Histrionic Personality Disorder: Key Symptoms, Causes, and Effective Therapies

June 5, 2024

Histrionic personality disorder (“HPD”) involves a deep-seated need for attention and excessively emotional behavior. This guide defines the key characteristics of HPD, discusses its impact on interpersonal relationships, covers understanding and managing HPD, and outlines the potential benefits of seeking professional help.

Key Takeaways

  • Histrionic Personality Disorder is characterized by exaggerated emotional reactions and attention-seeking behaviors, leading to difficulties in personal and professional relationships.
  • Diagnosis of HPD is based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM), requiring at least five specific behaviors, and is best done post-adolescence with a non-confrontational, broad-questions approach.
  • Treatment for HPD often includes psychotherapy—such as Cognitive Behavioral Therapy (CBT) and Psychodynamic Therapy—medication for co-occurring symptoms, and self-help strategies, alongside support from loved ones who are educated about the disorder and enforce healthy boundaries.

What Is Histrionic Personality Disorder (HPD)?

Personality disorders are mental health conditions where individuals have a lifelong pattern of perceptions and behaviors that can lead to difficulties in many aspects of life. Among these, Histrionic Personality Disorder (HPD) stands out with its unique blend of exaggerated emotional responses and a consistent desire for attention.

Unlike Borderline Personality Disorder and other related conditions such as Narcissistic Personality Disorder, Dependent Personality Disorder, and Antisocial Personality Disorder, HPD primarily revolves around attention-seeking behaviors rather than substantial despair or suicidal tendencies. In this context, antisocial personality disorder is one of the related conditions, but with a different set of symptoms and challenges.

These behavioral patterns can significantly disrupt various aspects of life, including family dynamics, social activities, work, and school.

Defining Histrionic Personality Disorder

Histrionic Personality Disorder is marked by:

  • A need to seek approval from others due to the lack of a strong sense of self-worth
  • A constant need for attention and validation
  • A tendency to be dramatic and theatrical in order to gain attention
  • Difficulty maintaining relationships due to the need for constant reassurance and validation

It’s a challenging mental health condition to live with, and can often be misunderstood, which is why it’s so important to shed light on this often overlooked mental disorder.

Prevalence and Demographics of Histrionic Personality Disorders

HPD may not be as commonly heard of as some other personality disorders, but it’s more prevalent than you might think. An estimated 1.8% of the general population has this disorder. While this condition is diagnosed more frequently in females than males, that may be due to differences in the expression across genders or underdiagnosis of males.

While this condition is diagnosed more frequently in females than males, that may be due to differences in the expression across genders or underdiagnosis of males.

Key Symptoms of Histrionic Personality Disorder

The key symptoms of Histrionic Personality Disorder include:

  • Excessive emotional expression
  • Attention-seeking behavior
  • Dramatic and exaggerated speech and gestures
  • Inappropriate seductive or provocative behavior
  • Shallow and rapidly changing emotions
  • Difficulty maintaining long-term relationships
  • Strong need for approval and reassurance
  • Easily influenced by others
  • Tendency to perceive relationships as more intimate than they actually are

At its core, HPD is characterized by a reliance on external validation for self-esteem, a trait that can lead to a cycle of attention-seeking behaviors and emotional turmoil.

Emotional Expression

The emotional landscape of an individual with HPD is a rollercoaster ride of highs and lows, often shifting rapidly and appearing exaggerated to others. Their emotional expression is often enmeshed with their physical appearance, which they may use to draw attention to themselves.

Their speech can be impressionistic and vague, revealing a lack of depth in their emotional experience. These individuals are also highly suggestible, easily influenced by others or circumstances.

Interpersonal Relationships

When it comes to relationships, people with HPD often see the world through rose-colored glasses. Their perceptions of relationships are often distorted, viewing them as more intimate than they actually are. This skewed perception can lead to inappropriate seductive or provocative behaviors in an attempt to create the intimacy they perceive. Despite their efforts, achieving real emotional and sexual intimacy often remains a struggle, leading to relationships that are less close than they believe.

