Histrionic Personality Disorder: Causes, Symptoms, Treatment

What is histrionic personality disorder?

Histrionic personality disorder (HPD), sometimes referred to as dramatic personality disorder, involves a lasting pattern of excessive attention-seeking and exaggerated emotional displays. Beneath this behavior is an intense desire for approval. Someone with HPD may feel uncomfortable when they’re not in the spotlight and go to great lengths to feel seen and loved.

Most of us crave attention or admiration on occasion. But, as is the case with other personality disorders, people with HPD have difficulty adapting their behavior to different situations. They may seem “over the top” or “theatrical” at inappropriate times, such as at work. Their flirtatious behavior might damage friendships and romantic relationships.

People with HPD have a tendency to be self-centered and have little room for self-doubt. Because of this, they often don’t realize they have a disorder, or see how their behavior has unwanted consequences.

Of course, not everyone with HPD is blind to their condition. If you’re aware of the problems it creates in your life, you may understand how you’re driven by a desire for recognition and validation. Your sense of self-worth hinges on how others view you. Because of this, even the slightest social rejection or criticism can feel incredibly devastating. You may have been labeled a “drama queen” or frequently told to “calm down.” Or you might feel close to people, only to later realize those feelings are unrequited.

Perhaps you see yourself caught in a pattern of self-sabotage, as your behavior always seems to undermine your efforts to be accepted. You may frequently ask yourself, “Why am I like this?”

Similarly, if someone you love has HPD, you may regularly question the authenticity of their words and actions. Are they being sincere or overexaggerating? You may feel embarrassed by their theatrics or provocative behavior, as if you’re watching a performance. Or perhaps you’re frustrated with their self-centeredness and feel unseen yourself.

Whether you’re concerned about your own or someone else’s behavior, know that you’re not alone. It’s estimated that histrionic personality disorder appears in two to three percent of the population. By understanding more about HPD, you can identify the symptoms and causes, discover self-help strategies, or learn to help a loved one.

Symptoms of histrionic personality disorder

Plenty of people love the spotlight at certain times. But how can you distinguish HPD from a normal desire for attention?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), for you or someone you love to be diagnosed with histrionic personality disorder requires the presence of five or more of the following eight symptoms:

1. Uncomfortable when not in the spotlight. A person with HPD is always seeking attention from others. If you’re not receiving attention, you feel unhappy or uneasy. You might tell exaggerated stories to feel seen, or excessively compliment others to be liked.
2. Seductive acts. To gain attention, you might flirt or make sexual advances in inappropriate situations, such as with a boss or coworkers, leading to problems at work.
3. Superficial and shifting emotions. You might rapidly go from angry to sad to excited, for example. Although the emotions seem intense, the rapid fluctuation can also make you seem insincere or shallow.
4. Emphasis on physical appearance. You might try to capture attention with flashy or revealing outfits, or by frequently changing hair color.
5. Vague speech. Even if you seem emotional about something or someone, you talk about it in a superficial way. For instance, you might say you love a book or movie, but struggle to give reasons why.
6. Exaggerated emotions. You may dramatically proclaim you feel like you’re going to die after a small inconvenience. Or act overly enthused to be at a party.
7. Easily influenced. Someone with HPD is quick to follow trends or change opinions based on what others say. You may hop on a diet trend without understanding it, or switch political opinions just because someone disagrees with your stance.
8. Overestimating closeness in relationships. You may refer to someone you just met as a best friend. Or perhaps believe that a stranger who simply glanced at you is madly in love with you.

Similar and co-occurring disorders

Histrionic personality disorder is categorized as a cluster B personality disorder, along with:

These disorders are characterized by emotional volatility and impulsiveness. Personality disorders can co-occur with one another, making diagnosis and treatment more complicated.

Histrionic versus borderline personality disorder (BPD)

HPD can seem especially similar to BPD. In fact, HPD is sometimes referred to as “BPD light.” Both can feature intense emotional reactions. However, important distinctions exist between the two conditions:

• People with BPD tend to have a more negative view of themselves than people with HPD
• BPD comes with more intense feelings of emptiness and anger, and a greater risk of self-destructive behavior.
• A person with histrionic personality disorder is often driven by a desire for attention. A person with borderline personality disorder carries an intense fear of abandonment.

Histrionic versus dependent borderline personality disorder

Histrionic personality disorder can also appear similar to dependent personality disorder, a cluster C disorder. Cluster C disorders involve unusual fears and anxiety.

