Histrionic Personality Disorder

What Is Personality?

Personality is a particular set of behaviors, traits, emotions, and patterns that make up a person, his character, and their individuality. Personality includes how we see the world, our thoughts, attitudes, and feelings. Personality is strongly influenced by our values, attitudes, perception of ourselves, and predicts our reactions to people, the world, stress, and problems.

While there are many different definitions of personality, most focus on the pattern of behaviors and characteristics that can help predict and explain a person’s behaviors.

What Is A Personality Disorder?

A person’s personality may be influenced by experiences, environment (surroundings, life situations) and inherited – genetic – characteristics. A person’s personality typically stays the same over time.

While personality disorders differ from mental disorders, like schizophrenia and bipolar disorder, they do, by definition, lead to significant impairment. Personality disorders are estimated to affect about 10 percent of people, although this figure ultimately depends on where clinicians draw the line between a “normal” personality and one that leads to significant impairment.

A personality disorder is a way of thinking, feeling, and behaving that is different from the expectations of the culture, causes distress, problems functioning, and lasts over time. Personality disorders are almost always associated with marked social and personal disruption and are both pervasive and inflexible. While these behaviors can produce poor coping skills, leading to personal issues including anger, anxiety, depression, and distress, they are considered appropriate by the person with the disorder.

There are 10 specific types of personality disorders. Personality disorders are long-term patterns of behavior and inner experiences that differs significantly from what is expected. The pattern of experience and behavior begins by late adolescence or early adulthood and causes distress or problems in functioning.

Without treatment, personality disorders can be long-lasting. Personality disorders must affect at least two of the following areas:

• Way of thinking about oneself and others
• Way of responding emotionally
• Way of relating to other people
• Way of controlling one’s behavior

What is Histrionic Personality Disorder?

Histrionic Personality Disorder (HPD) is a personality disorder characterized by a pattern of extreme, intense emotions as well as attention-seeking behavior. A person who has histrionic personality disorder needs to be the center of attention in a group – any group – and when they are not, they become upset and uncomfortable. Histrionic personality disorder (HPD) also majorly interferes with emotional stability, and are prone to emotional overreaction in a wide variety of situations, and from the viewpoint of others, they may seem constantly on edge. When they do react, it is usually from a self-centered perspective, and the needs of others are seldom their priority.

In addition to the extremes of their emotional sensitivity and reactivity, people with histrionic personality disorder have a strong need to be the center of attention and frequently exhibit a range of attention-seeking behavior. They also want instant satisfaction and are easily frustrated or overwhelmed by obstacles or criticism. People with HPD usually have good communication skills and are often quite charismatic, projecting a “life of the party” or “larger than life” image. But beyond good initial first impressions they have a difficult time establishing and maintaining close and satisfying relationships.

Despite their self-absorption, people with HPD are subsumed by insecurity, which usually leaves them frustrated and miserable and seeking answers for their feelings of inadequacy.

HPD is classified as a Cluster B personality disorder, along with borderline personality disorder, narcissistic personality disorder, and antisocial personality disorder. People with Cluster B conditions are known to be highly emotional, erratic in their feelings and behavior, and self-centered in their approach to socializing and building relationships.

Nearly 15 percent of the American population meet the diagnostic criteria for one or more of 10 recognized personality disorders. Histrionic personality disorder is one of the least common of these personality disorders, affecting about 1.8 percent of the population – which still represents about four million people. Histrionic personality disorder is diagnosed more frequently among women, who comprise about two-thirds of the known cases. This may not reflect the true incidence of the disorder, but could relate to the willingness of women (or unwillingness of men) to seek assistance for the symptom of HPD when they manifest.

The seeds of histrionic personality disorder are likely sown in childhood, but its symptoms don’t normally become apparent until late adolescence. The severity of the condition may then escalate during early adulthood and become a dominant factor from that point on.

Those with histrionic personality disorder need novelty and thrills, which may lead them to become bored with the usual routines. This may lead to frustration when gratification is delayed, as they want immediate satisfaction. Interest in jobs, friendships, and relationships may quickly dwindle in favor of the shiny newness of other relationships.

Someone with histrionic personality disorder often appears as effervescent, lively, and interesting (sometimes shallow), and cannot handle it when the attention is not focused entirely upon them. In order to direct attention back to themselves, they may begin sexually suggestive or seductive behavior. Despite being highly sexual, people with histrionic personality disorder often have problems with emotional intimacy in sexual or romantic relationships.

Whether or not they are aware, they often choose a role (victim, princess) within their relationships. People with histrionic personality disorder may try to control their partner through seductiveness or emotional manipulation while displaying a strong dependency on their partners on another level. Because people with histrionic personality disorder crave excitement and newness, longer-term relationships are difficult for them to maintain.

It’s hard for those with histrionic personality disorder to maintain same-sex friendships because their sexually-charged style may come across as a threat to their friends’ romantic relationships. In addition, people with histrionic personality disorder can alienate friends through their demands for constant attention, and their depression when that attention is not provided.

