Understanding Histrionic Personality Disorder: Symptoms, Causes, Gender Differences, and Treatment

Histrionic Personality Disorder (HPD) is a complex and often misunderstood mental health condition. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), HPD is characterised by a pervasive pattern of excessive emotionality and attention-seeking behaviour, typically beginning by early adulthood and present across a variety of contexts.

Individuals with HPD may display dramatic, highly expressive behaviours and often appear charming, energetic, and engaging. However, their emotional displays are frequently superficial and rapidly shifting. The need to be the centre of attention can manifest in both social and occupational settings and can cause significant distress or impairment in functioning.

Core Symptoms According to the DSM-5
The DSM-5 outlines the diagnostic criteria for HPD as the presence of five or more of the following:

Discomfort when not the centre of attention

Inappropriate sexually seductive or provocative behaviour

Rapidly shifting and shallow expression of emotions

Consistently uses physical appearance to draw attention to self

Style of speech that is excessively impressionistic and lacking in detail

Shows self-dramatisation, theatricality, and exaggerated expression of emotion

Is suggestible (easily influenced by others or circumstances)

Considers relationships to be more intimate than they actually are

These symptoms must lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Gender Differences in Presentation

While HPD is diagnosed in both men and women, research suggests it is more frequently identified in women — though this may reflect cultural or diagnostic bias. Female presentations tend to be marked by flirtatiousness, physical appearance, and overt emotionality. In contrast, male presentations might include boastful, dominant, or risk-seeking behaviour, often masked as charm or confidence.

Some psychologists argue that HPD in men may be underdiagnosed because certain traits (such as assertiveness or sexual bravado) are more socially accepted in males. Furthermore, traits that would attract concern in women may be overlooked or even rewarded in men, reinforcing gender-based discrepancies in diagnosis.

Causes and Contributing Factors

The exact cause of HPD is unknown, but it is generally considered to arise from a combination of genetic, neurobiological, and environmental factors. Early childhood experiences, such as inconsistent parental attention, trauma, or reinforcement of attention-seeking behaviour, may contribute to the development of this personality disorder.

Family history of personality disorders, substance misuse, or mental health difficulties can also increase vulnerability. Psychodynamic theory suggests that HPD may result from unresolved developmental conflicts related to attention, approval, or self-worth.
Ageing and Histrionic Personality Disorder

As individuals with Histrionic Personality Disorder age, the core need for attention and approval often persists, but the ways in which it manifests may shift. For many, the loss of youth — particularly physical attractiveness or sexual desirability — can lead to feelings of anxiety, irrelevance, or even depression. Women with HPD may find the decline in appearance-based validation particularly distressing, potentially resulting in exaggerated attempts to maintain youthfulness through cosmetic procedures or attention-seeking behaviour that appears increasingly incongruent with age. Men may respond by overcompensating in professional or social arenas, becoming boastful or controlling as a way to reclaim dominance or admiration. In both genders, the theatrical or provocative traits of HPD can evolve into bitterness, loneliness, or increased emotional volatility if their need for affirmation goes unmet. However, with maturity, some individuals develop greater self-awareness, particularly if supported by therapy, and may gradually shift toward more stable, authentic interpersonal relationships.

Treatment Options and the Role of the Psychologist

Treatment for HPD typically involves psychotherapy, with cognitive behavioural therapy (CBT) and psychodynamic approaches being most commonly used. The therapeutic goal is to help the individual understand the motivations behind their behaviours, regulate emotional expression, and develop healthier interpersonal skills.

CBT can be particularly effective in helping clients identify distorted thought patterns related to self-worth and attention, while psychodynamic therapy may address early relational issues and defence mechanisms. Clients with HPD may initially idealise their therapist, which can present challenges to therapeutic boundaries and progress. A trained psychologist will be aware of these dynamics and use them constructively within the therapeutic relationship.

In some cases, medication may be prescribed to manage co-occurring conditions such as anxiety or depression, but medication alone is not considered a primary treatment for HPD.

Public Awareness and Cultural Representation

Though celebrity diagnoses are rare due to privacy and stigma, there is speculation that several historical figures or entertainers may have displayed traits consistent with HPD. For example, Anna Nicole Smith and Marilyn Monroe have posthumously been associated with behaviours suggestive of the condition, though such claims remain speculative and should be approached cautiously.

The media often portrays histrionic traits in a caricatured manner, which can trivialise the lived experience of those with HPD and reinforce harmful stereotypes. In reality, HPD can be deeply distressing and isolating, especially when interpersonal relationships are marked by instability and unmet emotional needs.

Histrionic Personality Disorder is often misunderstood, partly due to its association with dramatic or performative behaviours. However, beneath the surface lies a vulnerable individual struggling with identity, self-worth, and interpersonal connection. With appropriate support, including structured psychological therapy and increased self-awareness, many individuals with HPD can experience improved relationships, emotional regulation, and life satisfaction.

Raising awareness of the condition, particularly regarding gender bias and misrepresentation, remains crucial in reducing stigma and improving access to meaningful treatment.