Histrionic vs Narcissistic Personality Disorder

What is histrionic personality disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders ^[1] which is used by mental health professionals in the US to diagnose mental health problems, histrionic personality disorder is a mental illness characterized by exaggerated emotions and attention-seeking behavior.

Typically, someone with histrionic personality disorder will:

• Feel uncomfortable when not the center of attention
• Behave in an inappropriately flirtatious or sexual way
• Appear shallow or superficial
• Use their appearance to get attention
• Speak in a dramaticand often vague way
• Display emotions in a strong, exaggerated,or theatrical way
• Be easily influenced by other people
• Believe personal relationships to be more intimate than they are

What is narcissistic personality disorder?

Typically, someone with narcissistic personality disorder ^[1] will:

• Have a grandiose sense of themselves, believing themselves to be superior to others
• Have strong fantasies about being successful, powerful, attractive, intelligent,and loved
• Believe themselves to be unique and keen to associate only with other equally special people
• Need lots of positive attention
• Have a sense of entitlement 
• Take advantage of other people for personal gain
• Have a lack of empathy with others, failing to recognize others’ needs or emotions
• Feel jealous of other people and believe other people are jealous of them
• Behave in a way that appears arrogant

How are histrionic personality disorder and narcissistic personality disorder similar?

Histrionic personality disorder and narcissistic personality disorder have several symptoms in common and may appear similar ^[1]. These similarities include:

• An unpredictable or erratic way of thinking or behaving
• Behavior or thoughts that others view as dramatic or an overreaction to the situation at hand
• A significant impact of these thought patterns or ways of behaving on the person’s life, leading to feelingsof distress

These are characteristics of cluster B personality disorders generally, which also includes borderline personality disorder and antisocial personality disorder. Histrionic personality disorder and narcissistic personality disorder share some specifics ^[1], including:

• A need for attention, which leads to attention-seeking behavior
• A tendency to flirt or behave sexually
• Superficial or shallow ways of behaving
• Low self-esteem (which is usually concealedin people with narcissistic personality disorder, but more evident in people with histrionic personality disorder).

How are histrionic personality disorder and narcissistic personality disorder different?

The differences between the two personality disorders mainly relate to the reasons behind the behaviors displayed.^[1]

These include:

Empathy

People with narcissistic personality disorder lack empathy for others in a way that people with histrionic personality disorder don’t.

Attention

Both seek attention, but the type of attention differs. People with narcissistic personality disorder tend to think very highly of themselves and feel superior to others. When they seek attention, it is admiration and recognition they are seeking. People with histrionic personality disorder, on the other hand, are more likely to have an attention-seeking desire rooted in low self-esteem. They are therefore looking to others to help boost their self-esteem and are more comfortable with being seen as vulnerable or in a more negative light.

Emotions

People with histrionic personality disorder are highly emotional, showing their emotions easily and often dramatically. People with narcissistic personality disorder are less emotional and may come across as reserved.

Relationships with others

Both are prone to overstating the strength of their personal relationships with others. However, people with narcissistic personality disorder are more likely to exaggerate their relationships to people of status, power, or wealth. People with histrionic personality disorder on the other hand have a keen need to be accepted by others, which can lead them to believe relationships are more intimate than they are.

Why do these distinctions matter?

Personality disorders can have a significant impact on a person’s life and personal relationships. They can cause significant distress but, with treatment, the impact can be lessened. Some people find labels unhelpful and getting a diagnosis of a personality disorder can be especially difficult, but the right diagnosis is often the first step to getting the right treatment.

Can these conditions occur together?

Narcissistic personality disorder and histrionic personality disorder can occur together. They can also occur alongside other personality disorder and other mental health conditions.^[1] This can make the process of diagnosis more complicated and may affect treatment.

What treatment options are available for histrionic personality disorder and narcissistic personality disorder?

Both narcissistic personality disorder and histrionic personality disorder can be treated with psychotherapy, which can help the person to explore and understand their emotions and develop different approaches to their reactions and behavior. However, people with narcissistic personality disorder are less likely to seek treatment. When they do, therapy can be especially challenging as it requires a great deal of self-reflection and taking responsibility for oneself, which people with narcissistic personality disorder can struggle with.

Therapy can be delivered on a one-to-one basis, in group settings or involve loved ones.

Medication is not usually used to treat personality disorders and the Food and Drug Administration (FDA) has not approved any drugs for use specifically with personality disorders. However, a doctor may prescribe medication for associated symptoms, such as antidepressants to treat depression, which can often co-exist with personality disorders.^[2]