If you (or a loved one) show signs of histrionic personality, consider reaching out for help. While personality disorders can be difficult to treat, therapy does help many people. In therapy it’s possible to learn how to cope with and manage symptoms. You can begin searching for a counselor here.
DSM-5 Criteria for Histrionic Personality
Histrionic personality belongs to the Cluster B personality disorder category. These conditions share features such as emotional thinking and unpredictable behavior.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists eight diagnostic criteria for HPD. To be diagnosed, a person must display at least five characteristics over an extended period, in more than one setting. A person who only displays these behaviors among friends and never at work or school would likely not be diagnosed with HPD.
Criteria include:
- Being uncomfortable when not the center of attention.
- Acting in flirtatious or sexually suggestive ways toward coworkers, acquaintances, teachers, and others. The flirting may be inappropriate for the situation, the relationship, or both.
- Emotions that change quickly and often. An individual may seem shallow or superficial.
- Trying to get attention from others with one’s physical appearance (clothes, makeup, hair, etc.). Individuals may seem overly concerned with their looks.
- A dramatic yet vague manner of speaking. An individual may express strong opinions without being able to elaborate on them in any detail.
- A pattern of exaggerated emotions and reactions that may seem excessively theatric. Even when these emotions appear to be intense, they may change so rapidly that they seem fake.
- Being suggestible, overly trusting, and easily influenced by others.
- A pattern of believing friendships and relationships are much closer than they actually are.
According to the DSM¬5, only about 1.8% of people have HPD. This pattern of behavior appears by early adulthood, often during the teen years. Some research suggests HPD occurs more often in women, but other studies indicate the rates of HPD may be similar for all genders.
What Causes Histrionic Personality?
Research about histrionic personality is still limited. It’s less common than other personality disorders, and the causes aren’t fully understood. Research suggests children of people with HPD may be more likely to develop it, which could indicate genetic factors. It could also mean children learn the behaviors from their parents.
That said, adults don’t need to be diagnosed with HPD to offer inconsistent parenting. Parents may provide attention or positive reinforcement at unpredictable times. They may offer little to no criticism or behavioral guidance. When children aren’t sure what “good” behavior and “bad” behavior is, they may continue to act unpredictably or emotionally later in life in order to get approval from others.
Such factors may prevent people with HPD from developing a strong sense of self-worth. They might instead link feelings of self-esteem to attention received from others. To get this attention, they might act in ways that seem inappropriate. They may flirt, start “drama,” or express extreme affection for people they don’t know well. They may also be overly influenced by the opinions of others.
How Does Histrionic Personality Affect Relationships?
HPD can make it hard for a person to control their emotions. An individual might lose patience easily or be very sensitive to criticism and rejection. They may have childlike tantrums or emotional breakdowns when things go wrong. This behavior can make them seem unpredictable or dramatic.
Recognizing emotions may be a struggle as well. According to a 2018 study, people with HPD have difficulty recognizing emotions in others. They may also have alexithymia, which is a deficit in recognizing one’s own emotions. These issues can make someone with histrionic personality seem as though they lack empathy.
This lack of emotional intelligence can create difficulties for people with histrionic personality. Although most people with HPD can function on a day-to-day basis, their symptoms often interfere with their social lives. For example:
- People with HPD can become easily frustrated with challenges at work. While they often show enthusiasm at the start of a task, boredom may cause them to lose motivation. They may be oversensitive to any criticism or feedback.
- Friends may struggle to understand an individual’s need to always have attention on them. Emotional breakdowns may embarrass or alienate others.
- Excessive flirtation could cause conflict in one’s social circle. It could also cause legal issues in a professional setting.
- An individual may have trouble achieving emotional intimacy in romantic relationships. They might feel insecure and try to manipulate their partner in order to hold their attention. In other cases, an individual’s desire for novelty may lead them to give up on a long-term relationship in order to pursue a new one.
These behaviors can lead to a pattern of troubled relationships in general. Feelings of depression or hopelessness may result. Like other personality disorders, HPD can cause significant distress and disruption in one’s life. Working with a therapist to address histrionic personality issues can lead to improvement of symptoms.
Histrionic Personality and Comorbid Mental Health Issues
People who meet the criteria for histrionic personality often meet criteria for another personality disorder. It often co-occurs with other Cluster B diagnoses: narcissistic, antisocial, and borderline personalities. Dependent personality is another common comorbidity.
