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Histrionic Personality Disorder

What Is It, Diagnosis, and More

Author: Ashley Mauldin, MSN, APRN, FNP-BC

Editors: Alyssa Haag,Ian Mannarino, MD, MBA

Illustrator: Jillian Dunbar

Copyeditor: Joy Mapes

Modified: 23 Sep 2021

What is histrionic personality disorder?

Histrionic personality disorder is a mental health condition in which an individual displays exaggerated emotional and attention-seeking behaviors, such as dressing provocatively or flirting inappropriately. Individuals with histrionic personality disorder typically feel disregarded or unimportant when they are not the center of attention. Histrionic personality disorder is also known as a dramatic personality disorder.

What causes histrionic personality disorder?

The exact cause of histrionic personality disorder is unknown, but it likely develops as a result of multiple influences. It is thought that both inherited factors (i.e., passed down from one’s parents) and things the individual has experienced or learned play a role. Having family members with any personality disorder, psychiatric disorder, or substance use disorder can increase an individual’s risk of developing histrionic personality disorder. Additionally, parents who themselves display emotional or attention-seeking behaviors or whose parenting style is inconsistent or significantly permissive may predispose their children to histrionic personality disorder. Finally, childhood trauma may put an individual at risk of this mental disorder, as the ways children learn to cope with trauma can lead them to adopt behavioral and emotional responses that are characteristic of personality disorders, including histrionic personality disorder.

What are histrionic traits?

Histrionic personality traits are characteristics or attributes that seek attention or demonstrate extreme emotional responses. As with similar mental health conditions -- such as borderline personality disorder, antisocial personality disorder, and narcissistic personality disorder -- traits exhibited in histrionic personality disorder include significant unpredictability, excitability, volatility, and a tendency to be “over-the-top.” People with this disorder may attempt to flirt, charm, or manipulate others, but they also tend to be easily influenced and gullible. They often trust others and form attachments too quickly because their self-esteem is typically dependent on the approval of others. Individuals with histrionic personality disorder generally experience strong emotions that change rapidly, and this may give others the perception that these individuals’ emotions are shallow or faked. Moreover, these individuals may embarrass their family members and friends with their dramatic behaviors and extreme expressions of emotion. People with this disorder often struggle to maintain positive relationships.

How is histrionic personality disorder diagnosed?

Histrionic personality disorder is generally diagnosed after a medical history and physical examination are completed. If the healthcare provider finds no medical reason for the symptoms, then a referral to a licensed mental health provider is usually recommended. Mental health providers may use assessment tools, like symptom questionnaires, or a structured diagnostic interview to evaluate the patterns of behavior and symptoms present.  

Considering that an individual’s personality continuously develops throughout adolescence, histrionic personality disorder is usually not diagnosed until adulthood. Per the clinical criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (i.e., DSM-5) diagnosis of histrionic personality disorder requires presentation of five or more of the following criteria: discomfort when not the center of attention; seductive behavior; emotional unpredictability, including little emotion shown in situations where more emotion is typical; attention-seeking appearance; affected and shallow speech; dramatic or exaggerated emotions; easily influenced; and overfamiliarity with acquaintances.

How is histrionic personality disorder treated?

Treatment of histrionic personality disorder usually consists of psychotherapy, a type of counseling aimed at working with the individual to discover what causes or contributes to their behaviors and what may help them relate to other people and situations more positively.

If depression or anxiety are experienced in combination with histrionic personality disorder, medication treatment may be recommended. An antidepressant like fluoxetine (e.g., Prozac) may be prescribed for both anxiety and depression. If the individual is experiencing severe mood swings, a mood stabilizer, such as lithium, may be prescribed.

How do you help someone with histrionic personality disorder?

In order to help an individual with histrionic personality disorder, it is important to encourage them to follow their treatment plan and to support them in doing so. People with this disorder may initially be reluctant to participate in treatment, and they may not follow up regularly with their health care providers. They are also at a higher risk than the general population to develop depression, anxiety, and substance use problems. Overall, a friend or family member can help an individual with histrionic personality disorder by positively encouraging the individual to continue with their treatment, learning more about histrionic personality disorder, and consulting with a mental health provider to know what to do in difficult situations with the individual.

What are the most important facts to know about histrionic personality disorder?

Histrionic personality disorder is a mental health condition in which an individual displays exaggerated emotional and attention-seeking behaviors. They feel disregarded or unimportant when they are not the center of attention. The exact cause of histrionic personality disorder is unknown, however, it’s thought that both inherited behaviors and learned behaviors from childhood play a role. Individuals with histrionic personality disorder can be described as dramatic, excitable, erratic, charming, flirtatious, seductive, manipulative, impulsive, and volatile. Their self esteem is entirely dependent on the approval of others. For diagnosis, a referral to a psychiatrist or psychologist is usually recommended. They will typically use the diagnostic and statistical manual of mental disorders, or DSM-5 criteria, to diagnose histrionic personality disorder. Treatment usually involves psychotherapy, a type of counseling aimed at assisting the individual in  discovering the root cause(s) behind their behaviors.  To help an individual with histrionic personality disorder, it’s important to be supportive and encourage them to follow their recommended treatment plan.

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