Ailey O’Toole
    Staff Writer

Histrionic personality disorder (HPD) is a cluster B mental illness.

If you recall some of my previous articles, cluster B is one of three categories used to designate personality disorders.

Cluster A personality disorders are known as “odd” disorders, such as schizotypal personality disorder.

The cluster B disorders, including the previously discussed borderline personality disorder, are known as the “dramatic” disorders, characterized by impulse control problems and a great deal of emotional turbulence, so to speak.

Cluster C personality disorders are known as the “anxious” personality disorders, such as obsessive-compulsive.

HPD is characterized by extreme attention-seeking behavior; for people with HPD, their self-esteem depends on the approval of others and does not arise from true feelings of self-worth. They often behave dramatically or inappropriately to get attention, constantly seeking approval and reassurance from others.

This makes them more sensitive to criticism.

Patients with HPD typically do possess good social skills, but they use those skills to manipulate the people around them into giving them attention.

HPD patients are uncomfortable in situations where they are not the center of attention.

Because of this, they tend to be overly flirtatious or seductive, often dressing in a manner that draws attention.

If a histrionic finds him or herself in a situation where he or she absolutely cannot obtain the amount of attention he or she wants, he or she will likely threaten suicide as a manipulation tactic.

Histrionics tend to exhibit an exaggerated degree of emotions, yet their emotional expression is shallow and lacking in detail. Hence, histrionics often come off as being disingenuous or insincere.

The repeated overly dramatic expressions often end up embarrassing friends, family and significant others. This behavioral style gets in the way of truly intimate relationships.

When HPD patients are in relationships, they often imagine the relations to be more intimate than they really are.

People with histrionic personality disorder tend to be more suggestible, meaning they are more easily influenced by other people’s suggestions and opinions.

HPD has five diagnostic criteria, as listed in the Diagnostic and Statistics Manual of Mental Disorders (DSM).

A patient must display five of these eight symptoms to be professionally diagnosed: is uncomfortable in situations in which he or she is not the center of attention; interaction with others is often characterized by inappropriate sexually seductive or provocative behavior; displays rapidly shifting and shallow expression of emotions; consistently uses physical appearance 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; has a high degree of suggestibility, that is, easily influenced by others or circumstances; considers relationships to be more intimate than they actually are.

The development of HPD is dictated by both learned and inherited factors. For example, HPD tends to run in families, suggesting that a genetic susceptibility for the disorder may be inherited. On the other hand, children could be learning this behavior from a histrionic parent.

Some of the possible environmental factors include a lack of criticism or punishment as a child or unpredictable attention giving from his or her parent(s). These behaviors lead the child to be confused about what behavior earns parental approval.

Psychotherapy is not a widely accepted treatment for HPD because the patient tends to exaggerate his or her symptoms to gain more attention.

This makes it hard for the therapist to figure out what the problem truly is and how he or she can help. Patients often make sexual passes at the therapist, which is not functional for a healthy therapist-patient relationship.

Because of all the attention-seeking behavior, histrionics tend to dislike and avoid routine, which makes following a treatment plan difficult.

Solution-focused therapy tends to be more effective; the focus of sessions should be short-term alleviation of specific problems in the person’s life, rather than a magical “cure.”

There are not any specific medicines used to treat HPD, though anti-anxiety medicines and antidepressants are sometimes prescribed to treat specific symptoms.