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Mental Health Series

Histrionic Personality Disorder (HPD) is a mental health condition characterized by excessive emotionality, attention-seeking behavior, and a strong need for approval. People with HPD often display dramatic, seductive, or provocative behaviors to gain the attention of others. Let’s explore the causes, theories, medical interventions, and non-pharmacological approaches to managing HPD.

Here are the top 10 symptoms commonly associated with HPD:

• Excessive Attention-Seeking
  • Individuals with HPD often feel uncomfortable when they are not the center of attention and will go to great lengths to ensure they are noticed by others.
• Inappropriate Seductive or Provocative Behavior
  • People with HPD can behave in a sexually suggestive or provocative manner to gain attention, even in inappropriate situations or relationships.
• Shallow and Rapidly Changing Emotions
  • Their emotions can appear exaggerated, shallow, and change quickly, often seeming disproportionate to the situation.
• Dramatic or Theatrical Behavior
  • Individuals with HPD tend to act in overly dramatic ways, with exaggerated expressions of emotions, often to garner sympathy or attention.
• Preoccupation with Physical Appearance
  • They tend to place an excessive emphasis on their appearance, using it to draw attention or feel validated.
• Easily Influenced by Others
  • People with HPD are often impressionable and easily swayed by the opinions of others or external events. Their views and behaviors oftentimes shift to align with those around them to maintain approval.
• Exaggerated Perception of Relationships
  • They may believe relationships are more intimate or significant than they actually are, often describing acquaintances as close friends or romantic partners.
• Self-Centeredness
  • Those with HPD are often preoccupied with themselves and their own needs, which can lead to difficulties in maintaining deep, meaningful relationships. This is deeper than self-care.
• Suggestibility
  • They are often highly suggestible and tend to adopt the opinions, ideas, or behaviors of people they admire or seek approval from.
• Constant Need for Approval and Reassurance
  • Individuals with HPD are deeply dependent on the approval of others to feel validated, often needing constant reassurance to boost their self-esteem.

These symptoms typically manifest across different areas of life, including social, professional, and personal relationships, leading to significant distress or impairment. Families and intimate relationship partners can struggle maintaining deep connections with people suffering from this disorder.

Causes of Histrionic Personality Disorder

The exact cause of HPD is unknown, but it is likely influenced by a combination of genetic, environmental, and psychological factors:

• Genetics: Individuals with a family history of personality disorders may have a higher risk of developing HPD.
• Childhood Experiences: People who experienced inconsistent or excessive praise, or who were the center of attention during their childhood, might develop attention-seeking behaviors in adulthood.
• Cognitive Factors: Maladaptive thinking patterns, like believing that self-worth depends on the approval of others (external validation), may contribute to the development of HPD.

Theories Behind Histrionic Personality Disorder

Several psychological theories explain the development of HPD:

• Psychodynamic Theory: This theory suggests that HPD stems from unresolved childhood conflicts, particularly around dependence and attachment. People with HPD may seek attention and approval as a defense mechanism against deep-seated feelings of insecurity or rejection. Behaviors like attention-seeking are seen as defenses (coping mechanisms) against deeper anxieties.
  • EX: For example, a woman with HPD might unconsciously seek approval from others because, as a child, she only received attention when she acted out emotionally. Through psychodynamic therapy, she could become more aware of this pattern and learn new ways to cultivate more stable and authentic relationships, rather than relying on attention-seeking behaviors.
• Cognitive-Behavioral Theory: According to this theory, people with HPD have learned that their dramatic and emotional behaviors yield the attention they crave. These behaviors are reinforced over time, leading to the development of HPD.
  • EX: Imagine a person with HPD, they frequently feel the need to act dramatically and use flirtatious behavior to gain approval. They might hold the belief, “If I don’t stand out and captivate everyone’s attention, I’m worthless.” This thought causes them to continue the behavior repeatedly and reinforces their personal limiting beliefs.
• Evolutionary Theory: Some evolutionary psychologists propose that attention-seeking behaviors may have been advantageous in social settings, helping individuals attract mates or gain social status.
  • EX: In ancient times, early humans relied heavily on group cohesion and social bonds for survival. Individuals who were more emotionally expressive may have been better at forming alliances, attracting mates, or gaining protection from others. In the modern world, these behaviors may become maladaptive when exaggerated, as in the case of HPD, where attention-seeking behaviors can impair personal relationships and cause distress. While emotional expressiveness may have been beneficial in small, tight-knit groups, in today’s society, it can be seen as dysfunctional or excessive.

Medical Interventions

While there are no specific medications for treating HPD, certain medications may help manage co-occurring symptoms, such as anxiety or depression, that often accompany the disorder:

• Antidepressants: SSRIs (Selective Serotonin Reuptake Inhibitors) are commonly prescribed to manage depressive symptoms that can occur alongside HPD.
• Mood Stabilizers: If mood swings or emotional instability are prominent, mood stabilizers like lithium or lamotrigine are often considered.
• Antipsychotics: In extreme cases, antipsychotic medication might be prescribed to manage severe emotional dysregulation or impulsivity.

