The Center of Attention

Rhonda had an insatiable craving to be the center of attention and felt uncomfortable when she wasn't. She used her physical appearance to get attention and would dress and act in inappropriately provocative and sexual ways. Some people saw her as outgoing and flirtatious. Others saw her as dramatic, unstable, and erratic. Rhonda was married to her fourth husband and had left a string of relationships, affairs, and one-night stands in her wake. Following problems at work and instability in her relationships, she was misdiagnosed with borderline personality disorder but later diagnosed correctly with Histrionic Personality Disorder.

Histrionic Personality Disorder

Histrionic personality disorder, or HPD, is also known as dramatic personality disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it's a Cluster B disorder, which refers to people who have difficulty regulating their emotions and behaviors. HPD is a lesser-known type of these disorders. It's often overshadowed by the more publicized ones, including Narcissistic, Borderline, or Antisocial Personality Disorders. (Those with this latter condition are popularly known as psychopaths and sociopaths.)

HPD is the only modern category in diagnostic classifications that conserves a derivative of the old concept of hysteria. The word hysteria derives from the Greek term “hystera,” meaning the womb or uterus. It has been used since ancient times and appears in the medical manuscripts of the Greeks, Romans, and Egyptians. In more recent times, psychoanalysts, including Sigmund Freud, have discussed "hysterical neuroses" as a re-experience of past psychological trauma, laying a foundation for modern theories of HPD.

Unstable emotions and relationships

In terms of modern diagnosis, HPD is characterized by a distorted self-image and a pattern of attention-seeking and impulsive behaviors. Sufferers demand attention and become depressed when they don't get it. They are overly seductive and flirtatious. People with HPD often dress and behave in inappropriately seductive and sexual ways, not only with romantic interests but also in other contexts, such as work or school. HPD is marked by unstable emotions; sufferers are seen as extroverted and dramatic, and their expressions of emotions appear to be exaggerated, shallow, and rapidly changing. The disorder is also marked by unstable relationships; sufferers crave novelty and bore easily. They often think their relationships are closer than they are, and they may change friends and romantic partners frequently.

With the possibility of increased anxiety, HPD can also include self-harm behaviors, eating disorders, and addictions. In terms of causes, researchers generally think that genes and early trauma may be responsible for the condition, with abuse or instability during childhood increasing the risk of developing the condition. HPD usually emerges by the late teens or early 20s. It is diagnosed in women more often, although due to diagnostic bias, it's likely the condition is misdiagnosed or underdiagnosed in men. Men don't often fit the "hysterical" stereotypes of HPD but may simply mask symptoms better than women and girls do.

Misdiagnosis and comorbidity

HPD is one of the most ambiguous diagnostic categories in psychiatry and, like in Rhonda's case, it's often misdiagnosed as one of the other personality disorders. In general, there is much overlap with Cluster B types, which share features and symptoms. Some HPD patients share traits with other personality disorders, while comorbidities are common. It's important for a person to be properly evaluated and to receive a correct diagnosis in order to gain access to appropriate treatment.

There is no cure for HPD. It's a lifelong condition, but it can be successfully managed through appropriate therapy, where people with this condition can gain insight into the disorder and be able to function better socially.

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