Histrionic Personality Disorder (HPD)

HPD Introduction

Histrionic Personality Disorder is characterized by an extreme interest in drawing the attentions of others, favorable or unfavorable, to oneself.

HPD is estimated to affect up to 1% of the population.

People who suffer from HPD are sometimes accused of being a "drama queen" or "drama major". They are the people who grab the microphone, hog the limelight, always change the subject to themselves, behave outrageously, have tantrums and generally refuse to be ignored.

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.

Histrionic Personality Disorder (HPD) - The DSM Criteria

Histrionic Personality Disorder (HPD) is listed in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM) as a Cluster B (dramatic, emotional, or erratic) Personality Disorder:

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Is uncomfortable in situations in which he or she is not the center of attention
2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
3. Displays rapidly shifting and shallow expression of emotions
4. Consistently uses physical appearance to draw attention to self
5. Has a style of speech that is excessively impressionistic and lacking in detail
6. Shows self-dramatization, theatricality, and exaggerated expression of emotion
7. Is suggestible, i.e., easily influenced by others or circumstances
8. Considers relationships to be more intimate than they actually are.

HPD Characteristics & Traits

The following list is a collection of some of the more commonly observed behaviors and traits of those who suffer from HPD. Click on the links on each one for more information about a particular trait or behavior and some ideas for coping with each.

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.

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 but rarely 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.

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

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.

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.

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 it feels like to live with someone with HPD

Living with a person who suffers from HPD can be an exhausting, humiliating, frustrating and isolating experience. It may feel like living with a toddler or child.

When they create chaos, it is often you who are the one who has to clean it up, be the "reasonable" one, make excuses and pay the consequences.

People who act out with HPD traits typically do not seek solutions to the problems they manufacture, because solutions tend to reduce the amount of attention they are likely to receive. Those closest to them often become frustrated as their attempts to help out or improve the situation often go ignored and may even be sabotaged.

It's also common for people closest to an HPD suffer to temporarily "abandon" caring for the person in an attempt to "teach them a lesson" after their attempts to help have been ignored or rejected. However, this is likely to trigger an equally hysterical "why don't you care" reaction. This often leaves the non-personality-disordered individual feeling trapped, used, and manipulated.

Trying to make someone with HPD happy may feel like trying to fill a black hole or empty the ocean.  Your loved one’s personality disorder often prevents them from seeing the destructiveness of their own behaviors and keeps them from noticing or empathizing with your own needs .

When your loved one acts out in front of other people, you may feel embarrassed or humiliated to be associated with them. You may feel as though others assume that you are guilty by association. You may begin to avoid public groups, settings and situations for fear that it will not go well.

When your loved one acts out destructively, you may fear their next move. You may feel afraid for your own safety or feel angry that you are not being treated with respect.

Other symptoms of living with a person who suffers from HPD:

• Important problems or concerns take a back seat to trivial, fabricated or exaggerated problems of a loved one
• You find yourself making excuses or covering up abnormal public behavior.
• You find them rapidly cycling between extreme emotional highs and lows without pausing at normal.
• Other healthy relationships and activities you enjoy outside the relationship are seen as competitive and discouraged or forbidden.

HPD Possible Causes

The instinctive desire to attract the attentions of others is an important survival skill in humans. It serves a useful purposeful in early childhood, gaining parental attention amidst a clamor of siblings, gaining social acceptance among childhood peers and in attracting members of the opposite sex during early adulthood. Most adults learn to self-regulate these attention-seeking instincts by considering their other long-term interests such as the advantages of stable relationships, earning the trust and respect of others, and the security of investments. People who suffer from HPD generally do not develop this level of emotional regulation or recognize when their short-term desire for attention is at odds with their own long-term interests.

The causes of histrionic personality disorder are not well understood and there is some debate over to what degree HPD is caused is by "nature or nurture". It is common for HPD to be passed down through family generations. Parents who have histrionic tendencies are often turbulent and inconsistent in their parenting approach. This has led to some debate over whether HPD traits are passed on genetically or by environment.

HPD is more commonly diagnosed in women than in men by a factor of about 4 to 1 (See Statistics).

HPD shares a number of similarities to NPD, which is more commonly diagnosed in men. This has led to some theories that Histrionic Personality Disorder is a feminine manifestation of Narcissistic Personality Disorder.

HPD Treatment

See our Treatment Page.

People who suffer from HPD are often impulsive in nature, which tends to make them inconsistent when it comes to seeking and following up with therapy. They are prone to exaggerating their problems. They may seek out a therapist's help is dealing with a perceived crisis but will often drop away from the therapy program without following through on action items when their feelings change. This makes treatment of people with HPD especially difficult.

People with HPD are often diagnosed as having a depression when they exaggerate the negatives in their situation and may also be diagnosed as bipolar if the therapist observes them alternating between describing high or low emotional states.

It's common for people who suffer from Histrionic personality disorder to go through a repetitive series of failed relationships where a partner is initially idealized for their positive attributes, then devalued or "split black" after a disappointment occurs.

Movies Portraying Histrionic Personality Disorder Traits

A Streetcar Named Desire - A Streetcar Named Desire is a is a 1947 play written by Tennessee Williams, later adapted for film, which tells the story of a woman who displays histrionic and borderline traits, who goes to live with her codependent sister and her narcissistic husband.

Gone With The Wind - Gone With The Wind is a 1939 romantic epic starring Vivien Leigh and Clark Gable, set in the American Civil War portraying the story of Scarlett O'Hara, a southern woman who manifests symptoms of Histrionic Personality Disorder (HPD).

HPD Support Groups & Links:

Psychforums HPD forum - Psychforums Site.