Dramatic people and HPD

The word histrionic means - dramatic or theatrical. Often casually called dramatic personality disorder.

A histrionic personality disorder is a personality disorder characterized by patterns of emotional and attention-seeking behavior. People with histrionic personalities are excitable and emotional, behaving in a dramatic, extroverted, and colorful fashion. They are the life of the party and have a larger-than-life presence. Their self-esteem depends upon others' approval. It is one of the four disorders under cluster B in DSM-5 personality disorders. The roots of modern histrionic personality disorder can be traced back to Freud’s description of “hysterical neuroses”. It was first included in DSM-II (Diagnostic and Statistical Manual of Mental Disorders 2), although it was one of the four disorders recommended to be removed from DSM-5 as many don’t believe in the validity of the diagnosis.

Symptoms

HPD patients have an eagerness to share their lives details. They are high-functioning individuals both professionally and socially. Their overwhelming desire to be noticed often gets the better of them. They usually have good communication skills but use them manipulatively. Gestures and dramatic punctuations are common in daily conversations. They manifest a high degree of attention-seeking behavior. Exaggeration of thoughts and feelings is to such to make everything sound more important than it is supposed to be. In craving stimulation and attention use physical appearance is common. Temper tantrums, crying and accusations are common ways of seeking attention. Their need for assurance is endless. Seductive behavior is very common in HPD as a means to control their partner. They are also gullible, being easily influenced by others.

Aetiology (the scientific study of the causes of disease):

Very little systematic research has been conducted for the histrionic disorder. Genetic predisposition for the disorder is high. Two personality traits extroversion and neuroticism are known to have a genetic basis. In extroversion, HPD includes a high level of gregariousness, excitement seeking, and positive emotions. Individuals with HPD have a higher secretion of neurotransmitter norepinephrine which is related to anxiety-provoking and high sociability.

Cognitive theorists emphasize the importance of maladaptive schemas revolving around the need for attention for the validation of self-worth. Core dysfunctional beliefs include – “unless everyone likes me I am nothing” or “If I don’t entertain them everyone would abandon me.” Early childhood experiences can also be a contributing factor. For example lack of criticism or punishment as a child, positive reinforcement only when a particular task is done, and unpredictable attention patterns of parents.

Sigmund Freud associated lustful behavior as a projection of a parent’s inability to love unconditionally. Parents who are dramatic, erratic, and portray inappropriate sexual behavior work as bad role models for the child. Even early trauma can pave the way where the behavior is used as an adaptive coping mechanism.

Epidemiology and complications

The prevalence rate for HPD is 1-3% in the general population. Women are four times more likely than men to be diagnosed with HPD. Researchers believe that women are diagnosed more with HPD because being sexually forward is less socially acceptable for women than men.

HPD affects people’s social and romantic relationships and how they react to stressful situations. HPD also makes people more prone to developing depression and substance use disorders. People with HPD tend to be ego-syntonic meaning they feel nothing is wrong with them or the way they behave.

Differences between Histrionic Personality Disorder (HPD) and Narcissistic Personality Disorder (NPD)

HPD and NPD both are cluster B disorders with some differences. A person with HPD may have empathy and emotions for others, while a person with NPD will never have empathy. While people with both kinds of disorders have a strong urge for external validation and have problematic relationships, A person with NPD tends to cause emotional harm.  

Treatment

Generally, people with HPD don’t seek treatment themselves assuming themselves to be perfect. Their exaggerated feeling of dislike of routines makes it difficult to formulate treatment plans. Psychotherapy is the chosen treatment plan for HPD patients. The goal is to help patients uncover fears and thoughts associated with behavior. Insight-oriented therapy can help in altering patients' dysfunctional personalities by helping them re-examine earlier milestones missed out in early developmental years. Holistic therapy (yoga, mindfulness, tai chi, etc.) is a new line of treatment being used to help patients develop control over inner feelings and impulses.