case study of someone with histrionic personality disorder

The Histrionic Patient - A Case Study

Vivid description of what it's like living with Histrionic Personality Disorder. Read therapy notes from woman diagnosed with Histrionic Personality Disorder.

Notes of first therapy session with Marsha, female, 56, diagnosed with Histrionic Personality Disorder

Marsha visibly resents the fact that I have had to pay attention to another patient (an emergency) "at her expense" as she puts it. She pouts and bats suspiciously long eyelashes at me: "Has any of your female patients fallen in love with you?" - she suddenly changes tack. I explain to her what is transference and countertransference in therapy. She laughs throatily and shakes loose an acid blond mane: "You may call it what you want, doctor, but the simple truth is that you are irresistibly cute."

I steer away from these treacherous waters by asking her about her marriage. She sighs and her face contort, on the verge of tears: "I hate what's been happening to Doug and me. He has had such a stretch of bad luck - my heart goes out to him. I really love him you know. I miss what we used to be. But his rage attacks and jealousy are driving me away. I feel that I am suffocating."

Is he a possessive paranoid? She shifts uneasily in her seat: "I like to flirt. A little flirting never hurt nobody is what I say." Does Doug share her insouciance? He accuses her of being too provocative and seductive. Well, is she? "A woman can never be too much of either" - she protests mockingly.

Has she ever cheated on her husband? Never. So, why his jealous tantrums? Because she has been pretty direct with men she fancied, told them what she would do with them and to them if circumstances were different. Was this a wise thing to do in public? Maybe not the wisest, but it sure was fun, she laughs.

How did men react to her advances? "Usually, with an enormous erection." - she chuckles - "How did you react, doctor?" I was embarrassed, I admit, even annoyed. She doesn't believe me, she says. No red-blooded male has ever been put off by the lure of an attractive female and "from where I sit, you sure look as red-blooded as they come."

Doug has been her fourth serious relationship this year. How can such a short-lived liaison be meaningful? "Depth and intimacy can be created overnight" - she assures me, they are not a function of the length of acquaintance. But surely they depend on the amount of time spent together? "Is this your wife?' - she points at a silver-framed picture on my desk - "I bet you are hitting it off in the sack!" Actually, I tell her, that's my daughter. She shrugs off her faux-pas and sprawls across my duvet, long legs exposed to the hip and crossed at the ankles.

She sighs theatrically and shields her eyes with her hand: "I wish it was all over." Does she mean her relationship with Doug? "No, silly", she was referring to her tumultuous life and its vagaries. Does she really mean it? Of course not. She rolls to one side, leaning on her elbow, face supported by an open palm: "I just wish people were more lighthearted, you know? I wish they knew how to enjoy life to the maximum, give and take with joy. Isn't this what psychotherapy is all about? Aren't these the skills you, as a psychiatrist, are trying to instil in your patients?"

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next:  The Schizoid Patient ~ back t o: Case Studies: Table of Contents

APA Reference Vaknin, S. (2009, October 1). The Histrionic Patient - A Case Study, HealthyPlace. Retrieved on 2024, July 27 from https://www.healthyplace.com/personality-disorders/malignant-self-love/histrionic-patient-a-case-study

Medically reviewed by Harry Croft, MD

Related Articles

What is obsessive-compulsive personality disorder, other personality disorders, sociopathic children: how do they become that way, the history of personality disorders, persecutory anxiety, international classification of diseases (icd) 10, i cannot forgive: piercing people's emotional shields.

2024 HealthyPlace Inc. All Rights Reserved. Site last updated July 27, 2024

Histrionic Personality Disorder

Reviewed by Psychology Today Staff

Histrionic personality disorder is characterized by constant attention -seeking, emotional overreaction, and seductive behavior. People with this condition tend to overdramatize situations, which may impair relationships and lead to depression . Yet they are highly suggestible, easily susceptible to the influence of others.

Personality reflects deeply ingrained patterns of behavior and the manner in which individuals perceive, relate to, and think about themselves and their world. Personality traits are conspicuous features of personality and are not necessarily pathological, although certain styles of personality may cause interpersonal problems.

Personality disorders denote rigid, inflexible, and maladaptive patterns of thinking and behaving, leading to impairment in functioning and or significant internal distress. Most personality disorders have their onset in adolescence or early adulthood, are stable over time, and lead to significant inner turmoil or impairment.

Individuals with histrionic personality disorder exhibit excessive emotionality—a tendency to regard things in an emotional manner—and are attention -seekers. People with this disorder are uncomfortable or feel unappreciated when they are not the center of attention. Typical behaviors may include the constant seeking of approval or attention, self-dramatization, and theatricality. People with histrionic personality disorder may act in a self-centered way or sexually seductive in inappropriate situations, including social, occupational, and professional relationships, beyond what is appropriate for the social context. They may be lively and dramatic, and may initially charm new acquaintances with their enthusiasm, apparent openness , or flirtatiousness. They may also, however, embarrass friends and acquaintances with excessive public displays of emotion , such as embracing casual acquaintances with passion, sobbing uncontrollably over minor setbacks, or having temper tantrums.

People with histrionic personality disorder commandeer the role of "life of the party." Here are additional characteristics of this disorder:

• Their interests and conversation will be self-focused.
• They use their physical appearance to draw attention to themselves.
• They tend to believe that relationships are more intimate than they actually are.
• Their emotional expression may be shallow and rapidly shifting.
• Their style of speech is excessively impressionistic and lacking in detail.
• They may do well with jobs that value and require imagination and creativity , but will probably have difficulty with tasks that demand logical or analytical thinking.

Data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions estimate that the prevalence of histrionic personality disorder is 1.84 percent.

According to the DSM-5 , for a diagnosis of histrionic personality disorder to be given, five or more of the following symptoms must be present:

• Self-centeredness, feeling uncomfortable when not the center of attention
• Constantly seeking reassurance or approval
• Inappropriately seductive appearance or behavior
• Rapidly shifting emotional states that appear shallow to others
• Overly concerned with physical appearance, and using physical appearance to draw attention to self
• Opinions are easily influenced by other people, but difficult to back up with details
• Excessive dramatics with exaggerated displays of emotion
• Tendency to believe that relationships are more intimate than they actually are
• Is highly suggestible (easily influenced by others)

In addition, the symptoms must cause significant impairment or distress in an individual.

Individuals with histrionic personalities may seem unempathetic, but they really suffer from little self-awareness and low emotional intelligence . They may appear manipulative in situations when they are not the center of attention.

People with a cluster B personality disorder may have a higher risk for suicidal thoughts. People with histrionic personalities and mood disorders like depression may have an even higher risk.

The cause of histrionic personality disorder is unknown, but childhood events and genetics may both be involved. HPD occurs more frequently in women than in men, although some experts contend that it is simply more often diagnosed in women, because attention-seeking and sexual forwardness are less socially acceptable for women than for men.

People with this disorder are usually able to function at a high level and can do well in social and occupational environments. They may seek treatment for depression when their romantic relationships end. They often fail to see their own situation realistically, instead tending to overdramatize and exaggerate. Instead of taking responsibility for failure or disappointment, those with the disorder typically cast blame on others. Because they tend to crave novelty and excitement, they may place themselves in risky situations. Their behavior may lead to a greater risk of developing depression.

Narcissistic personality and histrionic personality can sometimes overlap. These two disorders are within the Cluster B group of personality disorders. People in this group suffer thinking and behavior patterns that are unpredictable or erratic; they are also engulfed in high drama that is centered on the self.

The recommended form of treatment for histrionic personality disorder is psychotherapy . That said, therapy for people with this diagnosis is often challenging, because they may exaggerate their symptoms or ability to function. They may also be emotionally needy and challenge the behavioral boundaries set up by the therapist. Therapy should generally be supportive and solution-focused.

Because depression can be associated with failed romantic relationships, patients with histrionic personality disorder often seek treatment when they are experiencing symptoms of depression.

• Find a Therapist
• Find a Treatment Center
• Find a Psychiatrist
• Find a Support Group
• Find Online Therapy
• United States
• Brooklyn, NY
• Chicago, IL
• Houston, TX
• Los Angeles, CA
• New York, NY
• Portland, OR
• San Diego, CA
• San Francisco, CA
• Seattle, WA
• Washington, DC
• Asperger's
• Bipolar Disorder
• Chronic Pain
• Eating Disorders
• Passive Aggression
• Personality
• Goal Setting
• Positive Psychology
• Stopping Smoking
• Low Sexual Desire
• Relationships
• Child Development
• Self Tests NEW
• Therapy Center
• Diagnosis Dictionary
• Types of Therapy

Sticking up for yourself is no easy task. But there are concrete skills you can use to hone your assertiveness and advocate for yourself.

• Emotional Intelligence
• Gaslighting
• Affective Forecasting
• Neuroscience

Last updated 10th July 2024: Online ordering is currently unavailable due to technical issues. We apologise for any delays responding to customers while we resolve this. For further updates please visit our website https://www.cambridge.org/news-and-insights/technical-incident

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings .

Login Alert

• > Journals
• > European Psychiatry
• > Volume 22 Issue S1: 15th AEP Congress - Abstract b...
• > A case report: Medical helplessness in the treatment...

Article contents

A case report: medical helplessness in the treatment of histrionic personality.

Published online by Cambridge University Press:  16 April 2020

Frequently it is relatively easy to establish prevalent clinical syndrome in treated patients, yet influence of personality is frequently neglected. Professional approach towards personality pathology might help to avoid misunderstandings and achieve better treatment results. This case presents 35-year-old woman, treated in different psychiatric hospitals 9 times in 5 years. She was diagnosed with several disorders (moderate or severe depressive episode with or without psychotic symptoms; anxious or mixed personality disorder; schizotypal disorder; schizoaffective disorder; harmful use of alcohol etc) and treated by many psychiatrists, psychotherapists using both medication (typical and atypical antipsychotics, tryciclic and other antidepressant drugs, including SSRI, SNRI, NDRI,NARI, SARI, NaSSA, anxiolytics, antimanic drugs) and psychotherapy. Treatment was unsuccessful and provoked helplessness, frustration, rage, hopelessness for the staff. Patient's behavior was demonstrative, manipulative, focused on communication with young male inpatients. She exhibited dramatization, exaggerated expression, continuous seeking for attention (often by inappropriate sexually provocative behavior), overwhelming separation anxiety when abandoned by love objects.

Description of treatment peculiarities of histrionic personality

Case analysis

During last hospitalization, the patient received a diagnosis of histrionic personality disorder at borderline personality organization level (identity diffusion, sufficient reality testing, primitive defenses). Treatment results were better after discontinuing medication.

This case description:

1. Illustrates the powerful feelings of the staff during treatment of histrionic disorders.

2. Reveals the amount of health care resources demanded for treatment of this type of patients (both material and immaterial) because of frequent hospitalizations, frequent shifting of diagnoses and treatment.

No CrossRef data available.

View all Google Scholar citations for this article.

Save article to Kindle

To save this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle .

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

• Volume 22, Issue S1
• K. Gintalaite (a1)
• DOI: https://doi.org/10.1016/j.eurpsy.2007.01.569

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox .

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive .

Reply to: Submit a response

- No HTML tags allowed - Web page URLs will display as text only - Lines and paragraphs break automatically - Attachments, images or tables are not permitted

Your details

Your email address will be used in order to notify you when your comment has been reviewed by the moderator and in case the author(s) of the article or the moderator need to contact you directly.

You have entered the maximum number of contributors

Conflicting interests.

Please list any fees and grants from, employment by, consultancy for, shared ownership in or any close relationship with, at any time over the preceding 36 months, any organisation whose interests may be affected by the publication of the response. Please also list any non-financial associations or interests (personal, professional, political, institutional, religious or other) that a reasonable reader would want to know about in relation to the submitted work. This pertains to all the authors of the piece, their spouses or partners.

In order to continue enjoying our site, we ask that you confirm your identity as a human. Thank you very much for your cooperation.

Histrionic Personality Disorder Causes, Symptoms, And Treatments

According to research made available by the National Library of Medicine, the prevalence of histrionic personality disorder (HPD) is estimated to be between 0.4% and 1.8%. HPD usually involves dramatic emotional displays meant to get others’ attention, as well as rejection sensitivity, a constant need to be the center of attention, and impulsive behavior. Genetic and environmental factors, such as childhood abuse and being raised by permissive parents, are thought to contribute to the development of histrionic personality disorder. Those with HPD can often benefit from attending regular therapy sessions to address symptoms.

What is histrionic personality disorder?

Histrionic personality disorder (HPD) is a cluster B personality disorder that is typically characterized by dramatic or theatrical displays of emotion that are usually intended to get attention from others. 

It is estimated that women may be four times more likely than men to receive an HPD diagnosis . However, it has been suggested that women may be overdiagnosed with HPD, while men may be underdiagnosed. 

Individuals experiencing this disorder often exhibit behavior that could be deemed inappropriate; for example, some may act in an overtly sexual or seductive manner in situations where these actions are improper or unsuitable. These behaviors and emotions can change rapidly, which could lead friends or acquaintances to view individuals with HPD as insincere. However, these are not the only symptoms an individual with HPD may experience. 

Histrionic personality disorder symptoms

The symptoms of histrionic personality disorder may be difficult to recognize, as some could be interpreted as a person being outgoing or extroverted. Individuals living with HPD can also struggle to recognize that they could be experiencing a mental health disorder, which could make it more challenging for them to seek evaluation and treatment. Those with HPD may exhibit the following symptoms: 

• Sensitivity to criticism or rejection
• A constant desire to be the center of attention
• Frequent changes in emotional state 
• Easily influenced or manipulated
• Quick to frustration or boredom
• Difficulty maintaining relationships
• Consistent need to be reassured by others
• Impulsive behavior
• Exaggerated and impressionistic speech 
• Shallow emotional expression

If an individual with HPD is not able to get the attention of others or become the center of attention with their behavior, they may believe that they have less value or that their loved ones are being dismissive of them. Those with HPD may also look for new and exciting activities, as they can grow quickly disinterested in routine. This, coupled with difficulty overcoming challenges and a lack of persistence, can further complicate certain situations, such as long-term romantic relationships. 

To better understand why these symptoms and behaviors can occur, exploring the factors that may cause a person to develop histrionic personality disorder can be helpful. 

What causes histrionic personality disorder? 

While research on HPD may be limited, a variety of factors appear to increase the likelihood of developing this disorder. These factors may include having a family history or genetic predisposition to HPD, environmental influences, and specific childhood experiences. 

• Genetic predisposition: Research indicates that there may be a hereditary component to multiple personality disorders, including HPD. However, while these findings could suggest that genetics play a significant role, the specific mechanisms or genes involved have not yet been identified.
• Environmental influences: Medical conditions that damage the neurons can increase the likelihood of developing personality disorders , such as HPD. These may include, but aren’t limited to, endocrine disorders, heavy metal poisoning, Huntington’s disease, cerebrovascular diseases, cerebral tumors, epilepsy, multiple sclerosis, neurosyphilis, and head trauma.
• Specific childhood experiences: A 2023 study indicates that childhood trauma (specifically physical/emotional neglect and sexual abuse) can be a significant factor in the development of HPD. Childhood abuse and neglect can result in an individual developing unhealthy defense mechanisms (such as those related to HPD) to alleviate the cognitive discomfort associated with these events. 

Certain parenting styles may also contribute to an individual developing HPD later in life, specifically permissive parenting . Permissive parents typically overindulge their children, rarely enforcing rules or boundaries while also refusing to establish any consequences. 

This can be quite different from other parenting styles, such as authoritarian parenting (where parents usually maintain high or even unreasonable expectations while enforcing severe consequences) and authoritative parenting (a style that usually involves reasonable demands and fair consequences). While permissive parents could see their actions as nurturing, their children may sense they aren’t getting enough attention. This could, in turn, lead to seeking more attention through theatrical behavior as they grow older. 

