Those affected by a histrionic personality disorder, HPD for short, show pronounced theatrical and egocentric behavior. Therapy can only take place when those affected show insight and seek help themselves, and consists of many years of psychotherapy.
What is Histrionic Personality Disorder?
Like all personality disorders, according to abbreviationfinder, HPD manifests itself in a pattern of perception and behavior that has been described as abnormal. This influences the entire personality in its thinking, feeling and relationship behavior and has a negative effect on the entire professional and everyday life of those affected.
Those affected by the histrionic personality disorder show an emotionality that others perceive as exaggerated and tend to dramatize their experience. However, the feelings shown appear superficial and artificial to others, because those affected cannot and do not want to allow deep, real feelings and have no real sense of identity. Those affected are therefore easily influenced and change their mind very quickly.
Another symptom is the constant search for attention and new experiences. Histrionics are sensitive to not being the center of attention and will do anything to get attention. People who suffer from HPS show an erratic and fast-paced relationship behavior. Their social contacts rarely go deep and are based on sexual attraction, so that same-sex friendships in particular are difficult.
The causes of the histrionic personality disorder have not been sufficiently researched to date to be able to provide detailed information on this.
As with all personality disorders, the cause seems to lie in childhood. When children have not been able to develop their own identity, have been given a false sense of love and attention, or lacked stable, supportive relationships and sufficient attention from the outside world to feelings, a personality disorder develops. Psychological research also suspects that those affected have a genetic predisposition.
The causes of the personality disorder apparently lie in traumas of early childhood or even pregnancy. However, how it is decided which type of personality disorder develops in those affected has not been clarified.
Symptoms, Ailments & Signs
Signs of histrionic personality disorder rarely arise from an observation or a singular trait. However, it is symptomatic of the histrionic personality disorder that, overall, a person often shows an unnatural urge for self-expression. The emotions, which usually seem very exaggerated to third parties, mostly revolve around finding recognition, being praised and gaining attention for the personal life situation.
A particular theatricality of feelings that persists is typical of this form of personality disorder. What many of those affected have in common is that they initially appear interesting, funny and entertaining to those around them. However, the urge to always want to be the center of attention in social situations and to live out one’s own feelings in a very exaggerated manner often leads to increasing social isolation of those affected.
Most people who suffer from this disorder do not see their own appearance as conspicuous compared to that of their fellow human beings. As with many mental illnesses, there is a lack of insight into the illness at the beginning of a diagnosis. Those affected notice that they cannot maintain social contact for long, they experience themselves as socially excluded, but often do not attribute this to their own external image.
Diagnosis & History
The diagnosis is made in the diagnostic department of a psychiatric or psychotherapeutic clinic.
First, the presence of a personality disorder must be proven using standardized test methods. The exact personality disorder must then be diagnosed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV.
Differential diagnoses must be considered and clearly ruled out. If at least five of the following symptoms are present, a histrionic personality disorder has been proven:
- Feeling uncomfortable when the person concerned is not the focus
- The patient tries to attract attention with his physical appearance
- Interpersonal contacts of those affected are characterized by exaggerated sexually attractive behavior
- The affected person’s emotional state changes quickly and seems superficial
- However, it is theatrical and exaggerated and the person concerned tends to self-dramatize
- Descriptions of the person concerned are not very detailed
- The patient is easily influenced
- The relationship is disturbed, relationships are perceived as closer than they are.
The histrionic disorder is established in childhood and first appears as such in early adult life. The extent to which those affected can be enabled to lead a life that is considered normal depends on the severity of the disorder and timely therapeutic intervention. In principle, however, personality disorders are not considered to be completely curable.
Since the histrionic personality disorder is characterized by egocentricity, the constant search for attention, theatrical behavior, exaggerated emotionality, strong emotional fluctuations and manipulative behavior in combination with a low tolerance for frustration and a lack of empathy for the needs of others, this results in a number of complications in interpersonal relationships.
Affected people find it difficult to build stable, healthy relationships. The environment usually reacts strangely to their behavior. This is especially true when trivial events (which they are not for patients) are over-hyped. The constant search for attention and the need to be the center of attention often makes people keep their distance.
This is the case even when the manipulation techniques that histrionics use to try to get their needs met are recognized and rejected. These early learned strategies, which are inherent to histrionic personalities, repeatedly lead to interpersonal conflicts. However, even if histrionics are receiving adequate treatment, the deep-rooted behavioral patterns are difficult to correct, as they were usually learned in childhood.
Consistent behavioral therapy is indicated when dealing with such patients, whereby clear rules and boundaries must be formulated. In addition, histrionic characters are more prone to depression and anxiety disorders, so that there is often a comorbidity. Depression and anxiety can be treated with medication. Overall, however, this results in a very complex need for treatment.
When should you go to the doctor?