Like those with HPD, people with dependent personality disorder also have a high need for emotional validation from others. However, they are often more timid and less likely to show dramatic behavior.

Co-occurring disorders

Aside from other personality disorders, histrionic personality disorder can also frequently co-occur with:

Depression. Depression can occur if your HPD behavior frequently leads to social rejection, relationship instability, or an unfulfilled need for validation.

Anxiety. While anxiety appears to be more common in people with cluster C personality disorders, it can occur with personality disorders in general.

Somatic symptom disorder. This condition involves excessive concern over a physical symptom, and can seem like part of dramatization or attention-seeking behavior.

Substance use disorders. Having histrionic personality disorder may put you at higher risk of drug and alcohol abuse. This might be driven, in part, by impulsiveness and a desire to seek out novel and exciting experiences.

[Read: Dual Diagnosis: Substance Abuse and Mental Health]

Eating disorders. HPD seems to be linked to eating disorders, especially bulimia nervosa. Some researchers estimate that about 40 percent of anorexia and bulimia patients have a comorbid cluster B personality disorder, such as HPD. This may be because these personality disorders and eating disorders can both involve impulsivity.

Attention-deficit/hyperactivity disorder (ADHD). Some adults with ADHD may also meet the criteria for an HPD diagnosis. Both disorders can contribute to issues with interpersonal relationships. For example, if a person has both disorders, friends and family members might see them as unfocused and impulsive, as well as dramatic and needy for attention.

Internet addiction. Social media offers a convenient means to gain attention and approval by sharing photos, posts, and other content. Although social media addiction isn’t an official diagnosis, too much time online can still lead to problems. It can fuel feelings of isolation, anxiety, and depression. It can also distract you from work, in-person interactions, and self-reflection.

Suicide attempts. In some cases, a person with histrionic personality disorder may use threats of suicide to gain attention or manipulate those around them. However, it’s important to always take suicidal behavior seriously.

What causes histrionic personality disorder?

If you or a loved one has HPD, your disorder might be the result of multiple factors, including inherited traits, childhood experiences, and learned behavior.

While women are more likely to receive an HPD diagnosis, men may simply be underdiagnosed because they are less likely to report symptoms.

Learned behavior. If a parent or caregiver models dramatic or overly sexual behavior, a child may adopt the same behavior to gain attention. Parents who are lax at setting boundaries or who overindulge their children may also contribute to the development of HPD.

Anxious-preoccupied attachment style. A person’s attachment style develops in response to early experiences with their primary caregiver. The preoccupied attachment style develops when a caregiver is inconsistent in meeting their child’s needs.

This can cause the child to be anxious in future relationships and in constant need of reassurance and attention from romantic partners. You might be labeled “clingy” or “needy,” because of your fixation on a partner and sensitivity to rejection.

[Read: How Attachment Styles Affect Adult Relationships]

Progression

It might help to think of HPD as existing on a spectrum. A person can start out with mild symptoms. Maybe other people consider you friendly, social, and expressive, but also reactive, moody, and superficial. Despite these emotional reactions, people on the mild end of the histrionic spectrum are generally able to maintain social relationships.

If your behavior isn’t corrected in some way, you may progress to more moderate symptoms and theatrical behaviors. Persistent attempts to get attention and validation can make you appear shallow or needy, and, as a result, others begin to pull away. This rejection prompts more intense emotional displays, leading to even more difficulties in social situations.

Again, if you aren’t able to recognize and seek help for your behavioral patterns, they can progress to more extreme theatrical behavior. You may become stuck in a cycle of desperately wanting approval but also acting out in a way that leads to rejection.

How to deal with histrionic personality disorder

While there isn’t a cure for histrionic personality disorder, a combination of self-help strategies and professional intervention can greatly reduce the severity of symptoms.

If you have an HPD diagnosis, know that it’s possible to escape unhelpful thoughts and actions and enjoy a happy, healthy social life. The following self-help strategies focus on:

• Developing a healthier attachment style.
• Building self-awareness.
• Improving self-worth and self-esteem.
• Reducing dependency on others.

Additionally, you’ll want to address any co-occurring conditions. Discovering ways to deal with these conditions can boost your self-esteem and help you develop new coping skills. For example, while treating an eating disorder, you might learn self-regulation strategies and develop a greater sense of self-confidence. This, in turn, helps you manage the personality disorder.

