What is Histrionic Personality Disorder?
Histrionic personality disorder (HPD) is an illness characterized by an extreme need to be noticed and to be the center of attention. People with HPD typically behave in dramatic, overtly emotional ways to gain the attention of others. They have a distorted image of themselves and require the approval of others to feel good about themselves.
HPD is one of a group of conditions called Cluster B personality disorders. This group also includes borderline personality disorder, antisocial personality disorder, and narcissistic personality disorder.
Symptoms of Histrionic Personality Disorder
Common symptoms of HPD include:
- Behaving theatrically, with exaggerated energy and emotion, in a way that seems insincere
- Low mood when not the center of attention
- Preoccupation with appearance
- Dressing or behaving provocatively to gain attention
- Being inappropriately flirtatious
- Rapid changes in emotion
- Acting impulsively
- Sensitivity to criticism
- Need for approval or affirmation
- Lack of empathy
- Being overly trusting
- Being easily influenced or gullible
- Being easily bored
- Difficulty forming deep relationships
- Difficulty sticking with tasks to completion
- Threats of suicide
What Causes Histrionic Personality Disorder?
The exact cause of HPD has not yet been discovered. Several factors, however, seem to put an individual at increased risk of HPD.
- Family history and genetics. People with HPD often have a family history of the same disorder. Therefore, scientists suspect a genetic component to HPD, but no definite association with any gene or group of genes has been discovered.
- Childhood experiences. People who experience neglect, inconsistent attention, lack of criticism, or withholding of approval during childhood may be at a higher risk for HPD.
Is Histrionic Personality Disorder Hereditary?
Scientists have not yet been able to identify a specific genetic component that increases the risk of HPD. Inherited genes may increase an individual’s susceptibility to HPD, but the disorder’s actual development may result from external triggering circumstances.
How Is Histrionic Personality Disorder Detected?
HPD, like all personality disorders, involves a pattern of symptomatic behavior that remains consistent for a long time. By definition, HPD symptoms must begin in childhood or early adulthood.
Possible warning signs of HPD include:
- Discomfort when not the center of attention
- Mood swings
- Sensitivity to criticism
- Manipulative behavior
- Lack of concern for others
- Obsession with appearance
- Provocative or overly sexualized clothes or behavior
- Easily influenced by trends and other people’s views
How Is Histrionic Personality Disorder Diagnosed?
Diagnosis of HPD begins with determining that the patient has a cluster of symptoms that meet the diagnostic criteria for the disorder. A doctor will start with a physical exam to rule out biological problems that may be causing symptoms. After these exams, if the doctor suspects that HPD or another personality disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment to solidify the diagnosis further.
Diagnostic steps may include:
- A physical exam. This exam will rule out physical conditions that could be causing the symptoms.
- Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.
The results of the psychological assessments will be compared to the diagnostic criteria for histrionic personality disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM criteria for HPD include:
- A persistent pattern of excessive emotionality and attention-seeking.
- At least five symptoms are present.
- The symptoms begin by early adulthood.
PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.
How Is Histrionic Personality Disorder Treated?
There is no cure for HPD, and no medications are commonly used to treat the core disorder itself. Instead, the most common treatment course involves psychotherapy, with drugs sometimes used to treat other co-existing mental illnesses.
Psychotherapy has proven to be effective at managing the effects of HPD, and the general course of treatment is the same as that for other personality disorders. Psychodynamic therapy is often used to treat HPD. This type of therapy helps the patient to identify their patterns of behavior. The therapist is likely to encourage examining the patient’s emotions, beliefs, and early childhood experiences.
People with HPD often do not believe that they need treatment and may have difficulty sticking to a treatment plan.
Medicines may be used to treat symptoms such as depression or anxiety, which often co-exist with HPD. The drugs used to treat these symptoms include selective serotonin reuptake inhibitors (SSRIs). However, medicines are rarely used independently, and the most effective treatments combine medications with psychotherapy.
How Does Histrionic Personality Disorder Progress?
People with HPD typically have strong social skills, but they have difficulty forming relationships that go deeper than a superficial level. They tend to think their relationships are more substantial than they really are, leading to unstable interpersonal interactions.
HPD can have long-term adverse effects, including:
- Lack of success at work or school
- Unemployment or financial difficulties
- Substance abuse
How Is Histrionic Personality Disorder Prevented?
There is no way to prevent DPD from developing, but early intervention can sometimes successfully prevent the condition from producing its most destructive complications.
Histrionic Personality Disorder Caregiver Tips
Many people with histrionic personality disorder also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with HPD:
- Many people with HPD also suffer from depression or anxiety.
- Many people with HPD also have other personality disorders, especially Cluster B disorders (antisocial personality disorder, narcissistic personality disorder, and borderline personality disorder).
- Alcohol and substance abuse are common complications of HPD.
Histrionic Personality Disorder Brain Science
The symptoms of HPD are very similar to those of borderline personality disorder (BPD), and one study has suggested that as many as 10% of people with HPD also meet the diagnostic criteria for BPD. There is some debate among scientists over whether HPD and BPD are two distinct disorders or simply variants of the same disorder. Whichever is true, research into the brain science of BPD could also help scientists better understand the underlying causes of HPD.
