Treatment for Histrionic Personality Disorder

histrionic personality disorder

What is Histrionic Personality Disorder (HPD)?

Histrionic personality disorder is defined by the American Psychiatric Association as a disorder that displays extreme attention-seeking, usually in the form of a need for approval or flirtatious actions. 

Four times as many women are diagnosed with HPD as men and it is usually noticeable in early adulthood. It affects about 3% of the general population. Except for certain symptoms, people with HPD are able to function at a high level and be successful in social, school, and work situations.

Many personality disorders deal with a failure to display emotion or difficulty with types of expression. But histrionic personality disorder deals with overly emotional people. People with this disorder tend to be extremely emotional in ways such as being extremely enthusiastic, open, flirtatious, and loving.  

This can often result in embarrassment for others while the person with HPD may not feel any embarrassment from it. And the extreme emotions aren’t always enthusiasm or love; they can also be anger or sadness.

Treatment for Histrionic Personality Disorder

Generally, people with HPD don’t believe they need therapy. The very symptoms of the disorder make them exaggerate their feelings and make following a treatment plan difficult. However, depression over a failed relationship or a loss may cause them to look for help. 

Psychotherapy (a type of counseling) is usually the treatment of choice for histrionic personality disorder.

HPD is commonly treated with a combination of medication and therapy. Therapy helps the person:

  • Understand symptoms
  • Monitor for them
  • Develop coping skills
  • Learn new behavior
  • Create healthy boundaries

Medication is typically prescribed to:

  • Help control impulsive behavior
  • Control intense emotions
  • Treat co-occurring problems like depression and anxiety

10 Symptoms of Histrionic Personality Disorder

Human beings are social creatures therefore, it is in our DNA to want the attention of others. We want to spend time with others, share stories, and get support from other people. Because of this need for others, our physical and mental health can be affected significantly if we are isolated for long periods.

This need for attention from other people can be obsessive if you have histrionic personality disorder. People with HPD need to feel as though they are constantly getting attention from others. If not, they can behave in extreme ways to get the attention they want such as:

  1. Exhibitionism—Showing off can be entertaining and funny and help others have a good time. It can be done within reason but overdoing it can have negative reactions. Their manner of dressing, speaking, and acting are designed to make themselves the center of attention. The person with HPD will do whatever it takes to take over the spotlight from someone else.
  2. Obsession with physical appearance—We usually do what we can to look reasonably presentable and we’re likely to put in more effort when going out in public. There is nothing wrong with pride in our appearance. However, people with HPD are likely to be obsessed with their appearance. Their clothes, hair, and makeup must be perfect. They can spend hours getting ready and be uncomfortable if they think they don’t look perfect.
  3. Blaming others—Life doesn’t always go as planned. There are a lot of opportunities to learn from our mistakes. But to learn from a mistake, you need to learn to accept it. A person with HPD finds it very difficult to accept they made a mistake, let alone learn from it. They tend to blame other people, even for their own failures.
  4. Easily influenced—Everybody is influenced by other people in some ways. Peer pressure influences much of our lives. Despite this, most of us can say “no” when we think an idea is possibly harmful. It is much harder for people with HPD to say “no.” It can be easy to influence them to do things they would not normally do and lead them into potentially dangerous situations.
  5. Overdramatic—We all get emotional from time to time. Our emotions are usually appropriate to the situation. People with HPD are likely to become very emotional over even the smallest issue. They act in a dramatic, theatrical manner, exaggerating the problem. Their mood can change quickly, proving that it was just an act.
  6. Shallow—Most people do not let material and beautiful features dominate how they live and feel about other people. For some people (HPD), materialism, and beauty are more important than anything else. Many of their decisions are based only on outward appearance.
  7. Overtly sexual—Desiring and seeking sex is very natural and harmless. But if flirting is not done within reason, harm can be done socially and in other ways. The need to be desired can be so strong for people with HPD that they may act in extreme ways. It can be offensive to others and make them unwelcome in certain places.
  8. Exaggerating relationships—At any time in our lives, we probably have many friends and acquaintances. Usually, both parties understand the strength of the relationship. People with HPD tend to exaggerate the intimacy of their relationships with others. It’s easy for them to believe certain relationships are deeper than they actually are. 
  9. Constantly needing reassurance—Most of the time we are confident about what we’re doing, but some times, we want the opinions of other people. A symptom of HPD is the constant need to be told they did okay or positive feedback about their appearance or actions. It doesn’t matter how many times they have already been told.
  10. Manipulation—For individuals with HPD, it is essential to be the center of attention at all costs. They will use seduction and manipulation. Specialists on HPD have said that Marilyn Monroe is a good example of this disorder. Her seductive nature, attention-seeking behavior, and short but intense relationships meet the diagnostic model for HPD. 

What Causes Histrionic Personality Disorder?

The truth is, we don’t know what causes it. Some people believe and research has shown that it could be a genetic disorder due to its tendency to run in families.  Still, other people believe that childhood events may have an effect on the genetic weakness that already exists in some children. Or the child might just be repeating learned behavior.