Similarly, learning to set limits on your social media use can help you rein in the desire to seek attention online. Instead, you can direct your time and efforts toward healthier ways to improve your self-esteem.

Tip 1 for coping with HPD: Build secure attachment

An insecure attachment is often a factor that contributes to histrionic personality disorder. Although attachment styles are formed early in life, it’s never too late to foster a more secure approach to relationships.

Explore the roots of your attachment style. Preoccupied attachment style is most commonly associated with histrionic personality disorder. When you were an infant, your parent or primary caregiver may have been dealing with an issue such as physical or mental illness, preventing them from giving you consistent attention. If possible, try to reconnect with your parent to develop a better understanding of the challenges they faced. This may offer insight into your own attachment difficulties.

Seek out relationships with people who have secure attachment styles. Whether they’re friends or romantic partners, aim to connect with people who are confident and stable in relationships. Even though they’re not perfect, these types of people know how to set appropriate boundaries and have a healthy degree of self-worth. They can be supportive, reliable, and willing to communicate. In other words, they can model healthy behaviors.

Strengthen your emotional intelligence (EQ). Emotional intelligence involves your ability to understand your emotions, manage them, and empathize with other people. For example, you can use emotional intelligence to identify when your dramatic behavior is offending other people, and better control your outbursts. You can also use emotional intelligence to more effectively communicate your needs.

Tip 2: Increase your self-awareness

If you have HPD, you might have a hard time noticing connections between your emotions, your behavior, and outcomes in your life. Instead, you are often left wondering how you ended up in unhappy situations at work or in relationships.

Self-awareness can be strengthened through self-reflective exercises.

Reflect on your wants, needs, and strategies

At a party, you may want to be noticed or be seen as attractive. Or maybe you want attention or acknowledgment from a loved one. How do you typically go about getting those needs met? Do you dress in outfits that others often deem inappropriate for the occasion? Do you use emotional displays to grab attention?

What are common outcomes of these strategies? If they often seem to generate disapproval or push people away, brainstorm other strategies to experiment with. For instance, you may want to focus more on bringing other people into the conversation at a party. Or satisfy your need for attention by volunteering at an animal shelter, petting needy dogs and cats. Or, instead of acting out with a partner, simply try asking them to set aside more time for date nights, for example.

Aim to better manage your emotions

Another way to build self-awareness is to better understand and manage your emotions. Many of us struggle to control our emotions, especially intense ones that make it difficult to think rationally, or cause you to say and do things you later regret. A lot of self-sabotaging behavior is often rooted in how you cope with these strong emotions.

For example, when someone seems critical of you, you might raise your voice and make a big scene. While you’re expressing anger, it may be because that’s the emotional response that you feel comfortable with, regardless of what the situation requires. Acting angrily or impulsively can be just a way to avoiding feeling sadness, anxiety, or fear—perhaps fear of being looked down upon or fear of being rejected.

To learn how to better recognize and understand your own emotions, use HelpGuide’s free Emotional Intelligence Toolkit.

Tip 3: Improve your sense of self-worth

People with histrionic personality disorder tend to suffer from low self-worth, which is why they seek out validation from others. This could be the result of early childhood experiences, such as being teased by siblings or criticized by your parents.

Whatever the cause, though, it’s possible to increase your own sense of self-worth, making it easier to escape negative thought and behavior patterns.

Identify negative self-talk

Think of a situation (real or imagined) that diminished your sense of self-esteem. How did you feel in that moment? Perhaps you felt judged or humiliated when a friend corrected your behavior. Or maybe you felt forgotten when you weren’t invited to a social event.

Now try to remember what your self-talk was like in those situations. Did you call yourself worthless? Unlikable? Did your self-talk contribute to thoughts and actions that made the situation worse?

Once you’re aware of your negative self-talk, you can take steps to challenge it.

Challenge negative self-talk

What are some more compassionate (and realistic) phrases you can substitute when you feel rejected, ignored, or criticized? You can try, “I don’t need to be perfect,” or “Not everyone will like me, and that’s okay. I am still loved.”

You can also use our audio meditation Being Kind to Yourself to help build self-compassion.

Nurture your own interests

Feelings of jealousy can stir up when you think someone is more attractive or interesting than you. Rather than focus on them, remember that you have your own style, hobbies, and interests.