What Are The Core Features of Personality Disorders?

The general requirements for the diagnosis of a personality disorder are:

• a pervasive pattern of maladaptive traits and behavior
• beginning in early adult life
• it usually has its first manifestations in childhood and is clearly evident in adolescence
• it is not diagnosed before early adult life because these maladaptive traits are very common in childhood and adolescence, but most individuals age-out of these traits before early adulthood
• leading to substantial personal distress and/or social dysfunction, and disruption to others
• is of long duration, typically lasting at least several years
• Severity Rating Scale For Personality Disorders:

Severity rating scale for personality disorders in the International Classification of Diseases (ICD)-11:

Mild Personality Disorder: notable problems in many interpersonal relationships and the performance of expected work and social etiquette, but some relationships are maintained and/or some roles carried out. Mild personality disorder is typically not associated with substantial harm to self or others.

Moderate Personality Disorder: marked problems in most interpersonal relationships and in the performance of expected occupational and social roles across a wide range of situations that are sufficiently extensive that most are compromised to some degree. Moderate personality disorder often is associated with a past history and future expectation of harm to self or others, but not to a degree that causes long-term damage or has endangered life.

Severe Personality Disorder: There are severe problems in interpersonal functioning affecting all areas of life. The person’s general social dysfunction is profound and the ability and/or willingness to perform expected occupational and social roles is absent or severely compromised. Severe personality disorder usually is associated with a past history and future expectation of severe harm to self or others that has caused long-term damage or has endangered life.

HPD is a serious condition that isolates those who surround the people who have the disorder.

A mnemonic that has sometimes been used to describe the criteria for histrionic personality disorder is “PRAISE ME”:

 

 

 

 

 

 

 

 

P – provocative (or seductive) behavior
R – relationships, considered more intimate than they are
A – attention, must be at center of
I – influenced easily
S – speech (style) – wants to impress, lacks detail
E – emotional liability, shallowness

M – make-up – physical appearance used to draw attention to self
E – exaggerated emotions – theatrical

However, people who suffer from HPD are often just as interested in attracting negative attention, including shock, anger, outrage, shame, guilt and remorse.

What Causes Histrionic Personality Disorder?

Mental health experts believe that personality disorders like HPD usually develop as a result of stress, anxiety, and trauma experienced during childhood. Young people who are subjected to neglect or abuse must rely on limited resources and life experiences to cope with haunting memories and the feelings of shame, inadequacy, or weakness that accompany them, and personality disorders may develop as a form of adaptation or compensation.

Some families have a history of HPD, which lends credit to the theory that the condition may be explained in part by genetics.

On the other hand, children of parents with HPD may simply exhibit behavior they learned from their parents. It is also possible that a lack of discipline or positive reinforcement of dramatic behaviors in childhood can cause HPD. A child may learn HPD behaviors as a way to get attention from their parents. Overindulgent or inconsistent parenting can also lead to HPD later in life. This type of neglectful caregiving doesn’t set boundaries and can therefore interfere with a child’s healthy emotional and psychological development.

Having a family history of personality disorders, and other mental health conditions, is a risk factor for histrionic personality disorder. There are genetic factors involved that help explain the connection, but negative role modeling by parents with mental health issues can undoubtedly play a part in the development of HPD as well.

No matter the cause, HPD usually presents itself by early adulthood.

What Are Symptoms of Histrionic Personality Disorder? 

While people with Histrionic Personality Disorder are able to function at a high-level and be socially successful, they often use these skills to manipulate others and become the center of attention.

Personality disorders generally are marked by an obsessive concern for the self, rigid and uncompromising attitudes, and an inability or unwillingness to adapt to the needs and desires of others. These disorders function as a cover for deep-seated self-esteem issues, representing a form of overcompensation for feelings of insecurity and inferiority.

An accurate histrionic definition focuses on the distinctive symptoms HPD produces, which include:

• Strong and volatile emotions, both negative and positive
• Rapid shifts in mood, often triggered by seemingly benign events
• Self-centeredness, in conversation and behavior
• Exaggerated gestures or words designed to draw attention
• Expressions of sentiments toward others that seem shallow or insincere, as if meant to manipulate or create a certain impression
• Grossly exaggerated emotional displays
• Believe that their relationships are fa more intimate than they are
• A lack of patience, often accompanied by childish reactions
• Tendency to become flustered or frustrated when things go wrong
• Extreme sensitivity to criticism or perceived rejection
• Constant approval-seeking behavior
• Constant reassurance-seeking behaviors
• Flirtatious or sexually suggestive behavior that may violate interpersonal boundaries
• Exhibition-type behaviors
• Unwillingness to change; suggestions of change are viewed as threats
• Obsessive concern with physical appearance
• A tendency to become bored or distracted, making it difficult to finish tasks or projects
• Lack of empathy, no capacity to read the emotions of others or correctly interpret their words and actions
• Inability to maintain satisfying relationships due to self-centered tendencies and emotional outbursts

Many of these symptoms are common to other personality disorders, which inevitably interfere with personal, social, and professional functioning.