Environmental factors that might be involved include: 

  • a lack of criticism or punishment as a child 
  • positive reinforcement that’s given only when a child completes certain approved behaviors
  • unpredictable attention is given to a child by the parents
  • confusion about what types of behavior will earn approval from a parent

However, there don’t seem to be any individual traits or experiences that cause this type of disorder in children or adults. Instead of being able to pinpoint a cause, people from all different backgrounds are found to develop HPD at some point during their life.

Childhood Trauma

It is theorized that childhood trauma is one possible cause of the disorder. Some children may deal with childhood trauma by acting out behaviors common to histrionic personality disorder. What started as a way to cope with trauma becomes a full-fledged disorder if not dealt with early.

Personality Disorders and Substance Use Disorder

Substance use disorders (SUDs) are common and closely correlated to a variety of mental health conditions. When this happens it’s called a dual diagnosis or a co-occurring disorder. If a person has both a personality disorder and an SUD, they need a thorough and individualized treatment program to fully address the disorders and create a more balanced state.

Living with an untreated mental illness can cause depression and anxiety. As the person struggles to deal with the unsettled state of their mind and life, many turn to substance use to try to calm the inner turmoil. And this begins a vicious cycle. 

Drugs and alcohol change the chemistry of your brain. As the changes continue, the mental illness gets worse. To counteract this, the user may take more of the drug and the cycle continues.

Dual Diagnosis Treatment

Because of this, it is important that any person who is struggling with a SUD and a co-occurring disorder such as a personality disorder, get dual diagnosis treatment. Substance use and mental disorder must be treated at the same time. This is to make sure the person has the best chance for a successful recovery.

What Should I Do If I Am Diagnosed With HPD?

If you are diagnosed with histrionic personality disorder, you should seek professional help as soon as possible. Talk to your doctor or therapist and ask for testing to make sure you have an accurate diagnosis. This will confirm that your treatment is tailored to meet your needs and be successful.

The process of getting diagnosed involves:

  • You may get referred for a physical to discover whether there might be a physical cause for your symptoms.
  • You will then proceed to the clinical evaluation interview.
  • The doctor or therapist uses these tests to narrow down the specifics.
  • After confirmation of diagnosis, you get recommendations for treatment that may include medication and therapy.
  • When looking for a therapist, find someone who has experience working with your diagnosis, and is easy for you to talk to.

Symptoms of HPD may come and go during and after treatment. Your treatment may have to take place over a long period of time. Or you may be able to take breaks from treatment from time to time.

Depression and Histrionic Personality Disorder

This disorder can affect a person’s social, professional, or romantic relationships and how they react to the losses or disappointments. People with HPD also have a higher risk of depression. 

Often, people with histrionic personality disorder will go to therapy because of the depression they are coping with because of the disorder and their behavior patterns. Many have intense mood disorders and can be helped by the use of antidepressants and antipsychotics.

Can HPD be Cured?

If you get treatment, histrionic personality disorder can be managed. Psychotherapy is the first choice of treatment. Supportive therapy and psychodynamic psychotherapy (insight-oriented therapy) have proved to be successful. 

However, group therapy is not recommended because a person with this disorder usually can’t stop themselves from being the center of attention and may dominate the group process.

Do You Know Someone With HPD?

If you think a friend or loved one has this disorder, it’s important to first establish clear boundaries for your own wellbeing. You can’t help if you fall prey to their overdramatic tendencies. Don’t be manipulated.

Then, you need to summon all your compassion and patience. If they open up and show their vulnerable side, be a good listener. Encourage them to get treatment for any of the related psychological issues like anxiety or depression. This may be the best way to help them begin to address their personality disorder.

Once they’re diagnosed, you can help them see that there is hope. You can help them understand and accept the diagnosis and realize that recovery is possible. A calmer and more fulfilling life is possible.

Have You Been Diagnosed with Histrionic Personality Disorder?

Maybe you have been diagnosed with HPD. As you now know, this is not the end but the beginning of a more rewarding, less stressful life. 

At Sana Lake Recovery Center, we are experienced in treating mental health conditions and substance use disorders. If you are suffering from both, our compassionate, professional staff can help you on your way to recovery. 

Contact us. You’ll see why we are the answer for you.

References:

www.facty.com/conditions/mental-health 

www.webmd.com/mental-health

www.10faq.com/health

www.betterhelp.com

www.talkspace.com

Article Reviewed by David Sherman, MD

David Sherman, MDDavid Sherman, MD is a Fellow of the American Society of Addiction Medicine (FASAM) and board certified in Addiction Medicine with the American Board of Preventive Medicine. He is a native Missourian and graduated medical school at the University of Missouri-Columbia School of Medicine. Dr. Sherman completed a two-year fellowship in Addiction Medicine at the University of Florida in Gainesville. He leads a highly trained staff of master level certified addiction professionals. Men and women from all over Missouri and the United States come to Sana Lake Recovery Center to get the care they need and deserve.