Non-Pharmacological Ways to Manage HPD

Therapy is the cornerstone of treatment for HPD, focusing on helping individuals develop healthier ways of relating to others and managing emotions:

• Cognitive-Behavioral Therapy (CBT): CBT helps individuals identify and challenge dysfunctional thought patterns and replace them with healthier, more realistic beliefs about themselves and others.
• Dialectical Behavior Therapy (DBT): Originally developed for borderline personality disorder (also difficult to treat with medications), DBT is also effective for HPD. It teaches skills for emotional regulation, distress tolerance, and interpersonal effectiveness.
• Psychodynamic Therapy: This therapy aims to help individuals explore unconscious conflicts that may be driving their need for attention and approval. By addressing these conflicts, individuals can develop more stable and fulfilling relationships.
• Group Therapy: Group therapy can provide individuals with HPD the opportunity to practice healthier social interactions in a supportive environment.

History and Controversy

HPD was first introduced in the 1980 DSM-III and is rooted in older diagnostic concepts like “hysteria.” Historically, the disorder has been associated with overly dramatic or emotional behavior, especially in women, which has contributed to gender-related stereotypes. As a result, some have criticized the HPD diagnosis for reinforcing sexist ideas. There is also ongoing debate in the psychological community about the validity and utility of diagnosing personality disorders as discrete conditions, since many individuals present with overlapping traits from multiple disorders.

Research suggests that HPD is more commonly diagnosed in females, although there is some debate over whether this reflects actual gender differences in the disorder or diagnostic bias.

Prevalence Estimates

• According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), HPD is estimated to be diagnosed in approximately 1.8% of the general population and is more frequently identified in women.
• Studies indicate that HPD is diagnosed in women at a rate of about 2-4 times higher than in men, though this disparity could be influenced by social expectations or cultural biases that emphasize dramatic, attention-seeking behaviors in women as abnormal while possibly overlooking similar traits in men ​HealthDay.

However, some researchers argue that the difference might not be as large as it seems, suggesting that men may express HPD traits differently and thus may be underdiagnosed.

Possible Explanations for Gender Differences:

• Cultural Norms: Women may be socialized to express emotions more openly, which aligns with HPD characteristics like emotionality and attention-seeking. In contrast, men may be discouraged from showing these traits, potentially leading to underdiagnosis in males.
• Diagnostic Bias: Clinicians may be more likely to attribute emotional and dramatic behaviors to women as symptoms of a disorder, whereas similar behaviors in men might be interpreted differently.

Holistic and Lifestyle Approaches

Along with therapy and medication, several lifestyle changes can help individuals with HPD manage their symptoms and improve their quality of life:

• Mindfulness Practices: Techniques like meditation and deep breathing can help individuals with HPD regulate their emotions and reduce impulsivity. Any activity that helps calm the vagus nerve.
• Healthy Relationships: Encouraging individuals to foster stable, supportive, and healthy relationships can counter the need for attention-seeking behaviors. People must also be mindful of whom they keep company with, i.e. enablers, energy vampires, those with toxic behaviors, etc.
• Creative Outlets: Engaging in activities that allow for emotional expression, such as art, writing, or drama, can provide a constructive way to channel emotions.

Diet and Natural Techniques for Managing Histrionic Personality Disorder (HPD)

While there is no specific diet that cures or directly treats Histrionic Personality Disorder, certain dietary patterns and natural techniques can help improve overall mental health, emotional regulation, and well-being. Managing HPD focuses on promoting emotional stability, reducing impulsivity, and enhancing cognitive function.

Here are some approaches that helps with health and brain function:

Omega-3 Fatty Acids

Omega-3 fatty acids, commonly found in fatty fish (like salmon, mackerel, and sardines), flaxseeds, and walnuts, have been shown to improve mood regulation and reduce impulsivity. They play a role in maintaining brain health and may help stabilize emotions. A meta-analysis showed that omega-3s can have a significant impact on reducing aggression and impulsivity​. Research suggests that omega-3 supplementation can help manage mood disorders and impulsive behaviors, which are often seen in personality disorders like HPD.​

Balanced Diet with Complex Carbohydrates

A diet rich in whole grains, fruits, vegetables, and lean proteins helps maintain stable blood sugar levels, which can prevent mood swings and irritability. Complex carbohydrates (found in oats, quinoa, and brown rice) help regulate serotonin production, a neurotransmitter that affects mood stability.

Magnesium-Rich Foods

Magnesium has been linked to mood regulation and anxiety reduction. Foods such as spinach, almonds, avocados, and dark chocolate are rich in magnesium, which can help calm the nervous system and reduce emotional reactivity​.

Herbal Supplements

• Ashwagandha: Known for its adaptogenic properties, ashwagandha may help reduce stress and anxiety, promoting emotional stability.
• Rhodiola Rosea: Another adaptogen, rhodiola is used to enhance mental clarity and reduce fatigue and irritability, which may help with some of the emotional instability seen in HPD.

I can literally feel the difference in how calm I feel after taking this supplement by Eu Natural, Vitality. This supplement contains both of the herbs mentioned above along with a comprehensive formula that includes so much more. Get it here.

