Histrionic Personality Disorder

Cluster B disorders known in the medical community are referred to as dramatic personality disorders, this is where we categorize Histrionic Personality Disorder. The people who have histrionic personality disorder have very unstable, intense emotions that go along with an inaccurate self-image. Their approval in the eyes of others is very important even though it has nothing to do with their true feelings of self-worth. They are known for being inappropriate or dramatic to get attention from others.

Histrionic Personality Disorder Explained

Histrionic stands for theatrical or dramatic. People with this disorder exaggerate their emotions greatly and are drawn to any attention grabbing or emotional theme. If ever someone with histrionic is not the center of attention, they often feel underappreciated and uncomfortable. Common behaviors we see are self-dramatization, approval-seeking, braggy and showy. They are often sexually seductive in inappropriate situations, self-seeking, self-centered and indulged. Inappropriate situations include school, professional, and around people they are only acquaintances with.

Some situations could include embarrassing friends and loved ones with public displays of temper tantrums and excessive emotional breakdowns, including uncontrollable sobbing over minor issues. People struggling with histrionic personality disorder may go above and beyond to get attention.

Symptoms of Histrionic Personality Disorder

Those who suffer with histrionic personality disorder may be able to live a highly functionable life, this does not typically hinder someone from managing to live productively in society. Many who have this personality disorder could be unaware of any personality issues and could not be seeking treatment for the disorder itself. Many times we see those with histrionic disorder seek treatment for depression when relationships end without knowing it has been a personality disorder feeding these emotions the whole time.

Many individuals who struggle with histrionic personality disorder fail to see the reality of their condition. They are rarely able to accept failure or disappointment, especially if it is their fault or responsibility. Usually those with histrionic personality disorder have good social skills, a main reason why they are easily able to manipulate situations in order to be at the center of any attention.

Common symptoms of histrionic personality disorder can include:

 Constantly seeking reassurance or approval

 Self-centeredness

 Inappropriate seductive appearance or behavior

 Using physical appearance to draw attention to self

 Rapidly shifting emotional states

 Excessive dramatics with exaggerated emotions

 Easily influenced

 Believing relationships are more serious than they are

This disorder is not easily diagnosable right away because they require long-term observations into the patterns of behavior. It is rare to diagnose this disorder in adolescence or childhood because of all the personality changes that naturally occur growing up and constant development of the adolescent.

How Histrionic Personality Disorder and Substance Use Are Connected

The connection between histrionic personality disorder and substance use is well-documented in clinical literature. Research indicates that individuals with HPD face a significantly elevated risk of developing co-occurring substance use disorders, with alcohol use disorder and cannabis use disorder among the most common. The emotional dysregulation that defines HPD, the persistent need for external validation, and the intensity of mood swings create conditions in which substances can feel like an accessible and immediate form of relief.

Self-medication is the pattern that most commonly bridges HPD and substance use. When the emotional volume of HPD feels unmanageable and social situations feel insufficiently stimulating or when the gap between the attention a person needs and what their environment provides becomes too wide, substances step in as a regulatory tool. This pattern often goes unrecognized for years because the social and interpersonal behaviors associated with HPD can mask the severity of the substance use from those around the individual.

Treating substance use disorder in someone with HPD without addressing the personality disorder itself produces incomplete and often short-lived results. The emotional conditions that drove the substance use remain fully intact. This is why an integrated dual diagnosis approach, treating both conditions concurrently within the same clinical framework, is the standard of care for this population.

Causes of Histrionic Personality Disorder

The causes of histrionic personality disorder are both environmental and genetic. In most other personality disorders there is no definitive cause, but it is linked to both inherited and learned factors.

Environmental Factors

Common in most personality disorders, when a parent has a personality disorder such as histrionic personality disorder- the child is repeating learned behavior. Typically, children are learning behavior patterns from those they spend the most time with.

Additional factors specific to histrionic personality disorder can include lack of discipline or punishment as a child when acting out the above behaviors, and also when attention is given that is unpredictable. This causes at a young age, children to act in a way that receives the most attention, whether or not it be good or bad.

Genetic Factors

The main genetic factor of histrionic personality disorder would be if the condition runs in the family, if this is the case- then there is likely a predisposition to the personality disorder. If someone has histrionic personality disorder, research suggests that there is a slightly increased risk for this disorder to be passed on to their children.

Diagnosis of Histrionic Personality Disorder

Psychologists or psychiatrists are typically the ones who would be diagnosing any type of personality disorder. Most of the time, the initial problem to go to a family doctor, and from there would be passed on to some form of mental health professionals. Family doctors know who in the medical field would be best equipped to diagnose. It is not a blood or lab test that could come out with a diagnosis for personality disorders. It is also not common for those suffering with histrionic personality disorders to seek treatment for themselves. This is common in many of the personality disorders, until there is situations in their lives that influence their needing professional help, it is overlooked as just “how the individual acts”. When stress takes over and it is unbearable for the individual, treatment is finally sought after.

