Histrionic personality disorder can often go unnoticed. People with the disorder often function well at work and socially, although intimate relationships are typically rocky and unstable. To many, the person with histrionic personality seems highly extroverted and perhaps overly flirtatious. More intimate relations reveal the negative symptoms of the personality.

Histrionic personality disorder is defined by a constant need for approval, which reveals itself as constant attention seeking and a need to be the center of events. People with histrionic personality disorder tend to form emotional attachments quickly, and despite having a rather shallow emotional expression themselves, tend to believe that their relationships are more intimate than they actually are.

Histrionic Personality Disorder Causes and Risk Factors

The cause of histrionic personality disorder is unknown, although researchers suspect that genetics and childhood history are involved. The disorder occurs most often in women, but whether gender is a risk factor or not is questionable. Some experts suggest that histrionic personality disorder is diagnosed less in men because society considers extroversion and sexual promiscuity more acceptable in men than in women.

Symptoms of Histrionic Personality Disorder

Symptoms of histrionic personality disorder are often subtle: At a glance, the histrionic personality simply seems overly extroverted. It has been suggested that histrionic personality disorder may be at the extreme end of extroversion, where the character trait begins to exhibit clinical symptoms.

Unlike many other personality disorders, histrionic personality disorder does not necessarily have a negative impact on work or social functioning. People often describe the histrionic personality as energetic, attractive, and popular. People with the disorder are also often successful in their careers.

These apparently positive qualities have negative sources. Histrionic personality disorder sufferers are not simply extroverted. They have a desperate, driving need to be the center of attention at all times and will manipulate both people and events to ensure that all attention is focused on them. In order to stay in the spotlight, people with histrionic personality disorder may resort to emotional dramatics and potentially dangerous risk-taking behavior.

Histrionic personality disorder also produces a strong need for praise and appreciation, and people with the disorder are highly sensitive to even imagined criticism. Their feelings are easily hurt. When not "performing" as the center of attention, they are nervous and uncomfortable.

The histrionic personality is easily bored and constantly seeking new stimulation. To combat boredom, people with the disorder may change careers and jobs on a regular basis, move frequently, or take dangerous risks. Substance abuse, depression, and anxiety can occur due to boredom.

Common symptoms of histrionic personality disorder are listed below. Bear in mind that each case of histrionic personality disorder is unique, and symptoms that characterize one case are not necessarily present in another.

Common Histrionic Personality Disorder Symptoms

• easily frustrated
• "shallow" emotions that shift rapidly
• "theatrical" self-presentation
• discomfort when not the center of attention
• excessive emotional expression
• inappropriate sexual behavior or seductiveness
• speech patterns lack details
• uses physical dress and attractiveness to gain attention
• values and opinions changeable depending on social situation.

Self-Image, Outer Image, and Histrionic Personality Disorder

For someone with histrionic personality disorder, self-esteem is closely tied to physical attractiveness, appearance, and fitness. The desire for attention often manifests itself in the histrionic personality's appearance; being physically fit, wearing the latest fashions, having the best hairstyle and/or make up are common to people with histrionic personalities. Needless to say, the histrionic personality does not find aging comfortable or pleasant.

While most individuals with histrionic personality disorder are concerned with dressing well and attracting attention through physical attractiveness, some use startling or provocative appearance to get the attention they need.

Relationships and Histrionic Personality Disorder

Sustaining meaningful, intimate relationships is difficult for people with histrionic personality disorder. Successful relationships require deep and sincere emotions that the histrionic personality has trouble feeling. Despite their use of excessive emotional displays to attract attention, most people with histrionic personality disorder lack emotional depth and maturity. Their overwhelming need for attention and praise results in selfishness and a lack of regard for others; neither trait is conducive to long-term intimate relationships.

Histrionics bond to people quickly, but at a superficial level. Their demand for constant attention, often expressed as flirtatiousness or sexual promiscuity, often destroys their relationships.

Histrionic Personality Disorder Diagnosis

Although people with histrionic personalities rarely seek help for their attention-seeking compulsions, they may seek medical assistance for depression, especially when a romance fails. Diagnosis of histrionic personality disorder is based on observable symptoms and psychiatric evaluations. Physical appearance is also taken into account during diagnosis.

While histrionic personality disorder is easier to diagnose than some personality disorders, other medical conditions exist that can produce histrionic symptoms. Before a definitive diagnosis is made, these conditions must be ruled out:

• antisocial personality disorder
• borderline personality disorder
• dependant personality disorder
• narcissistic personality disorder
• personality changes from underlying medical conditions
• substance abuse.

Treatment of Histrionic Personality Disorder

Antidepressants may be prescribed for depression resulting from failed relationships. For direct treatment of histrionic personality disorder, however, medication is not recommended. Histrionic personality disorder patients may abuse medication or use medication for suicidal gestures.

Therapy is the preferred treatment for histrionic personality disorder, and has been used with varying degrees of success. Group or family therapy sessions are not advised; the histrionic personality\'s demand to be the focus of attention makes any multi-person therapy counterproductive.

Complications of Histrionic Personality Disorder and Suicidal Gestures

As noted above, failed romances, boredom, and low frustration levels may all produce depression in the histrionic personality. Substance abuse and alcohol abuse are risks the histrionic uses to attempt to alleviate boredom and seek new and riskier diversions.

The histrionic personality disorder patient can attempt to gain the attention of others through self-mutilation or suicidal "gestures." Although suicidal gestures are usually motivated by the need for attention rather than true suicidal behavior, such gestures should never be dismissed. If the histrionic personality is depressed, then he or she may actually be suicidal. Even if the suicide attempt is meant as an attention-seeking gesture, such gestures can still prove fatal.

Resources

American Psychiatric Association. Diagnostic criteria for 301.50: Histrionic personality disorder. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. American Psychiatric Association, Washington, DC, 1994.

Ekleberry, S. (2000). Dual diagnosis and the histrionic personality disorder.

Grohol, J. (nd). Histrionic personality disorder: Treatment.

Long, P. (nd). Histrionic personality disorder.

National Library of Medicine. (updated 2004). Histrionic personality disorder. MedlinePlus Medical Encyclopedia.

World Health Organization (WHO). (2003). Mental and behavioural disorders: Disorder of the adult personality and behaviour: Histrionic personality disorder [ICD-10 F604.4]. International Statistical Classification of Diseases and Related Health Problems, 10th Revision. 2003.