How to Diagnose Histrionic Personality Disorder

Recognizing Behavioral Symptoms

Identify attention-seeking behaviors. A person with histrionic personality disorder may dress or act in certain ways as a means to gain attention. For example, they may dress in an overly seductive way, or wear outrageous clothes or costumes as a way to seek attention. These people may attend events or social situations in which they can easily be the center of attention. Often, the behavior may be interpreted as inappropriate, over-the-top, or overly seductive. Behavior may be overly theatrical or purposefully flamboyant as a way to get people’s attention. For example, a woman guest may wear a wedding dress to another woman’s wedding, or a man may show up in an animal costume to a formal event. Someone with HPD may frequently dress inappropriately or in an attention-getting way, like by wearing revealing or seductive clothing to work, or putting on lots of jewelry or makeup. These people are often considered the “life of the party.” They may be viewed as charming or charismatic.

Recognize an overly dramatic response to problems. A person with histrionic personality disorder may respond to minor problems as if they are major or life-threatening. Instead of finding solutions, this person may exaggerate the severity of the problem or create other problems where they do not exist. Even minor problems provide the opportunity to create drama, which allows the person to draw more attention to themselves. For example, a person may date someone for one week and when the relationship does not work out, they may threaten suicide. Instead of taking responsibility, the person may blame other people or external factors for their own problems.For example, if the person’s business fails due to negligence and poor decision making, they may blame staff, location, bad customers, or other external factors. The person's behavior or reactions may be so intense or attention-grabbing that it may frighten, embarrass, or otherwise put off the people around them.

Note excessively dramatic speech. This person may speak very dramatically or emphatically. They may express strong opinions. Yet, when pressed, this person may be hesitant to respond or avoid giving details to provide any sort of evidence for the opinions. The person may appear more concerned with expressing the opinion than supporting it. For example, the person may have very strong and controversial beliefs, such as saying that all countries should be communist or that having children should be regulated by the government. When asked why, they may not give a direct answer or provide any reasons for these beliefs. They may inject themselves into conversations with a strong, opinionated statement - such as suddenly interrupting a meeting at work to say that the current project will make the company will go bankrupt.

Notice self-centered behavior. A person with HPD may seem to be overly focused on themselves, wanting to talk about themselves or their thoughts, without showing much concern for other people's perspectives or problems (and may even minimize them). As a result, someone with HPD may have strained relationships and others may view them as selfish, uncaring, or insensitive.

Be alert for impulsivity. A person with HPD might constantly seek out high-energy situations or events, and do things without forethought to get attention. They may also have strong or harsh reactions to things without considering how their actions might affect other people, which can strain their relationships.

Identifying Emotional and Interpersonal Symptoms

Observe shallow emotions. A person with histrionic personality disorder may be overly dramatic, yet may be shallow or unable to relate to others in their own personal emotional experience. Emotions may change rapidly and others may perceive the individual as disingenuous or insincere. For instance, the person may mention feeling extremely upset about something, but later become almost euphoric, as though the upsetting event never happened. They may seem to feel their emotions in very shallow extremes. It may seem to others like the person is constantly acting out their emotions or faking their feelings or responses, like they're putting on a performance. Does the person appear difficult to relate to? If you bring up a problem, does this person make it about themselves instead?

Recognize a need for reassurance or approval. This person may want assurance that they are accepted by others. The individual may check in on their social status, or do things to purposefully gain attention from others or create a reaction. As a result, this person may be easily susceptible or prone to peer pressure. They may also be easily influenced by other people’s opinions. This person may say, “I know that Jordan hates me, but you think I’m a good friend, right?” To gain approval, this person may do things like buy gifts to gain acceptance, or put down other people to make themselves look better. This person may be overly sensitive to criticism or disapproval. This may result in an emotional explosion or blaming others.

Identify an overestimation of closeness in relationships. Someone with histrionic personality disorder may believe they have many close friendships when in reality, people are more acquaintances or shallow friends. This person may also overestimate the level of intimacy in romantic relationships. The behavior can get in the way of truly intimate relationships. This person may act overly familiar with strangers or acquaintances. Someone with HPD may make inappropriate advances on others, such as propositioning coworkers or people they hardly know, or broaching professional boundaries (e.g. trying to befriend their psychiatrist).Did You Know? Someone with HPD may be overly flirtatious or sexually forward with many people, even if they aren't attracted to the people they're flirting with.

Notice discomfort in being ignored. Fear may exist around being ignored, so the person may create attention around themselves. This person receives social validation by gaining the attention of others. If this person is not in the center of attention, they may feel uncomfortable or unappreciated. They may respond to feeling uncomfortable by doing something outrageous to feel comfortable again. When thinking about this person, do you notice that they crave attention and cannot be without it? How does this person respond when ignored or overshadowed?