Research suggests HPD is linked to a high risk for depression. Difficulty coping with rejection or failed relationships may contribute to feelings of depression in people who have HPD.
Somatization (in which real physical symptoms appear with no medical cause) and conversion disorder (a form of somatization with neurological symptoms) also commonly occur with HPD.
Research has linked cluster B personality disorders to increased suicide risk. A study from 2015 linked HPD with a higher lifetime risk of suicide attempts. Suicide risk may be higher when histrionic personality co-occurs with depression. Clinical data suggest people with HPD may attempt suicide if they feel others do not care for them enough.
If you suspect you may have HPD, you can get support from a mental health professional. A therapist can help you manage your emotions and address harmful behaviors. They can also treat any co-occurring diagnoses. Therapy is a confidential way to get help without judgment.
References:
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association. 663-672.
- Ansell, E. B., Wright, A. G. C., Markowitz, J. C., Sanislow, C. A., Hopwood, C. J., Zanarini, M. C. … Grilo, C. M. (2015). Personality disorder risk factors for suicide attempts over 10 years of follow-up. Personality Disorders, 6(2). Retrieved from //www.ncbi.nlm.nih.gov/pmc/articles/PMC4415153
- Blagov, P. S., Westen, D. (2008). Questioning the coherence of histrionic personality disorder: Borderline and hysterical personality subtypes in adults and adolescents. Journal of Nervous Mental Disease, 196(11). Retrieved from //www.ncbi.nlm.nih.gov/pubmed/19008729
- Histrionic personality disorder. (2018, January 23). Cleveland Clinic. Retrieved from //my.clevelandclinic.org/health/diseases/9743-histrionic-personality-disorder
- Personality disorders. (2016, September 23). Mayo Clinic. Retrieved from //www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463
- Ritzl, A., Csukly, G., Balázs, K., & Égerházi, A. (2018, September 13). Facial emotion recognition deficits and alexithymia in borderline, narcissistic, and histrionic personality disorders. Psychiatry Research, 270(1), 154-159. Retrieved from //www.ncbi.nlm.nih.gov/pubmed/30248486
- Skodol. A. (2018). Histrionic personality disorder (HPD). Merck Manuals. Retrieved from //www.merckmanuals.com/home/mental-health-disorders/personality-disorders/histrionic-personality-disorder-hpd
- Teen drama vs. histrionic personality disorder. (2018, July 18). Newport Academy. Retrieved from //www.newportacademy.com/resources/mental-health/histrionic-personality-disorder-in-teenagers
Last Update: 12-10-2018
© 2014 Bill Eddy, LCSW, Esq.
Theatrical, dramatic
Superficial
Exaggerates, lies
Constant crises, needs help
Intense, shifting emotions
People with a Histrionic Personality Disorder (HPD) can be extremely irritating and unpredictable. The American Psychiatric Association has estimated that 2-3% of the population suffers from HPD * and that translates into a whole lot of people. You may be involved with someone with a full disorder or someone who just has traits of the problem, but either way they can be a handful. I’ll focus on the traits and share what I have learned from the High Conflict Institute and other readings as to what you can do to manage the drama and get some peace back into your life. I cannot give you clinical advice, but I will share general principles that can help.
Who’s a Histrionic?
They’re the people who make you roll your eyes when they regale you with their most recent problems and/or they make you feel like you must help them. They always want your attention—good or bad—and it’s very intense emotionally. They are dramatic and throw tantrums, but it frequently comes off as being superficial and fleeting—like someone who tells you they have every trendy illness making the Internet rounds then forgets it when a new trend hits. Other times, they get into genuine trouble and call you daily demanding your help but they are never responsible for their own crisis—you are! Histrionic Personalities are expert at projecting their issues onto others and you may find that they accuse people of the annoying behavior they are demonstrating themselves.
Perhaps most aggravating is their penchant for stretching the truth. Much of the research indicates they don’t generally lie with hostile intent. Rather, it seems as if the attractive drama of the moment simply overshadows any need to be accurate. For example, they may tell you they witnessed a horrific car crash and embellish with gory detail, when in reality they only saw a sanitized clip on the news. During the act of telling you, however, they are the center of your attention and that’s right where they feel most secure.
Researchers don’t know what causes the disorder. Childhood events and genetics may both play a part and some studies say more women are affected than men, while others say men may simply miss being diagnosed. There is a fair amount of consensus, however, that underlying all the mayhem is the Histrionic’s intense and unconscious fear of being ignored.