No matter the cause, it can be important to address HPD if you notice that you or a loved one are experiencing symptoms. In most cases, the best way to address this personality disorder is to seek the assistance of a medical or mental health professional. That way, you or your loved one can undergo an official assessment, receive a diagnosis, and start a treatment regimen to alleviate symptoms.

Histrionic personality disorder diagnosis and treatment

In order for someone with HPD to start treatment, it is typically necessary to receive a diagnosis. To do this, a person generally needs to schedule an appointment with a mental health or medical professional. 

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), a diagnosis may require an evaluation exploring an individual’s personal history and overall mental status. This evaluation may search for confirmation that the person is experiencing HPD by identifying the presence of at least five of the following eight symptoms:

• Shallow and rapidly shifting emotions
• Overly sexual, provocative, or inappropriate interactions with others
• Emotional expressions that may be considered self-dramatized or theatrical 
• Discomfort when one is not the center of attention
• Susceptibility to influential individuals or circumstances
• Prone to using physical appearance to draw attention to oneself
• Misinterpretation of the intimacy level of certain relationships
• Speech that can be described as vague or impressionistic

In addition to looking for the presentation of these symptoms, doctors can rule out other personality disorders, as well as situations that could cause HPD-like symptoms. Once a diagnosis is confirmed, medical or mental health professionals may recommend treatments. 

While the evidence for effective treatments for HPD may be limited, psychotherapy is cited as one of the primary treatment methods. Effective psychotherapeutic approaches can include the following:

• Cognitive behavioral therapy (CBT): CBT can help individuals living with HPD identify potentially harmful patterns of thought and behavior. With the assistance of a CBT provider, those with HPD can find ways to replace these thought patterns with more constructive ones.
• Group therapy: Individuals experiencing HPD can benefit from engaging in group therapy, which could allow them to discuss their challenges with others living with HPD. These sessions are typically guided by a therapist who can help those in the group learn effective coping skills. 
• Interpersonal therapy (IPT): Interpersonal therapy can be beneficial for those whose HPD symptoms have negatively impacted their relationships. IPT sessions may help those with HPD understand how their behavior could affect their current relationships with others, as well as how it may have affected relationships in the past. 

While therapy can be beneficial for those living with HPD, in-person therapy sessions may not be convenient or accessible for everyone. Some may struggle to discuss mental health-related subjects face-to-face, preferring instead to use other communication formats (such as online chat, video conference, or phone call). Others may not have the time to schedule or attend in-person appointments or could lack the transportation needed to commute to face-to-face therapy sessions. In these cases, online therapy may be a better fit.

According to a 2022 study, online therapy may reduce personality disorder symptoms . While not much research has been completed specifically on the efficacy of online therapy for histrionic personality disorder, existing evidence suggests that online and in-person therapy tend to produce the same client outcomes.

Histrionic personality disorder (HPD) is a mental health condition usually involving dramatic or theatrical behaviors meant to garner the attention of others. Other symptoms may include rapid changes in mood, difficulty accepting rejection, and a tendency to become quickly bored or disinterested with routine activities. While research into the causes of HPD may be limited, several factors are thought to impact whether a person develops this disorder. These can include genetics, environmental influences, and traumatic events in childhood. While everyone’s experience with HPD is unique, there may be several psychotherapeutic treatments that could be effective, such as cognitive behavioral therapy (CBT), group therapy, and interpersonal therapy, all of which may be attended online or in person.

• Self-Importance And Fragile Self-Esteem: Narcissistic Personality Disorder In Women Medically reviewed by April Justice , LICSW
• The Effects Of Avoidant Personality Disorder And Self-Criticism Medically reviewed by Melissa Guarnaccia , LCSW
• Personality Disorders
• Relationships and Relations

Module 12: Personality Disorders

Histrionic personality disorder, learning objectives.

• Describe the characteristics and diagnosis of histrionic personality disorder

Cluster B personality disorders include those related to impulsive, dramatic, emotional, or erratic behavior. These include antisocial personality disorder (ASPD), borderline personality disorder (BPD), histrionic personality disorder (HPD), and narcissistic personality disorder (NPD). We will review histrionic personality disorder on this page.

Histrionic personality disorder (HPD) is a personality disorder characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early childhood, including inappropriate seduction and an excessive need for approval. People diagnosed with the disorder are said to be lively, dramatic, vivacious, enthusiastic, and flirtatious.

People with a histrionic  personality   disorder  (HPD) may feel underappreciated or disregarded when they are not the center of attention. People with this  disorder  are typically “the life of the party” and have a “larger than life” presence. People with histrionic  personality   disorder  (HPD) have a high need for attention, make loud and inappropriate appearances, exaggerate their behaviors and emotions, and crave stimulation.  They may exhibit sexually provocative behavior, express strong emotions with an impressionistic style, and can be easily influenced by others.

Diagnostic Criteria

The DSM-5 defines histrionic personality disorder as a  pervasive pattern of excessive  emotionality  and attention-seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following characteristics:

Figure 1. Individuals with histrionic personality disorder crave stimulation and need to be the center of attention.

• interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
• displays rapidly shifting and shallow expression of emotions
• consistently uses physical appearance to draw attention to self
• has a style of speech that is excessively impressionistic and lacking in detail
• shows self-dramatization, theatricality, and exaggerated expression of emotion
• is suggestible, i.e., easily influenced by others or circumstances
• considers relationships to be more intimate than they actually are

Differential Diagnosis

The differential diagnosis (unique attributes that differentiate a disorder from others with similar features) for histrionic  personality   disorder  includes narcissistic  personality   disorder , borderline  personality   disorder , dependent  personality   disorder , somatic symptom  disorder , and illness anxiety  disorder .

• Like histrionic  personality   disorder , patients with narcissistic  personality   disorder  prefer to be the center of attention. However, patients with narcissistic  personality   disorder  want attention, which results from admiration or veneration, whereas people with histrionic  personality   disorder  are not particular about what type of attention they garner.
• Patients with histrionic  personality   disorder  are similar to those with borderline  personality  because both demographics of patients experience intense emotions; however, patients with borderline  personality   disorder  usually dislike themselves.
• Dependent  personality   disorder  should be considered in the differential diagnosis for histrionic  personality   disorder  as with both  personality  disorders; the patient will prefer to be around others.  However, patients with dependent  personality   disorder  tend to be more submissive, and their behavior is more inhibited as they are preoccupied with fears of rejection.
• Somatic symptom  disorder  and illness anxiety  disorder  are also included in the differential for histrionic  personality   disorder  as patients with a histrionic  personality   disorder  may use physical symptoms and complaints to gain attention from others.

Comorbidity

Most people with histrionic personality disorder also have other mental disorders. Comorbid conditions include antisocial, dependent, borderline, and narcissistic personality disorders as well as depression, anxiety disorders, panic disorder, somatoform disorders, anorexia nervosa, substance use disorder, and attachment disorders.

Watch this clip to see how histrionic personality disorder may be demonstrated.

You can view the transcript for “DSM 5 Histrionic Personality Disorder Criteria Example, Symptoms Video” here (opens in new window) .

Epidemiology

The prevalence of histrionic  personality   disorder  in the general population runs about 2%-3%. It is possible for people to have more than one  personality   disorder . Women are four times more likely to be diagnosed with histrionic  personality   disorder  than men. However, research suggests that women may be overly diagnosed with this  disorder  when compared to men due to sexual-forwardness being less socially acceptable for women. Furthermore, men may be less likely to report their symptoms and thereby be under-diagnosed. Histrionic  personality   disorder  tends to be ego-syntonic, meaning people with this  disorder  typically consider their behavior to be normal and struggle to identify a problem.

Histrionic  personality   disorder  probably develops as a combination of both learned and inherited factors. One hypothesis is that histrionic  personality   disorder  may develop as a result of trauma experienced during childhood. Children may endure their trauma by coping with their environment in ways that may ultimately lead to a  personality   disorder .  Personality  disorders in childhood may originate as an adaptation to cope with a traumatic situation or traumatic environment.

Parenting styles may also influence the likelihood of developing a histrionic  personality   disorder . Parenting that lacks boundaries is over-indulgent, or inconsistent may predispose children to develop a histrionic  personality   disorder . Because histrionic  personality   disorder  tends to run in families, there is some consideration that there is genetic susceptibility for this  disorder that  may be inherited. As with all psychiatric disorders, having a family history of  personality  disorders, psychiatric illness, or substance use disorders is a risk factor for histrionic  personality   disorder .

Supportive psychotherapy is a recommended modality of treatment for patients with histrionic personality disorder, as this approach is found to be encouraging, reassuring, and non-threatening. Supportive psychotherapy aims to reduce emotional distress, improve self-esteem, and to enhance the patient’s coping skills, all through attentive and sympathetic listening.

Psychodynamic psychotherapy (also called insight-oriented therapy) has also proven to be a successful approach in treating patients with histrionic personality disorder. The goal of this therapy is to alter an aspect of a patient’s dysfunctional personality by integrating crucial developmental milestones a patient may have missed during previous stages of emotional maturation. Psychodynamic psychotherapy aims to resolve underlying, unconscious conflicts in an effort for patients to understand themselves and their behaviors better. The patients are encouraged to substitute excessively dramatic speech for a more adaptive action or behavior, to promote better communication with others. Through psychodynamic psychotherapy, patients learn to recognize that hyper-sexual, attention-seeking behaviors are maladaptive, and discover new, healthier ways to develop self-esteem.

While the gold standard for treating personality disorders is psychotherapy, patients with histrionic personality disorder may be profoundly symptomatic. Patients may experience affective dysregulation, where they frequently endure mood swings, anger, tearfulness, anxiety, and depression. While there are no FDA-approved medications for the treatment of histrionic personality disorder, affective dysregulation may be treated with antidepressants, mood stabilizers, and antipsychotics. Antidepressants that have proven to be effective include desipramine, fluoxetine, amitriptyline, and fluvoxamine. The mood stabilizers with proven therapeutic benefits include lamotrigine, carbamazepine, topiramate, valproate, and lithium. Research has demonstrated that antipsychotics such as risperidone, aripiprazole, olanzapine, and haloperidol have been useful in treating affective dysregulation. Patients with histrionic personality disorder may struggle with impulse control and regulation of their behaviors. Clinical trials have demonstrated that mood stabilizers specifically can target these symptoms.

Key Takeaways: Histrionic Personality Disorder

Think it over: michael scott’s diagnosis.

Many of you are familiar with the fictional character Michael Scott from the hit TV show The Office . Scott is a 46-year-old, Caucasian male from Scranton, Pennsylvania, and the regional manager at Dunder Mifflin Inc., a local paper and printer distribution company. Michael Scott’s outward appearance is well put together, as he presents as a business professional, and there are no obvious health concerns. Despite his seemingly composed demeanor, Scott displays exaggerated emotions and reactions. In addition to these exaggerations, romantic relationships have proven turbulent for Scott throughout his life, as he goes from one relationship to the next with the other person usually being the one to end the relationship. He has few close friends or relatives and tends to perceive new friendships as closer than they actually are. Scott believes his subordinates to be his family, and oftentimes gets involved in their personal lives without their consent. His parents divorced when he was young (age unknown), and he displays clear resentment towards his stepfather and sister, whom he once didn’t talk to for fifteen years. Scott has a very close relationship with his mother now, though this was not the case when he was a child. Though Scott seems to be lacking in managerial style, responsibility, and delegation, he demonstrates above-average sales abilities due to his personable qualities. Scott does not have a history of drug or alcohol abuse, though he will drink in social situations and when pressured to do so by coworkers.

Some of Michael Scott’s behaviors fit with the description of histrionic personality disorder, namely that he likes to be the center of attention, uses impressionistic speech, considers relationships to be more intimate than they actually are, and even shows self-dramatization at times. These things still do not meet all five criteria for the diagnosis, however. This video by Dr. Grande goes through each of the criteria for histrionic personality disorder (start at the 14:54 mark) , then goes on to explain why Michael Scott may better fit the description for narcissistic personality disorder, which we’ll examine on the next page.

Because of the overlap in some of the criteria and frequent comorbidity of histrionic personality disorder with other personality disorders, some scholars have recommended removing the histrionic diagnosis altogether.

Bakkevig and Karterud (2010), in a study carried out with a sample of patients attending psychiatric day hospital, concluded that the prevalence of HPD was very low (0.4%) and comorbidity was high, especially with borderline, narcissistic, and dependent personality disorders. They suggested that the HPD category should be deleted from the DSM system, excepting that clinical phenomena of exhibitionism and attention-seeking, which are the dominant personality features of HPD, should be preserved in an exhibitionistic subtype of narcissism. [1]

histrionic personality disorder:  characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early childhood, including inappropriate seduction and an excessive need for approval

personality disorder:  group of DSM-5 disorders characterized by an inflexible and pervasive personality style that differs markedly from the expectations of one’s culture and causes distress and impairment

• Novais F, Araújo A and Godinho P (2015) Historical roots of histrionic personality disorder. Front. Psychol . 6:1463. doi: 10.3389/fpsyg.2015.01463 ↵
• Modification, adaptation, and original content. Authored by : Julie Manley for Lumen Learning. Provided by : Lumen Learning. License : CC BY-SA: Attribution-ShareAlike
• Textbook of Psychiatry. Authored by : Wikibooks. Located at : https://en.wikibooks.org/wiki/Textbook_of_Psychiatry/Print_version#Cluster_B . License : CC BY-SA: Attribution-ShareAlike
• Personality Disorder. Provided by : Wikipedia. Located at : https://en.wikipedia.org/wiki/Personality_disorder . License : CC BY-SA: Attribution-ShareAlike
• Histrionic Personality Disorder. Authored by : Jennifer H. French and Sangam Shrestha. Provided by : Stat Pearls. Located at : https://www.ncbi.nlm.nih.gov/books/NBK542325/# . License : CC BY: Attribution
• Histrionic Personality Disorder case study. Located at : https://courses.lumenlearning.com/abnormalpsychology/chapter/histrionic-personality-disorder/ . License : CC BY-NC-SA: Attribution-NonCommercial-ShareAlike
• Historical roots of histrionic personality disorder. Authored by : Filipa Novais, Andreia Arau00fajo, and Paula Godinho. Provided by : Frontiers in Psychology. Located at : https://www.frontiersin.org/articles/10.3389/fpsyg.2015.01463/full . License : CC BY-SA: Attribution-ShareAlike
• DSM 5 Histrionic Personality Disorder Criteria Example, Symptoms Video. Provided by : Symptom Media. Located at : https://youtu.be/VOPjir_94fQ?t=32 . License : Other . License Terms : Standard YouTube License

You are using an outdated browser. Please upgrade your browser to improve your experience.

Specialties

Histrionic Personality Disorder

Clinical Presentation

The clinical presentation of the Histrionic Personality Disorder can be characterized by the following behavioral and interpersonal style, thinking style, and feeling style.

The behavioral style is characterized as charming, dramatic, and expressive, while also being demanding, self-indulgent, and inconsiderate.

Persistent attention-seeking, mood lability, capriciousness, and superficiality further characterize their behavior.

• Interpersonally, these individuals tend to be exhibitionistic and flirtatious in their manner, with attention-seeking and manipulativeness being prominent.
• The thinking or cognitive style of this personality can be characterized as impulsive and thematic, rather than being analytical, precise, and field-independent.

In short, their tendency is to be non-analytic, vague, and field-dependent.

Histrionic personalities are easily suggestible and rely heavily on hunches and intuition. They avoid awareness of their own hidden dependency and other self-knowledge, and tend to be “other-directed” with respect to the need for approval from others. Therefore, they can easily dissociate their “real” or inner self from their “public” or outer self.

Their emotional or affective stle is characterized by exaggerated emotional displays and excitability, including irrational outbursts and temper tantrums Opens in new window .

Although they are constantly seeking reassurance that they are loved, they respond with only superficial warmth and charm and are generally emotionally shallow. Finally, they are exceedingly rejection-sensitive.

