Psychotherapy, as with most personality disorders, is the treatment of choice. Group and family therapy approaches are generally not recommended, since the individual who suffers from this disorder often draws attention to themselves and exaggerates every action and reaction. People with disorder often come across as "fake" or shallow in their interpersonal relationships with others. Patients often are express all feelings with the same depth of emotion, unaware of the subtleties of their own emotional states and of the vast range available to them.
Therapy should generally be supportive and good rapport will usually be easily established with the patient early on. Clinicians may often find themselves placed in a "rescuer" role, in which the therapist will be asked to constantly reassure and rescue the client from daily problems. Every problem is usually expressed in a dramatic fashion. Many times the therapist will be perceived as sexually attractive to the patient. Boundary issues in relationships and a clear delineation of the therapeutic framework are relevant and important aspects of therapy.
Approaches which take advantage of matter-of-fact and realistic assessment of situations and problems can also be important. Solution-focused therapy is often appropriate with this client. Most therapy approaches should not be focused on the long-term, personality change of the individual, but rather short-term alleviation of difficulties within the person's life. Few people could afford the time or cost required to "cure" someone of this disorder. This should be explicitly stated up-front at the onset of therapy to dismiss any thoughts the client may have of a "magical" cure for this disorder.
Suicidal behavior is often apparent in a person who suffers from histrionic personality disorder. Suicidality should be assessed on a regular basis and suicidal threats should not be ignored or dismissed. Suicide sometimes occurs when all that was intended was a gesture, so all such thoughts and plans should be taken with the same seriousness as with any other disorder. A suicide contract should be established to specify under what conditions the therapist may be contacted in case the client feels like hurting him or herself. Self-mutilation behavior may also be present in this disorder and should also be taken seriously as an issue of importance to discuss within therapy.
Therapists will find that taking a somewhat skeptical stance within therapy to be useful, due to the usual exaggeration of events and problems by the patient. By following a line of reasoning to its logical conclusion, the client can usually discover the unrealistic expectations and fears associated with many behaviors and thoughts. Since many people who have histrionic personality disorder will emphasize attractiveness ("style over substance") in their lives and relationships, discussing alternatives and trying out new behaviors may be helpful. The therapist can also help by pointing out, in session, when the client is using shallow criteria in which to judge another. The patient should eventually look to be able to do this themselves throughout their lives.
Insight- and cognitive-oriented approaches are generally largely ineffective in treatment of this disorder and should be avoided. People with this disorder are often incapable of examining unconscious motivations and their own thoughts to a degree where it is helpful. While these approaches can be a part of a larger treatment plan, they should not be the focus. Helping the client to examine interactions from a more objective point of view and emphasizing alternative explanations for behavior is likely to be more effective. Examining and clarifying a client's emotions are also important components of therapy.
Clinicians will often experience reactions to treating this disorder, because of the dramatic nature of the patient. Because of this possibility, therapists should be more attuned to their own feelings within the therapy setting and ensure that they are treating the patient fairly and with respect. As with Borderline Personality Disorder, individuals with histrionic personality disorder often find themselves discriminated against by mental health professionals because of the symptoms of their disorder. Clinicians and patients should be aware of this possible discrimination.
Last reviewed: By John M. Grohol, Psy.D. on 9 Oct 2013
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