The criteria for histrionic personality disorder diagnosis include:

 When someone is uncomfortable in any situation where they are not the center of attention

 Inappropriate sexually provocative behavior with others

 Swift changes in emotions or lack of emotion

 Using their physical appearance to draw attention to themselves constantly

 Exaggeration of emotion and self dramatization, “showing off” behaviors.

 People and circumstances often influence the individual and they have a high degree of vulnerability.

 When most of their personal relationships are exaggerated to be more intimate than they are.

Who Is at Risk for Histrionic Personality Disorder?

As with other personality disorders, these are developed commonly in people who experience trauma, stress, and anxiety in their childhood years. Abuse and neglected children rely on their minimal learned skills to react to situations and these negative coping skills alone can form into a personality disorder.

As previously mentioned, overindulgent or inconsistent parenting can lead to the development of histrionic personality disorder later in an individual’s life. Any parenting style that doesn’t set strong boundaries or has no structure can interfere with a child’s emotional development.

This disorder occurs more frequently in females than males, and if there is a family history or histrionic disorder or any other mental health conditions, there is more risk to the individual.

Histrionic Personality Disorder Stats

Just under 2% of the population suffer from histrionic personality disorder. Like most personality disorders, histrionic personality disorder typically decreases in intensity overtime, starting in early adulthood by then by the time the individual is 40-50 the symptoms seem to lessen. Four million Americans have been diagnosed with histrionic personality disorder even though it is one of the least common personality disorders diagnosed.

What Treatment for HPD and Co-Occurring Addiction Looks Like

Treatment for histrionic personality disorder alongside co-occurring substance use disorder requires a clinical team experienced in both domains simultaneously. The treatment cannot be sequential, addressing the substance use first and the personality disorder later, because the two are interdependent. The emotional patterns of HPD sustain the substance use, and the substance use destabilizes the emotional regulation work being done in therapy.

At The Best Treatment Center, our clinical model is built around this integrated approach. Our licensed master’s level clinicians carry expertise in personality disorders and co-occurring substance use, and our 11 clinical therapy modalities provide the range of tools that HPD treatment requires. Cognitive behavioral therapy addresses the dysfunctional thought patterns and attention-seeking behaviors that sustain the disorder. EMDR is indicated where trauma underlies the development of HPD, which clinical literature consistently identifies as a contributing factor in many cases. Motivational enhancement therapy supports engagement with the treatment process for a population that frequently does not recognize its own behaviors as problematic.

The full continuum of care is available at both our Florida facility in Lantana and our North Hollywood, California facility. For individuals whose clinical picture requires a structured residential environment to stabilize both the substance use and the emotional patterns of HPD, residential inpatient treatment provides the immersive setting where that foundational work can take place. Clients who are clinically stable and whose recovery is progressing can step down to partial hospitalization or intensive outpatient programming while continuing the therapeutic work.

Why Dual Diagnosis Treatment Matters for HPD

The majority of individuals with histrionic personality disorder who enter treatment do not present with HPD as their primary concern. They are more likely to seek help for anxiety, depression, relationship difficulties, or substance use, with the personality disorder identified during the clinical assessment process. This delayed recognition is one of the reasons that integrated dual diagnosis treatment is so important.

A clinical team that identifies HPD alongside a substance use disorder can design a treatment plan that addresses the whole clinical picture from the outset. At TBT, Joint Commission accreditation across all levels of care at both our Florida and California facilities reflects a verified standard of clinical quality. Our 3 to 1 staff-to-client ratio, compared to an industry norm of 8 to 1, means that our clinicians have the time and the depth of relationship with each client to do the nuanced work that personality disorder treatment requires.

Histrionic Personality Disorder and Drug or Alcohol Addiction at The Best Treatment Center

Self medication with drinking and drugs is common for those who suffer from histrionic personality disorder. Many of those who suffer from substance addiction and abuse see drinking and drugging as a way to ease their mental health issues. The self-medicating on drugs and alcohol often goes unnoticed until the substance use consumes all aspects of their life. If you or someone you know has been having these types of behaviors; professional treatment is needed as soon as possible.

At The Best Treatment Center all of our therapists are master’s level clinical staff who are experts in specialized treatment for patients who have co-occurring disorders. We know the best way to heal and ensure recovery for those suffering from a co-occurring disorder in an individualized treatment program. Our intensive co-occurring disorder treatment programs are created to treat both the mental health disorder and the substance use disorder together in one individualized treatment care plan.

The concurrent disorder treatment therapies we utilize at The Best Treatment Center are: 12-Step, EMDR Trauma, Creative Arts Therapy, Yoga, Mindfulness, and Cognitive Behavioral Therapy- these are provided both one-on-one and in peer group therapy sessions. The proper treatment program can be the determining factors of whether or not an individual will be successful in their journey through recovery.