Histrionic Personality Disorder

Information on Histrionic Personality Disorder – including presentation, symptoms and treatment.

Beliefs, emotions and behaviour.

This personality type is characterised by thinking that avoids internal thought, meaning the person may not consider the consequences and effects of their behaviour.  Their focus will be on seeking attention or admiration from others as a way to boost their confidence and feel valid.  Their core belief is that they are incapable of coping with life themselves, so need others to care for them. Such an individual will be overly attentive to small details, whilst often missing the bigger picture, coming across as lacking insight.  They see themselves as sociable, stimulating and charming.

Missing Interpersonal Ability:

Self Awareness

A person with a histrionic personality is likely to over react to situations and can appear provocative.  They do not like a lack of activity, which will lead them to act in an impulsive, highly emotional and theatrical way.  The person will often use clothes or highlight their natural features to draw attention to themselves, and will change this on a regular basis to try and be socially attractive.  They show extravagant emotion but this is superficial. and will initially come across as charismatic and extravert. They may talk in a way to impress others, but underneath there is a lack of depth to what they are saying, meaning they can struggle to hold a meaningful conversation.

Isn’t it just a version of extroversion?

Individuals with this personality pattern also score highly on extraversion scales. However, with Histrionic Personality Disorder, there is usually underlying fears and insecurities that lead to this behaviour. Many individuals who are extravert do not display behaviour that can impact negatively on themselves or others and are likely to have greater impulse control and ability to perspective take.

The only way that Lucy appears able to interact is through flirting with others, although as she lacks social skills this comes across as awkward.  She suffered abuse and neglect as a child but would get attention, albeit negative, when she had temper tantrums.  She often swings from being happy having a conversation, where she has all the attention, to suddenly starting to cry dramatically if another person interrupts this. 

Lucy can appear over the top with her facial expressions, with overly pronounced movements and exaggerated speech.  It appears as if she is performing, rather than really being angry, although becomes physically aggressive if she feels people are not listening to her.   She has had partners in the past, but relationships have been short lived as individuals find it hard to cope with her behaviour, and feel like she is not able to ‘be herself’. 

Histrionic Personality Disorder Diagnostic Criteria

To gain a diagnosis of this Personality Disorder, individuals must show five of the following traits, persistently and pervasively:

• A compulsion to be the centre of attention that results in discomfort if unmet
• Inappropriate sexual, seductive or provocative behaviour when interacting with others
• Shallow, rapidly shifting emotions
• The use of physical appearance to draw others’ attention
• Dramatic, impressionistic speech that lacks detail
• Exaggerated, theatrical emotional expression 
• Easily influenced by others or situations
• Assumes relationships are more intimate than they are

Treatment for Histrionic Personality Disorder

Therapy which allows for a supportive rapport to be built has been found to be useful for Histrionic Personality Disorder. This could include Schema Therapy or psychodynamic therapy. Any therapy that helps the individual to consider the origins of their behaviour, in a non-threatening way, will help.

As individuals with this personality often show emotional reactions and impulsive behaviour they may also benefit from DBT skills. This could include the modules on emotional management and distress tolerance.

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