Histrionic Personality Disorder. Non-Clinically Inclined

Histrionic personality disorder (HPD) is one of the least comprehended and most misrepresented mental health conditions. In popular culture, individuals with HPD are often portrayed as over-the-top characters who are vain, self-centred, attention-seeking, seductive and manipulative. In reality, however, they are lonely people who have a distorted view of themselves and others. They struggle to make genuine connections with others because they don’t understand social norms and expectations. Unlike what many believe, people with this condition aren’t necessarily pretending to be someone they’re not for personal gain or attention. Rather, they are struggling to cope with their feelings in an overstimulating world that evaluates them harshly if they fail to meet certain standards of appearance or behaviour. Below you will find details about the real signs of histrionic personality disorder.

Exhibit excessive narcissistic behaviours and beliefs.

They often suffer from what is known as “malignant narcissism”, which means that their narcissistic traits are particularly extreme and harmful. Many individuals with HPD believe that they’re superior to others, including their loved ones, and that they deserve to be idolized. Some may even exhibit a “pathological envy” of others, meaning that they resent the success of others because they feel that they deserve it more, and are constantly striving to “outdo” everyone else to prove themselves superior. Histrionic people also feel entitled to special treatment, which is another narcissistic trait and may engage in manipulative behaviours, such as excessive complaining or blaming, to receive the attention and praise that they crave and feel that they’re entitled to.

Criteria Used to Diagnose Histrionic Personality Disorder DSM-5 301.50 (F60.4)

For a diagnosis of histrionic personality disorder, patients must have at least 5 of the following:

• A persistent pattern of excessive emotionality and attention seeking
• Discomfort when they are not the centre of attention
• Interaction with others that is inappropriately sexually seductive or provocative
• Rapidly shifting and shallow expression of emotions
• Consistent use of physical appearance to call attention to themselves
• Speech that is extremely impressionistic and vague
• Self-dramatization, theatricality, and extravagant expression of emotion
• Suggestibility (easily influenced by others or situations)
• Interpretation of relationships as more intimate than they are

Also, symptoms must have begun by early adulthood.

A persistent pattern of excessive emotionality and attention seeking

Histrionic people often feel emotions more intensely than others, which can make them seem dramatic or overly sensitive in certain situations. People with this disorder may feel too deeply for their good, which can cause them to become emotionally overwhelmed and seek out others for support when they are unable to regulate their emotions on their own. In many cases, however, individuals with this condition simply can’t help but express themselves loudly and dramatically due to their poor emotional regulation skills. For example, if they feel angry, they are likely to scream and throw things. People with HPD often cry easily in the hopes of winning sympathy or attention from others. They also rarely feel shame or guilt and are therefore incapable of understanding when their behaviour is inappropriate.

Interaction with others that is inappropriately sexually seductive or provocative

They are often drawn to professions in the entertainment industry where their naturally excessive emotionality and dramatic flair may be celebrated rather than criticized. However, many HPD individuals try to use their style and flair to seduce potential romantic or sexual partners. Due to a distorted or inadequate view of their physical appearance, HPD people are often uncertain when they are feeling sexually attractive or desirable. They may attempt to compensate for their insecurities by flirting or dressing provocatively to attract attention or gain acceptance. This behaviour can become problematic when it’s used to draw attention away from the individual’s perceived flaws or insecurities or to rarely meet the attention they need or deserve.

Rapidly shifting and shallow expression of emotions

People with HPD often feel too many emotions at once and are unable to adequately express themselves. When this happens, they will often rapidly shift from one emotion to another without any logical explanation as to why. This rapid shifting can make it difficult for others to understand what they are feeling or find a meaningful connection with them.

Additionally, HPD individuals’ speech patterns are often extremely vague and impressionistic. They may struggle to express themselves and will often use words that mean different things to different people without realizing it. This can make it difficult for their loved ones to understand what they are feeling or needing.

Instability in their mood and behaviour can serve as another indication that something is amiss.

“Emotionally unstable” and experience a wide range of moods and emotions that seem to “come and go” very quickly. This is sometimes referred to as “emotional lability” and can serve as a telltale sign that something is not right. Histrionic people may also engage in dramatic, attention-seeking behaviours that are seemingly out of character, such as “self-mutilation” or “attention-seeking risk-taking” to draw attention to themselves. People with HPD can also exhibit a “pervasive pattern of attention-seeking behaviour” that indicates something is wrong. This can include “excessive attempts to attract attention”, such as “excessive talking” or “dramatic gestures”, as well as “interpersonal exploitation”, or manipulating and taking advantage of others, to gain attention.

They May struggle to form healthy, reciprocal relationships due to their inherent manipulative tendencies.

They often feel that they’re entitled to special treatment and are driven to seek out “higher status” people to engage in relationships with. As a result, histrionic individuals often “strive for a position of dominance or superiority in their relationships”, which can make it difficult for them to form healthy, reciprocal relationships. Histrionic people often struggle with the ability to compromise because they’re constantly seeking to be in control and are quick to dismiss the opinions and feelings of others.

Coexistence

It is estimated that 1.84% of the general population is affected by histrionic personality disorder of people according to data from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions.

It is more frequently diagnosed in women, but this finding may simply reflect the fact that women are more frequently seen in clinical settings. There is no consensus on whether histrionic personality disorder is a distinct disease. Several studies found that the prevalence in women and men was nearly identical. Other personality disorders (antisocial, borderline, narcissistic) are frequently comorbid with histrionic personality disorder, which suggests that these disorders share a biological susceptibility or cast doubt on whether HPD is a real disease. Patients sometimes present for care because of somatic symptoms, which may be why they are evaluated. Major depressive disorder, Persistent Depressive Disorder, and Conversion Disorder may coexist with it as well.

Contrasts from some other similar personality disorders:

There are some differences between HPD with other similar PDs:

Narcissistic Personality Disorder (NPD): Patients with NPD desire to be admired or glorified, unlike those with HPD, who simply want attention; HPD patients don’t care what kind of attention they get, as long as it is there, whereas patients with NPD desire to be admired or glorified.

Borderline Personality Disorder: Patients with BPD think of themselves as flawed and feel emotions deeply and profoundly, while those with HPD do not consider themselves flawed, even if they rely on other people's reactions as a result of their low self-esteem.

Dependent Personality Disorder: Patients with DPD, like individuals with HPD, covet the company of others, but are anxious, inhibited, and submissive (as a result of their fear of being dismissed); HPD patients, on the other hand, are less inhibited and more flamboyant.

Summing up

Individuals with this condition can indeed be treated, but many do not seek treatment or believe they need treatment. For those who do, two approaches prove to be most effective: psychotherapy and medication.

However, I prefer, to keep my distance whether possible.