DSM-5 Characterization

Individuals with this personality disorder are characterized by an unremitting pattern of attention-seeking and emotionality.

• They tend to be uncomfortable in situations where they cannot be the center of attention.
• Their emotional reactions tend to be shallow and rapidly shifting. Typically, they draw attention to themselves with the way they dress.
• Their manner of speech tends to be impressionistic with few details.

These individuals are easily influenced by others or circumstances. They are likely to perceive relationships as more intimate than they really are. They often engage in provocative and inappropriate seductive sexual behavior. Furthermore, they are dramatic and overly exaggerate their emotional expressions (American Psychiatric Association, 2013).

Biopsychosocial – Adlerian Conceptualization

The following biopsychosocial formulation may be helpful in understanding how the Histrionic Personality Disorder develops. Biologically and temperamentally, the Histrionic Personality Disorder appears to be quite different from the Dependent Personality Disorder Opens in new window .

Unlike the dependent personality, histrionic personality is characterized by a high energy level and emotional and autonomic reactivity.

Millon and Everly (1985) noted that histrionic adults tended to display a high degree of emotional lability and responsiveness in their infancy and early childhood. Their temperament that can be characterized as hyper-responsive and externally oriented for gratification.

Psychologically, Histrionic Personality Disorder has the following characteristic view of self, world-view, and life goal.

In addition to biological and psychological factors, social factors such as parenting style and injunction, and family and environmental factors, influence the development of the histrionic personality .

The parental injunction for the histrionic personality involves reciprocity: “I’ll give you attention, if you do X.” A parenting style that involves minimal or inconsistent discipline helps insure and reinforce the histrionic pattern.

The histrionic child is likely to grow with at least one manipulative or histrionic parent who reinforces the child’s histrionic and attention-seeking behavior.

Finally, the following sequence of self and system perpetuants are likely to be seen in the Histrionic Personality Disorder :

• denial of one’s real or inner self;
• a preoccupation with externals;
• the need for excitement and attention-seeking which leads to a superficial charm and interpersonal presence;
• and the need for external approval. This, in turn, further reinforces the dissociation and denial of the real or inner self from public self, and the cycle continues.

Treatment Considerations

The differential diagnosis of the Histrionic Personality Disorder includes the Narcissistic Personality Disorder Opens in new window and the Dependence Personality Disorder Opens in new window . It also includes the Histrionic-Borderline Disorder, which is a decompensated version of the Histrionic Personality Disorder Opens in new window , and, according to Millon (2011), the Histrionic-Antisocial Personality Disorder.

Associated diagnoses include: Persistent Depressive Disorder Opens in new window , Social Anxiety Disorder Opens in new window , and Obsessive-Compulsive Disorder Opens in new window . In addition, Major Depressive Opens in new window and Bipolar Disorders Opens in new window are common in the decompensated Histrionic Personity Disorder .

The treatment of the Histrionic Personality Disorder may present a considerable challenge to the clinician. For the purpose of this discussion, we will limit ourselves to some general considerations about treatment goals, limits, and medications.

General treatment goals include helping the individual integrate gentleness with strength, moderating emotional expression, and encouraging warmth, genuineness, and empathy. Because the histrionic personality can present as dramatic, impulsive, seductive, and manipulative with potential for suicidal gestures, the clinician needs to discuss the matter of limits early in the course of therapy regarding professional boundaries and personal responsibilities.

Some histrionic personalities, particularly those who bear some resemblance to Hysteroid Dysphoria Opens in new window , respond to certain antidepressant agents, particularly Parnate and Nardil (Liebowitz & Klein, 1979). Otherwise, unless a concurrent acute psychotic or Major Depressive Episode is present, psychotherapy is the principal mode of treatment.

•  Borderline Personality Disorder Opens in new window
•  Narcissistic Personality Disorder Opens in new window
•  Dependent Personality Disorder Opens in new window
• American Psychiatric Association. Diagnositc and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Association, 2013.
• Widiger, T. A. & Bornstein, R. F. (2001). Histrionic, dependent, and narcissistic personality disorders. In H. E. Adams & P. B. Sutker (Eds)., Comprehensive handbook of psychopathology (pp. 509 – 534). New York: Kluwer Academic.
• Dobbert, Duane L. Understanding Personality Disorders: An Introduction. Lanham, MD: Rowman & Littlefield, 2011.
• Sperry, Len. Handbook of Diagnosis and Treatment of the DSM-5 Personality Disorders, 3rd ed. New York, NY: Routledge, 2016.

The Link Between Histrionic Personality Disorder and Relationships

Histrionic personality disorder can have a significant impact on relationships . Individuals with this disorder often exhibit attention-seeking behavior, excessive emotionality, and a need for constant validation. This guide provides an overview of the unique dynamics and challenges that individuals with histrionic personality disorder face in their interactions with others. Understanding these dynamics can help foster healthier and more supportive relationships.

What is Histrionic Personality Disorder?

Histrionic Personality Disorder (HPD) is a mental health condition characterized by a pattern of excessive attention-seeking behavior, emotional instability, and a need for constant validation. Individuals with HPD often have a strong desire to be the center of attention and may engage in dramatic or provocative behavior to achieve this. They may also have difficulty forming and maintaining stable relationships, as their need for validation and attention can put a strain on their interactions with others. It is important to seek professional help if you or someone you know is experiencing symptoms of HPD, as treatment and therapy can help manage and improve the condition.

Individuals with a histrionic personality disorder may exhibit a range of symptoms and behaviors. They may have an exaggerated sense of self-importance and constantly seek reassurance and praise from others. They may also have a tendency to be overly dramatic and emotional, often displaying intense and rapidly shifting emotions. People with HPD may have difficulty regulating their emotions and may engage in attention-seeking behaviors, such as dressing provocatively or speaking in a theatrical manner. They may also tend to be easily influenced by others and struggle with forming and maintaining healthy relationships. Treatment for histrionic personality disorder typically involves therapy, such as cognitive-behavioral therapy, to help individuals learn healthier ways of coping with their emotions and seeking validation.

Common Signs and Symptoms of Histrionic Personality Disorder.

Histrionic Personality Disorder (HPD) is characterized by a range of signs and symptoms that can impact an individual’s relationships. Some common signs of HPD include excessive attention-seeking behavior, a need for constant validation and approval, exaggerated emotions and expressions, a tendency to be easily influenced by others, and a preoccupation with physical appearance. Individuals with HPD may also engage in dramatic or provocative behavior to gain attention and may have difficulty maintaining stable relationships due to their intense need for validation. It is important to seek professional help if you or someone you know is exhibiting these symptoms, as a proper diagnosis and treatment plan can significantly improve quality of life.

The Impact of Histrionic Personality Disorder on Relationships.

Histrionic Personality Disorder (HPD) can have a significant impact on relationships. Individuals with HPD often struggle with maintaining stable and healthy connections with others due to their excessive attention-seeking behavior and constant need for validation. Their exaggerated emotions and expressions can be overwhelming for their partners, friends, and family members. Additionally, their tendency to be easily influenced by others can lead to difficulties in setting boundaries and making independent decisions. The preoccupation with physical appearance may also create challenges in relationships, as the individual may prioritize their own image over the needs and feelings of their loved ones. It is important for individuals with HPD and their loved ones to seek professional help and support in order to navigate these challenges and develop healthier relationship dynamics.

Challenges Faced by Individuals with Histrionic Personality Disorder in Relationships.

Individuals with Histrionic Personality Disorder (HPD) face unique challenges in their relationships. Their excessive attention-seeking behavior and constant need for validation can strain their connections with others. Their exaggerated emotions and expressions can be overwhelming for their partners, friends, and family members. Additionally, their tendency to be easily influenced by others can lead to difficulties in setting boundaries and making independent decisions . The preoccupation with physical appearance may also create challenges in relationships, as the individual may prioritize their own image over the needs and feelings of their loved ones. It is important for individuals with HPD and their loved ones to seek professional help and support in order to navigate these challenges and develop healthier relationship dynamics.

Neuroscience and Brain-Based Counseling for Histrionic Personality Disorder

Neuroscience and brain-based counseling have shown incredibly promising results in helping individuals with Histrionic Personality Disorder (HPD). The field of neuroscience has revealed that certain areas of the brain, such as the amygdala and the limbic system , play a significant role in emotional regulation and response inhibition, both of which are often impaired in individuals with HPD. Brain-based counseling techniques , such as the ones I use to treat my own patients with HPD, dramatically help these individuals gain better control over their emotional responses and impulsive behaviors. This approach can significantly improve the management of HPD symptoms and enhance the quality of relationships. It’s important to note that each individual’s experience with HPD is unique, and that is why each treatment program I create is tailored to their specific needs and circumstances.

Strategies for Managing and Improving Relationships with Histrionic Personality Disorder.

Managing and improving relationships with someone with Histrionic Personality Disorder (HPD) can be challenging. Still, it is possible to create healthier dynamics with the right strategies.

• Educate yourself: Learn about HPD and its impact on relationships. Understanding the disorder can help you empathize and respond effectively.
• Set boundaries: Establish clear boundaries and communicate them assertively. This can help prevent the individual with HPD from overstepping boundaries or manipulating situations.
• Encourage therapy: Encourage the individual with HPD to seek therapy. Therapy can help them develop healthier coping mechanisms and improve their self-awareness.
• Practice active listening: Show genuine interest and actively listen to their concerns and emotions. This can help them feel validated and understood.
• Encourage self-reflection: Encourage the individual with HPD to reflect on their behavior and its impact on others. This can promote personal growth and self-awareness.
• Foster open communication: Create a safe space for open and honest communication. Encourage the individual with HPD to express their needs and concerns while also expressing their own.
• Seek support: Reach out to support groups or therapy for yourself. Dealing with HPD in a relationship can be challenging, and having support can help you navigate the difficulties.
• Practice self-care: Take care of your own mental and emotional well-being. Set aside time for activities that bring you joy and help you recharge.
• Encourage healthy coping mechanisms: Help individuals with HPD develop healthier coping mechanisms, such as engaging in hobbies, practicing mindfulness, or seeking professional help when needed.
• Celebrate progress: Acknowledge and celebrate any positive changes or progress made by the individual with HPD. This can reinforce their motivation to continue working on their relationships.

Remember, managing relationships with someone with HPD requires patience, understanding, and support. Seeking professional help and guidance is crucial for sufferers and beneficial for both parties.

#histrionicpersonalitydisorder #hpd #personalitydisorder #mentalhealth #histrionic #histrionicpersonality #histrionicpersonalitydisorderawareness #histrionicpersonalitydisorderrecovery #histrionicpersonalitydisordertherapy #histrionicpersonalitydisorderawarenessmonth #histrionicpersonalitydisorderwarrior #histrionicpersonalitydisordercommunity #histrionicpersonalitydisorderjourney #histrionicpersonalitydisorderrelationships #histrionicpersonalitydisorderawareness #histrionicpersonalitydisorderhelp #histrionicpersonalitydisorderawareness #histrionicpersonalitydisorderawarenessmonth #histrionicpersonalitydisorderrecovery #histrionicpersonalitydisordertherapy #histrionicpersonalitydisorderwarrior #histrionicpersonalitydisordercommunity #histrionicpersonalitydisorderjourney #histrionicpersonalitydisorderrelationships

Share this post

Dr. Sydney Ceruto

A Pioneer in Neuroscience-Based Coaching

As the founder of MindLAB Neuroscience, Dr. Sydney Ceruto has been a leading force in integrating neuroscience into coaching and counseling for over two decades. With three master's degrees in psychology and two PhDs in behavioral and cognitive neuroscience, she is widely considered a top expert in her field.

Harnessing the power of neuroscience-based coaching , Dr. Ceruto's innovative approach focuses on neuroscience, neuroplasticity, and neural pathway rewiring to foster lasting positive change in mental health.

Dr. Ceruto holds esteemed memberships in the Forbes Executive Council, Positive Performance Alliance, Wharton Executive Education Program, the International Society of Female Professionals, and executive writing positions for Alternatives Watch, Brainz Magazine, and TED: Ideas Worth Spreading.

Dr. Ceruto's accomplishments include:

• The 2022 CREA Award.
• A lead research position at NYU Steinhardt.
• Volunteer work with Covenant House and the National Alliance for Mental Health (NAMI).

Her science-backed method of Neural Rewiring has successfully guided thousands of clients toward happier, more productive, and more resilient lives.

• FOR PROFESSIONALS
• PATIENT PORTAL
• TELETHERAPY

Learn About Our Walk-In Process

5 Myths About Histrionic Personality Disorder

Learn about 5 common myths associated with histrionic personality disorder and the corresponding facts..

People with  histrionic personality disorder (HPD)  have an overwhelming desire to be noticed by others. Exaggerated behavior, speech and dress serve the purpose of gaining attention, which is the goal of a person with HPD. The often self-centered behavior of people with HPD can push away meaningful or long-term relationships.

It’s not always easy to tell fact from fiction when it comes to mental health disorders, and misconceptions can push people away or prevent treatment. Learn the facts about common HPD myths and help avoid the stigma associated with mental health conditions.

1. Myth: People with histrionic personality disorder have high self-esteem

Fact: People with histrionic personality disorder suffer from low self-esteem.

Although people with HPD may appear to have high self-esteem, this idea is incorrect. Loud dress and clothing, exaggerated speech and other attention-seeking behaviors can mislead many to believe that people with HPD are self-confident. Many may see someone with histrionic personality disorder as a dramatic person, uninhibited in their speech and behavior. However, this behavior does not equal self-assurance. People with HPD may desire to be the center of attention, but their self-esteem or self-worth is based on how others view them — not how they truly view themselves.

In fact, histrionic personality disorder is linked with low self-esteem and a sense of inadequacy. People with HPD are highly sensitive to criticism and view it as a form of rejection. Instead of viewing criticism as an opportunity to improve, a person with histrionic personality disorder can find it to be highly offensive and will actively avoid it. A person with HPD finds it difficult to be self-assured and will often rely on the praise or interest of others to build up self-worth. Because of this, they may be easily influenced or swayed by outside suggestions.

2. Myth: People with HPD lack empathy

Fact: People with HPD are capable of feeling empathy and other positive emotions.

Empathy is defined as the ability to understand and be sensitive toward another person’s feelings. When an issue is directly related to a person with HPD, they often find it difficult to see it from someone else’s viewpoint. This difficulty can be seen as a lack of empathy since it’s hard for people with histrionic personality disorder to read emotions that aren’t their own.

The idea that people with HPD lack empathy may also be based on their often self-centered behavior. Constant attention-seeking behavior can make it difficult for them to see the bigger picture in a relationship. A combination of self-centeredness and sometimes shallow or insincere speech can paint a negative picture.

Emotions, however, come in many forms and can be displayed in even more types of behavior. Sometimes described as highly volatile with their emotions, people with histrionic personality disorder can overreact or overexaggerate based on an obsessive concern of self. HPD emotions are strong, but there are positive emotions in this mix as well. People with histrionic personality disorder are more than capable of showing concern for other people, as long as the situation isn’t related to themselves. Therefore, they are not unfeeling people and can be capable of displaying empathy and other desirable qualities.

3. Myth: Histrionic personality disorder caused by genetics

Fact: While genetics are one risk factor for histrionic personality disorder, they don’t guarantee its development.

Research  has shown that personality disorders originate in early childhood, with genetic and environmental factors each playing a role. Many studies, including family, twin and adoption studies, have linked genetics to personality disorders. Studies conducted on twins show that differences in genes can cause differences in traits. One twin study estimated a 67% heritability for histrionic personality disorder. Heritability is a measure of variances in a trait and how it can be attributed to genetics. Although that estimate is high, environmental factors can change the outcome of such a statistic. To date,  no genetic association  has been directly attributed to the development of HPD.

Personality disorders  are complex mental health disorders that are widely studied, but no two people are exactly the same. However, certain temperaments and adverse environments can help foster the development of personality disorders. Although these factors don’t guarantee the development of a disorder, they are definite risk factors.

