Histrionic personality disorder (HPD): Signs and treatments

Reviewed by Katelyn Baxter-Musser, LCSW, C-DBT, C-PD, CCTP

Written by

therapist.com team

Last updated: 04/08/2025

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What is histrionic personality disorder?

Histrionic personality disorder (HPD) is a mental health condition that involves an intense, ongoing need to be noticed by others.¹ People with HPD often behave in dramatic, attention-seeking ways and feel a strong drive to be the focus of attention in social situations. When they’re not, they often feel uncomfortable and even upset.

They may exaggerate emotions and behaviors to make sure they’re not overlooked. A core feature of HPD is the need for external validation. People with HPD rely on this validation to build their self-esteem, rather than carrying an internal sense of self-worth.

HPD usually appears in a person’s late teens or early adulthood. It’s part of the Cluster B group of personality disorders in the DSM-5, which also includes borderline, narcissistic, and antisocial personality disorders.² HPD involves long-lasting patterns of excessive attention and approval-seeking behaviors along with unstable and shallow emotions.³ These patterns and emotions significantly affect how a person interacts with others and manages their emotions.

Histrionic vs. borderline personality disorder

Both HPD and borderline personality disorder (BPD) involve intense and quickly shifting emotions. The two disorders overlap in several areas, and it is possible for one person to be diagnosed with both disorders. However, the two diagnoses differ somewhat.

People with BPD are more likely to have the following defining struggles:⁴

• Self-destructive actions
• Chronic feelings of emptiness
• Unstable sense of self

While people with BPD seek emotional connections to feel secure and avoid abandonment, people with HPD seek attention to feel seen and validated.

Histrionic vs. narcissistic personality disorder

Though they share attention-seeking traits, HPD and narcissistic personality disorder (NPD) have some differences in how they present. People with HPD tend to be more emotionally expressive and flirtatious.⁵

While both disorders cause people to crave attention, their underlying motivations vary. People with NPD are more concerned with achieving a high status, maintaining an image of superiority, and fulfilling their need for admiration. Meanwhile, people with HPD are less preoccupied with status and may be willing to be viewed as fragile or needy if it leads to gaining attention and meeting their needs for emotional validation.  

A person with HPD may exaggerate their distress to gain concern from others, but a person with NPD wouldn’t. Presenting themselves as vulnerable in this way would be a direct contradiction for their need to be seen as powerful, important, and above others. 

Can a person have more than one personality disorder?

Research has shown interesting patterns in how personality disorders can occur together. One small study involving a group of patients with BPD found that those who also had NPD tended to also meet the criteria for an HPD diagnosis.⁶ They also had more severe personality disorder symptoms overall, including increased paranoid and schizotypal traits.

Interestingly, these patients had fewer psychiatric hospitalizations and fewer non-personality related mental health conditions. This research highlights how personality disorders can overlap in complex, and sometimes unexpected, ways.

Histrionic personality disorder symptoms

People with HPD often exhibit certain patterns in their temperament.⁷ Habits that may be a sign of HPD include:

• Taking risks easily without worrying about consequences
• Loving to try new things and getting excited by novel experiences
• Being easily bored with routine
• Depending heavily on getting praise and attention from others
• Having trouble sticking with tasks when things get difficult

Other behaviors common in people with HPD include:⁸

• Feeling upset when they’re not the center of attention
• Acting in overly sexual or suggestive ways, even when it’s not appropriate
• Having quickly changing emotions that appear shallow and superficial
• Using their looks to get attention from others
• Speaking in a vague, dramatic style without giving much detail
• Acting dramatically and showing exaggerated emotions
• Being easily convinced or influenced by others
• Thinking relationships are more intimate than they really are

It’s important to remember that if someone acts in these ways, it doesn’t necessarily mean they have HPD. A diagnosis of HPD requires the presence of multiple symptoms that cause a significant impact on your daily life and relationships and is diagnosed by a mental health professional.

If you’ve noticed any patterns in your behavior or emotions that you’re concerned about, seek out a licensed mental health professional. They can help determine if these behaviors are due to HPD and whether you have other mental health concerns that may need to be addressed.

