Do you have someone in your life that needs to be the center of attention at all times? They might be described as “dramatic” or “theatrical” and seem to be willing to do whatever it takes to keep the spotlight on themselves. It can be nearly impossible for this person to maintain genuine relationships. It’s rare that they are able to show empathy and they may make risky life choices to keep the drama flowing.

If so, you may be dealing with a friend or loved one who has histrionic personality disorder.

The truth is, approval from others is what this person craves the most. They lack self-esteem and aren’t satisfied with the hum-drum of everyday life. One of the toughest things about having someone in your life with histrionic personality disorder is that they often bring down anyone who stops them from living out their need to be the center of the party.

Symptoms of Histrionic Personality Disorder

While you can’t diagnose someone with histrionic personality disorder yourself — only a psychologist, psychiatrist, or MD can do that — it can be helpful to know what to look for in case you may be able to encourage this person to seek treatment.

It’s estimated that about 2% of the population has histrionic personality disorder. The disorder seems to be more prevalent in women than men, although that may be because women are more likely to show overt symptoms such as flirting or wearing attention-grabbing clothing, and are also more likely to seek treatment for the disorder.

Histrionic personality disorder is one of ten personality disorders recognized by psychiatrists. It’s considered one of the “Cluster B” personality disorders, which also includes narcissistic personality disorder, borderline personality disorder, and antisocial personality disorder. These personality disorders are particularly difficult to treat, and are often described as “dramatic,” “volatile,” or “erratic.”

The DSM-5 lists specific criteria to diagnose histrionic personality disorder. Five of the criteria listed need to be met for a person to be diagnosed.

  1. Does not feel like themselves if they are not the center of attention
  2. Displays dramatic or provocative behavior
  3. A rollercoaster of emotions, often exhibiting “shallow” emotions
  4. Highly focused on physical appearance and uses physical appearance to garner attention
  5. Vague and imprecise speech patterns
  6. Overly dramatic and highly exaggerated emotions
  7. Gullible, highly suggestible
  8. Has an unrealistic concept of their intimate relationships; may think their relationships are more close-knit than they actually are

What Causes Histrionic Personality Disorder?

Like other personality disorders, histrionic personality disorder isn’t caused by one thing only, but rather a “perfect storm” of factors. Psychiatrists believe that most cases of the disorder occur as a result of a combination of genetic and environmental factors.

Childhood trauma

Childhood trauma is one potential cause of the disorder. It’s hypothesized that some children deal with childhood trauma by exhibiting behaviors common to histrionic personality disorder. What started out as a way to adapt to trauma becomes a full-fledged disorder if not addressed early on.

Parenting styles and genetics

The way a child is parented may also contribute to the disorder. Parents who do not provide appropriate boundaries, who are inconsistent, and who show over-indulgent tendencies may predispose certain vulnerable children to the disorder. Parents who exhibit traits of the disorder themselves, such as dramatic tendencies or abnormal sexual behavior, also may prompt the disorder in their children.

Finally, genetics may be at play. Histrionic personality disorder tends to run in families. Being part of a family with a history is psychiatric disorders, including other personality disorders or substance abuse disorders, may increase a person’s risk of developing histrionic personality disorder.

Histrionic Personality Disorder Treatment

One of the most heartbreaking and frustrating aspects of a disorder like histrionic personality disorder is that the disorder itself makes it difficult for sufferers to seek treatment. For many people with histrionic personality disorder, the idea that there might be something wrong with them seems nearly unfathomable, and would be viewed as a sign of weakness that threatens their exalted sense of self.

The good news is that if treatment is sought, histrionic personality disorder can be managed. Psychotherapy is thought to be the first line of treatment. Supportive therapy and psychodynamic psychotherapy (insight-oriented therapy) have been found to be successful; group therapy is not recommended, as people with histrionic personality disorder usually can’t stop themselves from craving the spotlight and may dominate the group dynamic.

Often, someone who has histrionic personality disorder will come to therapy not because of the disorder itself but because of the depression they are experiencing as a result of the disorder and their patterns of behavior. Many sufferers of histrionic personality disorder have profound mood disorders and may be helped with the use of psychotropic drugs such as antidepressants and antipsychotics.

If You Suspect Your Loved One Has Histrionic Personality Disorder

What can you do if you think a friend or loved one has histrionic personality disorder? First, it’s important to create clear boundaries for yourself and your own wellbeing. You will not be able to help your loved one if you fall prey to their dramatic tendencies.

Then, you will need to muster up all the compassion and patience you’ve got. If they are able to open up and show you their more vulnerable side, be a good listener. Urging them to get treatment for any related psychological disruptions — like anxiety or depression — might be the best way to help them begin to tackle their personality disorder; if possible, gently nudge them in that direction. Once they are diagnosed, you can help them to see that there is hope for them. They need to understand and accept their diagnosis and then keep the faith that a road to recovery is out there, that this disorder is not their destiny, and that a calmer and ultimately more fulfilling life awaits them.