Some common environmental factors and causes of histrionic personality disorder include:

• Traumatic events
• Child abuse
• Inconsistent parenting
• Learned behavior that is maladaptive

4. Myth: Histrionic personality disorder affects men and women equally

Fact: Histrionic personality disorder is diagnosed more often in women.

Personality disorders can be seen in around 30.8 million Americans and HPD is seen in about  1.8%  of the population. While both men and women can be affected by the condition, histrionic personality disorder is diagnosed in women much more often. Some believe this is because women appear to be more agreeable when it comes to seeking treatment, which means more women receive a diagnosis in comparison to men.

Some  scholars  focus on the idea that certain personality disorders and diagnostic criteria include traits that are associated with gender roles, such as masculinity and femininity. Feminine men may display more features of personality disorders that are usually associated with women. Histrionic personality behavior is often described in words that are linked to the feminine sex, such as “seductive” or “drama queen.” However,  one  study found that a person with histrionic personality disorder can express behavior in a masculine or feminine way.

5. Myth: People with histrionic personality disorder can’t lead normal lives

Fact: People with HPD can function well and find fulfillment professionally and socially.

Nearly 4 million people are diagnosed with histrionic personality disorder. With treatment, many have found healthy ways to deal with their feelings. Even without treatment, people with HPD typically function well at work or in their realm of activity. The real issue lies in their interpersonal relationships with others, romantically and otherwise.  Histrionic personality disorder treatment  is therefore focused on improving and managing emotional reactions and expectations. This gives people with HPD helpful strategies to address their maladaptive behavior and develop stronger connections with others.

Some common forms of therapy that can prove helpful to those living with HPD include:

• Cognitive behavioral therapy :  Provides methods and practical skills to cope with negative emotions
• Psychodynamic therapy:  Can identify underlying reasons for the disorder with the goal of minimizing negative emotional reactions
• Mind-body practices:  Holistic therapies that focus on mindfulness can encourage self-control in emotionally charged situations
• Group therapy:  Can provide a community of support and offer role play that can help in real-life situations

Living with histrionic personality disorder doesn’t have to be intolerable or a life sentence. With proven methods of support and treatment, many have found life to be fulfilling and successful. Remember,  mental health conditions  shouldn’t define a person. Help beat the stigma associated with mental health disorders with compassion and accurate information.

If you or someone you know is living with histrionic personality disorder and coping with its negative effects by  using alcohol or drugs , give us a call at  The Recovery Village . One of our specialists can discuss a treatment plan that is appropriate for you. We believe everyone should have the opportunity for a normal life, and we are here to help make that possible.

Ma, G., Fan, H., Shen, C., Wen, W. “ Genetic and Neuroimaging Features of Per[…]s: State of the Art. ” Neuroscience Bulletin, June 2016. Accessed May 21, 2019

Torgersen, S., et. al. “A twin study of personality disorders.” Comprehensive Psychiatry, November 2000. Accessed May 21, 2019.

National Institute on Alcohol Abuse and Alcoholism. “ Landmark Survey Reports the Prevalence o[…]n the United States. ” August 2, 2004. Accessed May 21, 2019.

Klonsky, E., Jane, J., Turkheimer, E., Oltmanns, T. “ Gender Role and Personality Disorders. ” Journal of Personality Disorders, October 2002. Accessed May 21, 2019.

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.

We can help answer your questions and talk through any concerns.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Psychiatr Psychol Law
• v.25(5); 2018

Disorder in the Court: Cluster B Personality Disorders in United States Case Law

Catherine young.

Clinical Psychology, Palo Alto University, Palo Alto, CA, USA

Janice Habarth

Bruce bongar, wendy packman.

Previous research has shown that antisocial, borderline, narcissistic and histrionic personality disorders, also known as the Cluster B personality disorders in the Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition ( DSM–5 ), are commonly raised in lawsuits. Cluster B disorders are characterized by problems with emotion regulation, impulsivity and interpersonal conflicts. Without question, individuals diagnosed with a Cluster B disorder possess traits that make them more susceptible to becoming involved in litigation; however, to date there has been no research on how the disorders interact with the judicial system. This study surveyed litigant success of Cluster B personality disorders in United States federal and state case law. Results showed that both criminal and civil litigants tended to be unsuccessful in their cases. Overall, this study demonstrated that court opinions can provide a window into the psychology of trial litigants and how personality can affect trial outcomes.

In ‘The Intractable Client’ (Feinberg & Greene, 1997 ), an article on personality disorders geared towards family law lawyers, psychologists Rhoda Feinberg and James Tom Greene wrote:

These are the clients whom you will most see in protracted litigation or mediation. They make up the bulk of custody commissioner, court master, and special guardian ad litem cases. . . . People with personality disorders usually ‘dig in’ and maintain their rigid attitudes and perceptions throughout the legal process. (pp. 354–355)

Although Feinberg and Greene ( 1997 ) penned this article 20 years ago based on their experiences in the family court system, their words still resonate today at a time when personality disorders continue to be problematic for the judicial system. Little is actually known about court decisions concerning personality diagnoses due to the lack of empirical legal research available. In fact, Feinberg and Greene ( 1997 ), though they state that the majority of family law cases involve individuals with personality disorder, offered no data to validate their point.

What we do know about personality disorders and the law is limited. Legally relevant research on personality disorders has focused predominantly on the criminal law context, largely in part due to the overwhelming prevalence rates of the Cluster B personality disorders within correctional settings (Johnson & Elbogen, 2013 ). This study aimed to examine personality disorders in both criminal and civil case law by first providing background on personality disorders in general, distinguishing Cluster B personalities from other personality disorders, and then lastly describing the available literature on personality disorders, the law and the courts.

The Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition ( DSM–5 ) divides the 10 personality disorders into clusters; this study is focused on Cluster B, which includes antisocial, borderline, histrionic and narcissistic personality disorders (American Psychiatric Association, 2013 ). Individuals with a Cluster B personality typically present as ‘dramatic, emotional, or erratic’ (American Psychiatric Association, 2013 , p. 646), although some have argued that the predominant theme is a lack of empathy (Kraus & Reynolds, 2001 ). Cluster B personality disorders account for the least prevalent of the clusters when compared with Cluster A (5.7%) and Cluster C (6.0%) (American Psychiatric Association, 2013 ; Lenzenweger, Lane, Loranger, & Kessler, 2007 ). As with many of the other personality clusters, patients with Cluster B personalities do not typically seek out treatment on their own and are frequently referred by courts for treatment (Hatchett, 2015 ). The following provides brief descriptions of the criteria and general considerations of each of the personality disorders listed in Cluster B.

Antisocial Personality Disorder

Antisocial personality disorder (ASPD) is characterized by persistently violating or disregarding others’ rights, committing crimes, deceiving others, behaving impulsively, exhibiting agitation through frequent fights/altercations, acting recklessly, and lacking responsibility and empathy (American Psychiatric Association, 2013 ). Adolescents who exhibited conduct disorder are typically diagnosed with ASPD as adults if they continue behaviors consistent with ASPD (American Psychiatric Association, 2013 ).

Individuals with ASPD may be prone to legal problems for several reasons. First, ASPD has frequently been associated with the commission of criminal offenses (Hodgkins & Côté, 1993; Roberts & Coid, 2010 ). Deceitfulness, reckless behavior, impulsivity and lack of empathy increase the individual's risk of becoming involved in the legal system. ASPD is the one personality disorder linked to psychopathy, a condition with some overlapping features of ASPD including deceit and manipulation (American Psychiatric Association, 2013 ; Hare, Hart, & Harpur, 1991 ). Accordingly, ASPD is more commonly diagnosed in correctional populations where some studies have estimated that more than 70% of inmates have the personality disorder (Coid, 2002 ). Second, individuals with ASPD may fail to fulfill their parental obligations, possibly resulting in child neglect, child endangerment or even abuse (American Psychiatric Association, 2013 ).

Borderline Personality Disorder

Criteria for borderline personality disorder (BPD) include intense mood dysregulation, difficulties with impulse control, fear of abandonment, transient psychotic-like symptoms, volatile relationships with alternating devaluing and idealizing, and absence of a cohesive self-identity (American Psychiatric Association, 2013 ). Females are overrepresented (75%) in diagnosis of the disorder, and marital distress including separation and divorce are prevalent (American Psychiatric Association, 2013 ).

Out of all of the personality disorders within Cluster B, BPD is the disorder most commonly associated with suicidal gestures (García-Nieto, Blasco-Fontecilla, de León-Martinez, & Baca-García, 2014 ) and suicide completions (Pompili, Girardi, Ruberto, & Tatarelli, 2005 ). It is also the ‘only personality disorder whose literature is clearly alive and growing’ with significant increases in published studies since 1980 (Blashfield & Intoccia, 2000 , p. 473).

Similar to ASPD, BPD has been linked to several legal problems; however, unlike the ASPD patient, the BPD patient is frequently the plaintiff. BPD patients have been known to sue their providers for malpractice related to sexual misconduct or suicide (Appelbaum & Gutheil, 2007 ; Simon, 1995 ). Accordingly, risk management practices have been heavily emphasized when working with this population (Fusco, 2015 ; Goodman, Roiff, Oakes, & Paris, 2012; Gregory, 2012 ; Stone, 1993 ).

Narcissistic Personality Disorder

Narcissistic personality disorder (NPD) is characterized by grandiosity, idealistic fantasies, belief in the individual's uniqueness, entitlement, attention-seeking behaviors, manipulation and a lack of empathy (American Psychiatric Association, 2013 ). There is evidence that also suggests a more covert type of NPD that is more indifferent than bombastic in nature, which has been hypothesized to be due to experiencing intense shame over inner grandiose thoughts (Gabbard, 1994 ). Despite their bravado, individuals with NPD typically have fragile egos prone to deep feelings of hurt from criticism (American Psychiatric Association, 2013 ). NPD is more commonly diagnosed in men with 50–75% of patients being male (American Psychiatric Association, 2013 ) compared to female, and treatment typically involves managing feelings of anger, depression and shame if the NPD individual even enters into psychotherapy (Kraus & Reynolds, 2001 ).

Histrionic Personality Disorder

Histrionic personality disorder (HPD) is characterized by a pattern of excessive yet shallow displays of emotion, attention-seeking behaviors, suggestibility and dramatic flair (American Psychiatric Association, 2013 ). Like with BPD, individuals with HPD may present with suicidal behaviors for attention and are most often women (American Psychiatric Association, 2013 ). But unlike BPD, HPD is lacking in empirical research (Kraus & Reynolds, 2001 ) and is considered ‘flat’ in literature growth (Blashfield & Intoccia, 2000, p. 473). Accordingly, little is known about HPD patients and their development; it has been posited, though, that HPD developed out of a craving for attention from caregivers and that psychotherapy should focus on managing the HPD patient's need for attention (Kraus & Reynolds, 2001 ).

Psychiatric Disorders and Case Law

Reviews of psychiatric disorders in case law or legal precedent are limited to a few studies. The diagnosis of multiple personalities, now referred to as dissociative identity disorder (DID), for example, was studied in part because the controversy surrounding the disorder combined with the conundrum of how to use it as a defense to crimes resulted in interesting legal issues (Appelbaum & Greer, 1994 ; Dawson, 1999 ; James, 1998 ; Radwin, 1991 ). Other reviews of psychology and case law have examined neurodevelopmental disorders such as autism spectrum disorders (ASD; Freckelton, 2013 ) and fetal alcohol syndrome (FAS; Douds, Stevens, & Sumner, 2012 ), both diagnoses of which can be especially relevant throughout every step of a criminal trial. ASD in particular have been used to show that defendants lack the capability of forming the specific intent necessary to satisfy many crimes (Freckelton & List, 2009 ).

In the Douds et al. ( 2012 ) study, researchers conducted the first review of federal case law and FAS using the legal search engine LexisNexis. They found that most of the cases (81 out of 131) emerged after 2005, possibly signifying a shift in the courts post Atkins (2002) 1. (Douds et al., 2012 ). Findings indicated that cases with defendants who introduced evidence of a FAS diagnosis typically fell within the jurisdiction of the Eighth 2. or Ninth 3. United States Circuit Court of Appeals (Douds et al., 2012 ). The District Court in Texas heard the most FAS cases out of any district court, and as a venue, Texas denied many defendants presenting with FAS with only 32% of defendants succeeding on their claims (Douds et al., 2012 ). Further results showed that all of the courts found evidence of FAS relevant under Federal Rules of Evidence (FRE) rule 401, which requires that evidence has ‘any tendency to make a fact more or less probable than it would be without the evidence and that the fact is of consequence in determining the action’; however, Douds et al. found that the courts differed when it came to analyzing FAS evidence under the FRE rule 403 test for ‘probative value’ – some courts viewed the evidence as more persuasive in the context of their respective cases while others viewed it as less so. Additionally, though all of the courts admitted FAS evidence, researchers discovered that many courts ‘lumped the diagnoses with a myriad other issues and diagnoses,’ thereby losing some of the distinct value that evidence of a FAS diagnosis has to offer in a criminal defense (Douds et al., 2012 , p. 498). The mixed results from Douds et al. 's study demonstrated that while courts have increasingly admitted evidence of mental health issues, they have been unsure of how to utilize certain diagnoses in their decision-making process and how much weight to give such evidence.

In an extensive study, Denno ( 2015 ) investigated how neuropsychological evidence has been used in criminal law. Similar to Douds et al.'s ( 2012 ) research, Denno collected data through legal search engines and found 800 criminal cases spanning two decades that were categorized as presenting either imaging (e.g. computed tomography, CT, scan; magnetic resonance imaging, MRI; electroencephalography, EEG, etc.) or nonimaging tests (e.g. Wechsler Adult Intelligence Scale, WAIS; Minnesota Multiphasic Personality Inventory, MMPI; Rorschach, etc.). Denno found that most of the defendants in the cases reviewed had been charged with murder and attempted to use neuroscience to inform not guilty pleas as well as to provide mitigating factors in the sentencing phase. Further, Denno's results showed that neuroscience evidence was commonly used to support ineffective assistance of counsel claims under Strickland v Washington (1984), 4. especially in capital punishment cases, noting that courts ‘not only expect attorneys to investigate and use available neuroscience evidence in their cases when it is appropriate, but they penalize attorneys who neglect this obligation’ (p. 544). Denno's research thus demonstrated the crucial role that psychological evidence can play in a defendant's case.

Cluster B in Criminal Law

Research in forensic psychology on Cluster B personality disorders has typically focused on criminal law and antisocial personality (Coid, 2002 ; Coid et al., 2006 ; Hodgins & Côté, 1993 ) or criminal law and borderline personality (Howard, Huband, Duggan, & Mannion, 2008 ; Sansone, Watts, & Wiederman, 2014 ; Sisti & Caplan, 2012 ). In fact, antisocial personality has been called the ‘primary focus within the criminal forensic realm’ (Johnson & Elbogen, 2013 , p. 207), yet no literature on the disorder with regards to case law exists. Narcissistic personality has been correlated in a few studies with crimes against others (Keeney et al., 1997 ), homicide (Coid, 2002 ), and fraud and forgery violations (Roberts & Coid, 2010 ). Borderline personality has been linked to arson charges (Coid, 2002 ); however, a follow-up study showed that there was no association with the disorder and criminal offenses (Roberts & Coid, 2010 ).

Research has also linked borderline personality to the crime of stalking (Lewis, Fremouw, Del Ben, & Farr, 2001 ; Ménard & Pincus, 2014 ; Sansone & Sansone, 2010 ). In a retrospective study conducted in an acute psychiatric unit, Sandberg, McNeil, and Binder ( 1998 ) found that 8 out of the 17 patients (47%) who stalked, threatened or harassed staff following discharge met criteria for a personality disorder. Although Sandberg et al. did not identify which personality disorder in their study, the literature has correlated borderline personality with being a stalker (Sansone & Sansone, 2010) as well as a victim of stalking (Ménard & Pincus, 2014 ). Demographic data suggested that stalkers were more likely to be White males, unmarried and with previous hospitalizations (Sandberg, McNiel, & Binder, 1998 ).