This emotional dependency can result in consistently seeking new and thrilling experiences from different relationships, often accompanied by manipulative behaviors to draw support and affirmation from others.

Self-Image and Esteem

For those with HPD, their self-image is often intertwined with the attention they receive from others, leading them to be highly dependent on external validation and approval. Their self-esteem is closely connected to how others perceive their outward appearance, and they might utilize their physical appearance as a means to garner attention.

This reliance on external validation can create a fragile sense of self, easily swayed by the opinions and approval of others.

Causes and Risk Factors

Histrionic Personality Disorder is believed to be caused by a combination of genetic and environmental factors. These may include childhood experiences and a family history of personality disorders. Is it something in our genes, or is it shaped by our experiences? It’s likely a mix of both. Genetic influences are believed to contribute to the development of HPD, while early childhood experiences and individual temperament, including one’s psychological style and ability to cope with stress, are significant risk factors.

Additionally, people with HPD may have an anxious-preoccupied attachment style, which can be traced back to their childhood experiences.

Genetic Factors

Our genes shape us in many ways, from the color of our eyes to our propensity for certain health conditions. The same holds true for our mental health. Genetic factors may play a significant role in the development of HPD, potentially influencing our temperament and emotional expression.

There is an identified genetic susceptibility to personality disorders that can contribute to the risk of developing HPD. So if HPD runs in your family, it’s possible that you may be at a higher risk.

Childhood Experiences

Our childhood experiences can leave a lasting mark on our mental health. For individuals with HPD, exposure to dramatic or overly sexual behavior by parents or caregivers and the absence of appropriate boundaries can contribute to the emergence of the disorder. If a child learns behaviors from a parent or caregiver who exhibits features of HPD, they may be predisposed to developing the condition themselves.

These early experiences can set the stage for the development of HPD later in life.

Attachment Styles

Our early relationships with our caregivers shape our attachment styles, which in turn influence our later relationships and interactions. An anxious-preoccupied attachment style is characterized by a strong desire to form secure relationships, coupled with fear of abandonment and insecurity. Individuals with this type of attachment style are more likely to develop HPD, potentially due to earlier patterns of inconsistent caregiving.

Understanding this link can inform treatment approaches for HPD.

Diagnosis and Assessment

The process to diagnose histrionic personality disorder is complex. Given that most individuals with personality disorders do not recognize their behavior as problematic, the path to a diagnosis can be fraught with challenges. Mental health professionals such as clinical counselors, psychiatrists, psychologists, or other licensed behavioral health professionals utilize a non-confrontational approach, involving broad, general questions that avoid defensive responses. Once diagnosed, it is crucial to treat histrionic personality disorder with appropriate therapy and support.

Family and friends often provide additional insights for the assessment of HPD, especially when the individual lacks self-awareness of their behaviors.

Mental Health Evaluation

When it comes to diagnosing HPD, the mental health evaluation process requires a delicate balance of tact, insight, and understanding. Mental health professionals often use a non-confrontational approach with broad questions to minimize the likelihood of defensive responses from the patient. They value additional insights from family and friends to aid in the diagnosis.

Given the ongoing personality development during childhood and adolescence, healthcare providers typically wait until after an individual has reached the age of 18 to diagnose HPD.

Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides the criteria used by mental health professionals to diagnose HPD. Diagnosis requires the presence of at least five specific behaviors outlined in the DSM. These behaviors include persistent attention-seeking and seductive behavior, shifting shallow emotions, and an overestimation of the intimacy in relationships.

By adhering to these criteria, mental health professionals ensure a thorough, accurate diagnosis that can guide the subsequent treatment plan.

Treatment Approaches

Once diagnosed with HPD, what’s next? The good news is that there are various treatment approaches available, including psychotherapy, medication, and self-help strategies. Treatment for HPD is aimed at helping individuals alter harmful thought and behavior patterns into healthier, more productive ones. However, treatment success can be significantly influenced by tailoring the approach to the individual’s specific needs.


Psychotherapy is a central treatment for HPD, with various approaches utilized to address the disorder’s unique challenges. Cognitive Analytic Therapy identifies ‘triggers’ and targets problems, and Functional Analytic Psychotherapy focuses on past reinforcement contingencies.