What Are Some Of The Traits Of Those Who Have HPD?

The following list is a collection of some of the more commonly observed behaviors and traits of those who suffer from HPD. Note that these traits are given as a guideline only and are not intended for diagnosis. People who suffer from HPD are all unique and so each person will display a different subset of traits. Also, note that everyone displays “borderline” behaviors from time to time. Therefore, if a person exhibits one or some of these traits, that does not necessarily qualify them for a diagnosis of HPD. See the DSM Criteria on this page for diagnostic criteria.

Catastrophizing – The habit of automatically assuming a “worst case scenario” and inappropriately characterizing minor or moderate problems or issues as catastrophic events.

Chaos Manufacture – Unnecessarily creating or maintaining an environment of risk, destruction, confusion or mess.

Baiting – A provocative act used to solicit an angry, aggressive or emotional response from another individual.

Acting Out – Acting Out behavior refers to a subset of personality disorder traits that are more outwardly-destructive than self-destructive.

“Always” and “Never” Statements – “Always” and “Never” Statements are declarations containing the words “always” or “never.” They are commonly used by most people but arerarely true.

Anger – People who suffer from personality disorders often feel a sense of unresolved anger and a heightened or exaggerated perception that they have been wronged, invalidated, neglected or abused.

Belittling, Condescending, and Patronizing – This kind of speech is a passive-aggressive approach to giving someone a verbal put-down while maintaining a facade of reasonableness or friendliness.

Blaming – The practice of identifying a person or people responsible for creating a problem, rather than identifying ways of dealing with the problem.

Cheating – Sharing a romantic or intimate relationship with somebody when you are already committed to a monogamous relationship with someone else.

Circular Conversations – Arguments which go on almost endlessly, repeating the same patterns with no resolution.

Confirmation Bias – The tendency to pay more attention to things which reinforce your beliefs than to things which contradict them.

Denial – Believing or imagining that some painful or traumatic circumstance, event or memory does not exist or did not happen.

Dependency – An inappropriate and chronic reliance by an adult individual on another individual for their health, subsistence, decision making or personal and emotional well-being.

Depression – People who suffer from personality disorders are often also diagnosed with symptoms of depression.

Dissociation– A psychological term used to describe a mental departure from reality.

Emotional Abuse – Any pattern of behavior directed at one individual by another which promotes in them a destructive sense of Fear, Obligation or Guilt (FOG).

Emotional Blackmail – A system of threats and punishments used in an attempt to control someone’s behaviors.

Engulfment – An unhealthy and overwhelming level of attention and dependency on another person, which comes from imagining or believing one exists only within the context of that relationship.

Escape To Fantasy – Taking an imaginary excursion to a happier, more hopeful place.

False Accusations – Patterns of unwarranted or exaggerated criticism directed towards someone else.

Favoritism and Scapegoating – Systematically giving a dysfunctional amount of preferential positive or negative treatment to one individual among a family group of peers.

Fear of Abandonment – An irrational belief that one is imminent danger of being personally rejected, discarded or replaced.

Feelings of Emptiness – An acute, chronic sense that daily life has little worth or significance, leading to an impulsive appetite for strong physical sensations and dramatic relationship experiences.

Frivolous Litigation – The use of unmerited legal proceedings to hurt, harass or gain an economic advantage over an individual or organization.

Harassment – Any sustained or chronic pattern of unwelcome behavior by one individual towards another.

Holiday Triggers – Mood Swings in Personality-Disordered individuals are often triggered or amplified by emotional events such as family holidays, significant anniversaries and events which trigger emotional memories.

Hoovers & Hoovering – A Hoover is a metaphor taken from the popular brand of vacuum cleaners, to describe how an abuse victim trying to assert their own rights by leaving or limiting contact in a dysfunctional relationship, gets “sucked back in” when the perpetrator temporarily exhibits improved or desirable behavior.

Hysteria – An inappropriate over-reaction to bad news or disappointments, which diverts attention away from the real problem and towards the person who is having the reaction.

Identity Disturbance – A psychological term used to describe a distorted or inconsistent self-view

Impulsiveness – The tendency to act or speak based on current feelings rather than logical reasoning.

Invalidation – The creation or promotion of an environment which encourages an individual to believe that their thoughts, beliefs, values or physical presence are inferior, flawed, problematic or worthless.

Lack of Conscience – Individuals who suffer from Personality Disorders are often preoccupied with their own agendas, sometimes to the exclusion of the needs and concerns of others. This is sometimes interpreted by others as a lack of moral conscience.

Lack of Object Constancy – An inability to remember that people or objects are consistent, trustworthy and reliable, especially when they are out of your immediate field of vision.

Low Self-Esteem – A common name for a negatively-distorted self-view which is inconsistent with reality.

Manipulation – The practice of steering an individual into a desired behavior for the purpose of achieving a hidden personal goal.

Masking – Covering up one’s own natural outward appearance, mannerisms and speech in dramatic and inconsistent ways depending on the situation.