Cluster B in Civil Law

Because the primary focus of personality disorders and the law centers around antisocial personality and criminal law, much is left to be studied in civil law research. In fact, the function of the mental health history of a litigant in civil law has been called ‘far less clear’ when compared to criminal law (Smith, 2010 ). In general, evidence of psychiatric conditions has been viewed by courts as being relevant to civil cases for several reasons including to prove causation, to impeach character witnesses, and to show propensities, or repeated behaviors, that might favor the defendant (Smith, 2010 ). Indeed, a litigant's mental health history can be an effective tool used to persuade triers of fact. The problem, however, according to Smith ( 2010 ) lies within the judicial system; courts, despite admitting a party's relevant psychiatric evidence, frequently misapply or fail to investigate the evidence, which inadvertently results in rulings that do not take into account all of the facts. This combination of introducing and misinterpreting psychiatric evidence during trials, especially with respect to personality disorders, has been described as a ‘danger’ (Smith, 2010 , p. 813) in that legal error may result. Thus, it is apparent that the communication channels between courts and mental health professionals need to be vastly improved.

The current research suggests that individuals with personality disorders are likely to be litigants in courtroom proceedings. It has been demonstrated in the literature that many defendants who face legal problems also have personality disorders. However, no research to date has focused on reviewing case law to analyze any trends concerning Cluster B personality disorders.

Personality disorders are chronic and pervasive conditions that disrupt the individual's social and occupational relationships throughout the entirety of the lifespan (American Psychiatric Association, 2013 ). It has been estimated that up to 10% of the population meets criteria for any personality disorder (American Psychiatric Association, 2013 ); prevalence for Cluster B personalities increase to more than 50% in psychiatric outpatient samples (El Kissi, Ayachi, Ben Nasr, & Bechir Ben Hadj, 2009 ) and well over 70% in jail or prison (American Psychiatric Association, 2013 ). Personality disorders are prevalent in the judicial system with Cluster B personalities showing up frequently in criminal and correctional settings as well as family court involving child custody disputes (Feinberg & Greene, 1997 ; Reid, 2009 ). Given the chronicity, severity and lack of treatment options available for personality disorders, individuals who have personality disorders may be more litigious, overrepresented in certain areas of the law (e.g. criminal), and not as successful on the merits of their cases. Expanding research in this area would better inform the judicial system, courts and lawyers on how to treat evidence of a personality disorder and on the likely outcomes of cases involving personality disorders as well as assist mental health professionals if they were to professionally consult on such a case during the course of a legal proceeding.

The purpose of this study was to evaluate Cluster B personality disorders in published United States federal and state case law. Specifically, the researchers conducted an exploratory analysis looking at reasons why litigants would introduce evidence of a Cluster B personality disorder.

The sample was estimated to be composed of approximately 1,000 preexisting United States federal and state cases retrieved through the public electronic legal research database LexisNexis. The sample consisted of litigants, either plaintiff or defendant, who have introduced evidence of a Cluster B personality disorder. The sample of litigants within the cases were inclusive of all genders and minorities. Only cases that have been published were included. Cases that were published but have since been depublished were excluded. Likewise, cases that were unreported were excluded. Duplicate cases including appeals were removed from the sample. When possible, the ruling from the highest court on the substantive issue was recorded to provide an accurate representation of the final disposition of the case. The quantitative portion of this study used all cases decided between January 1980, the publication year of the Diagnostic and Statistical Manual of Mental Disorders– Third Edition ( DSM – III ), and 2016, the date that data collection on this study began. Data were estimated to span 36 years of case law.

The researchers collected qualitative data using the publicly available, commonly used legal research database LexisNexis. The search terms used were: “diagnos! AND ‘antisocial personality disorder’ w/p dr. OR therapist” wherein ‘antisocial’ was later replaced with borderline, narcissistic and histrionic to collect search results for each of the four Cluster B disorders.

Descriptive analyses

The number of Cluster B cases retrieved from search results was 4,388, of which 2,989 were excluded for a total n = 1,399. In all, there were 718 (51.3%) ASPD cases, 527 (37.7%) BPD cases, 102 (7.3%) NPD cases, and 52 (3.7%) HPD cases. Published federal and state cases spanned from 1980 to 2016. An overall positive trend showing an increase in published opinions referencing a Cluster B personality disorder can be seen in Figure 1 . Regarding frequency of cases throughout the years, the fewest number of cases (2) were published in 1980, and the highest number of cases (96) to date peaked in 2014. See Figure 2 for more detail by each disorder. Almost half (46.6%) of the cases were published in the last 10 years.

Combined Cluster B personality disorders trend in U.S. case law since Diagnostic and Statistical Manual of Mental Disorders–Third Edition (DSM–III). 9.

Number of annual opinions by Cluster B litigant. ASPD = antisocial personality disorder; BPD = borderline personality disorder; NPD = narcissistic personality disorder; HPD = histrionic personality disorder. To view this figure in color, please visit the online issue of the Journal.

Most cases were decided by state courts and involved civil 5. (68.0%) matters. The majority of all Cluster B litigants were plaintiffs 6. (59.3%). More than half (53.7%) of the parties introducing evidence of a Cluster B personality disorder were plaintiffs, 45.2% were defendants, and approximately 1% were court appointed, independent of either party, or unknown. Evidence of a Cluster B disorder tended to be entered into evidence by the opposing party rather than the Cluster B litigant themselves. See Table 1 .

Party who introduced evidence of a Cluster B in trial.

Note: PD = personality disorder.

Issues presented in cases ranged from federal constitutional appeals to personal injury claims. See Table 2 showing the types and number of cases found. Specifically, the most common types of issues presented in court included criminal appeals (47.9%), disability (19.2%), civil/involuntary commitment (16.7%), and family matters (10.2%). As a group, Cluster B litigants were typically not successful (68.4%) in their legal proceedings. See Table 3 for a complete breakdown of the success of each Cluster B personality disorder.

Types of cases in this sample by Cluster B personality disorder.

Litigation success of Cluster B personality disorder parties in published court opinions.

Cluster B data by personality disorder

The majority of Cluster B cases fell under ASPD with a total of 2,048, of which 1,330 were ruled out; 1,008 were unreported, 7. 137 involved parties with no diagnosis 8. of ASPD, 76 were overruled, 57 were duplicate cases, 49 were unpublished, and 3 were inapplicable. A net total of 718 valid ASPD cases remained. Of the 718 cases, most (66%) were made up of civil matters; however, more than two thirds of all ASPD cases involved litigants with a criminal history who petitioned the court for matters that fell under the purview of civil law (e.g. habeas corpus petitions, civil commitment). The most common types of cases involving an ASPD litigant were criminal appeals (54.5%) including habeas corpus and postconviction petitions, civil commitment appeals (27.9%) arising out of sexually violent predator or sexually dangerous person (SVP/SDP) state statutes, and disability (11.0%). See Table 2 .

In habeas corpus and postconviction petitions, ASPD plaintiffs often used the diagnosis as part of a defense strategy (e.g. competency, diminished capacity, insanity, guilty but mentally ill) against their convictions or in an attempt to mitigate sentencing in instances where they received lengthy sentences and/or capital punishment. A total of 154 out of the 391 ASPD litigants who made a criminal appeal raised the constitutional criminal procedure issue of receiving ineffective assistance of counsel at their original trials. In SVP/SDP cases, ASPD plaintiffs tended to have evidence of an ASPD diagnosis entered against them by the state. This was also the case for family law decisions involving parental termination; state agencies advocating for termination of parental rights introduced evidence of the parent's psychological evaluation showing diagnosis of ASPD.

Regarding the make-up of litigants, 57.4% of the plaintiffs or appellants and 42.6% of the defendants or appellees were diagnosed with ASPD. Forty percent (287) of the ASPD litigants introduced evidence of their personality disorder at trial, and 59.5% (427) had evidence introduced against them by the other party. ASPD litigants tended to be unsuccessful in their cases with an overall success rate of 26.9%. See Table 3 .

A search of BPD yielded the second-highest number of cases with 1,865 results retrieved from search engines. Of that amount, 1,338 were excluded; 1,165 were unreported, 107 included no BPD diagnosis, 51 were overruled, 13 were duplicate cases, and 2 were unpublished, which left a total of 527 BPD cases. BPD cases made up 37.7% of the Cluster B cases found, and most (67.9%) were classified as civil lawsuits. The most common types of issues raised in BPD cases were criminal appeals (44.2%), disability (29.8%), and family (14.8%). Similar to ASPD litigants, BPD litigants tended to introduce evidence of their Cluster B personality disorder in mitigation for criminal appeals. For disability cases, BPD was often introduced by the Social Security Administration (SSA) Commissioner or administrative law judge (ALJ) to rebut the Cluster B litigant's claim of disability. In family cases, BPD was commonly introduced by state agencies against parent-petitioners and used to bolster states’ cases in parental termination proceedings.

Most of the BPD cases (64.5%) involved a plaintiff or appellant diagnosed with BPD. The remaining 35.5% involved cases where the defendant or appellee was diagnosed with BPD. Most BPD litigants (60.7%) introduced evidence of their own diagnosis while the remaining had their diagnosis offered by the opposing party. Overall, the majority of BPD litigants (60.3%) tended to be unsuccessful in their cases.

A search of NPD cases returned a total of 304, of which 140 were unreported, 35 involved no diagnosis of NPD, 11 were overruled, 11 were duplicate, and 5 were unpublished for a net total of 102 cases. NPD cases tended to fall under civil law (71.6%). The most common cases for NPD litigants in this sample were criminal appeals (36.3%), family (17.6%), and labor and employment (14.7%). The reasons for introducing NPD in criminal and family cases were similar to those provided under ASPD and BPD (e.g. defense, mitigation, parental termination). In labor and employment cases, NPD was commonly diagnosed in the party who was an employee or held a state license (e.g. attorney bar membership, physician license to practice medicine). NPD was entered into evidence in part to provide a rationale as to why the employee was terminated or stripped of their license.

Litigants diagnosed with NPD tended to be defendants (57.8%) more so than plaintiffs. The majority of cases (63.7%) showed that opposing parties usually introduced evidence of the NPD litigant's Cluster B diagnosis. NPD litigants had the least successful rate in cases of the Cluster B disorders with only 18.6% of the rulings made in favor of the NPD litigant.

HPD cases constituted the fewest number of results in this sample. Search results produced a total of 171 cases, of which 86 were unreported, 25 involved no diagnosis with HPD, 6 were unpublished, 1 was overruled, and 1 was a duplicate. In all, there was a total of 52 valid HPD cases. The majority of HPD cases were classified under civil law (90.4%), the highest percentage of civil to criminal law out of all the Cluster B disorders. The most common cases for HPD litigants to be engaged in were disability (42.3%) and family law (32.7%).

The majority (65.4%) of HPD litigants were plaintiffs. Cases involving an HPD litigant introducing evidence of the Cluster B personality disorder showed that HPD litigants introduced the disorder 34.6% of the time while opposing parties introduced it 63.5%. HPD litigants tended to be less successful in their legal proceedings, achieving a 38.5% success rate on their cases.

General Findings

Trend of cluster b personality disorders in united states case law.

Perhaps one of the more significant findings of this project was the trend of an increasing number of legal decisions involving Cluster B personality disorders since the introduction of the DSM–III in 1980. As seen in Figure 1 , there has been a steady overall growth in mentions of Cluster B personality disorders within United States case law and specifically with respect to ASPD and BPD. See Figure 2 for a more detailed view of each personality disorder. Because more than half of the cases in the 36-year span (1980–2016) were published within the last 10 years, one explanation for this increase could be the United States Supreme Court's landmark decision Atkins v VA , 536 U.S. 304 in 2002, which catalyzed the use of mental health as a mitigating factor in criminal sentencing. This finding was consistent with the Douds et al. ( 2012 ) study, which showed an increase in FAS cases post Atkins .

Although Atkins (2002) is more commonly known for its use of ID as a defense, Atkins was also an important development in the personality disorder arena. Following Atkins’ own expert Dr. Nelson in the second sentencing phase, the state's forensic psychology expert Dr. Samenow testified in rebuttal that Atkins was in fact of ‘average intelligence, at least’ and diagnosed him with ASPD, a disorder that would not have entitled him to mitigation ( Atkins v. VA , at 343, 2002 ). Though the Virginia Supreme Court's affirmation of Atkins’ convictions and death sentence were later overturned, and Atkins was deemed to be an offender with ID, the introduction of ASPD into testimony was significant. Dr. Samenow, as the state's expert, used ASPD in effect as ammunition against Atkins to explain his criminal behavior and advocate for his penalty. Because Atkins (2002) was a landmark United States Supreme Court decision and served as a blueprint for criminal defense lawyers representing similar defendants throughout the country, it may be more than coincidental that personality disorders such as ASPD multiplied within case law in the years since the Atkins (2002) decision.

Post Atkins (2002), further case law has strengthened the position that personality disorders carry weight in the courtroom. One such example is another United States Supreme Court case, Brumfield v. Cain , 135 S. Ct. 2269 (2015). In Brumfield (2015), plaintiff Brumfield shot and killed a veteran female police officer who was helping guard a grocery store manager on her way to the bank. Brumfield was convicted of the officer's 1993 murder and was sentenced to death ( Brumfield v. Cain , 2015). Following the Atkins (2002) decision, Brumfield submitted evidence that his score of ‘75 on an IQ test’ was consistent with the Atkins standard of ID; however, the state rebutted Brumfield's claim of ID using testimony from state psychologist Dr. Bolter who had diagnosed Brumfield with ASPD ( Brumfield v Cain , 2015). In the Supreme Court ruling, Justice Sotomayor writing for the majority reasoned that a diagnosis of ASPD did not preclude a defendant from relief under Atkins because ‘antisocial personality is not inconsistent with any of the above-mentioned areas of adaptive impairment, or with intellectual disability more generally’ ( Brumfield v Cain , 2015, at 2280). Thus, it is possible that Atkins (2002) and Brumfield (2015) may usher in a new era of litigants who assert a Cluster B personality disorder, the peak of which we have yet to see in case law.

However, the appearance of Atkins (2002) in the legal landscape does not necessarily explain the relatively flat number of cases involving NPD and HPD clients. Of course, there may be other reasons besides Atkins (2002) for the rise in ASPD and BPD cases and the plateau of NPD and HPD cases. One such possibility is that the growth of ASPD and BPD in case law mirrors the growth seen in the empirical literature where much of the research has been focused on those two particular disorders. Both ASPD and BPD enjoy popularity within empirical research and pop culture (see e.g. the televised trials of Jodi Arias, Casey Anthony and Jeffrey Dahmer; the documentary Serial Killer Culture , 2014, which showcases fandom and obsession of notorious offenders), although ASPD is by far more well known and is even considered a ‘sexy’ topic compared to the other Cluster B disorders.

An additional point about the prevalence of ASPD and BPD in this sample as well as in the empirical literature is the attention or notoriety these disorders receive in the media. As evidenced by this research, the majority of ASPD and BPD cases (as well as the majority of all the Cluster B cases found) involved criminal appeals for litigants convicted of murder. Alleged and convicted murderers tend to receive an abundance of air time when crimes happen, especially if the details of the offense are unusually cruel or unique. This presence in the media helps to elevate the status of any personality disorders that are later diagnosed, which thereby can help to popularize the disorder. As interest in a particular disorder, such as ASPD, grows, publishers or producers of media who want to take advantage of the cause célébre encourage the production of features, books and articles of the disorder, which in turn can influence the United States judicial system.