Conspicuous behavior that other people describe as being above the norm must always be examined by a doctor. If people in the immediate vicinity notice a change in their usual appearance, it is advisable to seek medical advice. In the case of a histrionic personality disorder, it is part of the clinical picture that the person affected does not have any insight into the illness. The sick people are therefore dependent on the support and judgment of relatives or people in their social environment. You have an increased responsibility to contact a doctor and ask for help. It is advisable to gain the trust of the person concerned in order to initiate a visit to the doctor together with them.
A doctor should be consulted as soon as the behavior of a person is very emotionally hurtful or established rules are not observed in everyday life. If those affected behave recklessly, if they violate the privacy of their fellow human beings or if they are irreverent, it makes sense to investigate the causes. If the behavior of several people in the social environment can no longer be tolerated despite all attempts, a visit to the doctor is advisable. In particularly difficult situations, compulsory instruction may take place. For this purpose, a medical officer must be called to assess the situation.
Treatment & Therapy
The histrionic personality disorder requires lengthy treatment that is exhausting for the patient, their relatives and the psychotherapist.
Therapy is only possible if the person concerned sees a need for action and therapy himself, since his cooperation is an important prerequisite for the success of the therapy. Compared to other personality disorders, sufferers of HPD appear to seek help more quickly and bring greater insight with them.
Behavioral therapy offers the best prospects. Research into the causes can be carried out and be helpful, but it is more important to show those affected new behavior options and to practice them. Psychiatric drugs can be used alongside therapy when people are depressed, but are not helpful in pure HPS.
Outlook & Forecast
Therapy for histrionic personality disorder is difficult and lengthy. Those affected lack any insight into the nature of their illness. Therefore, the prognosis is generally not very good. Setbacks and discontinuations of therapy are to be expected in the case of a histrionic personality disorder.
The problem lies in the lack of recognition and acceptance of those affected by this diagnosis. Most people with histrionic personality disorder think they have a physical illness or some other mental illness. Even when careful differential diagnosis has shown that this is not the case, they persist in their assumption. The patient therefore often refuses therapy. Due to the dramatic personality structure, there are often suicidal tendencies. The unreasonable patient wants to use all means to ensure that the therapy is terminated or suspended.
The prognosis is only improved if the person concerned is willing to acknowledge the reality of his illness with a histrionic personality disorder. Up to now, the histrionic personality disorder has not been treatable without long-term therapy. There are currently no medications for such disorders. In this respect, the prospect of improvement for the majority of those affected is poor.
Success can only be achieved with long-term cognitive behavioral therapy. However, the behavioral problems and irrational actions persist if the patient is not confronted with alternative options for action.
Only parents can prevent histrionic personality disorder in early childhood by educating their offspring to be strong personalities. Those affected have no preventive options themselves.
After inpatient or semi-inpatient therapy, outpatient care should be provided for further treatment of the histrionic personality disorder. The focus of this aftercare is often the rehabilitation of the patient and the reintegration into the professional and private environment. From a behavioral perspective, treating people with personality disorders takes several years.
The coping methods learned in therapy must be stabilised, which can only be guaranteed through continuous care. During this time, the patient has the opportunity to try out new ways of behaving and experiencing, which can be solidified in further outpatient therapy. Important measures in aftercare are therefore cooperation with a psychotherapist or the community in group therapy.
If the problem is particularly severe and persistent, a renewed psychotherapeutic treatment – in the sense of an interval treatment – may be necessary after a few years. The success of the treatment can be evaluated in the various stages of rehabilitation and after the treatment has been completed by means of questionnaires, interviews or reports.
If the symptoms have subsided and the patient has been successfully reintegrated, he is considered to have been rehabilitated. However, the patient should continue to be given the option of seeking psychotherapeutic help or be provided with a permanent contact person.
You can do that yourself
Due to the ego synthony of the disorder, those affected with histrionic personality disorder rarely allow themselves to be treated for the disorder as such. They are more likely to seek medical help for secondary mental illnesses such as anxiety disorders or depression.
To date, no drugs have been developed to treat this disorder. In the context of psychotherapy, however, those affected can certainly be helped. Cognitive behavioral therapy, in which the psychotherapistin cooperation with the person concerned tries to break up their dysfunctional thought structures. It is important that the personality traits behind the disorder are not abandoned. As with any personality disorder, they are part of one’s character. However, as part of the therapy, the affected person learns to reduce the characteristics of his personal characteristics to a reasonable level, so that a histrionic personality disorder can become a histrionic personality style.
If the person concerned manages to find their way back to (genuine) recognition and happiness, then the conditions that justify an intervention, namely suffering and impairment, are removed. The relatives can help the affected person with empathy and a lot of patience. They need information about the clinical picture so that they can correctly interpret the behavior of the person affected.