What causes histrionic personality disorder?

The exact cause of HPD isn’t fully known. It likely involves a combination of factors, including:⁹

Genetics: HPD tends to run in families, suggesting that there may be a genetic element that makes people more likely to develop the disorder.

Childhood experiences: Traumatic events, inconsistent or overindulgent parenting, and exposure to dramatic or inappropriate behaviors during childhood may increase the risk of developing HPD. In particular, childhood abuse and neglect (especially childhood sexual abuse) are considered major risk factors for developing HPD.

Learned behaviors: People who learned to use unhealthy behaviors to cope with difficult or traumatic situations as children may have a higher chance of developing HPD.

HPD is fairly rare, with one estimate suggesting it occurs in about 0.6% of the population.¹⁰ It’s four times more likely to be diagnosed in women compared to men, though it’s been argued that this is due to the criteria for HPD skewing towards feminine stereotypes.^11,12

Research suggests that HPD may have gender differences both in how it’s passed genetically and presented socially.¹³ Women seem to be more likely to inherit HPD than men. They also tend to display less aggressive, but more seductive, behavior comparatively.

The impact of HPD on well-being

Living with HPD can significantly affect a person’s quality of life and relationships. People often face challenges in several key areas:¹⁴

Relationships: An intense need for constant attention and approval can make it difficult to maintain lasting relationships. People with HPD may misread relationships, thinking they’re deeper and more intimate than they actually are. They may also become overly dependent on others for emotional support.

Emotional regulation: Quick mood swings are common in HPD. Even events that seem minor could trigger strong emotional reactions. Criticism or lack of attention can feel like personal attacks, leading to strong emotions. Emotional experiences tend to be exaggerated, making it difficult to self-regulate.

Social interactions: While they might excel at making first impressions, dramatic behavior and a constant need for admiration can eventually wear on others. People with HPD might use their appearance and personality to attract attention, but struggle to maintain deeper connections.

These challenges can create a pattern where attention-seeking behaviors, which initially may draw people in, ultimately push others away and affect success both professionally and personally.

HPD diagnosis and treatment options

Diagnosing HPD isn’t as simple as checking off symptoms on a list. Trained professionals need to observe someone’s behavior patterns over a long time and in different situations to determine if they have HPD.¹⁵ Making an accurate diagnosis can be a challenge because HPD symptoms look similar to, and overlap with, other mental health conditions.

HPD can be fairly treatment-resistant because people with HPD often struggle with insight into their behaviors. They may become disengaged from therapy when their needs for attention, approval, and validation are not met.

Therapy is the first choice for intervention, but there’s only limited evidence of its effectiveness. However, dialectical behavior therapy (DBT) has proven effective in managing the emotional dysregulation common in HPD and other Cluster B personality disorders.

Medications are generally not effective for treating HPD, and there are no FDA-approved drugs specifically for the disorder. But treating other mental health challenges that occur alongside HPD may help improve overall symptoms.

Therapy for histrionic personality disorder

Though research on therapy techniques for HPD has shown mixed results, it may still be worth exploring.

Dialectical behavior therapy (DBT) teaches skills like emotion regulation and tolerance for distress. Because people with HPD may struggle with these issues, DBT can be a helpful intervention.¹⁶

Clarification-oriented psychotherapy (COP) has shown some potential for treating HPD, with improvements in the patient-therapist relationship being consistently related to better outcomes.¹⁷

Functional analytic psychotherapy (FAP) has been proposed as a treatment option for Cluster B personality disorders, including HPD. The therapy focuses on building interpersonal skills using the therapist-client relationship, with the hope of creating lasting change.¹⁸

Schema therapy may be more effective than both clarification-oriented psychotherapy and treatment as usual for treating certain personality disorders. In one study, researchers found it led to higher recovery rates and lower dropout rates amongst participants.¹⁹

If you’re concerned that you or someone you know may have HPD, consider seeking out a mental health professional. Visit our directory to find a therapist in your area who specializes in assessing and diagnosing personality disorders.