Studies have shown identifiable differences in the brains of people with borderline personality disorder compared to the brains of people without the disorder:
- In the brains of people with BPD, the parts of the brain that control emotion might not communicate effectively with the areas of the brain that control decision-making. These parts of the brain include the amygdala, the hippocampus, and the medial temporal lobes.
- Studies have shown that BPD sufferers may have problems processing or producing certain brain chemicals, such as the hormone oxytocin and the neurotransmitter serotonin. These chemicals are vital contributors to functions such as mood regulation, emotional responses, and social bonding.
Histrionic Personality Disorder Research
Title: Five Factor Model Treatment for Borderline Personality Disorder
Principal investigator: Shannon Sauer-Zavala
University of Kentucky
The primary purpose of this study is to explore the acceptability, feasibility, and preliminary efficacy of a novel cognitive-behavioral treatment for borderline personality disorder (BPD). Extant treatments for this condition are intensive, long-term (usually at least one year), and have, understandably, focused on targeting the life-threatening and therapy-interrupting behaviors that often characterize this disorder. BPD, however, is a heterogeneous disorder with diagnostic criteria that can be combined to create over 300 unique symptom presentations (Ellis, Abrams, & Abrams, 2008); to date, no treatments have been explicitly designed with lower risk presentations of BPD in mind. This is unfortunate, as there is evidence to suggest that the majority of individuals with BPD do not demonstrate the recurrent life-threatening behaviors that warrant intensive, long-term care (Trull, Useda, Conforti, & Doan, 1997; Zimmerman & Coryell, 1989). Additionally, various studies have shown that the difficulties experienced by individuals with BPD can be understood as manifestations of maladaptive variants of personality traits (e.g., Mullins-Sweatt et al., 2012). Specifically, individuals with BPD demonstrate high levels of neuroticism and low levels of agreeableness (antagonism) and conscientiousness (disinhibition); these traits may not be universally present across all individuals with BPD, perhaps underscoring the heterogeneity in presentations of this condition.
Title: The Effect of Oxytocin Administration on Interpersonal Cooperation in Borderline Personality Disorder Patients and Healthy Adults
Principal investigator: Harold Koenigsberg, MD
Icahn School of Medicine at Mount Sinai
New York, NY
This is a pilot study to support the submission of a larger-scale federally funded study. The study is designed to develop new strategies for treating the severe interpersonal dysfunction in borderline personality disorder (BPD) by modeling the interpersonal disturbance in BPD in the laboratory, identifying its neural correlates, and determining whether the social neuropeptide, oxytocin, can ameliorate the interpersonal dysfunction. The study will examine behavioral patterns and underlying neural correlates which distinguish patients with borderline personality disorder (BPD) from healthy subjects as they participate in a two-person trust game and will determine whether administration of intranasal oxytocin (OT) will normalize trust game performance and concomitant neural processing in the BPD group.
The specific aims of the study are 1) to determine whether BPD patients and healthy controls (HC) differ in their pattern of investing in a trustee when the trustee behaves benevolently or malevolently towards them or suddenly becomes malevolent after a period of benevolence (or vice-versa) in a multi-round economic exchange game (“The Trust Game”), and 2) to determine the effect upon behavior of the administration of 40 IU intranasal oxytocin relative to placebo in BPD subjects and HC’s engaged in the Trust Game.
Title: Ketamine in Borderline Personality Disorder
Principal investigator: Sarah Fineberg, MD, PhD
Connecticut Mental Health Center
New Haven, CT
This clinical trial primarily tests the impact of ketamine on suicidal thoughts in Borderline Personality Disorder (BPD). It also tests the impact of ketamine on symptom intensity (for mood, BPD, and pain symptoms), social cognition, and neuroplasticity in people with BPD.
Suicidal ideation and action are too common in BPD, occurring at rates similar to those in people with depression or schizophrenia. Intensive psychotherapy helps, but many people with BPD do not have access to that treatment, and not everyone responds to psychotherapy if they do get access. No medication is FDA-approved for BPD, and no medication has been shown to decrease suicidality in BPD.
Ketamine is a promising medication for this problem. It is an FDA-approved anesthetic medication with N-methyl D-aspartate activity. Sub-anesthetic doses of ketamine decrease suicidality and improve mood in people with Major Depressive Disorder (MDD). This effect is rapid, with symptom improvement within hours that endures approximately two weeks. People with BPD can have symptoms that overlap with those of MDD. However, the effective treatments for BPD and MDD differ. This clinical trial will test if ketamine, which is effective in MDD, is also effective in BPD.
The investigators will use semi-structured interviews and self-report questionnaires to measure suicidal ideation and clinical symptoms (adverse events, mood symptoms, BPD symptoms, and pain). Social cognition will also be measured using both interviews/questionnaires and cognitive psychology tasks.
One proposed mechanism of ketamine’s effect in MDD is increased neuroplasticity – opening a window during which new learning can occur. This mechanism has been demonstrated in rodent models of depression. In BPD, negatively biased social interpretations impede meaningful recovery and increase suicide risk over time. A post-ketamine neuro-plastic window may provide an opportunity for revisions of rigid social attributions. The investigators will test for changes in neuroplasticity using a cognitive psychology task and electro-encephalography.
Baseline measures of demographics, life experiences, and symptoms may also be used to predict outcomes or as covariates in our analyses.