Histrionic Personality Disorder and BPD

Histrionic personality disorder (HPD) is a personality disorder that tends to co-occur with other personality disorders, particularly borderline personality disorder (BPD), narcissistic, and dependent personality disorders. There is a great deal of overlap between BPD and HPD features, so much so that some experts believe that HPD may not actually be distinguishable from BPD.

HPD is one of 10 personality disorders recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). HPD is one of the Cluster B disorders, which are characterized as dramatic, overly emotional, and/or erratic.

The DSM-5 defines histrionic personality disorder as a pattern of extreme emotionality and attention seeking behavior that begins by early adulthood and is obvious in different situations. In addition, you must have five or more of the following signs or symptoms to be diagnosed with HPD:

• Discomfort in situations in which you're not the center of attention
• Interaction with others that's often characterized by inappropriate sexually seductive or provocative behavior
• Rapidly shifting and shallow expression of emotion
• Consistently uses physical appearance to draw attention to self
• Style of speech that is excessively impressionistic and lacking in detail
• Shows self-dramatization, theatricality, and exaggerated expression of emotion
• Is easily influenced by others or by circumstances
• Considers relationships to be more intimate than they actually are

People with HPD might be described as being overly dramatic, emotional, or attention-seeking. This pattern of behavior rises to the level of a clinical disorder when it significantly interferes with relationships, work, or other important domains in life.

There are only a few studies that have examined the co-occurrence of HPD and BPD. One particularly rigorous study found that about 15 percent of patients with BPD also meet the diagnostic criteria for HPD. In another study that used a community sample, about 10 percent of people with BPD also met criteria for HPD.

There is marked overlap between the symptoms of HPD and BPD. For example, both share the features of rapidly shifting and reactive emotions, both are associated with impulsive behavior, and both are characterized by very strong expression of emotion.

While some clinicians argue that the qualities of these symptoms are different in HPD versus BPD, for example, that the rapidly shifting emotions in HPD are not experienced with the same depth and intensity as those in BPD, other experts have argued that HPD and BPD are not necessarily distinct disorders. However, despite predictions that the HPD diagnosis would be dropped in DSM-5, it was not, and so it remains its own specific and unique diagnosis.

While there is some advice for clinicians treating HPD, it's generally based on expert opinion or experiences rather than on research data. Much more research is needed on this topic, but in general, psychotherapy is often used and may be helpful. If you have symptoms of other issues such as depression or anxiety, medication may help to alleviate those symptoms as well.