Compass
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HPD

Histrionic Personality Disorder

Cluster B. Dramatic / Emotional / Erratic · Table 7.2 [1]

Pervasive, excessive emotionality and attention-seeking; uncomfortable when not the center of attention.

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Characteristics (Table 7.2) [1]

Triggering Event(s)Situations in which the person is not the center of attention
Behavioral Style
  • Self-dramatization
  • Suggestibility
  • Charming and excitement-seeking
Interpersonal Style
  • Needs to attract others' attention
  • Seductive or provocative interactions
  • Exhibitionistic and/or flirtatious
  • Misreads intimacy of relationships
Cognitive Style
  • Impulsive
  • Thematic, field-dependent
  • Impressionistic style of speech
Affective Style
  • Rapidly shifting, shallow expression of emotions
  • Exaggerated emotional display
Temperament
  • Hyperresponsive infantile pattern
  • Externally oriented for gratification
Attachment StylePreoccupied
Parental InjunctionLearned that attention was conditional, granted only in exchange for compliance.
Self-ViewFeels a compelling need to be seen and noticed.
World-ViewFinds life anxiety-provoking and therefore feels owed special care and consideration from others.
Maladaptive Schemas
  • Approval-seeking
  • Emotional deprivation
  • Defectiveness
Optimal Diagnostic CriterionFeels ill at ease whenever they are not the focus of everyone's attention.

DSM diagnostic criteria

Essential feature

A far-reaching pattern of overblown emotional display and attention-seeking, present from early adulthood.

Criteria, 5 or more of 8 criteria
  • Grows uncomfortable in any setting where they are not the center of attention.
  • Frequently relates to others through inappropriately seductive or provocative behavior.
  • Expresses emotions that shift quickly and lack depth.
  • Routinely leverages physical appearance to draw others' notice.
  • Speaks in a sweeping, impressionistic way that is thin on specifics.
  • Comes across as theatrical and self-dramatizing, with emotion pitched for effect.
  • Is readily swayed by other people or by circumstances.
  • Overestimates how close and intimate their relationships really are.
Key differentials
  • Borderline PD (adds identity disturbance, self-harm, abandonment terror)
  • Narcissistic PD (attention sought to confirm superiority, not approval)
  • Dependent PD (clinging without the dramatic display)
  • Somatic symptom disorder

Treatment

Goals
  • Develop attention to detail and reflective (vs. impressionistic) thinking
  • Build tolerance for not being the center of attention
  • Identify and pursue genuine, internally defined goals and relationships
Strategy

Provide structure that counters the global, impressionistic cognitive style; gently slow the patient down and ask for specifics. Maintain professional boundaries in the face of seductive or dramatized relating, reframing the wish for attention as a wish to be valued.

Modalities
  • Cognitive therapy (systematic, detail-focused)
  • Group therapy (interpersonal feedback)
  • Psychodynamic / interpersonal therapy
Interventions
  • Slow the narrative and ask for concrete detail to build reflective capacity.
  • Set and maintain clear boundaries around seductive or dramatized relating.
  • Use here-and-now feedback (especially in group) on the impact of attention-seeking.
  • Help articulate authentic preferences and longer-term goals.
Common obstacles
  • Seductive or dramatized relating that tests boundaries
  • Superficial engagement; difficulty staying with emotionally specific material
  • Approval-seeking that shapes responses to please the therapist
Prognosis

Fair to good; many patients respond to structured therapy, especially when attention-seeking and superficial relating are addressed in the relationship.

Practise this presentation

Bianca: A dramatic story, short on the details that matter
42-year-old presenting with 'a complete breakdown'; vivid and theatrical but vague, and visibly deflated when attention shifts.
Intermediate

For training only. Diagnostic criteria are summarised, consult the full sources [1,2] for the complete text; see References. Not a substitute for supervised clinical assessment.