Mood Swings – Unpredictable, rapid, dramatic emotional cycles which cannot be readily explained by changes in external circumstances.

“Not My Fault” Syndrome – The practice of avoiding personal responsibility for one’s own words and actions.

No-Win Scenarios – When you are manipulated into choosing between two bad options

Panic Attacks – Short intense episodes of fear or anxiety, often accompanied by physical symptoms, such as hyperventilating, shaking, sweating and chills.

Push-Pull – A chronic pattern of sabotaging and re-establishing closeness in a relationship without appropriate cause or reason.

Raging, Violence and Impulsive Aggression – Explosive verbal, physical or emotional elevations of a dispute. Rages threaten the security or safety of another individual and violate their personal boundaries.

Relationship Hyper Vigilance – Maintaining an unhealthy level of interest in the behaviors, comments, thoughts and interests of others.

Riding the Emotional Elevator – Taking a fast track to different levels of emotional maturity.

Sabotage – The spontaneous disruption of calm or status quo in order to serve a personal interest, provoke a conflict or draw attention.

Selective Memory and Selective Amnesia – The use of memory, or a lack of memory, which is selective to the point of reinforcing a bias, belief or desired outcome.

Selective Competence – Demonstrating different levels of intelligence, memory, resourcefulness, strength or competence depending on the situation or environment.

Self-Aggrandizement – A pattern of pompous behavior, boasting, narcissism or competitiveness designed to create an appearance of superiority.

Self-Harm – Any form of deliberate, premeditated injury, such as cutting, poisoning or overdosing, inflicted on oneself.

Self-Loathing – An extreme hatred of one’s own self, actions or one’s ethnic or demographic background.

Self-Victimization – Casting oneself in the role of a victim.

Sense of Entitlement – An unrealistic, unmerited or inappropriate expectation of favorable living conditions and favorable treatment at the hands of others.

Silent Treatment – A passive-aggressive form of emotional abuse in which displeasure, disapproval and contempt is exhibited through nonverbal gestures while maintaining verbal silence.

Situational Ethics – A philosophy which promotes the idea that, when dealing with a crisis, the end justifies the means and that a rigid interpretation of rules and laws can be set aside if a greater good or lesser evil is served by doing so.

Splitting – The practice of regarding people and situations as either completely “good” or completely “bad.”

Stunted Emotional Growth – A difficulty, reluctance or inability to learn from mistakes, work on self-improvement or develop more effective coping strategies.

Testing – Repeatedly forcing another individual to demonstrate or prove their love or commitment to a relationship.

Thought Policing – Any process of trying to question, control, or unduly influence another person’s thoughts or feelings.

Threats – Inappropriate, intentional warnings of destructive actions or consequences.

Triggering -Small, insignificant or minor actions, statements or events that produce a dramatic or inappropriate response.

Tunnel Vision – The habit or tendency to only see or focus on a single priority while neglecting or ignoring other important priorities.

What Other Mental Health Disorders Occur In People Who Have HPD?

It is possible for a person to have the symptoms of more than one personality disorder as these disorders often blend into one another.

Among people diagnosed with HPD, borderline personality disorder, dependent personality disorder, and narcissistic personality disorder are also frequently diagnosed. Borderline personality disorder is the most commonly detected of these conditions, and some mental health professionals actually classify HPD as a borderline personality disorder subtype.

Some of the other mental and behavioral health disorders routinely diagnosed in people with histrionic personality disorder include:

• Depression. HPD creates strong emotional responses, and when rejection or disappointment is experienced people with histrionic personalities can easily slip into clinical depression.
• Anxiety disorders, including panic disorder. In one study, between 35 and 52 percent of those with various anxiety disorders also met the diagnostic criteria for a personality disorder, usually of a type that affects emotion and stress responses (such as HPD)
• Somatoform Disorders
• Attachment Disorders, such as reactive attachment disorder
• Eating disorders. About one-third of eating disorder sufferers also have one or more co-occurring personality disorders, often including HPD.
• Substance use disorders. While different studies have produced varying results, most research has shown as least some relationship between histrionic personality disorder and addiction. However, the association is not as strong as with several other types of personality disorder.

When an additional mental or behavioral health condition is diagnosed in people with HPD, treatment plans must be developed that focus equally on each disorder.

How is Histrionic Personality Disorder Diagnosed?

HPD is not a devastating psychological disorder, which means that people with this disorder rarely seek treatment as most people with HPD function successfully in society and at work. In fact, people with HPD usually have great people skills. unfortunately, however, they often use these skills to manipulate others.

According to the Diagnostic and Statistical Manual of Mental Disorders (5^th edition), people with histrionic personality disorder must have at least five (or more) of the following symptoms:

• Is uncomfortable in situations in which they are not the center of attention
• Has interactions with others characterized by inappropriate sexually seductive or provocative behavior
• Displays rapidly shifting and shallow expression of emotions
• Consistently uses their physical attention to draw attention to self
• Has a style of speech that is excessively impressionistic and lacking in detail
• Shows self-dramatization, theatricality, and exaggerated expression of emotion
• Is suggestible (that is, they are easily influenced by others or circumstances)
• Considers relationships to be more intimate than they actually are

If you have HPD, you might also be easily frustrated or bored with routines, make rash decisions before thinking, or threaten to commit suicide in order to get attention.

