parenting style, incredibly inconsistent or overly condescending boundaries
  • Parents modeling abrupt or erratic behavior
  • Family history of mental disorders, substance use, or personality disorders.
  • Childhood trauma


Histrionic personality disorder Treatment

A histrionic personality disorder is often challenging because people with the disease often seek treatment only when the illness is causing them serious problems or stress. When seeking help, treatment may include psychotherapy, medication, or a combination of these with lifestyle changes.

  • Psychotherapy

Psychotherapy can effectively treat HPD to help reduce emotional distress, increase self-esteem, and improve patient coping skills. Therefore, supportive psychotherapy is the preferred treatment option. This approach aims to increase self-esteem, reduce emotional stress, and enhance coping skills5.

Group therapy and family therapy are not recommended because HPD symptoms such as asking group members for attention and exaggeration symptoms can be triggered or aggravated in a group setting.

  • Medication

Although there are no FDA-approved drugs for the treatment of Histrionic personality disorder, medications can be used to treat the affective dysregulation or mood swings, anger, tearfulness, anxiety, and depression that often accompany the disease. In addition, any associated depression or anxiety disorders can be treated with antidepressants.

  • Holistic therapy

Mindfulness techniques, including yoga, tai chi, and biofeedback, can also help people with personality disorders control their inner feelings, including impulsivity and emotional reactivity.


Histrionic personality disorder Coping

People with HPD are often underestimated and under-treated, so perhaps the best way to improve your symptoms is to identify them first. With appropriate treatment, you can learn to manage your symptoms and make a self-help plan to improve your quality of life, including:

  • Creating a consistent meal and sleep schedule
  • Regular exercise
  • Avoiding drugs and alcohol
  • Enlist the help of friends and family you trust to keep you on track


Histrionic personality disorder Complications

Histrionic personality disorder can affect a person’s social, professional, or romantic relationships and react to loss or setback. People with this disorder are also at a higher risk of depression than the general population.