The American Psychiatric Association defines histrionic personality disorder (HPD) as one that features extreme attention-seeking, usually in the form of a need for approval or flirtatious behavior. Doctors diagnose four times as many women with HPD as men, and it affects around three percent of the general population. Beyond certain symptoms, individuals with HPD will be able to function at a high level and remain successful socially, in school, and at work.
Most people with HPD have strong social skills, allowing them to maintain many relationships and succeed socially. However, they may use their skills to manipulate others and become the center of attention. Many people with HPD choose to withdraw from frustration rather than face the issue. They may exhibit a sensitivity to criticism, as well as an immense personal sense of pride. Often, they feel that relationships are more intimate than they are. Exhibitionist behavior and inappropriate sexual behavior is also common. The disorder can also lead to other people easily influencing the person with HPD.
Theodore Millon, an American psychologist, studied many personality disorders and was the founding editor of the Journal of Personality Disorders. He believed there are variants to all personality disorders and that by recognizing the differences, experts could reach a better understanding of each. He classified HPD into six different subtypes with varying definitions for each one. Millon’s subtypes of HPD are appeasing, vivacious, tempestuous, disingenuous, theatrical, and infantile.
A person with the appeasing histrionic subtype has dependent and compulsive features. Approval is everything to this subtype. They may seek to placate others and have an intense desire to mend social issues. This may extend into compromising or conceding against their own interests. Additionally, acquaintances who refuse to compromise can easily take advantage of a person with this subtype. One of the defining features of appeasing histrionic subtype is the desire for praise from others for solving a difficult situation or performing exceptionally.
Those who fall under the vivacious histrionic subtype exhibit seductiveness, excessive energy, and some narcissistic tendencies. Others may view a person with this subtype as charming or animated. However, it exceeds being perky or bubbly. They are often impulsive and optimistic to a fault, which causes them to ignore potential consequences. Their energy is a result of hypomania, a mood state of euphoria and lack of inhibition that can lead to displaying personality traits at inappropriate moments. Many people with this subtype will become quickly infatuated with someone, then grow bored with them shortly after. This typically leads to many partners in quick succession.
The features of a tempestuous histrionic subtype are negativistic or passive-aggressive. Others may describe these individuals as moody and emotionally variable. People diagnosed with the tempestuous histrionic disorder are often hypersensitive to criticism and may perceive an insult where none was meant. They may alternate from moments of sulking to impulsive behavior, violent anger, or extreme excitement. People with this subtype may lose some of their histrionic behaviors over time, replacing them with a critical view of other individuals and their successes.
Individuals of the disingenuous histrionic subtype have antisocial features. Their symptoms and behavior depend on the severity of their disorder. Many disingenuous histrionics are sociable and likable upon first meeting. However, antisocial individuals view kindness as a weakness, leading to a fear that others will perceive them as such. This can cause them to be quick to break social conventions, ignore promises, and behave irresponsibly. Occasionally, in severe cases, the antisocial behaviors may be more psychopathic. These individuals are self-centered and insincere. They may also be more aware of their manipulative behaviors than those of the standard subtype.
Millon considered the theatrical histrionic subtype to be the pure form of HPD. These individuals follow the most typical symptoms of the disorder. They are dramatic and attention-seeking. They may also be excessively romantic. Their characteristics change to suit the atmosphere and audience of the moment. Women may wear bright jewelry or provocative clothing. Men may pursue interests such as bodybuilding or adopt an appearance that suggests masculinity. Rare cases of the theatrical histrionic subtype can create a desire for excessive spending followed by displaying consumer goods.
Those with the infantile histrionic subtype also exhibit symptoms similar to borderline personality disorder. Infantile histrionics often lack a sense of identity, becoming attached to and dependent on others. They will constantly seek reassurance and may exhibit depressive symptoms if they do not receive approval. Like a child, their emotions change rapidly and easily. They may also express many emotions at the same time. They may believe that others do not love them or treat them poorly.
Few people have attempted to discover the cause of HPD or its various subtypes. It is possible there is no one cause, but that HPD is the result of a combination of issues. Those with HPD have high levels of norepinephrine, which leads to anxiety and high sociability. Some studies show that the disorder is hereditary. Around two-thirds of those with HPD also meet the criteria for antisocial personality disorder, suggesting that the two disorders may share an underlying cause. This may be the result of media portrayals of what is attractive, or of environmental factors of a child’s family.
Medication has proven ineffective in combating HPD, though it may alleviate depressive symptoms. Cognitive therapy and psychotherapy have proven to be the most effective methods. A psychotherapist attempts to act on their client’s actions as they happen, giving direct feedback on the outcomes those actions would have. A patient and their psychotherapist may discuss issues outside of sessions, creating a direct line of support between the two. A therapist may also discuss what the client desires from treatment, allowing a more personal approach.