Histrionic personality disorder (HPD) is a personality disorder characterized by a pattern of excessive attention-seeking behaviors, usually beginning in adolescence or early adulthood, including inappropriate seduction and an excessive desire for approval.
People with HPD have a high desire for attention, make loud and inappropriate appearances, exaggerate their behaviors and emotions, and crave stimulation. They very often exhibit pervasive and persistent sexually provocative behavior, express strong emotions with an impressionistic style, and can be easily influenced by others. Associated features can include egocentrism, self-indulgence, continuous longing for appreciation, and persistent manipulative behavior to achieve their own wants.
Histrionic personality disorder is also linked with hyperbolic language and hyperbolic communication.
Signs and symptoms People diagnosed with HPD may be dramatic. They often fail to see their own personal situation realistically, instead dramatizing and exaggerating their difficulties. Patients with this disorder can have rapidly shifting emotions and a decreased ability to recognize the emotions of others. Their emotions may appear superficial or exaggerated to others. This disorder is associated with extraversion, a lower tolerance for frustration or delayed gratification, and openness to new experiences. People with HPD may have little self-doubt and often appear egocentric.
Research has also shown that those with histrionic personality have a greater desire for social approval and reassurance and will constantly seek it out, making those with HPD more vulnerable to social media addiction. People with this disorder often display excessive sensitivity to criticism or disapproval. They will work hard to get others to pay attention to them, possibly as a method of testing the stability of relationships. They may enjoy situations in which they can be the center of attention, and may feel uncomfortable when people are not paying attention to them. People with this disorder may wear flamboyant clothing, try body modifications, and fake medical conditions in an attempt to draw others' attention. They may be inappropriately sexually provocative, flirtatious, or exploitative. Sexually suggestive and exhibitionist behavior are also behaviors people with this condition sometimes exhibit, and are more likely to seek out casual sexual relationships. When their desire for attention is not met, it can heighten the severity of their symptoms.
Patients with HPD are usually high-functioning, both socially and professionally. They usually have good social skills, though they tend to use same to make themselves the center of attention. HPD may also affect a person's social and romantic relationships, as well as their ability to cope with losses or failures. People with HPD tend to consider relationships closer than they usually are. They may seek treatment for clinical depression when romantic (or other close personal) relationships end. They may go through frequent job changes, as they become easily bored and may prefer withdrawing from frustration (instead of facing it). Because they tend to crave novelty and excitement, they may place themselves in risky situations. All of these factors may lead to a greater risk of developing clinical depression. People with this condition can have an impressionistic and undetailed style of speech.
Despite these traits, they can be prideful of their own personality, and may be unwilling to change, viewing any change as a threat. They may even blame their personal failures or disappointments on others.
Causes Little research has been done to find evidence of what causes histrionic personality disorder. Although direct causes are inconclusive, various theories and studies suggest multiple possible causes of a neurochemical, genetic, psychoanalytic, or environmental nature. Traits such as extravagance, vanity, and seductiveness of hysteria have similar qualities to women diagnosed with HPD.Barlow, H.D. & Durand, V.M. (2005). Personality Disorders. (pp. 443–444). Abnormal Psychology: An Integrative Approach (4th ed.). Belmont, CA: Thomas Wadsworth. HPD symptoms typically do not fully develop until late teens or early 20s, while the onset of treatment only occurs, on average, at approximately 40 years of age.Fancher, R.E. & Rutherford, A. (2012). Pioneers of psychology. New York, NY: W.W. Norton & Company.
Major character traits may be inherited, while other traits may be due to a combination of genetics and environment, including childhood experiences.
Authoritarian parenting There may be an association between having one or more parents with authoritarian or distant attitudes, and developing this disorder later in life.
Psychoanalytic theories incriminate authoritarian or distant attitudes by one (mainly the mother) or both parents, along with conditional love based on expectations the child can never fully meet. Using psychoanalysis, Freud believed that lustfulness was a projection of the patient's lack of ability to love unconditionally and develop cognitively to maturity, and that such patients were overall emotionally shallow.Pfohl, B. (1995). Histrionic personality disorder. The DSM IV Personality Disorders, 173–192. He believed the reason for being unable to love could have resulted from a traumatic experience, such as the death of a close relative during childhood or the divorce of one's parents, which gave the wrong impression of committed relationships. Exposure to one or multiple traumatic occurrences of a close friend or family member's leaving (via abandonment or mortality) could make the person unable to form true and affectionate attachments towards other people.Nickert, J. (n.d.) Histrionic Personality Disorder.
