ADHD Comorbidities & Related Conditions

What Is Histrionic Personality Disorder? HPD Symptoms, Treatments & Causes

Histrionic personality disorder (HPD) is a Cluster B personality disorder that causes dramatic attention-seeking behaviors. Here, understand HPD’s symptoms, causes, and treatments, plus its link to ADHD.

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What Is Histrionic Personality Disorder?

Histrionic Personality Disorder (HPD) is psychiatric condition associated with a pattern of attention-seeking behavior, inappropriate sexually seductive behavior, and discomfort with being outside the center of attention. People with HPD are overly dramatic and display exaggerated emotions1.

HPD is one of the rarest personality disorders, occurring in only 0.83% of the population2.

HPD is one of 10 personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Along with borderline, antisocial, and narcissistic personality disorders, HPD is a Cluster B disorder, which causes affected individuals to appear erratic, emotional, or dramatic.

What are the Symptoms of Histrionic Personality Disorder?

People with histrionic personality disorder exhibit at least five of the following symptoms in a variety of situations:

  • Experiences discomfort when he or she is not the center of attention
  • Frequently displays inappropriate sexually provocative or seductive behaviors
  • Has shallow and fleeting emotions
  • Uses appearance to draw attention
  • Vague but highly emotional speech
  • Displays dramatized and exaggerated emotions
  • Is highly suggestible
  • Behaves as if relationships were more intimate than they are3

[Self-Test: Symptoms of Histrionic Personality Disorder]

Other Signs of HPD

People with HPD may struggle to form and maintain relationships, both platonic and romantic. They may alienate friends with inappropriate sexual behavior. They crave novelty and stimulation and are prone to becoming bored with their usual routine. Starting a project may feel invigorating, but they will often have trouble finishing, as they struggle with delayed gratification. HPD is also associated with low self-esteem, which leads to the need for approval and attention4.

Causes of HPD

HPD has no known definitive cause, however preliminary studies have shown potential roots of the disorder, including:

  • Genetics. HPD runs in families, so researchers theorize that there may be an underlying genetic link.
  • Trauma. Trauma can change the way a child perceives the world, and therefore the way they interact with it, potentially resulting in HPD.
  • Parenting. Most research into the cases of HPD has centered on parenting. HPD is correlated with permissive, over-indulgent parenting5.

HPD and ADHD

According to a German study of adults with ADHD, about 35% of subjects receiving care in a tertiary referral center met criteria for HPD.6  This relationship, however, warrants much more research, as ADHD and HPD share many symptoms, which may lead clinicians to improperly execute a differential diagnosis.

[Self-Test: Symptoms of Borderline Personality Disorder]

Treating HPD

Like many personality disorders, HPD is ego-syntonic, meaning that HPD sufferers often do not realize they have a problem. Ego-syntonic disorders are more difficult, though not impossible, to diagnose and treat.

HPD is most often treated with supportive psychotherapy that aims to improve self-esteem and coping skills in a patient, encouraging environment. Psychodynamic therapy, which aims to resolve unconscious conflicts and help patients understand themselves, is also effective. Some patients also benefit from cognitive behavioral therapy (CBT), which aims to help them unlearn negative patterns of thought and adopt healthier ways of thinking and interacting with the world.

Though there is no approved pharmacological treatment for HPD, antidepressants, mood stabilizers, and antipsychotics may be helpful to reduce emotional dysregulation7.

Histrionic Personality Disorder: Next Steps

Sources:

1American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 667 https://doi.org/10.1176/appi.books.9780890425596
2Volkert, J., Gablonski, T., & Rabung, S. (2018). Prevalence of personality disorders in the general adult population in Western countries: Systematic review and meta-analysis. The British Journal of Psychiatry, 213(6), 709-715. https://doi.org/10.1192/bjp.2018.202
3American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 667 https://doi.org/10.1176/appi.books.9780890425596
4American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 667 https://doi.org/10.1176/appi.books.9780890425596
5Batool, N., Shehzadi, H., Riaz, M. N., & Riaz, M. A. (2017). Paternal malparenting and offspring personality disorders: Mediating effect of early maladaptive schemas. The Journal of the Pakistan Medical Association, 67(4), 556–560.
6Jacob, C. P., Romanos, J., et al. (2007). Co-morbidity of adult attention-deficit/hyperactivity disorder with focus on personality traits and related disorders in a tertiary referral center. European archives of psychiatry and clinical neuroscience, 257(6), 309–317. https://doi.org/10.1007/s00406-007-0722-6
7French JH, Shrestha S. Histrionic Personality Disorder. [Updated 2021 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542325/


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