The World Health Organization’s ICD-10 lists histrionic personality disorder as:

A personality disorder characterized by:

• shallow and labile affectivity,
• self-dramatization,
• theatricality,
• exaggerated expression of emotions,
• suggestibility,
• egocentricity,
• self-indulgence,
• lack of consideration for others,
• easily hurt feelings, and
• continuous seeking for appreciation, excitement and attention.

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

A diagnosis of histrionic personality disorder occurs through a thorough examination by a psychiatrist or psychologist by reviewing symptoms and taking a detailed health history. If the symptoms meet the diagnostic criteria, a diagnosis of histrionic personality disorder is made.

What Are The Subtypes for Histrionic Personality Disorder?

Histrionic Personality Disorder Subtypes (As Suggested by Million)

Subtypes of HPD	Description	Personality Qualities
Infantile HPD	includes borderline PD symptoms	Labile, high-strung, volatile emotions; childlike hysteria and nascent pouting; demanding, overwrought; fastens and clutches to another; is excessively attached, hangs on, stays fused to and clinging.
Vivacious Histrionic	The seductiveness of the histrionic mixed with the energy typical of hypomania. Some narcissistic features may also be present	Vigorous, charming, bubbly, brisk, spirited, flippant, impulsive; seeks momentary cheerfulness and playful adventures; animated, energetic, ebullient.
Tempestuous histrionic	Includes passive aggressive PD	Impulsive, out of control; moody complaints, sulking; precipitous emotion, stormy, impassioned, easily wrought-up, periodically inflamed, turbulent.
Appeasing histrionic	Includes compulsive and depended PD	Seeks to placate, mend, patch up, smooth over troubles; knack for settling differences, moderating tempers by yielding, compromising, conceding; sacrifices self for commendation; fruitlessly placates the unplacatable.
Disingenuous histrionic	HPD and antisocial PD	Underhanded, double-dealing, scheming, contriving, plotting, crafty, false-hearted; egocentric, insincere, deceitful, calculating, guileful.
Theatrical histrionic	Variant of “pure” pattern	Affected, mannered, put-on; postures are striking, eyecatching, graphic; markets self-appearance; is synthesized, stagy; simulates desirable/dramatic poses.

How Is Histrionic Personality Disorder Treated?

Those who suffer Histrionic Personality Disorder are generally hard to treat for many reasons. People with HPD often only seek treatment when their symptoms have become too much for them to handle. Once in treatment, however, these people often exaggerate their symptoms and lack of ability to function. They also have a hard time, as they are emotionally needy, terminating therapy may become a problem.

If people who have HPD are truly determined to change their emotional and psychological reactions, HPD can be amenable to treatment.

Inpatient or intensive outpatient treatment programs in mental health treatment facilities are ideal for people diagnosed with HPD, who require peace, quiet, and ample social and psychological support in the early stages of recovery.

Psychotherapy is the preferred method of intervention for histrionic personality disorder. Some of the therapies that have proven effective for this condition include:

• Cognitive behavioral therapy (CBT). Through CBT people with histrionic personalities can begin to think and act more calmly and with more deliberation and contemplation. CBT is also effective against depression and anxiety disorders, which can co-occur with HPD.
• Interviews and self-report methods generally, in clinical practice with assessment of personality disorders, one form of interview is the most popular; an unstructured interview. The actual preferred method is a semi-structured interview. The reason that a semi-structured interview is preferred over an unstructured one is that semi-structured interviews tend to be more objective, systematic, replicable, and comprehensive. Unstructured interviews, despite popularity, tend to have problems with unreliability and are susceptible to errors leading to false assumptions of the client. One of the single most successful methods for assessing personality disorders by researchers of normal personality functioning is the self-report inventory following up with a semi-structured interview. There are some disadvantages with the self-report inventory method that with histrionic personality disorder there is a distortion in character, self-presentation, and self-image. This cannot be assessed simply by asking most clients if they have the criteria for the disorder.
• Psychodynamic therapy. The goal in psychodynamic therapy is to decrease emotional reactivity by identifying and demystifying the underlying reasons for the development of HPD.
• Family and couples therapy. Family therapy should be explored only after the person with HPD has done some hard work on him or herself; otherwise, the person with HPD is apt to dominate all conversations
• Holistic mind-body practices. Mindfulness techniques acquired through meditation, yoga, Tai Chi, biofeedback, and other holistic therapies have much to offer people with HPD, who need to reprogram their minds to more effectively control their hair-trigger emotional reflexes.
• Medications are not indicated for treatment of histrionic personality disorder, though they may be used to treat some of the symptoms and/or other, co-morbid, disorders.
• Self-help groups and/or group therapy is not effective for those who have HPD as they are prone to hysterics and outbursts

With careful and compassionate intervention that extends from initial treatment through aftercare, people with histrionic personality disorder can learn to minimize the condition’s influence on their lives. HPD cannot be cured, but over time its capacity to control emotional reactions can be reduced to a manageable level.

