Personality Disorders 101: Histrionic PD

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The word histrionic comes from the Latin word “histrio”, which means both “actor” and “excessively dramatic or emotional”. People with HPD struggle to be genuinely intimate in relationships, so often maintain relationships through acting out a role. Yet they are skilled at setting up situations which force specific emotions from others, often by using their appearance to attract others. Their reliance on seduction can generate many shallow friendships, while sparking distrust from longer-term friends or partners.

In the DSM-5 Histrionic Personality Disorder is a long-term pattern of being excessively emotional, dramatic, and attention-seeking, which is true across multiple areas of life. To be diagnosed with HPD, a person must meet 5 or more of these criteria:

  • They are uncomfortable whenever they are not the center of attention
  • They use inappropriate sexually seductive or provocative behavior to interact with others
  • They express rapidly shifting and shallow emotions
  • They consistently use their physical appearance to draw attention
  • They speak in an excessively impressionistic way which lacks detail
  • They are dramatic and theatrical, showing exaggerated expressions of emotion
  • They are suggestible – easily influenced by others or circumstances
  • considers relationships to be more intimate than they actually are

The general PD criteria mentioned in the first post must also apply. “A person needs to have a collection of unusual behaviours and traits which affects a large portion of their everyday life. Those behaviours and traits must start before early adulthood. They need to cause negative consequences for the person, who should be upset by or annoyed at those behaviours.”

However, someone with HPD generally won’t see their actions as dysfunctional. “Rapidly shifting emotions” applies to how a person views other people and external situations, not themselves; even if a person with HPD tires of a friend or partner, or suddenly quits a job they enjoyed the previous week, they will keep a good image of themselves. Another criteria is “distorted views of relationships”, which is also found in BPD. Yet while someone with BPD can alternate between pulling people closer and pushing people away to protect them, a person with HPD will solely pull others to them.

Because someone with HPD does not perceive any issues with their actions, they usually seek assistance due to a conflict with someone else such as a relationship breakup. As someone with HPD considers relationships to be stronger than they actually are, a break-up will be a severe shock, especially if they believed they were being a perfect partner. They may feel intensely depressed after relationships end, and may feel victimised by the breakup; noticing this pattern can flag up HPD.

Many sources discuss HPD using the same exemplar character: Scarlett O’Hara from Gone With The Wind. Although Scarlett’s main motivation is the good cause of protecting her homestead and herself from further traumatic experiences, she is unable to realise when she has gone too far in reaching a goal. She is an expert manipulator who makes multiple men fall for her despite being unsure of her feelings for them. She desires to be the centre of attention, without caring how she gets there- she interrupts a conversation on war merely to call it trivial.  While often appearing highly social, intelligent and functional in everyday life, she can also enter a very self-centered, almost infantile mode.

This character demonstrates many of the traits associated with HPD. However, it is important to remember that the character was written decades before the idea of HPD, or the DSM itself, was developed.

Psychological Criticisms of HPD

HPD is one condition where friends and family may experience greater distress than the person themselves. Although the DSM specifies that histrionic traits need to cause functional impairment such as job problems or an inability to maintain relationships in order to be diagnosed as HPD, conditions diagnosed mostly through observable behaviour still raise questions about how to ensure psychiatric diagnoses are fair and useful tools rather than judgemental reactions to individual differences.

This complaint is especially relevant for HPD because people with it do not often experience as many negative consequences as people with some other PDs. Although many people with Antisocial PD receive criminal convictions, and some (though not all) people with Borderline PD experience frequent hospitalizations, these events are rarely part of HPD.

Another criticism of HPD is over gender bias. HPD has very similar criteria to Borderline PD and Narcissistic PD. HPD differs mostly because it does not feature suicidal behaviour (a common Borderline PD trait) or envious and jealous behaviour (a Narcissistic PD trait). As a result, some researchers argue that HPD and NPD could be male and female sides of the same disorder rather than two separate diagnoses.

However, >75% of people diagnosed with NPD are male, while about 75% of people diagnosed with HPD are female. The HPD criteria sound like an exaggerated version of negative female stereotypes; being overly emotional and relying on appearance or physical appeal are often seen as female traits. Similarly,  seductive behaviour is shown almost entirely by female characters in media, which biases people’s idea of what that behaviour looks like.

Finally HPD is under-researched; possibly because people with HPD keep a lower profile in regards to legal and medical services, or because people with HPD are unlikely to volunteer themselves for treatment or research into it. This lack of research means the potential causes, triggers, and treatments for HPD are even less clear than for other PDs.

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