• Aim to spend a little time alone each week and do something purely for your own personal joy and satisfaction. You might decide to paint, put together a puzzle, or write poetry. Just do it for you.
• Alternatively, take the focus off yourself altogether by volunteering to help others or contribute to your community. It can help raise your self-esteem and add meaning to your life.

Tip 4: Strive for independence

Histrionic personality disorder may come with a reduced sense of independence. You may have been so focused on gaining other people’s approval that you haven’t had much practice in making decisions on your own.

By learning to be more independent, you can shift your focus away from other people and act with more self-confidence.

Practice separating your opinions, wants, and needs from those around you. Try this journaling exercise:

• First, make a list of beliefs and values that you hold. It might include anything from political opinions to spiritual beliefs. The list is private, so let go of the fear that others will judge you.
• Next, write down a few of your desires. Maybe you want to travel to another country or develop your artistic talents. What are things you would want, even if no one else was around to do them with you?

This can help you separate your sense of identify from other people’s.

Create and climb a fear ladder. A fear ladder is a list that arranges stressful situations in order of least to most nerve-racking. You move up the ladder by confronting your fears one “rung” at a time.

• Make a list of activities that you typically feel uncomfortable doing alone. Put them in order of least to most intimidating. For example, you might be more willing to go grocery shopping alone than to attend a party by yourself.
• Challenge yourself to complete each item on your list.
• If you struggle with anxiety, familiarize yourself with a few anxiety-reducing strategies, such as deep breathing or mindfulness, before working on your fear ladder.

Professional treatment

Psychotherapy can help someone with histrionic personality disorder develop a stronger sense of self-esteem, and explore coping skills to reduce self-sabotaging thoughts and behaviors. A therapist can help you to understand the roots of your problematic behaviors, and replace those behaviors with healthier alternatives.

For example, a therapist might help you explore how your childhood experiences have contributed to an overly dramatic communication style.

[Read: Finding a Therapist Who Can Help You Heal]

While traditional or online therapy can be extremely helpful, keep in mind the following:

• One-on-one sessions are likely to be more effective for you than group-based therapy. Since people with HPD feel drawn to be the center of attention, this can disrupt the dynamic of a group.
• While finding the right therapist can often involve some trial and error, be aware that people with HPD are prone to “therapist hopping.” This means you find reasons to keep switching therapists if the current one doesn’t meet your need for constant validation. This can make it difficult for therapy to ever be effective.

Helping someone with HPD

If your loved one has histrionic personality disorder, it can be difficult to understand and cope with their behavior. You might feel constantly embarrassed by their attempts to flirt with people, or never certain if they’re overexaggerating or being sincere. You might even feel exhausted by their constant quest for external validation and compliments.

Learn as much as you can about the roots of HPD. Try to keep in mind that, for your loved one, these behaviors are often unconscious reactions. They’ve learned to turn to theatrics and inappropriate behavior to have their needs met. They may not even recognize that their actions lead to specific consequences.

Manage your emotions. Just because your loved one overreacts to situations, it doesn’t mean that you need to follow suit. If you respond to their dramatic behavior with the same intensity, you run the risk of escalating conflict. On the other hand, if you ignore them, they may just try even harder to get your attention. To keep your cool in the moment, learn some quick stress relief techniques.

Set boundaries. Be clear and direct in communicating how your loved one’s behavior makes you feel. For example, “I feel uncomfortable when you make inappropriate passes at my friends. Please don’t do it again.” It’s also important to state a consequence that you’re willing to follow through on. “If you do it again, I’ll stop inviting you to join us.”

[Read: Setting Healthy Boundaries in Relationships]

Make them feel seen. Although you can’t be expected to give the person constant attention and validation, take time to listen and acknowledge them. Offer them praise for their accomplishments and growth.

Encourage them to get professional treatment. This might involve helping them become more aware of their own behavior and the consequences that follow. You might point out, “You always seem to have an outburst when you receive criticism, and that makes communicating with you even harder.” Once they begin therapy, encourage them to continue it by pointing out the progress they’re making.

Practice self-care. If you feel overwhelmed by your loved one, take a step back and focus on your own well-being. You may need to minimize contact for a short time, take time to enjoy your own hobbies, or spend time around people who energize you.

Remember that you can’t take responsibility for another person’s behavior. But you can support your loved one as they work towards acknowledging their problems and coping with histrionic personality disorder symptoms.

Last updated or reviewed on January 8, 2024