Histrionic Personality Disorder (HPD) is a mental health condition characterized by excessive attention-seeking behaviours, emotional instability, and a strong desire to be the center of attention. Individuals with HPD often exhibit exaggerated emotions, and dramatic expressions, and may engage in inappropriate behaviours to gain attention.

Features that define Histrionic Personality Disorder

• Attention-Seeking: The incessant desire to command attention, which frequently results in ostentatious displays or provocative actions.
• Emotional instability is characterized by quickly fluctuating, flimsy, and exaggerated feelings.
• Inappropriate Behavior: People with HPD can act seductively or flirtatiously when it's not acceptable.
• Excessively Preoccupied with Appearance: Frequently excessively preoccupied with their outward look and the opinions of others.
• Extremely Suggestible: Capable of being swayed by others, willing to modify beliefs or actions to suit their desire for acceptance.

Causes of Histrionic Personality Disorder

Although the precise etiology of HPD is unknown, several genetic, environmental, and psychological factors are thought to have a role in the disease's development.

• Genetic Factors: Research indicates that personality disorders and other mental health issues may run in families, increasing the likelihood that an individual may acquire HPD (Paris, 2010).
• Environmental Factors: HPD can arise as a result of childhood experiences such as excessive or inconsistent praise, maltreatment, or lack of criticism. Trauma or overindulgent parenting might cause people to continually look outside of themselves for approval (Beck, 2014).
• Psychological Factors: Because of low self-esteem or feelings of inadequacy, people with HPD may have an underlying desire for attention and praise. Their emotional outbursts and attention-seeking actions are driven by this psychological demand (Blais et al., 2017).

Histrionic Personality Disorder Symptoms

HPD patients exhibit a variety of symptoms, many of which are connected to their intense desire for recognition and attention. Among the most prominent symptoms are:

• Excessive Emotionality: Individuals with HPD may display feelings that are disproportionate to the circumstances they face, often exhibiting overly dramatic reactions. For example, minor annoyances might lead to intense crying spells or episodes of anger, demonstrating a heightened emotional sensitivity. This emotionality can overwhelm both the individual and those around them, creating a cycle of chaos and instability in their relationships (American Psychiatric Association, 2013).
• Behaviour Seeking Attention: A hallmark of HPD is the incessant need to be the center of attention. Individuals may go to great lengths to ensure they remain in the spotlight, employing various strategies such as acting provocatively or creating dramatic situations to draw others' focus. This behaviour can manifest in social settings where they might dominate conversations or engage in outlandish antics to maintain attention, leading to strained interactions with others (Widiger & Bornstein, 2015).
• Inappropriate Seductive Behavior: People with HPD may engage in provocative or flirtatious behaviours to attract attention, often in contexts where such conduct is inappropriate. This can include dressing in a sexually suggestive manner or making suggestive comments, which can lead to misunderstandings and discomfort in social and professional environments (Millon & Davis, 1996). Their behaviour may not align with social norms, further complicating their relationships.
• Shallow and Shifting Emotions: Emotions in individuals with HPD can appear shallow or fake, with feelings that shift rapidly and dramatically. They may experience intense emotions that quickly fade, making it difficult for others to understand the depth or authenticity of their feelings. This emotional volatility can lead to challenges in forming genuine connections, as their moods can change unexpectedly, leaving those around them feeling unsettled (APA, 2013).
• Relationship Overestimation: Individuals with HPD often perceive their relationships as closer than they are, leading to miscommunication and disillusionment. They may believe that others are as emotionally invested in the relationship as they are, which can result in unmet expectations and feelings of betrayal when others do not reciprocate their intensity. This tendency to overestimate the depth of connections can contribute to a pattern of unstable and tumultuous relationships (APA, 2013).

Histrionic Personality Disorder Treatment

Although there isn't a known treatment for HPD, people can control their symptoms and have more satisfying lives with the support of several types of psychotherapy and, occasionally, medicines.

• Psychotherapy: Specifically, Cognitive Behavioral Therapy (CBT) is the main psychotherapy used to treat HPD. Through the identification and modification of maladaptive beliefs and actions, cognitive behavioural therapy (CBT) enables people to create more healthy coping mechanisms (Beck, 2014).
• Dialectical Behavior Therapy (DBT): DBT is an additional treatment modality that helps people manage stress, solve interpersonal issues, and control their emotions. Building emotional control, distress tolerance, mindfulness, and interpersonal efficacy are its main goals (Linehan, 1993).
• Group Therapy: Taking part in group therapy can benefit people with HPD because it offers a controlled setting for them to practice their interpersonal skills and get feedback from others, which helps them understand how their actions impact other people (Widiger & Bornstein, 2015).
• Medication: Although not the mainstay of treatment for HPD, drugs might be recommended to treat co-occurring conditions such as anxiety or depression. When mood swings or emotional instability are severe, mood stabilizers or antidepressants may be beneficial (APA, 2013).

Conclusion

A complicated disorder called Histrionic Personality Disorder (HPD) is characterized by excessive attention-seeking behaviours and emotional instability. Its development is influenced by a mix of psychological, environmental, and hereditary variables. The best treatment is psychotherapy, especially Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT).

Individuals suffering from HPD can enhance their quality of life and relationships by learning how to control their symptoms with the correct therapy methods. Seeking professional help, such as from therapists at TalktoAngel, can provide valuable support. For those looking for online counselling or the best psychologists in India, reaching out to qualified professionals can significantly improve coping strategies and overall well-being.

Contribution: Dr (Prof) R K Suri, Clinical Psychologist, life coach & mentor TalktoAngel & Ms Sangeeta Pal, Counselling Psychologist.

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Publishing. Retrieved from https://psychiatry.org/psychiatrists/practice/dsm
• Beck, A. T. (2014). Cognitive Therapy and Emotional Disorders. Penguin. Retrieved from https://www.penguinrandomhouse.com/books/298413/cognitive-therapy-and-the-emotional-disorders-by-aaron-t-beck/
• Blais, M. A., Hilsenroth, M. J., & Castlebury, F. D. (2017). Personality disorders and relationships: The impact of histrionic personality disorder on interpersonal functioning. Journal of Personality Assessment, 78(2), 349-360. Retrieved from https://www.tandfonline.com/doi/abs/10.1207/s15327752jpa7802_10
• Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press. Retrieved from https://www.guilford.com/books/Cognitive-Behavioral-Treatment-of-Borderline-Personality-Disorder/Marsha-Linehan/9780898621839