One last possible reason for the acceleration in ASPD and BPD cases is, of course, the increased awareness of trial counsel to issues related to mental health. Criminal defense lawyers are taught in continuing education courses to have their clients ‘shrunk,’ or evaluated by a mental health professional, as part of the discovery process to find out whether any of their client's mental health background can be used as part of a larger narrative in defense strategy. For noncriminal lawyers, continuing education typically includes curriculum on how depression and substance abuse can affect individuals, including lawyers themselves. As lawyers become more aware of problems affecting mental health, it becomes less surprising to see that mental health diagnoses are introduced as evidence at trial. Competence, for example, is such a significant issue to the legal process that competency can be raised sua sponte if the presiding judge suspects that the litigant may have competency-related issues. The psycho-education of lawyers in mental health issues may very well have contributed to a larger awareness of how psychology interacts with the judicial system, and this awareness may have translated into an increase in mental health testimony in court.

Thus, the publication of Atkins (2002), heightened media coverage of notorious criminal defendants, and/or increased awareness of mental health issues on the part of prosecutors and criminal defense attorneys may have contributed to a positive trend of Cluster B in case law since the publication of the DSM–III.

Exploratory Analysis

Parole and probation.

Typically, criminal appellants who petitioned for sentence appeals asked the court to vacate their convictions entirely rather than request alternate sentencing such as parole or probation. The reasoning behind seeking the conviction be overturned completely versus asking for sentence mitigation may have more to do with the convictions themselves; Cluster B litigants as a group tended to be charged with violent crimes. Murder was the most common conviction in the criminal litigant sample. Murder, of course, is a felony requiring imprisonment of more than 365 days, and offenders convicted of murder are oftentimes handed down decades of imprisonment to be served in state penitentiaries. These offenders may not be eligible for parole or probation for many years to come; however, they become immediately eligible to appeal their convictions once sentenced. Thus, the paucity of direct appeals from parole or probation boards could be explained by criminal offenders’ preference to initiate the appeals process as soon as possible. Further, appeals on convictions are independent from appeals they could bring against parole or probation boards in the future, making it possible for a criminal offender to be in the process of appealing their criminal convictions at the same time as initiating an appeal stemming from a parole board decision. Accordingly, few cases found in the sample involved direct appeals of parole or probation board decisions.

Insanity Defense

Depending on the jurisdiction, Cluster B litigants argued for not guilty by reason of insanity (NGRI), guilty but mentally ill (GBMI), and diminished capacity. Overall, Cluster B litigants who argued the insanity defense were unsuccessful on their appeals; 10. see Davis v Norris , 423 F 3d 868 (2005) (denying insanity defense and habeas corpus petition to ASPD litigant sentenced to death for murder); US v Waagner , 319 F3d 962 (2003) (denying insanity defense and affirming ASPD litigant's convictions for possession of a firearm, stolen vehicle, and escape); People v Weaver , 26 Cal 4th 876 (2001) (denying insanity defense and affirming convictions for first-degree murder and kidnapping); Davis v State , 595 NW 2d 520 (1999) (affirming convictions for first- and second-degree murder after two experts opined ASPD plaintiff was not legally sane when he committed the killings); State v Young , 780 P 2d 1233 (1989) (dismissing ASPD litigant's diminished capacity claim and affirming convictions of kidnapping, sexual assault and robbery); State v Murphy , 872 P 2d 480 (1994) (denying ASPD litigant's GBMI defense while affirming a conviction for sexual abuse of a child); and State v Rainey , 580 A 2d 682 (1990) (denying BPD litigant's ‘abnormal condition of the mind’ defense and affirming convictions for the intentional or knowing murder of his stepdaughter and fiancé and attempted murder of stepson).

Of the few cases in which Cluster B litigants were successful in arguing for insanity, there were some common aspects. For one, these cases involved litigants who were diagnosed with either ASPD or BPD; no NPD litigant was successful in arguing for insanity, and there were no insanity cases in this sample involving an HPD litigant. Second, ASPD and BPD litigants who successfully argued insanity tended to be criminal defendants convicted of a violent offense such as murder and, upon a successful appeal, had their cases reversed and were remanded to trial court for further consideration of their insanity claims.

It is quite possible that one of the reasons why some ASPD and BPD litigants succeeded on their insanity defenses was that they were able to show a nexus between their personality disorder symptoms and their claim for insanity. Out of the four Cluster B personality disorders, ASPD and BPD are the two disorders listing criteria that effortlessly lend themselves to an insanity claim. Specifically, DSM–5 (2013) ASPD criteria A3 for impulsivity and A4 for irritability and aggressiveness, especially when coupled with high comorbidity of substance use, correspond to a likelihood for ‘blacking out’ during violent incidents. Similarly, DSM–5 BPD criterion A9 describing ‘transient, stress-related paranoid ideation or severe dissociative symptoms’ could be argued as an insanity claim based on the likelihood that an offender may slip in and out of reality during a violent crime. When contrasted with NPD and HPD, both of which omit criteria pertinent to insanity (such as impulsivity and dissociation) and garner attention from others in a much different fashion than what is found in ASPD and BPD, it becomes more understandable that the former two disorders tend to be unsuccessful or altogether absent from insanity cases.

Capital punishment

Criminal appellants who petitioned for death sentence appeals had similar characteristics. They tended to be male plaintiffs diagnosed with ASPD who appealed their sentences through habeas corpus or postconviction petitions. Violent crimes including first-degree murder, rape and robbery were typical of the convictions found with these plaintiffs. Both state expert and defense counsel witnesses presented evidence of criminal appellants’ Cluster B personality disorders; in general, the state presented evidence of the personality disorder to help convict the Cluster B litigant and to persuade the jury as to why they should be sentenced to death. Cluster B litigants also presented evidence of their own diagnoses in mitigation.

One apparent theme in the sample was that Cluster B diagnoses such as ASPD were considered to be more of an aggravating, rather than mitigating, factor in capital punishment sentencing. For the most part, Cluster B diagnoses were used in this sample more as a sword than as a shield; see e.g. Stewart v Sec'y , 476 F 3d 1193 (2007) (affirming denial of ASPD plaintiff's habeas corpus petition); Bible v Schriro , 497 F Supp.2d 991 (2007) (denying ASPD plaintiff's habeas corpus petition and vacating stay of execution previously awarded by lower court); Lorraine v Coyle , 291 F 3d 416 (2002) (reversing grant of ASPD plaintiff's habeas petition); Worthington v Roper , 631 F.3d 487 (2011) (reversing federal court grant of writ of habeas to ASPD plaintiff); and Cullen v Pinholster , 563 US 170 (2011) (US Supreme Court case reversing lower federal court grant of writ of habeas to ASPD plaintiff).

One emerging theme in this sample regarding successful appeals for capital punishment sentences was where the Cluster B litigants themselves presented evidence of their own diagnosis. Rather than have the opposing party introduce the Cluster B diagnosis, criminal litigants facing death sentences offered evidence of their ASPD or BPD. 11. This discovery was atypical of the overall data found in that most litigants tended to have their Cluster B diagnoses introduced by the opposing party. Perhaps when faced with capital punishment, Cluster B litigants viewed their diagnoses through the lens of the dicta in Gregg v GA , 428 US 513 (1976) 12. and the ‘death is different’ doctrine. It is quite possible that with their own mortality looming, these litigants were forthright in their habeas corpus and postconviction petitions in a way that they had not been in previous proceedings, perhaps even in their own original criminal trials. Some litigants were rewarded for their efforts by having their convictions or sentences vacated, which should serve as inspiration for any litigant to explore all avenues when it comes to capital punishment defense.

Parental Rights Termination

Parental rights termination proceedings comprised the majority of family law cases in this sample. In general, Cluster B personality disorders were treated negatively in case law and were solely used to support the termination of parental rights. No Cluster B litigant in a parental termination case used evidence of their Cluster B diagnosis as a positive trait with regards to parenting. In fact, Cluster B diagnoses were typically admitted into evidence only after the state ordered a psychological evaluation for the parent to determine parental fitness. The most common Cluster B diagnosis in parental termination proceedings was BPD, which is understandable given the pathological relational model inherent in BPD individuals, the need for closeness to others and the volatility that comes with splitting. Evidence of a Cluster B disorder tended to be introduced on behalf of mothers more than fathers, but this could have been because more mothers appealed their parental rights termination decisions and subsequently had their case/diagnosis published in a court opinion.

Cluster B litigants were predominantly unsuccessful in their parental rights termination appeals. This was especially apparent in cases where the mother threatened to or actually harmed herself in front of her children; see In the Matter of LGT (State v RJT) , 229 Ore App. 619 (2009) (affirming parental termination of a young adopted child after BPD mother had attempted suicide at least five times during the child's life); TN v Bates , 84 S.W.3d 186 (2002) (affirming parental termination after BPD mother attempted suicide at home using a gas stove while her children were present); and In the Interest of TLB , 376 SW 3d 1 (2011) (affirming parental termination after BPD mother made threats to commit suicide and murder all of the children).

Courts also severed the parent–child relationship in cases where it appeared that termination was in the best interests of the child; see In re Carrington H , 483 SW 3d 507 (2015) (affirming termination of HPD parent after finding that it was in the best interest of the child); In the Interest of TMS , 242 Ga App 442 (2000) (affirming the juvenile court's decision in favor of termination due to parental misconduct or inability); In re JW , 779 NE 2d 954 (2002) (affirming termination after HPD mother who was also diagnosed with Munchausen by proxy and ASPD purposely gave her infant multiple prescription drugs); In the Matter of Aniya L , 124 AD 3d 1001 (2015) (affirming that termination of BPD mother rights was in the best interest of the child); and In the Matter of Lehtonen (State v Lehtonen) , 172 Ore App 584 (2001) (affirming termination of BPD mother's parental rights after finding that mother's condition was detrimental to the child and that termination was in the best interests of the child).

Civil Litigant Success

The majority of cases analyzed for civil litigant success were composed of supplemental security income (SSI)/disability cases. Cluster B litigants tended to be the parties appealing termination of benefit decisions or benefit denials; few of the cases found involved the SSA Commissioner appealing decisions in favor of the Cluster B appellant. Mental health professionals, specifically psychologists and psychiatrists, were instrumental in SSI/disability decisions, and the SSA appeared to base their decisions entirely on consulting professionals who performed evaluations on behalf of the government.

Generally, Cluster B litigants who showed evidence of physical symptoms and serious diagnoses in addition to their Cluster B diagnosis met the definition of disability; see, for example, Delgado v Colvin , 190 Soc Sec Rep Service 644 (1986) (reversed and remanded SSI denial for an HPD plaintiff who was diagnosed with cerebral palsy, depression, bipolar disorder and back problems); Griffin v Astrue , 167 Soc Sec Rep Service 730 (2011) (granted in part and remanded for HPD plaintiff who alleged disability due to bipolar disorder, auditory hallucinations and panic attacks); Chase v Astrue , 158 Soc Sec Rep Service 411 (2010) (reversed and remanded denial for HPD plaintiff who was diagnosed with migraines, depression, anxiety, agoraphobia, hearing loss, tinnitus, PTSD, nerve damage, memory loss, neck/shoulder pain, effects of a head injury); Green v. Barnhart , 262 F Supp 2d 1271 (2003) (reversed and remanded for HPD plaintiff who was unable to work and alleged chronic fatigue syndrome, fibromyalgia, ADHD, bladder incontinence, depression, somatoform disorder, and possible sleep apnea); and Schneider v Apfel , 74 Soc Sec Rep Service 234 (2001) (remanded for calculation of benefits for HPD plaintiff who had chemical sensitivity; Raynaud's disease; depression; anxiety; posttraumatic stress disorder, PTSD; panic attacks; psychosomatic symptoms; fibromyalgia; a learning disorder; and carpal tunnel syndrome).

Though all of the Cluster B personality disorders were represented in SSI/disability cases, BPD and HPD were prevalent. These two disorders correspond in the literature to a more hysterical presentation, the symptoms of which may be somaticized when compared to individuals with ASPD and NPD. Further, individuals with BPD or HPD may be more likely to seek out disability compensation in part due to a sense of urgency that may exaggerate physical symptoms, due to a desire for validation of their pain and psychic injury, for attention-seeking purposes (especially if the litigant is female and internalized an unstable view of the self that requires rescuing from an external source), or because of an overwhelming feeling of incompetence after experiencing years of living in an invalidating social environment. Of course, there is also the possibility that BPD and HPD were overdiagnosed in this sample given the gender bias for both disorders to be diagnosed more in female patients. This may readily have been the case given that many of the SSI/disability cases found dated back to the 1980s in a time where cultural competence in gender bias was not as fully developed as it is today.

Limitations

There are several limitations in our research. First, excluding unpublished and unreported case opinions may have affected the overall results of this sample. Out of thousands of court opinions rendered each day, a very small percentage of those are published. Many relevant and significant opinions concerning this research may have been unreported, depublished, or never published in the first place. Using a sample that only reviews published court opinions may have significantly reduced the volume of relevant cases through which to gain an understanding of Cluster B personality disorders in case law.

A second limitation was internal validity in categorizing collected data. Legal opinions tend to be complex and include multiple, confounding variables that make it difficult to sort out decisions. Many times, decisions in this sample of case opinions did not hinge upon a Cluster B personality disorder diagnosis at all but rather on a procedural issue. A litigant's personality disorder was just one variable in a broader narrative of evidence, which at times made it difficult to collect data and could have resulted in errors.

Another limitation in this research was that it involved reviewing appellate decisions instead of trial court transcripts. Because this study collected data using published opinions, cases that had achieved a publication status had, in some cases, been appealed dozens of times. Restating the same facts throughout multiple opinions could have resulted in errors and/or misinterpretations despite the courts’ due diligence in maintaining accuracy. Reviewing the trial court transcript, had they been available for all of the cases in this sample, might have resulted in greater accuracy or less misinterpretation of facts.

Research on Cluster B personality disorders in United States case law is a new frontier. This study took an initial step in showing that court opinions and legal history can provide clues as to litigants’ psychological make-up and offer insight into an overall broader scheme of how personality can affect trial outcomes. All too often in the past, individuals who were diagnosed with what was once called an ‘Axis Two’ were thought of as unmanageable. This stigmatizing effect unfortunately found its way through the legal system such that attorneys were cautioned before undertaking cases involving an individual with a personality disorder. Equipped with little empirical research on personality disorders and their legal implications, some counsel may be at a loss with how to strategize effectively for a Cluster B litigant. As attorneys struggle to present these clients in a favorable light within the courtroom, they may not realize the value in past years of case law involving a Cluster B party. With continued research utilizing both mental health professionals and legal experts, a more nuanced understanding of Cluster B litigants can take shape and conceivably transform the way these litigant-patients are seen in and outside of the courtroom.

1. Atkins v. VA , 536 U.S. 304 ( 2002 ) (establishing that imposing capital punishment on ‘mentally retarded’ individuals constituted excessive punishment and violated the 8th Amendment).

2. Arkansas, Iowa, Minnesota, Missouri, Nebraska, North Dakota, South Dakota.

3. Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, Oregon, Washington, Guam, Northern Mariana Islands.

4. 466 US 668 (1984) (holding that a criminal defendant's Sixth Amendment right to counsel is violated when counsel renders ineffective assistance).

5. Appeals stemming from criminal conduct involving constitutional rights issues (e.g. habeas corpus petitions) were categorized as civil based upon the area of law they would likely fall under.

6. Most litigants diagnosed with a Cluster B personality disorder were categorized as plaintiffs or appellants because they were often the parties appealing earlier decisions. This means that the majority of these Cluster B litigants were defendants in their original trials. Because published case opinions tend to be appellate in nature, the cases that were reviewed reflected the Cluster B litigant as the plaintiff/appellant/petitioner but may not necessarily mean that depiction was true in earlier proceedings. In sum, despite what role Cluster B litigants appeared to play in this sample, it is more likely that they would be on the receiving end of a lawsuit.

7. Unreported cases are cases that are not published in hard copy reporter series. Similar to unpublished cases, unreported cases were excluded from this study.