Note if the person is easily bored. Someone with HPD may become restless with routines or mundane activities and frequently seek out excitement. They may frequently change things up or drop activities or projects midway through, and struggle with delayed gratification. It may seem like they thrive on excitement or drama, and can't be without it. Someone with HPD may constantly switch from job to job, friendship to friendship, and relationship to relationship as a means of excitement.

Ruling Out Other Conditions

Discern between histrionic personality disorder and anxiety disorders. People with anxiety disorders may catastrophize about problems, and act as if they are much more serious than they really are. They also may need lots of reassurance from others. However, there is usually no desire to be the center of attention. For instance, someone with illness anxiety disorder (hypochondria) may frequently go to the doctor over little things, but this is because they genuinely think they're sick, not to get attention. Anxiety can often co-occur with histrionic personality disorder.

Distinguish histrionic personality disorder from narcissistic personality disorder (NPD). HPD and NPD can both involve attention-seeking behavior, self-centeredness, difficulty handling criticism, and trouble with empathy. However, NPD involves feelings of grandiosity and an inflated self-importance, and the person doesn't require attention to feel validated. Signs of NPD include: Heightened feelings of importance, entitlement, or talent Fantasizing about power, importance, intellect, or attractiveness Manipulating others for their own gain Wanting others to think of them as important or be jealous Notable lack of empathyTip: Consider what kind of attention the person is seeking. Someone with NPD wants positive attention and for people to think highly of them; someone with HPD will seek any type of attention, positive or negative.

Differentiate between histrionic personality disorder and borderline personality disorder (BPD). HPD and BPD may involve intense relationships, behavior viewed as attention-seeking, and explosive reactions. Unlike in HPD, someone with BPD tends to have a negative self-image, feels their emotions very intensely, and may see situations or relationships in black-and-white. Signs of BPD include: Fear of abandonment, taking action to avoid being abandoned, and struggling to trust other people Idealization (thinking the best of someone) and devaluation (thinking the worst of someone) in interpersonal relationships Intense, hard-to-control emotions Confusion or uncertainty over their sense of self (unstable identity) Dissociation Constantly feeling empty or hollow Self-injurious behavior and/or suicidal thoughts or intent

Know the difference between histrionic personality disorder and dependent personality disorder. Both histrionic and dependent personality disorder involve an intense need for approval, rapidly-progressing relationships, and "clingy" or seemingly attention-seeking behavior. However, someone with dependent personality disorder tends to avoid the theatrical or seductive behavior of HPD, and is often more inhibited due to fear of abandonment. Signs of dependent personality disorder include: Feeling unable to take care of themselves or be independent Difficulty in making any decisions independently; having others make decisions for them Frequently seeking support, reassurance, or comfort from others Struggling to disagree or voice opinions that are different from others; being a people-pleaser Fear of not being in a close relationship, or of being abandoned

Obtaining a Diagnosis

Obtain a psychological evaluation. A psychologist may diagnose histrionic personality disorder through use of evaluation and observation. Personal, medical, and family history will be discussed. The psychologist may assess the frequency, duration, and severity of the symptoms. Common factors to assess include behavior, appearance, and personal history. It can be important to assess a person’s social and romantic history to gain insight on how they relate with others.

Identify onset. Histrionic personality disorder is most often diagnosed in the late teens or early 20s. Adolescents commonly display behavior that is immature or dramatic, yet this behavior typically decreases and is replaced with more mature or socially adaptive behavior and emotional regulation. If the behavior increases or does not improve into adulthood, then histrionic personality disorder may be considered. Histrionic personality disorder is more often diagnosed in women than men, however, this may reflect socially acceptable roles and not the actual prevalence of histrionic disorder in the general population. For example, a woman who is more sexually forward may be considered outside the norm, while this may be considered normal behavior for men.

Note co-occurring disorders. Many people with histrionic personality disorder may experience depression and/or anxiety as a result of their conflicts with others or after a failed romantic relationship. They may also feel depressed when not the center of attention or when alone. Sometimes, treatment is sought to cope with the depression. Substance use is common in those with histrionic personality disorder. If a person uses substances that affect their functioning, substance treatment may be necessary.

Be aware that there's no known cause of histrionic personality disorder. Although there are no direct links associated with histrionic personality disorder, there may be some probable causes or associated traits. For example, genetic influences and early childhood experiences may contribute to the experience of this personality disorder. Childhood experiences might include learning behaviors or responses from adults. This could be unpredictable attention given as a child. A child may become confused when feedback is inconsistent or when they don’t know how to interpret when parents are pleased.

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