Neurochemical/physiological Studies have shown that there is a strong correlation between the function of certain hormones, neurotransmitters, and the Cluster B personality disorders such as HPD. This seems to be especially evident with respect to the catecholamines. Individuals diagnosed with HPD have a highly responsive noradrenergic system, which is responsible for the synthesis, storage, and release of the neurotransmitter norepinephrine. High levels of norepinephrine lead to anxiety-proneness, dependency, novelty seeking, and high sociability.
Genetic Twin studies have helped break down the nature versus nurture debate. A twin study conducted by the Department of Psychology at the University of Oslo attempted to establish a correlation between genetics and Cluster B personality disorders. With a test sample of 221 fraternal and identical twins, 92 monozygotic (identical) and 129 dizygotic (fraternal), researchers interviewed the subjects using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and concluded that there was a correlation of 0.67 that histrionic personality disorder is hereditary.
HPD and antisocial personality disorder Another theory suggests a possible relationship between histrionic personality disorder and antisocial personality disorder. Research has found that 2/3 of patients diagnosed with histrionic personality disorder also meet criteria similar to those of antisocial personality disorder, which suggests both disorders, based on sex-type expressions, may have the same underlying cause.
Some family history studies have found that histrionic personality disorder, as well as antisocial and borderline personality disorders, tend to run in families, but it is unclear how much is due to genetic versus environmental factors.Nolen-Hoeksema, S. (2014). Personality Disorders. (pp. 266–267). Abnormal Psychology (6th ed.). New York, NY: McGraw-Hill. Both examples suggest that predisposition could be a factor as to why certain people are diagnosed with histrionic personality disorder; however, little is known about whether or not any biological compound influences the disorder or is genetically inheritable. Little research has been conducted to determine the biological sources, if any, of this disorder.
Diagnosis The person's appearance, behavior and history, along with a psychological evaluation, are usually sufficient to establish a diagnosis. There is no test to confirm this diagnosis. Because the criteria are subjective, some people may be wrongly diagnosed.
Assessment In general clinical practice with assessment of personality disorders, one form of interview is the most popular: an unstructured interview.Sutker, P.B. (2002). Histrionic, Narcissistic, and Dependent Personality Disorders. Comprehensive handbook of psychopathology (3rd ed., pp. 513–514). New York: Kluwer Academic. The actual preferred method is a semi-structured interview but there is reluctance to use this type of interview because they can seem impractical or superficial. The reason that a semi-structured interview is preferred over an unstructured interview is that semi-structured interviews tend to be more objective, systematic, replicable, and comprehensive. Unstructured interviews, despite their popularity, tend to have problems with unreliability and are susceptible to errors leading to false assumptions of the patient.
One of the single most successful methods for assessing personality disorders by researchers of normal personality functioning is the self-report inventory following up with a semi-structured interview. A disadvantage to the self-report inventory method is that, with histrionic personality disorder, there is a distortion in character, self-presentation, and self-image. This means that most clients cannot be assessed by simply asking them if they match the criteria for the disorder. Most projective testing depends less on the ability or willingness of the person to provide an accurate description of the self, but there is currently limited empirical evidence on projective testing to assess histrionic personality disorder.
Classification Classification of personality disorders differs significantly between the two most prominent frameworks for classification of mental disorders, namely: the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, the most recent editions of which are the DSM-5-TR and ICD-11, respectively. While personality disorders, including HPD, are diagnosed as separate entities in the DSM-5, in the ICD-11 classification of personality disorders they are assessed in terms of severity levels, with trait and pattern specifiers serving to characterize the particular style of pathology. There is also a hybrid model, called the Alternative DSM-5 model for personality disorders (AMPD), which defines personality disorder diagnoses through combinations of pathological traits and areas of overall impairment.