Histrionic Personality Disorder Treatment
Histrionic personality disorder (HPD) is “a pervasive pattern of excessive emotionality and attention seeking” that starts by early adulthood and occurs in a variety of settings, according to the DSM-5.
Individuals with HPD get uncomfortable when they’re not the center of attention. They tend to be dramatic and dependent. They often fish for compliments. Their behavior can be inappropriately seductive or provocative. Their opinions and feelings are easily influenced by others. And they think their relationships are more intimate than they really are.
Symptoms of HPD tend to overlap with other personality disorders, including borderline personality disorder, narcissistic personality disorder, and dependent personality disorder.
HPD also can co-occur with mood disorders, dissociative identity disorder, and somatic symptom disorder.
The treatment of choice for HPD is psychotherapy. Medication may be helpful for co-occurring symptoms and conditions.
Research on histrionic personality disorder (HPD) is very limited. In fact, there are no controlled, rigorous studies on psychotherapy interventions, which means there aren’t definitive recommendations. Case studies, treatment manuals, and other resources, however, do point to some promising therapies. These include: cognitive therapy, cognitive analytic therapy, and functional analytic psychotherapy.
Cognitive therapy (CT) for HPD focuses on specific and concrete treatment goals that are created collaboratively, between client and clinician. Goals might include: tolerating situations with low approval or attention from others; demonstrating effective communication and social skills; showing empathy for others; and increasing awareness of emotions and successfully regulating them.
Therapists help clients challenge common core beliefs in HPD, such as: “I need others to admire me to be happy,” “I must always be able to get other people’s attention,” “Being rejected or not being able to get approval shows that I am worthless and unlovable,” and “Being rejected is terribly humiliating and unbearable.”
Therapists also help clients test out their fears around rejection by setting up behavioral experiments. And individuals learn to build confidence when facing actual criticism.
Cognitive analytic therapy (CAT) is a time-limited, collaborative therapy that helps individuals identify relational patterns that’ve led to their self-defeating, unhelpful thoughts, feelings, and behaviors. CAT consists of three processes: reformulation, recognition, and revision.
The first process is the most important. It involves the therapist and client working together to write a non-blaming letter about how and why these relational patterns developed. CAT helps the client learn to objectively observe their behavior and its effects on others and themselves. CAT also helps the client develop and practice more adaptive relational patterns (which is partly done through the relationship with the therapist).
At the end of therapy, which typically consists of 16 sessions, both therapist and client write each other a letter reflecting on the progress made and the process of therapy.
Functional analytic psychotherapy (FAP) is based on the belief that the problems individuals experience in their relationships also occur in session with a therapist. In other words, if an individual has a hard time expressing their emotions with a partner, they’ll also have a hard time expressing their emotions with their therapist.
Therapists identify different client responses that occur in the therapeutic relationship, which are called clinically relevant behaviors (CRBs). CRBs include problematic behaviors that occur in session along with more effective behaviors. When a client engages in adaptive behavior, the therapist responds by reinforcing or supporting that behavior.
For example, according to an article in the Journal of Contemporary Psychotherapy, “if the client described his or her level of discomfort in making a request for social support from the therapist, then the therapist would attempt to reinforce this response naturally by providing that support and possibly commenting on how easy it is to be supportive when the client makes a clear request.”
Because HPD overlaps with other personality disorders (e.g., borderline personality disorder), it’s possible that the same treatments may also help HPD, according to Carrotte and Blanchard.
Currently, there’s no medication approved by the U.S. Food and Drug Administration for histrionic personality disorder (HPD). In fact, medication typically isn’t prescribed for treating HPD symptoms.
Instead, medication is often prescribed for co-occurring conditions. For example, a doctor might prescribe a selective serotonin reuptake inhibitor (SSRI) for treating clinical depression.
If your doctor prescribes a medication, it’s important to discuss potential side effects, how those side effects can be reduced, when you should expect to see improvement, and what that improvement will look like.
Self-Help Strategies for HPD
If you have histrionic personality disorder (HPD), the best action you can take is to seek therapy. Below are additional strategies you can try on your own.
Practice self-care. Try to get enough sleep and rest. Include nutrient-rich foods in your diet. Participate in physical activities that you enjoy. Cut down on alcohol (and eliminate any other unhealthy substances). Not only are these habits vital for your well-being, but they also help you manage depression and anxiety, which tend to co-occur with HPD.
Engage in effective stress management. Prevent and reduce stress by participating in healthy activities, such as meditating, practicing yoga, and spending time in nature.
Journal about your emotions. Journaling can help you identify your emotions, better understand them, and release them. Try to add a 15-minute journaling practice to your morning and bedtime routines. Start each practice by simply asking yourself how you’re feeling right now (or what’s been bothering you).
Check out reputable resources. It also can help to use workbooks to learn and practice ways to manage distress and overwhelming emotions. There’s very little on HPD, but because the disorder overlaps with borderline personality disorder (BPD), it might help to look for workbooks on BPD. Here’s one example: The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation and Distress Tolerance.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Callaghan, G.M., Summers, C.J., Weidman, M. (2003). The treatment of histrionic and narcissistic personality disorder behaviors: A single-subject demonstration of clinical improvement using functional analytic psychotherapy. Journal of Contemporary Psychotherapy, 33, 4, 321-339. DOI: https://doi.org/10.1023/B:JOCP.0000004502.55597.81.
Carrotte, E, and Blanchard, M. (2018, June). Understanding how best to respond to the needs of Australians living with personality disorder. Melbourne. Prepared by SANE Australia for the National Mental Health Commission. Retrieved from https://www.sane.org/images/NMHC_SANE_PD_Report.pdf.
McCutcheon, L.K., Kerr, I.B., Chanen, A.M. (2019). Cognitive analytic therapy: A relational approach to young people with severe personality disorder. In Ueli Kramer (Ed.), Case formulation for personality disorders (95-111). Cambridge, MA: Academic Press. DOI: https://doi.org/10.1016/B978-0-12-813521-1.00006-0.
Smith, F., Lilienfeld, S.O. (2012). Histrionic personality disorder. Encyclopedia of Human Behavior, 312-315. DOI: https://doi.org/10.1016/B978-0-12-809324-5.06447-6.
Sungur, M.Z., Gündüz, A. (2015). Histrionic personality disorder. In Aaron T. Beck, Denise D. Davis & Arthur Freeman (Eds.), Cognitive therapy of personality disorders (3rd ed., pp. 325-345). New York, NY: Guilford Press.
Tartakovsky, M. (2020). Histrionic Personality Disorder Treatment. Psych Central. Retrieved on April 2, 2020, from https://psychcentral.com/disorders/histrionic-personality-disorder/treatment/