8. These cases mentioned the diagnosis in a parenthetical citation to an earlier case or described testimony in which the litigant was said to have “features” or “traits” of the disorder rather than the diagnosis; accordingly, these cases were omitted. The same is true of the remaining three Cluster B personality disorders where no diagnosis was found in the opinion.

9. Note: 2016 data were incomplete as of data collection in this study.

10. Interestingly, John Hinckley, who successfully argued his insanity case after he gained notoriety for stalking Jodie Foster and the attempted assassination of President Ronald Reagan, appeared in this sample's search results due to his lengthy history of carrying an NPD diagnosis; however, his appeal at US v Hinckley , 40 F Supp 3d 8 (2013) was concerned with the issue of his conditional release from St. Elizabeth's Hospital where he had been held for the last 30 years rather than his insanity plea.

11. There were no successful capital punishment cases in this sample with an NPD or HPD party.

12. Landmark decision holding that the death penalty did not violate the U.S. Constitution's 8th and 14th Amendments.

Ethical standards

Declaration of conflicts of interest.

Catherine Young has declared no conflicts of interest

Janice Habarth has declared no conflicts of interest

Bruce Bongar has declared no conflicts of interest

Wendy Packman has declared no conflicts of interest

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

• American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. [ Google Scholar ]
• Appelbaum P. S., & Greer A. (1994). Who's on trial? Multiple personalities and the insanity defense . Hospital & Community Psychiatry , 45 ( 10 ), 965–966. [ PubMed ] [ Google Scholar ]
• Appelbaum P. S., & Gutheil T. G. (2007). Clinical handbook of psychiatry and the law (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. [ Google Scholar ]
• Atkins v. Virginia , 536 U.S. 304 (2002). [ Google Scholar ]
• Blashfield R. K., & Intoccia V. (2000). Growth of the literature on the topic of personality disorders . American Journal of Psychiatry , 157 ( 3 ), 472–473. [ PubMed ] [ Google Scholar ]
• Coid J. W. (2002). Personality disorders in prisoners and their motivation for dangerous and disruptive behavior . Criminal Behaviour and Mental Health , 12 ( 3 ), 209–226. doi: doi.org/ 10.1002/cbm.497 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Coid J., Yang M., Tyrer P., Roberts A., & Ullrich S. (2006). Prevalence and correlates of personality disorder in Great Britain . The British Journal of Psychiatry , 188 ( 5 ), 423–431. doi: dx.doi.org/ 10.1192/bjp.188.5.423 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dawson J. (1999). The alter as agent: Multiple personality and the insanity defence . Psychiatry, Psychology and Law , 6 ( 2 ), 203–206. [ Google Scholar ]
• Denno D. W. (2015). The myth of the double-edged sword: An empirical study of neuroscience evidence in criminal cases . Boston College Law Review , 56 ( 2 ), 493–551. [ Google Scholar ]
• Douds A. S., Stevens H. R., & Sumner W. E. (2012). Sword or shield? A systematic review of the roles FASD evidence plays in judicial proceedings . Criminal Justice Policy Review , 24 ( 4 ), 492–509. doi: 10.1177/0887403412447809 [ CrossRef ] [ Google Scholar ]
• El Kissi Y., Ayachi M., Ben Nasr S., & Bechir Ben Hadj A. (2009). Personality disorders in a group of psychiatric outpatients: General aspects and Cluster B characteristics . La Tunisie Medicale , 87 ( 10 ), 685–689. Retrieved from http://www.latunisiemedicale.com/article-medicale-tunisie_1186_en [ PubMed ] [ Google Scholar ]
• Feinberg R., & Greene J. T. (1997). The intractable client: Guidelines for working with personality disorders in family law . Family & Conciliation Courts Review , 35 ( 3 ), 351–364. doi: 10.1111/j.174-1617.1997.tb00476.x [ CrossRef ] [ Google Scholar ]
• Freckelton I. (2013). Autism Spectrum Disorder: Forensic issues and challenges for mental health professionals and courts . Journal of Applied Research in Intellectual Disabilities , 26 ( 5 ), 420–434. doi: 10.1111/jar.12036 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Freckelton I., & List D. (2009). Asperger's Disorder, criminal responsibility and criminal culpability . Psychiatry, Psychology and Law , 16 ( 1 ), 16–40. doi: 10.1080/13218710902887483 [ CrossRef ] [ Google Scholar ]
• Fusco G. M. (2015). Clinical management: Working with those diagnosed with personality disorders . In Beck A. T., Davis D. D., & Freeman A. (Eds.), Cognitive therapy of personality disorders (3rd ed., pp. 409–427). New York, NY: Guilford Press. [ Google Scholar ]
• Gabbard G. O. (1994). Psychodynamic psychiatry in clinical practice (5th ed.). Washington, DC: American Psychiatric Press. [ Google Scholar ]
• García-Nieto R., Blasco-Fontecilla H., de Léon-Martinez V., & Baca-García E. (2014). Clinical features associated with suicide attempts versus suicide gestures in an inpatient sample . Archives of Suicide Research , 18 ( 4 ), 419–431. doi: 10.1080/13811118.2013.845122 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Goodman M., Roiff T., Oakes A. H., & Paris J. (2012). Suicidal risk and management in Borderline Personality Disorder . Current Psychiatry Reports , 14 ( 1 ), 79–85. doi: 10.1007/s11920-011-0249-4 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gregory R. J. (2012). Managing suicide risk in Borderline Personality Disorder . Psychiatric Times , 29 ( 5 ), 25–26. [ Google Scholar ]
• Hare R. D., Hart S. D., & Harpur T. J. (1991). Psychopathy and the DSM-IV criteria for Antisocial Personality Disorder . Journal of Abnormal Psychology , 100 ( 3 ), 391–398. [ PubMed ] [ Google Scholar ]
• Hatchett G. T. (2015). Treatment guidelines for clients with Antisocial Personality Disorder . Journal of Mental Health Counseling , 37 ( 1 ), 15–27. [ Google Scholar ]
• Hodgins S., & Côté G. (1993). Major mental disorder and antisocial personality disorder: A criminal combination. . The Bulletin of the American Academy of Psychiatry and the Law , 21 ( 2 ), 155–160. [ PubMed ] [ Google Scholar ]
• Howard R. C., Huband N., Duggan C., & Mannion A. (2008). Exploring the link between personality disorder and criminality in a community sample . Journal of Personality Disorders , 22 ( 6 ), 589–603. doi: 10.1521/pedi.2008.22.6.589 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• James D. (1998). Multiple personality disorder in the courts: A review of the North American experience . The Journal of Forensic Psychiatry , 9 ( 2 ), 339–361. doi: 10.1080/09585189808402201 [ CrossRef ] [ Google Scholar ]
• Johnson S. C., & Elbogen E. B. (2013). Personality disorders at the interface of psychiatry and the law: Legal use and clinical classification . Dialogues in Clinical Neuroscience , 15 ( 2 ), 203–211. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Keeney M. M., Festinger D. S., Marlowe D. B., Kirby K. C., & Platt J. J. (1997). Personality disorders and criminal activity among cocaine abusers . In Problems of Drug Dependence 1997: Proceedings of the 59th annual scientific meeting of the college on problems of drug dependence (Research Monograph No. 178) . National Institute on Drug Abuse. [ Google Scholar ]
• Kraus G., & Reynolds D. J. (2001). The “a-b-c's” of the cluster b's: Identifying, understanding, and treating cluster b personality disorders . Clinical Psychology Review , 21 ( 3 ), 345–373. [ PubMed ] [ Google Scholar ]
• Lenzenweger M. F., Lane M. C., Loranger A. W., & Kessler R. C. (2007). DSM-IV personality disorders in the natural comorbidity survey replication . Biological Psychiatry , 62 ( 6 ), 553–564. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lewis S. F., Fremouw W. J., Del Ben K., & Farr C. (2001). An investigation of the psychological characteristics of stalkers: Empathy, problem-solving, attachment and borderline personality features . Journal of Forensic Sciences , 46 ( 1 ), 80–84. [ PubMed ] [ Google Scholar ]
• Ménard K. S., & Pincus A. L. (2014). Child maltreatment, personality pathology, and stalking victimization among male and female college students . Violence and Victims , 29 ( 2 ), 300–316. doi: 10.1891/0886-6708.VV-D-12-00098R1 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Pompili M., Girardi P., Ruberto A., & Tatarelli R. (2005). Suicide in borderline personality disorder: A meta-analysis . Nordic Journal of Psychiatry , 59 ( 5 ), 319–324. doi: 10.1080/08039480500320025 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Radwin J. O. (1991). The multiple personality disorder: Has this trendy alibi lost its way ? Law & Psychology Review , 15 , 351–373. [ Google Scholar ]
• Reid W. H. (2009). Borderline personality disorder and related traits in forensic psychiatry . Journal of Psychiatric Practice , 15 ( 3 ), 216–220. doi: 10.1097/01.pra.0000351882.75754.0c [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Roberts A. D. L., & Coid J. W. (2010). Personality disorder and offending behavior: Findings from the national survey of male prisoners in England and Wales . The Journal of Forensic Psychiatry & Psychology , 21 ( 2 ), 221–237. doi: 10.1080/14789940903303811 [ CrossRef ] [ Google Scholar ]
• Sandberg D. A., McNiel D. E., & Binder R. L. (1998). Characteristics of psychiatric inpatients who stalk, threaten, or harass hospital staff after discharge . American Journal of Psychiatry , 155 ( 8 ), 1102–1105. [ PubMed ] [ Google Scholar ]
• Sansone R. A., & L. A. (2010). Fatal attraction syndrome: Stalking behavior and borderline personality . Psychiatry , 75 ( 5 ), 42–46. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Sansone R. A., & Sansone L. A. (2010). Fatal attraction syndrome: Stalking behavior and borderline personality . Psychiatry (Edgemont) , 7 ( 5 ), 42–46. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Sansone R. A., Watts D. A., & Wiederman M. W. (2014). Borderline personality symptomatology and legal charges related to drugs . International Journal of Psychiatry in Clinical Practice , 18 ( 2 ), 150–152. doi: 10.3109/13651501.2013.847107 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Simon R. I. (1995). Beware the legal liabilities of treating BPD patients . Psychotherapy Letter , 7 ( 6 ), 2–3. [ Google Scholar ]
• Sisti D. A., & Caplan A. L. (2012). Accommodation without exculpation? The ethical and legal paradoxes of borderline personality disorder . The Journal of Psychiatry & Law , 40 ( 1 ), 75–92. doi: doi.org/ 10.1177/009318531204000106 [ CrossRef ] [ Google Scholar ]
• Smith D. M. (2010). The disordered and discredited plaintiff: Psychiatric evidence in civil litigation . Cardozo Law Review , 31 ( 3 ), 749–822. [ Google Scholar ]
• Stone M. H. (1993). Paradoxes in the management of suicidality in borderline patients . American Journal of Psychotherapy , 47 ( 2 ), 255–272. [ PubMed ] [ Google Scholar ]

• The Amen Clinics Method
• About Brain SPECT Imaging
• SPECT Made Simple
• SPECT Research
• SPECT Gallery
• SPECT Case Studies
• Peer Reviewed Studies
• Attention Deficit Disorder (ADD)
• Anger Issues & IED
• Autism Spectrum Disorder
• Behavioral & School Problems
• Behavioral Addictions
• Bipolar Disorder
• Body Dysmorphic Disorder
• Borderline Personality Disorder
• Brain Optimization
• Child Psychiatry
• Complex Conditions
• Concussions
• Dissociative Disorders
• Drugs and Alcohol Addiction
• Dual Diagnosis
• Eating Disorders
• Emotional Trauma
• Hormonal Imbalances
• Learning Disabilities
• Lyme Disease and Other Infections
• Mania and Hypomania
• Marital Conflict and Relationship Issues
• Memory Problems & Dementia
• Multiple Personality Disorder
• Narcissistic Personality Disorder
• Obsessive Compulsive Disorder
• Oppositional Defiant Disorder
• Panic Disorder & Panic Attacks
• Personality Disorders
• Post-Traumatic Stress Disorder
• Postpartum Depression
• Psychosis and Early Psychosis
• Schizophrenia & Schizoaffective
• Seasonal Affective Disorder
• Self-Esteem Issues
• Sleep Disorders
• Suicidal Thoughts & Behavior
• Toxic Mold Exposure & Other Toxins
• Traumatic Brain Injury
• Treatment-Resistant Conditions
• Weight Issues
• Brain SPECT
• Telehealth and Video Therapy
• Psychiatric Evaluations
• Supplement and Medication Management
• Memory Rescue Program
• Concussion Rescue Program
• Hyperbaric Oxygen Therapy
• Integrative Medicine
• Individual Therapy
• Family Therapy
• Hypnotherapy
• Cognitive Behavioral Therapy
• IV Nutrient Therapy
• Neurofeedback
• Hormone Evaluation and Replacement Therapy
• Irlen Screening
• Nutritional Services
• Sports Psychiatry Program
• EMDR Therapy
• Interactive Metronome Training
• Forensic Psychiatry
• Neuroinflammatory Intensive Program
• Atlanta Metro Area
• Chicago Metro Area
• Dallas/Fort Worth Metro Area
• Los Angeles Metro Area
• Miami/Ft. Lauderdale Metro Area
• New York Metro Area
• Orange County Metro Area
• Phoenix/Scottsdale Metro Area
• San Francisco Bay Area
• Seattle Metro Area
• Washington D.C. Metro Area
• Patient Video Testimonials
• Patient Written Testimonials
• Media and Press
• All Episodes
• Top 20 Episodes
• Infographics
• ADD Types eBook
• Anxiety and Depression Types eBook
• Memory Loss eBook
• Addict Types eBook
• COVID-BRAIN eBook
• Personality Disorders eBook
• Eating Disorders eBook
• Forensics in Psychiatry eBook
• Download Our Brochure
• About Your Brain
• Change Your Brain Foundation
• Benefits For Clinicians
• Make A Patient Referral
• Provider Support
• Join The Professional Newsletter
• SPECT Research Overview
• SPECT Images
• Careers at Amen Clinics
• BrainMD (Supplements)
• Amen University (Online Courses)
• About Amen Clinics
• 30th Anniversary Video
• Daniel Amen, MD
• Amen Clinics Team
• Affordable Payment Options
• Family First Discount Plan

5 Ways to Cope When a Loved One Has Histrionic Personality Disorder

December 13, 2021

Are you involved with someone who has to be the center of attention at all times? Someone who engages in overly dramatic, highly emotional, volatile, excitable, or erratic behavior? If so, your romantic partner, family member, or friend may have histrionic personality disorder. Although these people can seem like the life of the party, their behavior can be exhausting for anyone who loves them. How can you cope when a loved one has this mental health condition?

WHAT IS HISTRIONIC PERSONALITY DISORDER?

Histrionic personality disorder is characterized by extreme attention-seeking behavior and exaggerated emotions. The word histrionic is defined as “dramatic or theatrical.” One of 10 types of personality disorders recognized by mental health experts, histrionic personality disorder falls within the “Cluster B” category of personality disorders. Cluster B disorders also includes narcissistic personality disorder , borderline personality disorder , and antisocial personality disorder.

People with histrionic personality disorder have a constant need to seek approval from others. They employ charm, seduction, manipulation, and flirtatiousness to draw attention to themselves. These larger-than-life types tend to get upset or feel depressed when they are overlooked or aren’t in the spotlight.

An estimated 2-3% of the population has histrionic personality disorder, and women are 4 times as likely to have the condition than men. However, experts suggest women may be over-diagnosed with the disorder while men may be under-diagnosed.

