Histrionic Personality Disorder

Diagnostic criteria: Excessive emotionality and attention seeking.

People with Histrionic Personality Disorder exhibit a pervasive pattern of excessive emotionality and constant attention seeking. They feel uncomfortable or unappreciated when they are not center stage.

To capture the gaze of others, they frequently use their physical appearance in a conspicuous manner and employ sexually seductive or provocative behavior, even in inappropriate contexts such as work or clinical settings.

Their emotions, although expressed with great theatricality and drama, are often superficial and change with disconcerting rapidity.

Imagine someone who cries inconsolably over a piece of news and, seconds later, laughs out loud at a trivial comment.

Their speaking style is overly subjective and impressionistic, but lacking in concrete details; they can give vehement opinions on a subject without providing facts to support their position.

In addition, they are highly suggestible, being easily influenced by others or by the fashions of the moment.

Differentiation with Narcissism

It is common to confuse histrionic disorder with narcissistic disorder, as both share the need for attention and may appear self-centered. However, the underlying motivation is different.

The histrionic person seeks attention to establish an emotional connection and be affectively validated; their self-esteem depends on being seen and liked, showing emotional vulnerability and dependence.

In contrast, the narcissist seeks attention to confirm his superiority and gain admiration (narcissistic supplement), not intimacy.

While the histrionic may appear fragile or "victimized" to attract care, the narcissist projects an image of grandiosity and self-sufficiency, lacking the empathy that the histrionic may sometimes feign or superficially feel.

The histrionic is willing to appear "foolish" or dependent if it guarantees attention; the narcissist will never tolerate an image that is not one of power or success.

Therapeutic Strategies: Focusing and Limits

Treatment of the histrionic patient requires firm therapeutic framing. Given his global and diffuse thinking style, the therapist must help the patient focus on concrete problems and "ground" his dramatic speeches.

It is crucial to avoid over-familiarity; the therapist should not be seduced by emotional intensity or adopt the role of "savior", but maintain clear professional boundaries so as not to reinforce dependency.

Cognitive techniques, such as thought recording, help the patient to identify his or her changing emotions and to challenge the irrational belief that the loss of a relationship is catastrophic.

Problem-solving and assertiveness training is essential for them to learn to ask for what they need in a direct and mature manner, rather than resorting to emotional manipulation or theatrical meltdowns.

It seeks to transform their superficial relationship style into a more genuine and profound one.

Summary

These individuals exhibit excessive emotionality and a constant search for attention. They are uncomfortable if they are not center stage, often using physical seduction and drama to stand out.

Unlike the narcissist who seeks admiration for superiority, the histrionic seeks emotional connection and validation. They are willing to show themselves fragile or dependent if it warrants attention, being highly suggestible by the environment.

Therapy requires firm professional boundaries to avoid emotional seduction. The goal is to "ground" their dramatic discourse to concrete problems and teach assertiveness to replace theatrical manipulation with genuine relationships.