Coping With Histrionic Personality Disorder:

Lots of people with HPD lead normal lives and are able to work and be a part of society. In fact, many people with HPD do very well in casual settings. Many of them only encounter problems in more intimate relationships. Depending on your case, your HPD may affect your ability to hold a job, maintain a relationship, or stay focused on life goals. It may also cause you to constantly seek adventure, putting you into risky situations.

You are also at a higher risk for depression if you have HPD. The disorder can affect how you handle failure and loss. It can also leave you feeling more frustrated when you don’t get what you want. You should talk to your primary care provider if you have symptoms of HPD, especially if they are interfering with your everyday life and work or your ability to lead a happy, fulfilling life.

Loving Someone With Histrionic Personality Disorder:

It is exhausting to deal with a person who has this personality disorder as they are particularly demanding – which is part of the disorder. Sometimes, it may be possible to stop being around such a person and extricate oneself from the situation, in other cases, especially where family members are concerned, that is never a choice. Then what is one to do and how is one to keep the relation going?

Sometimes, people with HPD may be abusive. You are not obligated to spend time with an abusive person, and you have the right to distance yourself or cut contact altogether. Do what’s right for you.

Here are some ideas for dealing with a person who has histrionic personality disorder:

Establish And Maintain Boundaries:

Create realistic goals. Histrionic personality disorder is a complicated disorder, and there may be limited things that you can do to help your loved one. Therefore, realistic goals are incredibly important when you decide to help them.You must understand that you may never be able to help them with their condition.  Create some safe space between you for your own self care. You must take care of your self.

• Help your loved one set their own goals. For example, you may want to help them set goals related to the way they dress, the types of sexual relationships they have, or the amount of times they act out in a dramatic or theatrical way.

Set limits and stick to them. When your loved one has Histrionic Personality Disorder, you need to establish strict boundaries for your relationship. Your loved one may engage in attention-seeking, manipulative, or embarrassing behavior at any time, which does directly affect you. Try to have an open, honest discussion with them about your personal limits.

• For example, tell your loved one, “If you start manipulating me, I will leave” or “If you start acting out or embarrassing yourself to get attention, I will leave” and stick with this plan.

Make sure they know that you still love them. A relationship with a loved one with HPD can be complicated and tense as this personality disorder can cause major problems that cause hurt feelings and complicated, strained relationships. You should try to your loved one know that you still love them, even though you have limits and may sometimes leave, you still love and care for them.

• You can tell them, “I love you and want you in my life. However, there are times I cannot be around you because of your behavior.”

Know how and when to distance yourself. You may find yourself in a situation where your loved one is being manipulative, cruel, hurtful, embarrassing, or harmful which can be overwhelming to you. People with HPD often do anything to be the center of attention; including manipulation, acting dramatically, and love to play the victim. They may act in an overly provocative way, or act out in a hateful or angry way to gain attention. As you know, all of this can negatively affect you. Be aware that you may have to distance yourself from your loved one to protect yourself and your own well-being.

• Some people just aren’t equipped to help a person with HPD. Be aware that as a last resort, you may have to completely remove yourself from the situation and sever all ties.

Taking Care of Yourself:

Consider seeing a therapist. Talking with a therapist about your challenges and feelings regarding your loved one’s histrionic personality disorder is a good way to care for yourself. A therapist can help you to develop healthy coping mechanisms, learn how to communicate with your loved one more effectively, and work through your emotions. Consider talking to a therapist as part of your self-care strategy.

Seek help from your friends and family. Dealing with a loved one with HPD can be an emotionally exhausting rollercoaster and you may feel helpless, trapped, and/or confused. Find support from your loved ones when you need it, and ensure that you make time to be away from your loved one, and instead, visit and interact with others. This can help you feel supported.

• Talk to your friends and family about your difficulties. You can even ask them for advice if things get too much to bear.

Don’t let your loved one to dictate your other relationships. Because people with HPD often feel inadequate or inferior, they may throw fits or act in an over-dramatic way when you form relationships and spend time with other people. You cannot let the person with HPD dictate your other relationships.

• Your loved one may see another friend, partner, or even child as a threat. Discourage this behavior. Don’t give into any behavior in which your loved one tries to discourage the relationship.
• For instance, you can say, “I have friends and invite them over once in a while. This does not affect my love for you.”
• Your loved one may get jealous or threatened by you participating in activities that don’t include them. Refrain from giving up activities because of your loved one’s HPD.

Come to terms with the idea that your loved one may never understand your needs. People with HPD appear to be self-centered, which means that they may not understand or respect your needs, even if you have clearly outlined them. People who hav do not realize their actions are wrong, or how their actions affect other people.

• You may need to accept that your loved one will never treat you how you deserve to be treated. This is why setting boundaries and limits in the relationship is so important.