The Hysterics of Histrionics
Let’s say you got the following email from your sister:
PAUL,
WHY DON’T YOU ANSWER YOUR PHONE? YOU KNOW YOU NEED TO HELP ME. THAT’S WHAT A BIG BROTHER IS FOR. BUT NO! YOU WILL SIT THERE IN YOUR NICE CONDO AND LET ME—YOUR OWN SISTER—LIVE IN HER CRAPPY CAR. YOU’RE SO SELFISH! WHY IS EVERYTHING ALWAYS ABOUT YOU!!?? YOU NEEDED TO HELP ME FIX MY CAR SO I COULD GET TO WORK. NOW SEE WHAT HAPPENED? I LOST MY JOB BECAUSE I COULDN’T GET THERE AND NOW I’M ABOUT TO LOSE MY APARTMENT BECAUSE OF YOU. YOU SHOULD BE ASHAMED OF YOURSELF. THE LANDLORD IS KICKING ME OUT TOMORROW. YOU HAVE TO LET ME COME LIVE WITH YOU UNTIL I GET BACK ON MY FEET. IT’S YOUR FAMILY RESPONSIBILITY. I’LL BE OVER LATER TODAY WITH A LOAD OF MY STUFF.
THANKS.
JENNIFER
Wow. All caps and bold—it feels like you’re being screamed at. Again. It’s all about Jennifer’s crisis. Again. Full of guilt-trips, yet no taking responsibility for anything. Again. You’re tired of being blamed for problems she creates and yet you feel terribly torn. You don’t want her out in the cold, but you don’t want her living with you either. You’re also quite annoyed: how can she possibly hold you responsible for this and why do you somehow feel guilty about it? You want to write back to set her straight, but you’re sure that would be useless since she’d just dive deeper into her pity party. Oh, what to do, what to do?
How to Dodge the Drama
Once you recognize that you might be dealing with an HPD, the easiest thing you can do is ease out of contact and he/she will find someone else to give them attention. If you can’t end the relationship, you can try this strategy to limit it.
Think about your choices. Paul was weary of the drama. Instead of responding right away, he took a few minutes to write out some options so he could calm himself and think:
A. Let Jennifer move in
B. Tell her she is on her own and to leave him alone
C. Ignore Jennifer’s email.
D. Talk with Jennifer with a therapist
E. Give Jennifer some rent money
Paul decided that A and E were out of the question. He was afraid of the commotion she would create under his roof, and he was not about to bail her out of financial trouble again. Besides, if he caved in, it would reinforce her behavior in the future because she got what she wanted through her dramatics. He also decided against B. Paul loves his sister and cutting her out of his life altogether would be difficult to uphold. The drama would find its way to him through other family, anyway. Option C was also out. Like B, it would be hard to maintain and he knew from experience that Jennifer would only increase her attempts to reach him, possibly showing up at his job and creating a scene.
Paul decided that D was a good mix of not feeling like he abandoned his sister, while trying to get help with her behavioral issues. He sat down and wrote a carefully worded BIFF Response to her email. A BIFF Response is Brief, Informative, Friendly and Firm and is much less likely to trigger Jennifer further.
Dear Jennifer, I love you very much but I cannot let you move in again. We have talked about this kind of thing before, and it didn’t seem to help, so I have decided that I can only communicate with you about this problem with the help of a therapist who can help with a good plan. You seem to have some recurring issues and a therapist could help you feel and do better with events in your life. Until you accept some help getting back on track and taking responsibility for your problems, I will not help you nor respond to any more emails nor answer the phone/door. I will help pay for the therapist and we can pick one you are comfortable with, though. Many people have had the same kind of issues you have and therapy helped them a lot, so I hope you will accept. Love, Paul
Note that Paul’s response ignored all the accusations of being a bad brother, which would trigger a more intense response from Jennifer, and he presented a plan for helping her while setting firm limits. In short, Paul was not emotionally hooked by Jennifer’s Histrionics. Instead, the reply directed the discussion to a more positive outcome. The difficult part for Paul would be that he has to refrain from answering further emails or calls (or stick to his plan with another BIFF Response), but doing so means less stress for him and his family.
You may be saying that it can’t be that easy, and you’d be right.
Bill Eddy is a lawyer, therapist, and mediator. He is the co-founder and Chief Innovation Officer of the High Conflict Institute, a training and consultation firm that trains professionals to deal with high conflict people and situations. He is the author of several books and methods for handling high conflict personalities and high conflict disputes with the most difficult people.