Probiotics and Gut Health

Recent research has highlighted the importance of the gut-brain axis, the communication pathway between the gut and the brain. Probiotics (found in yogurt, kefir, and fermented foods) can help improve gut health, which in turn may influence mood and emotional regulation. A healthy gut microbiome is linked to improved mental health outcomes and emotional balance​. My go to is Athletic Greens, which includes over 75 ingredients to help maintain optimal health. Get it here.

Natural Techniques to Manage HPD

Mindfulness and Meditation

Mindfulness techniques, such as meditation, can help individuals with HPD become more aware of their emotional responses and reduce impulsive behavior. Studies show that regular mindfulness practice helps individuals decrease stress and manage attention-seeking behaviors​. Research published in Frontiers in Psychology found that regular mindfulness practice was associated with improved emotional regulation and reduced impulsivity, suggesting that these techniques can be particularly beneficial for individuals with personality disorders​ HealthDay.

Cognitive Behavioral Techniques (CBT)

Incorporating aspects of Cognitive Behavioral Therapy (CBT) in daily life can help individuals challenge distorted thinking patterns. Techniques like self-monitoring (tracking behaviors and emotional responses) and reframing negative thoughts can help those with HPD to manage their attention-seeking behaviors and impulsivity.

Exercise

Regular physical activity, like aerobic exercises, yoga, or tai chi, can help reduce symptoms of stress, anxiety, and emotional dysregulation. Exercise promotes the release of endorphins and serotonin, which can improve mood and emotional stability​. A study published in JAMA Psychiatry found that regular aerobic exercise was associated with a reduction in symptoms of anxiety and depression, which can be comorbid with personality disorders. Exercise has been shown to improve mood and reduce impulsive tendencies by balancing neurotransmitter activity​ HealthDay.

Journaling and Emotional Expression

People with HPD may benefit from journaling as a way to express their emotions in a controlled manner. Writing down feelings and thoughts can provide insight into emotional patterns and help develop healthier ways to process and express emotions without the need for external validation. Several patients I’ve talked to report that journaling has even helped with racing thoughts.

Supporting Research and Statistics

While direct research into diet’s impact on HPD is limited, there is substantial evidence supporting the benefits of certain diets and lifestyle changes for general mental health:

• Omega-3 Fatty Acids: Multiple studies indicate that omega-3 supplements can reduce symptoms of impulsivity and emotional instability in various mood disorders. A meta-analysis showed that omega-3s can have a significant impact on reducing aggression and impulsivity​.
• Meditation and Mindfulness: Research published in Frontiers in Psychology found that regular mindfulness practice was associated with improved emotional regulation and reduced impulsivity, suggesting that these techniques can be particularly beneficial for individuals with personality disorders​ HealthDay.
• Exercise: A study published in JAMA Psychiatry found that regular aerobic exercise was associated with a reduction in symptoms of anxiety and depression, which can be comorbid with personality disorders. Exercise has been shown to improve mood and reduce impulsive tendencies by balancing neurotransmitter activity​ HealthDay.

Conclusion

While there is no one-size-fits-all diet or natural remedy for Histrionic Personality Disorder, a holistic approach that incorporates a healthy diet, mindfulness techniques, regular exercise, and emotional regulation strategies can support overall mental health and help manage the symptoms of HPD. Combining these natural interventions with therapy and medical treatments can enhance emotional stability and improve quality of life overall.

Histrionic Personality Disorder is a complex condition influenced by a variety of factors. Effective treatment often involves a combination of therapy, lifestyle changes, and medication to manage co-occurring symptoms. By helping individuals develop healthier emotional regulation and interpersonal skills, treatment can significantly improve quality of life.

Written with the aid of ChatGPT and/or Perplexity for efficiency and brevity.

Sources:

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-5)

ScienceDaily

HealthDay

Helplines and support

India: Call the Vandrevala Foundation Helpline at 1860 2662 345 or 1800 2333 330

In the U.S.: Call 1-800-950-6264 or visit NAMI.org

UK: Call 0300 5000 927 or visit Rethink: Schizophrenia

Australia: Call 1800 18 7263 or visit Sane Australia

Canada: Visit Canadian Mental Health Association for links to helplines and services

Do you or someone you know need help?

If you would like to seek help for yourself for any mental health issues, please contact someone. If you think you may hurt yourself, someone else or attempt suicide, call 911 in the U.S. or your local emergency number immediately.

Also consider these options if you’re having suicidal thoughts:

• Call your doctor or mental health professional. Or 211 to speak to a live person about mental health options.
• Contact a suicide hotline.
  • In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.
  • U.S. veterans or service members who are in crisis can call 988 and then press “1” for the Veterans Crisis Line. Or text 838255. Or chat online.
  • The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).
• Numerous Apps are now available to talk with someone in the privacy of your own home. Click here for a free app list. Other Apps include: Talkspace, BetterHelp, and Sanvello.
• Reach out to a close friend or loved one.
• Contact a spiritual leader or someone else in your faith community.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room. DO NOT leave them alone.