How To Cope With HPD:

Don’t make excuses. If your loved one has HPD, you may find yourself wanting to make excuses for their behavior, cover up their behavior, or clean up any messes they have made. This is not your job, and can take a toll on you. Try not to make excuses or mediate any messes your loved one has made. This may just enable your loved one’s behavior.

• Your loved one’s behavior may be humiliating for you. However, learning to walk away or detach yourself may be the best way to take care of yourself.

Avoid trying to teach your loved one a lesson. Sometimes, loved ones of those with HPD abandon the person to teach them some sort of lesson. This can arise when the person with HPD manipulates you too much or you feel nothing that you do is working. This kind of punitive behavior does not work with people with HPD, so you should avoid the temptation.

• • If you do this, your loved one may feel abandoned and throw a dramatic fit since you abandoned them.
  • You may end up feeling helpless and manipulated if you try to use this kind of manipulation on your loved one. Avoid using games with your loved one. Stay direct and open with them instead.

Don’t reward attention-seeking behavior. Your loved one may engage in dramatic, attention-seeking behavior regularly, and one of the best ways to deal with this is to ignore it. Don’t engage with them when they are acting like this, it will further reinforce the negative behavior with attention.

• Your loved one likely has a chemical imbalance, which means they may not be able to help their behavior. Instead of getting into an argument or encouraging behavior, just ignore it and let it pass.

Remain calm. One of the best things you can do to help your loved one is to stay calm. A person with Histrionic Personality Disorder thrives on chaos and drama, if/when they get dramatic or have a fit, reacting to them in a negative way will play into what they want and encourage the behavior. Instead, remain calm during these fits.

• You may need to engage in deep breathing exercises or step away from your loved one for a few moments to collect yourself.

Put physical distance between you and your loved one. People with HPD form intimate attachments very easily, which means they may cross physical boundaries. They may not be able to understand or respect the boundaries you have set for yourself. You may find your loved one hugs you, touches you, or invades your space more than you wish. Your loved one may interpret your actions as threatening or inappropriate. To help with this, keep physical distance between you and them.

• For example, you may want to sit in a chair if your loved one is on the couch, or sit on the other end of the couch. When standing, keep a few feet between you and your loved ones.
• Be mindful not to do anything that might be suggestive or interpreted as inappropriate. You don’t want your loved one to misinterpret what you are doing. Always be mindful of your boundaries.

Encourage your loved one to evaluate and think about what other people say. Some people who have HPD are highly suggestible and will go along with what other people say without enforcing their own boundaries and desires. If you notice that your loved one is blindly agreeing with people or doing what other people tell them to do, try to encourage your loved one to think for him or herself.

• If you notice that your loved one is agreeing with someone without evaluating the statement, you could try asking some questions to help you loved one evaluate what the person said.
  • For example, your loved one might repeat a political opinion as a fact because they heard someone else say it. You could then ask your loved one questions like, what is the evidence for that? How did they come to that conclusion? Why do you agree with them?
• If your loved one is doing something because someone has suggested it, then you can also use questioning to help.
  • For example, your loved one might start dressing differently because someone suggested it. You might ask your loved one questions like, do you really want to do that? Would you be doing that if he or she had not suggested it? What might you be doing if he or she had not suggested that?

Suggest different clothing for your loved one. One of the main symptoms of HPD is wearing provocative clothing to garner attention. This type of attire is not suitable for all situations, such as work. You can help your loved one by suggesting they dress differently for certain situations.

• Make sure to start any suggestion with a compliment. Those with HPD respond extremely negatively to any criticism. By complimenting them, you can help yourself get a positive response.
• For example, you may say, “I really love that outfit. You should wear that tomorrow night when you go out with your friends! Why don’t you wear this to work instead today? It looks great on you, and everyone will think you look classy.”

Ask for support when your loved one states their opinion. Often, people with HPD will just talk or argue because they like the attention and drama. They may offer strong opinions while offering no support. When this happens, ask your loved one to back up their opinion.

• For example, you may say, “What are you basing that opinion on?” or “Do you have any examples to support your opinion?” You may also say, “That doesn’t sound like a correct statement. Can you give me some evidence to support your position?”
• If your loved one cannot support their opinion, explain that they need to only provide opinions based on facts or details. Encourage research issues so they can make informed opinion

Help your loved one come up with solutions. Often, people with HPD ignore solutions in favor of focusing on the drama of the problem. One way you can try to help your loved one is by encouraging them to come up with solutions and focus on problem-solving techniques instead of the problem.

• For example, when your loved one gets dramatic about a problem, listen to what they say about the problem. Then say, “I understand you have a problem, but dwelling on it will not help you or anyone else. Let’s work together to find a solution.”

Explore other things. To help keep your loved one’s attention-seeking or manipulative behavior to a minimum, you should talk about or do other things with them. Don’t let your loved one dwell on problems or dominate the spotlight. Talk about yourself or suggest that the two of you do an activity together.

• • For example, you may want to say, “We have been talking about you for a long time now. I would like to share with you things about my life.”
  • You can try to distract your loved one if they are in a middle of an attention-seeking or manipulative episode. You can change the subject, start watching television, or suggest that you go for a walk or to a movie.

