21st Nov 2022
Histrionic personality disorder is a mental health condition without a single known cause, but it is believed to be related to genetics and early life experiences. Symptoms are characterized by overly dramatic and attention-seeking behavior, and are often treated with psychotherapy.
Histrionic personality disorder (HPD) is a personality disorder marked by exaggerated expression of emotions and attention-seeking behaviors. Those with HPD may appear lively, charming, and flirtatious. Their self-esteem relies predominantly on attention and approval from others.
Symptoms typically begin in early adulthood.  Individuals with HPD tend to quickly shift between dramatic and intense emotions, which may appear insincere. They may act and dress in inappropriate or seductive ways to get attention. They may also speak in a vague, theatrical manner that lacks substance. They are likely to be gullible and easily swayed by others. They often consider their relationships as more intimate than they are, referring to individuals they barely know as close friends.
Those with histrionic personality disorder do not often realize that their behavior is problematic and can make other people uncomfortable. They do not handle criticism or rejection well, but they do not understand that their actions drive others away.
People with HPD might:
The causes of HPD are not yet fully understood. However, psychologists believe that a combination of genetic and environmental risk factors can play a role. Genetic factors include a family history of HPD, other types of personality disorders, substance abuse, or other mental illnesses. 
Environmental factors include childhood trauma and emotional neglect. Parenting styles may also have an impact. Individuals may be at higher risk if their parents modeled inappropriate attention-seeking behaviors themselves. Parenting styles that lack boundaries, rules, or punishment may also predispose children to develop HPD. 
If HPD is left untreated, several complications can occur, including significant effects on the individual’s personal life and the development of other medical conditions.
The symptoms of HPD may cause individuals to:
People with HPD are more likely than the general population to develop:
While the actual prevalence of suicidal behavior is not known, those with HPD are at increased risk of using suicidal threats to get attention. 
Diagnosis of HPD begins with a psychological evaluation. A mental health professional will look at the history of the symptoms, as well as overall medical history. They will also consider the patient’s appearance, behavior, work history, and relationship history.
Based on the above assessment, the professional will determine whether the patient meets the DSM-5’s criteria for HSP. They must first meet the diagnostic criteria for a personality disorder, marked by patterns of behavior, thoughts, and emotions that :
Then, they must meet at least five of the following criteria :
Differential diagnoses that must be ruled out include borderline personality disorder (BPD), narcissistic personality disorder (NPD), and dependent personality disorder (DPD). Generally, the differences between HPD and these other psychiatric disorders are:
There is no specific way to prevent this disorder, as the causes are not well-understood. However, early recognition, diagnosis, and treatment are key to managing the symptoms of HPD and preventing complications.
While those with HPD do not usually believe they need treatment, they may seek treatment for complications, such as depression. Therapy is generally the most effective treatment plan for someone with HPD.
The primary treatment of choice for HPD is talk therapy. Supportive psychotherapy is generally recommended, as it is non-threatening and sympathetic to the patient.  This approach seeks to help the patient develop coping skills and increase self-esteem. It is important for the professional to set strict boundaries, as patients may act overly friendly or flirtatious with them.
Psychodynamic therapy is also often used, and begins with revisiting underlying conflicts and developmental milestones that may have been missed.  The therapist then helps the patient learn new, healthier ways to express themselves and how to improve their self-esteem.
Group therapy is not generally recommended.  Because those with HPD need to be the center of attention, they may feel uncomfortable in group settings and have trouble engaging in a meaningful way. Similarly, they may try to impress others in the group rather than express their true emotions.
While there is no specific medication used to treat HPD, medications for similar conditions can help. Anti-depressants, anti-psychotics, and mood stabilizers are often used to manage symptoms such as impulse control, mood swings, anxiety, and depression. 
As a complement to therapy, practicing self-care can help improve overall well-being. People with HPD should exercise regularly, eat a healthy diet, practice healthy sleeping habits, and avoid drugs and alcohol. These practices can help to keep symptoms under control. Mindfulness techniques are also helpful as a way to manage stress and control impulsive behavior.
You can help someone with HPD by educating yourself on the condition. This will give you the tools you need to properly communicate with your loved one. It is important to remain calm and supportive, instead of critical of their behavior. Do not ignore them, as this can cause their behavior to escalate. Encourage them to seek treatment and help them find the appropriate resources.
Although there is no cure, many people with HPD can live full lives. They can often still function well in social and professional settings. Those who receive treatment, through therapy and/or medication, tend to have better outcomes than those who do not.  Unfortunately, those with severe HPD may continue to have trouble at work and in interpersonal relationships. 
HPD is relatively rare. Research estimates it affects anywhere between 1-3% of the general population.  It is more common in women, who are four times as likely to be diagnosed as men.  However, it is suspected that women may be overdiagnosed and men underdiagnosed due to the nature of the symptoms.  Men may also be less likely to report their symptoms.
While both HPD and BPD can include attention-seeking, erratic, and manipulative behavior, there are some significant differentiators. People with BPD tend to have low opinions of themselves and fear abandonment.  On the other hand, those with HPD often do not see a problem with their behavior. Suicidal ideation and self-harm are also hallmark symptoms of BPD, but they are less common with HPD.