An estimated 9% of people in the US have a personality disorder, which is defined by the American Psychiatric Association as a long-term pattern of behavior and inner experiences that don't fit cultural expectations. Ten personality disorders are recognized by the Diagnostic and Statistical Manual of Mental Health Disorders–5 (DSM–5), and one in particular is called histrionic personality disorder (HPD).
Histrionic Personality Disorder , which adds that the disorder typically emerges when a person is in their late teens or early 20s.
What causes histrionic personality disorder?
While there's no known definitive cause for HPD, many researchers believe the disorder is a result of a combination of both nature (genetics) and nurture (environment), Julian Lagoy, MD, a psychiatrist in San Jose, California with Community Psychiatry and MindPath Care Centers, tells Health.
"Some HPD have family members with the same disorder, which suggests that there is genetic predisposition for it," Forman adds.
Family may play a role in others ways, too. Children of inattentive parents may develop histrionic behaviors as a way to gain attention, and children of parents who exhibit their own attention-seeking behavior might simply learn this behavior from them, modeling their parents' actions and emotions. As they become adults, they continue the HPD behavior patterns they developed in childhood.
Registered cases of HPD show that women are more likely to have the condition than men, but some researchers suggest that could be down to over-diagnosis of women.
Diagnosing histrionic personality disorder
HPD is diagnosed in adulthood when five or more of the diagnostic criteria identified in the DSM–5 are present and significantly interfere with the person's life. "It is a pervasive pattern of excessive emotionality and attention-seeking beginning in early adulthood," Dr. Lagoy says.
The diagnostic criteria are as follows:
- Discomfort in situations in which the person is not the center of attention
- Interaction with others characterized by inappropriate sexually seductive behavior
- Rapidly shifting and shallow expression of emotions
- Consistent use of physical appearance to draw attention
- A style of speech that is excessively impressionistic and lacking in detail
- Self-dramatization and exaggerated expressions of emotion
- Being suggestible and easily influenced by others or circumstances
- Considering relationships to be more intimate than they actually are
One of the problems with making a diagnosis of HPD is that some symptoms overlap with other personality disorders, Dr. Lagoy notes. For example, "rapidly shifting and shallow expression of emotions" could be mistaken for borderline personality disorder (BPD).
Often, HPD shows up as manipulative behavior, a highly sexualized demeanor, a strong desire to be noticed, and a need to get approval and self-worth from others, says Forman.
Treating histrionic personality disorder
Psychotherapy is the most common and effective choice of treatment for a person with HPD. "Cognitive–behavioral therapy (CBT) can be used to help the person understand the thoughts that drive their behaviors," Forman says. "CBT can also teach the person appropriate interpersonal skills and healthy forms of communication."
Dr. Lagoy agrees that seeing a therapist or psychiatrist should be the first step if someone thinks they might have a personality disorder (whether that's HPD or something else). If the person with suspected HPD also shows signs of depression and/or anxiety, medication may be prescribed. However, there are no medications to treat personality disorders.
People with HPD can often be extremely attractive to others, because they tend to be animated and sociable—they act like the life and soul of the party. But their attention-seeking ways can be difficult for other people to deal with, which puts relationships in jeopardy.
If someone you know has HPD, Dr. Lagoy's advice is simple: love that person just like anybody else "Try to be very patient and forgiving with your partner and not take anything too personally, as often actions are caused by the personality disorder (from their troubled childhood or genetics) and are not fully intentional," he explains.