Communication With Your Loved One:

Try empathizing with them, then set a limit. People with HPD may feel sensitive to rejection, because they’re deeply insecure. Helping them label their feelings allows them to better understand how they’re feeling, and know that you aren’t rejecting them (just asking them to stop doing something).

• • • “I get that you’re feeling lonely. But faking an injury isn’t a healthy way to get attention. If you want, we could do something simple together, like taking a walk or playing a board game.”
    • “I know you’re excited to be with friends. Please remember to let Jamal talk, too.”
    • “I can tell that you’re upset. I’m exhausted, though, and I don’t have the energy to talk about it. Could you call your sister, or talk to me in the morning?”

Try labeling their behaviors. People with HPD report being somewhat oblivious to their destructive habits, meaning that they may not realize when they are out of line. Make an observation or question about what they’re doing. This encourages them to step back and re-evaluate what they’re doing.

• • • “You’re spiraling.”
    • “Are you trying to manipulate me?”
    • “It looks like you’re starting something self destructive.”
    • “Honey, you’re making it about you again.”

Remind them of the consequences of what they’re doing. People with HPD may not think things through, or realize that their actions could have destructive consequences. Calmly remind them of what could happen if they act, or keep acting, a certain way.

• • • “You’re making me uncomfortable. If you keep doing this, I will leave.”
    • “This is John’s special day. If you do that at his party, he’ll feel really hurt and upset.”
    • “You could get seriously hurt if you do that.”
    • “When you do this, it makes me not want to spend time with you.”

Express feelings and boundaries clearly and calmly. People with HPD can benefit from explicit boundaries and reminders. Try using “I” language to explain how their behavior makes you feel. This can serve as a warning so that they can slow down and think.

• • • “When you ______, I feel ______. Because of this, _________.”
    • “Please, stop interrupting me. I’m getting frustrated.”
    • “That really hurt my feelings.”
    • “You’re embarrassing me. It makes me want to leave.”

Follow through with consequences if your loved one doesn’t heed your warning. They need to know that when you set boundaries, you mean what you say.

• • • For example, if you say that you’re going to leave if they keep doing something, and they keep doing it, then leave.

Talk about inappropriate behavior, without criticizing them personally. People with HPD act out because they feel insecure, and you don’t want to be cruel or make things even worse. Talk about their behavior, and the consequences of their behavior, without labeling them as selfish or bad. This helps them re-examine their actions and learn from them.

• • • Unhelpful: “You’re such a drama queen! I can’t deal with you anymore! I’m never taking you anywhere again.”
    • Helpful: “I’m disappointed and embarrassed that you flirted with my boss, even after I asked you to stop. It makes me not want to take you to work parties anymore, because I don’t know how to deal with this.”
    • Unhelpful: “You’re so embarrassing! If you don’t stop being like this, you’ll end up sad and alone.”
    • Helpful: “You really embarrassed me in the grocery store today. Now I feel bad, and I don’t know what I’ll do next time I see Mrs. Martinez in public.”

Helping Your Loved One Get Treatment for HPD:

Encourage treatment. The best way a person with HPD can get better is through treatment. However, most people with HPD either don’t seek treatment or they only stay in treatment for a short period of time. You should encourage your loved one to get treatment. If they are already seeking treatment, help encourage them to continue treatment, even when they get bored or want to quit.

• • • “I love you, and your behavior is hurting yourself and me. Would you be willing to get treatment?”
    • “I know you feel that treatment is no longer exciting or that you are better, but this is a major condition that cannot be fixed quickly. Will you please reconsider going back to treatment?”

Help them get psychotherapy. Psychotherapy is the most effective treatment for HPD. This includes talking with a therapist who can use different therapeutic approaches to help your loved one, such as cognitive behavioral therapy. Most people with HPD don’t continue with their therapy after beginning because they lose interest, think they are better, or are too impulsive to follow through with their treatment.

• Cognitive behavioral therapy can address problematic behaviors, such as impulsive actions, manipulative behaviors, and theatrics.

Seek treatment for underlying conditions. Often, people with HPD also have other, co-occurring disorders, such as depression. Because of their feelings of insecurity, inadequacy, and abandonment, they may feel depressed and need to be treated for this.

• If this is the case, your loved one can take selective serotonin reuptake inhibitors (SSRIs) to treat the depression, which may help their overall mood. SSRIs are common in the treatment of depression, and include medications such as Zoloft, Celexa, and Prozac.

Keep watch for destructive behavior. Histrionic personality disorder may lead to self-destructive behavior. People with HPD often exhibit suicidal behavior or behavior leading to self-harm. The person may just be threatening these behaviors to gain attention, so you need to make a decision about the seriousness of the threat.

• Some people with HPD will harm themselves or try to commit suicide to gain attention. Try to notice when your loved one is getting to this destructive stage.
• People with HPD may also exhibit dangerous behavior towards others. Watch your loved one to see if they exhibit any tendencies to hurt those around them