Histrionic personality disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 26, 2016
StartDiseasesHistrionic personality disorder

Histrionic personality disorder is a maladaptive behavioral pattern. It is characterized by acts of attention-seeking, excessive reactions, and ongoing personal turmoil, but individuals with this condition are often high-functioning and intelligent. The most obvious and salient symptom of this condition is the individual's need for attention and their necessity to be at center stage in all situations in a manner that disturbs their relationships with others in a dramatic way. 


Definition & Facts

Personality disorders constitute internal distress caused by a sharp deviation in the internal and external cultural expectations set by each individual. By “cultural,” what is meant is the compendium of intellectual, gender-based, financial, educational and social goals that individuals set for themselves, or are expected to achieve by others. A histrionic personality condition stems from how the individual uses his or her own behavioral map, and how they use the tools within the environment, to respond to this, and other external stimuli.

As with most personality disorders, the onset of histrionic personality disorder occurs in adolescence or during early adulthood. The tendency of people with this disorder is to maintain a rigid view of themselves that detours from a flexible, healthy and accepting daily negotiation of who they are. As such, they tend to exhibit excessive emotional reactions to everyday situations that other individuals would manage with less emphasis. 

Symptoms & Complaints

Histrionic people are universally described as people who act out when the focus of attention within a group, or from an individual, is not centered on them. The acting out entails attention-seeking activities that involve over-dramatization, theatrics, dangerous activities, threats, and boisterous behavior.

Other, more antisocial behaviors may include provoking arguments, breaking rules on purpose, antagonizing, or even conducting inappropriate sexual overtures, just for the sake of getting people’s attention.

Histrionic personality conditions are not considered to pose a medical or clinical threat. However, the consequences that may arise as a result of the antics that histrionics tend to conduct may lead to dangerous scenarios such as physical confrontations, break-ups, divorce, or family disputes.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V), histrionic personality disorder is diagnosed more in females than males. These individuals are often high-functioning, cognitively advanced, socially adept and even charming. They tend to naturally attract attention when they first come in contact with people.

One of the best ways to explain histrionic personality disorder is by using the acronym “PRAISE ME,” which is an accepted practice among psychologists. The acronym stands for each of the specific requests that individuals with this disorder demand when they are expressing symptoms:

  • P, stands for their provocation, either inciting fights, or acting sexually for attention.
  • R, stands for how they view relationships; they consider themselves immediately attached to people or believe that they are boyfriends/girlfriends or love interests of others.
  • A, stands for the attention that they seek consistently.
  • I stands for the way that they become so easily influenced by the opinions and judgments of others.
  • S stands for their impressive use of speech, which details a lot but says nothing.
  • E stands for their lack of empathy and shallow emotions.
  • M stands for “made up,” that is manipulating their appearance in order to call the attention of others.
  • E is for excessive emotion, or theatrics. 


Personality is a combination of environmental input and genetic inheritance. The environmental input comes from the parameters and limitations within which we operate as members of a cultural group. The genetic inheritance factors come from our inherent propensity to behave, psychological blueprint, or any inherited biological pathology.

Given that there are so many variables involved in personality development, the DSM-V attributes no specific causal factor, but a combination of the previously mentioned factors as the source of histrionic personality disorder. Additionally, childhood events and potentially traumatic situations may cause the onset of the condition. 

Diagnosis & Tests

The typical protocol followed by clinicians upon an initial complaint is to order a complete medical history and psychiatric history. Physical examinations, blood tests, and neuroimaging studies are usually included among a battery of other tests. This helps rule out any underlying conditions that may affect behavior.

There are specific personality and assessment tools used by mental health counselors in the form of checklists. Often these checklists are created out of the Diagnostics and Statistical Manual of Mental Disorders, 5th edition, (DSM-V), which is the authority in diagnosing psychological conditions and illnesses. In addition to checklists, personal interviews and social history helps to bring together all the variables that are used to finally diagnose this, or any other mental disorder.

Treatment & Therapy

The biggest challenge in treating mental health conditions is motivating the individual to come forward with the initial complaint. Another is to have the individual state the exact symptoms of the condition so that a clear assessment is made.

Client-centered therapy and cognitive behavioral therapy (CBT) are the two forms of psychotherapy most widely-used. The method of treatment is non-invasive; that is, the professional will not physically intervene in any way with the client except for one-on-one conversations, asking questions, and developing action plans.

Therapy will only work if the client abides by the action plan created with the therapist and makes a commitment to attend ongoing visits. Journaling, personal affirmations, reading and sharing with family members are some of the methods used by clients to help themselves during the course of psychotherapy.

Prevention & Prophylaxis 

Personality disorders are dependent on a mixture of biology, life events that shape the overall view of life that a person has, and however those events affect their views of themselves. This means that personality disorders are neither preventable nor predictable; they happen as a consequence of environmental input and genetic inherited factors.

This is why it is important for people to be knowledgable and vigilant about any symptoms of personality conditions that hinder their relationship with others. Such vigilance and self-awareness may help a person establish meaningful, safe, altruistic, and loving bonds with the people around them.