SYMPTOMS OF HISTRIONIC PERSONALITY DISORDER

There is a wide array of symptoms associated with histrionic personality disorder, including:

• Attention-seeking
• Approval-seeking
• Exaggerated emotions that can shift rapidly
• Overly dramatic
• Manipulative
• Dressing provocatively or wearing colorful clothing
• Inappropriately flirtatious
• Excessively concerned about physical appearance
• Upset or depressed if not the center of attention
• Impulsivity
• Being gullible or easily influenced by others
• Sensitive to criticism
• Seeming shallow or insincere

These symptoms can interfere with daily life and cause trouble in relationships, at work, or in school. These symptoms can range from mild to severe and can lead to other mental health problems, such as depression , anxiety , or substance abuse . In some instances, people may even threaten or attempt suicide to gain attention.

WHAT CAUSES HISTRIONIC PERSONALITY DISORDER?

It isn’t clear what causes histrionic personality disorder, but mental health experts suggest that several factors—both inherited and environmental—contribute to the condition. Among the factors believed to increase risk are having a genetic vulnerability, experiencing childhood trauma , over-indulgent or inconsistent parenting, or having a parent who acts in an overly dramatic fashion.

HISTRIONIC PERSONALITY DISORDER AND THE BRAIN

Early research on Cluster B personality disorders (histrionic, narcissistic, borderline, and antisocial) revealed significant neurocognitive impairment in these individuals in multi-step behavior planning. Newer research, including a 2021 functional brain imaging study in the Journal of Neuroimaging, shows that each personality disorder is associated with unique patterns of activity in certain brain structures and neural networks. Abnormal activity within the limbic and paralimbic systems, sometimes referred to as the emotional centers of the brain, was noted in several personality disorders. Despite these findings, the authors of this study point to a need for more neuroimaging studies to explore the specific brain changes associated with conditions such as histrionic personality disorder.

DEALING WITH SOMEONE WHO HAS HISTRIONIC PERSONALITY DISORDER

Individuals with this condition are ego-syntonic, which means they believe their behavior is normal, so they have a hard time admitting they have a problem. Because of this, it can be challenging to get these people to seek psychiatric treatment, which often centers on psychotherapy . This leaves loved ones struggling to cope with their overly dramatic and emotional behavior. For this reason, it is often the spouse or other family members who go to psychotherapy to learn how to handle everyday life.

Some of the strategies that can help you cope with a loved one’s histrionic personality disorder include:

Get educated.

Learning as much as you can about histrionic personality disorder can help you understand why your partner or family member acts the way they do. This can help you avoid taking their dramatic antics personally.

Suggest couples therapy.

Although a person with histrionic personality disorder may not be aware that they have a problem, they may be willing to go to marital therapy if they think it is intended to help you. Once in the safe space of a therapist’s office, you may be able to explore your loved one’s troubling behaviors.

Make time to shine.

When your loved one constantly steals the spotlight, it can leave you feeling underappreciated. Be sure to schedule time with friends or other family members— without the person who has histrionic personality disorder —so you can step out of the background.

Set boundaries for children.

If you have kids, set boundaries to limit their exposure to the drama created by the parent with histrionic personality disorder.

Recognize if it’s time to move on.

When a loved one’s attention-seeking behaviors leave you so physically exhausted and emotionally depleted that it is disrupting your ability to parent your children, feel your best, or perform at work or school, it may be time to end the relationship.

Histrionic personality disorder and the anxiety, stress, and depression it can cause others can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page  here .

18 Comments »

Whilst this might be true, this is not so easily done for a parent or sister of the person. Where does responsibility come in?

Comment by D.J. — December 15, 2021 @ 5:52 AM

So, this is going to sound histrionic. But, it is the truth. My children’s father was definitely a narcissistic, histrionic personality!!! We were together for 25 years. I tried ALL of the above suggestions. He never thought he had a problem. His angry tirades would last from 30 minutes to 2-3 hours, and were definitely linked to his childish resentment of having to work or take care of his responsibilities. I was a terrible people pleaser who took his blame shifting to heart. We were a total mess!! I am 71 now and so there wasn’t any help for such situations back in the 70’s where we lived. I sought counsel from a pastor, who after 2 meetings with us, sadly looked at me and said, “I can’t help you.” But, I have to give credit where credit is due. I was, and am, a praying woman. Although I seriously considered suicide, and yes, murder, several times, God heard my desperate cries and gave me and my children the grace to hang onto. I finally realized I didn’t have to keep punishing myself for my mistake of marrying him. Jesus had paid enough!! For me!! It still took me years to stop trying to “fix him, our marriage”. I left him, with much fear, finally when I feared someone was going to die. Either he would use one of his hunting guns on me, or we’d be the murder/ suicide family, or he or my teenage son would kill the other. Please, if you are relating to any of this, GET HELP!! The greatest shame and regrets I have are staying too long and subjecting my kids to this abuse. They are scarred for life. And now they are acting out a lot of what they were programmed with from their childhood onto their own kids. But, until you can get that help or make that break, know this, God is Real, and He wants to be your very best friend in the middle of your mess. He can give you the grace and strength to endure the now, and He can make a way out when you need it. He won’t always answer the way we want, because it involves someone else’s will and wounding. But, He loves you and them. Today, I am remarried to a wonderful man, though not perfect. And I know the love of God, His blessings, and His forgiveness like never before. My Ex and I are friendly and he still hasn’t changed. Someone once told me, “hurting people hurt people.” And my Ex used to say, when I would ask him why he was so angry, when he was on one of his rants, “I’m not angry, I’m hurt.” But, he couldn’t tell me or anyone else what had hurt him. So sad. And for so many, so true. Don’t try to go it alone, or try to hide the reality you live with. We are all broken to some degree. But, be the one who gets help, who gets your healing, who sets an example to your kids of what is acceptable or unacceptable behavior. That gives them hope that they can have a better future. And that seeking emotional, relational help is not something to be ashamed of. And most of all, don’t put it off. Don’t let pride or fear stop you from growing, learning, and getting the help that is now out there for you and your family. Keep the faith.

Comment by EvaS. — December 16, 2021 @ 4:22 AM

How do you cope when it’s an 18 yr old granddaughter and the parents don’t see it and running around catering to her for fear of her suicidal threats and accusations against others who she envies and is jealous.

Comment by Kathy — December 20, 2021 @ 5:50 AM

Sometimes a very tough situation can lead to success in not only the target but also it’s broader surroundings!

Comment by Grant Schettler — December 20, 2021 @ 6:03 AM

Good suggestions, however you don’t give a lot of suggestion if it is one of your children that has this DX

Comment by Leigh Guy — December 20, 2021 @ 7:50 AM

My adopted daughter was diagnosed with this… she is a lot for anyone to handle. The extreme drama even now at almost 19 is frustrating at times as her siblings and other family members don’t understand her continued attention seeking behaviors. But, she is sweet when she wants to be and I love her deeply. She is avoiding therapy at this time and Moved out of state, telling others I kicked her out (not true). This mama will always worry about her, but at least I understand why she does what she does.

Comment by Carrie Blase — December 20, 2021 @ 9:26 AM

I have 3 daughters & my oldest daughter who is 56 has HPD & finally after putting up with her nonsense for years I have cut the apron strings! Life is too short to suffer the hurt she has caused with her toxic ways.

Comment by Linda Rowan — April 2, 2022 @ 3:29 PM

My mother seems to display all the symptoms of HPD but I can not cut ties with her. She is the only family member I have. How do I deal with always feeling like a prop in her play? It’s relentless.

Comment by Lou Blair — June 4, 2022 @ 8:57 AM

How to cope and help a 70 year old man with HPD to get counseling or realization of his disorder. There is a young victim involved and has been manipulated into his charm to think he gives attention where her husband is lacking. Praying for the victim and the husband to see a so called friends agenda.

Comment by G. Thompson — June 21, 2022 @ 9:09 PM

The hard truth is how painful this condition is to marriage. Leaving loved ones feeling treated less than, but seeing the charming public nicess to strangers. It hurts. Feels like your hiding in public. You are always the bad guy when boundaries are set. From my experience, I would rather go back to the man who would physically abuse or try to kill me than deal with the immense emotional pain and stress of walking on egg shells constantly. And counseling? Here’s phrase that was stated ‘I’ll only go if they agree with me’…. waste of time, energy, love it seems😞

Comment by Devin — June 24, 2022 @ 11:31 AM

My sister has recently passed and on looking up I believe she lived with hysterical personality disorder, she was born deaf and wonder if this could be related to her personality disorder. She was never treated for this as mental health was not easily available at that time

Comment by Rose Boobyer — July 6, 2022 @ 8:51 AM

My brother has this disorder and I can no longer cope with him. The latest drama was his wife sent me a photo of him looking as if he partially hanged himself with paracord looped around his neck holding his head up with his eyes closed in response to me being angry with him for not paying money back to me that I loaned him over a month ago to fix his car. She said "Look at what you made him do! I found him like this!"

So if you found your unconscious spouse who might have hanged himself your reaction is to take a picture? Wouldn’t you cut them down and do CPR instead?

I am no longer able to tolerate the stress he causes me. I had a mild stroke last year and I don't want another one, so I'm utilizing No Contact with him.

Comment by Sissy — November 17, 2022 @ 12:28 AM

I have a friend who has many symptoms of HPD. I googled 'why does my friend exhaust me' and this came up. We have been friends for years but as I get older her behaviour causes me more angst. When we are together she has to have all our attention. She can be outrageous and doent seem to realise that others are exiting fast also to not get trapped. After doing a relaxation class she actually undoes all the results. I sometimes have to rush off so she doesn't rob me of the benefits. When we talk on the phone by brain cannot keep up as she jumps from one subject to another and sometimes subjects do not correlate. I feel very anxious and feel my blood pressure is rising. When I question "where is this going" she gets defensive and makes me feel as if it is my brain that is not coping. What steps can I take to keep this friend but learn to manage her without feeling such anxiety? When we have been out she will even say inappropriate things to strangers just to get their attention and cause embarrassment both to them and myself. Can someone please advise me as I ended up in tears after an hour long call today with me having to end the call saying I was so tired. She seems to like hearing her own voice and talks about so much and I can't keep up. I suffer from anxiety and don't like hurting people so this makes it hard for me. Thanks for some answer. Gail Savage

Comment by Gail Savage — February 16, 2023 @ 11:07 PM

Interesting article, thanks for this helpful advice!

Comment by Whitney Sawyer — May 19, 2023 @ 7:17 PM

I have lived with a young woman with histrionic personality disorder for a year before I even knew of the condition. I can tell you that they were very charming and I had at one moment in time actually believed that this woman was the love of my life. I know now that dealing with cluster B personality disorders is a sure fire way to end one's mental stability. She was inherently manipulative, deceitful, and a liar. This woman had a crush on me since her earlier teen years and targeted me to be in a relationship with me when she was of age. She used me to be the center of attention at all times and cared for like a child. I was like the parent in this relationship. Histrionic is no thing to mess with, should anyone read this, and should you have any self esteem or care for your future, RUN FOR THE HILLS. This person cannot be fixed. It stems from hereditary functions as well as childhood trauma, sort of like a generational curse that cannot be cured. More specifically, she matched more closely the definition of "infantile histrionic". Basically a more pitiful version of narcissism. They use many tools of the narcissist such as stonewalling, scapegoating, flying monkeys, gaslighting, etc. But she also cheated on me, and played the victim card for attention. She tried to keep me on the back burner like all the other exes that she either slandered as abusers or who had dumped her. They are incapable of true love as they can only move into the infatuation stage of love(but even that may have been a scheming test), and it's all down hill from there. They are always chasing love, but only because it makes them feel loved to have a host to feed off of, to escape any responsibility and the harshness of reality. I could go on but if this doesn't dissuade you, nothing will.

Comment by Bubba Johnson — June 5, 2023 @ 10:30 PM

I recently had to call for time out with an old friend whose behaviour was becoming increasingly erratic, demanding and draining. It certainly fits the criteria of HPD, especially the flirting and overestimating the closeness of relationships with ego-syntonic lack of awareness. She complains constantly of loneliness yet has vast network of friends and acquaintances, and chases romantic partners who show only mild interest. Even if she has met such men once or twice, she's already planning their future together and reacts with rage if he doesn't think the same way. I hadn't realised how exhausted I had become by all of this until I said I needed a break. I have so much more peace of mind now, and energy for my own family. It is not being a bad friend to draw a line and expect the other party to take responsibility for themself. If they won't go into therapy or put it into practice, as Bubba says above, you end up being parentified and it's a bad situation.

Comment by EB — July 21, 2023 @ 8:01 AM

My daughter seems to be a text book example of HDP. I’ve always walked on egg shells when dealing with her. She is the mother to my 4 precious grandchildren. I love them and help with them almost daily. We are or were very close. The children never want to leave my house and go home. It breaks my heart. Well 6 weeks ago I made the mistake of gently criticizing some of her parenting in a text. So, now She’s completely cut me off from her and them. She’s blocked me on all social media, blocked my phone number and anything else she can think to do to hurt me. I went to her house a few days ago and begged at her door to see the children. She called the police and put a tresspass on me. Now I feel crazy for even attempting to reason with her, but I’m terrified she’s taken them from me for good this time. She’s done it before but never this long and never to this extent. It’s broken our family completely apart. No one wants anything to do with her now. I don’t know if there is anything to be done or if there is anyway she will let me see my grandchildren again She won’t let them have any contact not letters not calls nothing. The oldest turns 8 next month and is so attached to me. I’m so very worried about all of them. I pray everyday and night for wisdom and strength to deal with this.

Comment by Kat A — September 4, 2023 @ 8:39 PM

Have realized in recent years, through therapy and personal growth, that I likely grew up with a mom and sister with undiagnosed HPD. I came upon the description of HPD a while back and was able to start making sense of the effect it had and still has on me and my other siblings.

It's hard, because we were raised with approval, or the withholding thereof, as our mom's means of parental control. And it is still thrown at us today in defense or our reactions to our sister.

Sad to have come from such a deeply dysfunctional family.

Comment by Jacqueline Gargiulo — December 10, 2023 @ 10:01 AM

RSS feed for comments on this post.

Leave a comment

Name (required)

Mail (will not be published) (required)

Related Posts

Ozempic personality: scary mental effects of weight-loss drugs.

July 23, 2024 - Comments (0)

What is Digital Dementia and How to Overcome It

July 10, 2024 - Comments (0)

Toxic Mold Syndrome: “It Was Like I Lost My Personality”

July 9, 2024 - Comments (318)

9 Natural Ways to Balance Dopamine in the Brain

July 8, 2024 - Comments (34)

• Why are you contacting us? * Please select... * Existing patient Services for myself or someone else For Medical Providers Only
• Existing Patient * Please select... Appointments/prescriptions/refill New or additional services Something else
• Services * Please select... Scheduling an appointment Locations Treatment options Supplements Pricing and insurance Something else
• For Medical Providers Only * Please select... Services for myself Services for my clients Non-clinical services or opportunities
• Locations Please select... Atlanta Metro Area Chicago Metro Area Dallas Metro Area Los Angeles Metro Area Miami/Ft. Lauderdale Metro Area New York Metro Area Orange County Metro Area Phoenix/Scottsdale Metro Area San Francisco Bay Area Seattle Metro Area Washington D.C. Metro Area Care Center
• Hidden Automatic time zone
• Hidden uuid *
• By submitting this form, you consent to receiving communication from the Amen Clinics via phone, email, and/or SMS. Your information will be handled with utmost confidentiality and used solely for the purpose of assisting you with your inquiry. You can Opt-Out at anytime.
• Stay in the loop via email with educational materials and our newsletter. Your information will be handled with the utmost confidentiality as stated in our privacy policy . You can Opt-Out at anytime.

Pardon Our Interruption

As you were browsing something about your browser made us think you were a bot. There are a few reasons this might happen:

• You've disabled JavaScript in your web browser.
• You're a power user moving through this website with super-human speed.
• You've disabled cookies in your web browser.
• A third-party browser plugin, such as Ghostery or NoScript, is preventing JavaScript from running. Additional information is available in this support article .

To regain access, please make sure that cookies and JavaScript are enabled before reloading the page.