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Dramatic displays of behavior are common when acting in a play or giving a speech; however, theatric behavior is how people with histrionic personality disorder manage their world. The word “histrionic” means overly theatrical or melodramatic, the main type of behavior displayed in histrionic personality disorder.
Histrionic personality disorder, also known as HPD, is one of ten personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).1 People with histrionic personality disorder exhibit highly emotional or dramatic behavior, impeding their social functioning and preventing them from developing healthy relationships.2
HPD is a historic mental disorder with references throughout history. The Greek word “hystera,” which is the root of hysteria, means womb or uterus. Ancient Greeks believed that a displaced womb or uterus was the cause of many illnesses in women, including mental disorders.
The belief was that an unhealthy womb impeded breathing and caused sickness. In the Middle Ages, demonic possession was designated as the cause of hysteria. Another common belief was that hysteria stemmed from an excess of animal spirits inflicting the nerves in different parts of the body.3
During the 1800s, hysteria was studied in medical schools. Some physicians believed hysteria was psychological frustrations caused by a woman’s role in society and the physiological changes women undergo. Gradually, physicians started to suspect that hysteria was not caused by the womb or spirits and began considering the brain. It was during this time that hysteria was also extended to include men.3
Clinicians made histrionic personality disorder a formal part of the Diagnostic and Statistical Manual of Mental Disorders in its second edition (DSM-II). The Diagnostic and Statistical Manual of Mental Disorders is the manual universally utilized by clinicians to diagnose mental health conditions.3
A thorough psychological evaluation is conducted when diagnosing HPD, including:
Clinicians may perform lab tests and physical evaluations to rule out other sources and confirm a histrionic personality disorder diagnosis.4
People with histrionic personality disorder often crave excitement and, therefore, may find themselves in high-risk situations. Managing frustration and stress can be challenging with a histrionic personality, causing higher anxiety, depression, and suicidal thoughts.4
Many people with HPD are socially engaged and, for the most part, have good social skills. Regardless, their social skills are often used to manipulate others into giving them what they want. As a result, they end up harming their close relationships. Histrionic personality disorder can be shown through various signs and symptoms, including:
Histrionic personality disorder symptoms may lead to misinterpretation of other people’s emotions, causing disruptions in relationships. In a study published in the Journal Psychiatry Research, individuals with histrionic personality traits may have alexithymia—the inability to recognize emotions, both in themselves and others.5
Due to their personality disorder, histrionic individuals misinterpret the emotions of others and assume that others are much more fond of them than they really are. What’s more, they may be disconnected from their thoughts and feelings, thus behaving in a way that goes against their well-being.6
The causes of histrionic personality disorder remain unknown. Researchers believe that the disorder has a multifactorial origin, with causes stemming from inherited factors and environmental surges.
Childhood trauma may play a role in the development of histrionic personality disorder. For example, a child may develop certain coping mechanisms to handle their trauma that can later lead to histrionic personality disorder.
Additionally, parenting styles may also play a part in histrionic personality disorder etiology. Over-indulgent or inconsistent parenting styles or parents who model histrionic, dramatic behaviors may place children at high risk for developing histrionic personality traits later in life.
This disorder also runs in families, so people who have family members with histrionic personality disorder are more likely to develop it than the general population.7
Research indicates that about 2% to 3% of the general population have histrionic personality disorder, some of which are also diagnosed with an additional, or comorbid, disorder.
Although both men and women are equally prone to developing HPD, women are four times more likely to be diagnosed with the disorder. This disparity may stem from the history behind the disorder, along with the overtly sexual or seductive histrionic personality traits connected to the disorder.7
Society may be less likely to tolerate sexual-forwardness in women than men, putting women at a higher risk for adverse outcomes. What’s more, society may be more accepting of dramatic or aggressive behavior in men, while women might not have the same leeway.
In addition, it was found that men are less likely to seek assistance for relationship issues, which is the area of life most affected by personality disorders like HPD.7
Because the exact cause for HPD is unknown, there is no way to guarantee prevention. Nonetheless, mitigating the circumstances under which histrionic personality disorder develops is essential. Preventing childhood trauma and offering supportive therapy can help prevent HPD and other personality disorders.
While the factors and symptoms of histrionic personality disorder can enable someone to function well in society, these same factors can result in adverse outcomes.
For example, many individuals with HPD may lead successful and productive lives, mainly because of their savviness in social situations. In contrast, the desire for attention and dramatic behavior may bleed into their work or personal relationships, leading to disagreements or disturbances.
In addition, people with personality disorders, such as histrionic personality disorder, have higher rates of substance abuse. In the general population, the prevalence of personality disorders ranges from 10% to 14.8%; however, the prevalence of personality disorders in people with substance use disorders ranges from 34.8% to as high as 73.0%. Risk-taking behavior, high impulsivity, and desire for excitement put people with HPD at a higher risk for the development of substance abuse disorder.8
Treatment for HPD is vital for managing the detrimental effects of the disorder. Although there’s no cure for HPD, treatment can reduce the presence of disruptive symptoms.
Individuals who have histrionic personality disorder typically already possess the social skills to function well in society—thus, the best treatment helps diminish the behaviors that get in the way.
Moreover, treatment for histrionic personality disorder may also occur simultaneously with treatments for other mental health conditions or substance use disorders. Co-occurring or dual diagnosis rehabilitation centers treat substance use and mental health disorders at the same time, resulting in successful recoveries.
Although there are no medications made specifically for any personality disorder, various medications can help alleviate symptoms like mood instability, anxiety, and outbursts. Antidepressants, antipsychotics, and anti-anxiety medications are effective treatments for histrionic personality traits, especially when combined with psychotherapy.
Psychotherapy, also known as talk therapy, is the first-choice treatment approach for histrionic personality disorder.
Through psychotherapy, an individual can learn skills to manage the disruptive emotions and behaviors linked to HPD. In addition, psychotherapy enables individuals to get to the root of their actions and deal with the trauma that might have occurred in their past.
Cognitive behavioral therapy (CBT) is a psychotherapy approach that focuses on how a person thinks, acts, and feels.
CBT teaches individuals how to change their thoughts and behaviors to prevent adverse choices and outcomes. Thus, an individual with histrionic personality disorder can identify negative behaviors and initiate interventions to curb them.
As with other psychiatric conditions, rehabilitation is possible either through inpatient or outpatient approaches, depending on the needs of each individual.
Outpatient treatment benefits individuals whose symptoms are less severe. During outpatient treatment, the individual lives off-site and travels to a rehabilitation center to treat their histrionic personality disorder symptoms.
If you or your loved one needs treatment, The PAC Program can help. We provide a supportive and caring environment staffed with well-trained and qualified professionals. We offer personalized treatment programs that address each patient’s needs and situation, including programs for substance use, mental health, and co-occurring disorders.
The best treatment for histrionic personality disorder takes compassion and support, and our staff is ready to assist you. Contact The PAC Program today and begin the journey to a happy and healthy life.
If you or a loved one needs help, please call us at
623-523-4748 and our team at Blueprints For Recovery in Arizona will help.
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