Psychodynamic therapy resolves unconscious conflicts, while cognitive behavioral therapy develops management strategies for attention-seeking behaviors. Interpersonal therapy and group therapy support skill-building in communication and social interactions, while supportive psychotherapy reinforces self-confidence.

The therapists at Resilience Lab are here to provide you with a customized care plan based on your current circumstances and your personal needs.


While no medication is specifically approved for HPD, some may be prescribed to manage symptoms of co-occurring conditions like depression or anxiety. The following medications may be prescribed to treat symptoms of HPD:

  • Antidepressants such as Prozac and Norpramin to treat symptoms of depression and anxiety
  • Mood stabilizers like Lamictal and Tegretol to improve impulse control and emotional lability
  • Antipsychotics such as Risperdal and Abilify to manage emotional dysregulation

It’s important to remember that these medications are used in conjunction with psychotherapy to enhance its effectiveness.

Self-Help Strategies

Alongside professional treatment, self-help strategies can play a significant role in managing HPD. Building a healthy sense of self-worth through challenging negative self-beliefs and recognizing positive qualities can support treatment. Adopting self-care practices, such as maintaining good sleep hygiene, eating a balanced diet, and regular physical activity, can improve symptoms.

Journaling and mindfulness exercises like meditation or yoga can also be beneficial. Engaging in hobbies and other enjoyable activities can aid in the development of self-confidence.

Supporting a Loved One with Histrionic Personality Disorder

Living with or caring for someone with HPD can be challenging. The disorder’s characteristics can strain relationships and require a high level of patience and understanding.

Supporting a loved one with HPD involves several key components: educating oneself about the disorder, setting boundaries, and encouraging treatment.

Educating Yourself

Education is a powerful tool when supporting a loved one with HPD. Understanding the disorder can provide necessary support and understanding for your loved one. This involves understanding the characteristic behaviors of HPD, such as excessive attention-seeking, and recognizing that these behaviors are typically unconscious and used by individuals with HPD to fulfill their emotional needs.

Setting Boundaries

Setting boundaries with a loved one with HPD is essential for maintaining healthy interactions. These boundaries should clearly communicate how their behavior impacts you and enforce consequences if necessary.

It’s important to remember that it is not necessary to always say yes to others, and setting boundaries by saying no when needed is important for one’s own well-being.

Encouraging Treatment

Encouraging a loved one with HPD to pursue professional treatment can be instrumental in helping them recognize their behavior patterns and work towards healthier coping mechanisms. This involves assisting them in researching treatment options and expressing pride in their steps toward recovery.

In addition, seeking support through therapy, either individually or together, can be a beneficial step in encouraging treatment for the person with the disorder.

Frequently Asked Questions

What is Histrionic Personality Disorder (HPD)?

Histrionic Personality Disorder (HPD) is characterized by exaggerated emotional responses and a consistent desire for attention, primarily involving attention-seeking behaviors.

What are the symptoms of HPD?

The symptoms of HPD include excessive emotional expression, problematic interpersonal relationships, and a reliance on external validation for self-esteem. These symptoms can have a significant impact on a person's life.

What causes HPD?

Among the factors contributing to development of HPD are genetic factors, childhood experiences, and attachment styles.

How is HPD treated?

HPD is typically treated with a combination of psychotherapy, medication, and self-help strategies. It is important to consult a healthcare professional for personalized treatment.

How can I support a loved one with HPD?

Supporting a loved one with HPD involves educating yourself about the disorder, setting boundaries, and encouraging treatment. Empathy and understanding are important in providing support.

If you or someone you know is experiencing a crisis and needs immediate help, please call 911 or go to the nearest emergency room. This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition.

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Clinically Reviewed by Christine Carville, LCSW-R.

Christine Carville, LCSW-R, is the co-founder and Chief Clinical Officer of Resilience Lab. Christine developed the Resilience Methodology, a trans-theoretical training model for therapists to provide individualized, flexible, trauma-informed care. She has also been teaching at the Columbia School of Social Work since 2016 and continues to maintain her own private psychotherapy practice.

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