Since writing various other articles about narcissism I have received many emails from people asking about the difference between Histrionic Personality Disorder (HPD) and Narcissistic Personality Disorder (NPD.)
Therefore, I have written the following article to describe HPD for those who may not yet have an understanding of it. I put “Female Narcissism” in the title, as it is often known, because it is very similar to narcissim, but with more feminine traits.
HPD is associated more with women, whereas NPD is associated more with men. These associations are determined by the ratio of diagnoses attributed to either men or women.
Approximately two to three percent of people are histrionic, and the majority of those who have been diagnosed with HPD, which derives from the word hysteria and is listed in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM) as a Cluster B Disorder—the person displays the same patterns of behavior since early adulthood.
Individuals with this disorder have very similar characteristics to those with NPD and this is mainly because they are egocentric and have a grandiose opinion of themselves, which comes with a desperate need for stimulation and a strong desire to be the center of all attention. They like to constantly be in the limelight and are loud, lively, dramatic, vivacious personalities and usually appear externally as the life and soul of the party. This is one of the reasons that diagnosis can be difficult, as they can seem as though they are highly positive, fun people who are a pleasure to be around, however, this is all on the surface and done for admiration.
It is not yet known whether it is nature or nurture that causes this disorder. It is believed to be partly due to genetics and the development of it depends upon how a child interacts with their family members and peers throughout their early years.
Histrionics are often known as the drama kings or queens and are excellent performers. Their actions are severely exaggerated and are often similar to the theatrical behavior we might witness on a stage.
HPDs manipulate and control other people either through seduction, provocative behavior, dependency, or extreme and explosive emotional displays. Usually their expressions are erratic, outrageous, flamboyant and highly inappropriate and are all played out for attention and validation.
Although they appreciate positive attention, they gain just as much pleasure from negative attention. They like to shock, infuriate, anger, embarrass, intimidate and cause volatile emotions to erupt from anyone they are in the company of.
According to the DSM-5 there are eight criteria for Histrionic Personality Disorder:
Uncomfortable when they are not the center of attention.
Inappropriate sexual, seductive, flirtatious and provocative behavior.
Quickly changing shallow emotions.
Dresses or uses physical appearance specifically to draw attention to themselves.
Speech is overly impressionistic and shallow.
Dramatic, theatrical, and excessively emotional personal expressions.
Believes relationships are far more intimate than they actually are.
Histrionics are often compulsive liars and they are so seeped in deception they seemingly believe their own lies. When they are confronted they usually become hysterical and will deliberately try to turn the situation around so that the other person is then in the spotlight, and from there they will accuse, blame and try and shame others in order to make themselves appear innocent.
Their emotions are so up and down and dysfunctional that they may be diagnosed as bi-polar or possibly with depression as every emotion and feeling is intensified so it appears as though they are experiencing everything at extreme levels—and most of the time they are.
Key Traits of HPD:
Rages easily and emotions get very quickly out of control over seemingly insignificant issues.
Constant desire to be the center of attention.
They have no guilt, shame or remorse and project all of their behavior and emotions outwards so that other people take accountability for them. Nothing is ever their fault in their eyes.
Not only will they have no qualms about cheating on their own partner, they also have no consideration for whether the person they are involved with already has a partner.
Puts other people down and undermines others at any opportunity.
They will only remain in a friendship or relationship if the other person consistently meets their needs and their extremely high expectations.
Naturally lies and will often show no remorse for deceiving people and will go to all lengths to deny any wrongdoings.
Demands attention, power or control.
Dislikes being alone, constantly needs to be in a relationship or around people who pay attention and validate them. Relies on other people to balance their emotional wellbeing and often their financial circumstances too.
May be diagnosed with depression or frequently experiences bouts of extremely low emotions and feelings.
Talked into anything easily and can be led to do things they wouldn’t normally do by people who are also persuasive.
They feel as though they deserve special treatment or privileges as they feel “above” everyone around them.
Makes up stories and exaggerates every experience they have.
Energized when around other people and feel low energy when they are alone.
Fear of Abandonment:
They may have issues from childhood or from previous emotional wounds that have caused them to feel afraid they will be left on their own.
Uses manipulation to make their partner feel as though they are going crazy by getting them to struggle to trust their own intuition and be unable to make decisions.
Believe they are far better than other people with very high self-importance and seek favorable attention.
Uses manipulation or seduction to suck their ex-partner back after a period of separation.
Very theatrical and hysterical behavior and the more attention it gives them, the more they play up to it.
Unpredictable and acts at the spur of the moment without thinking about consequences.
Lack of Compassion/Consideration:
Very little humility, compassion, care or concern for other people or their suffering or difficulties.
They use charm, flattery or threats to manipulate people into giving them what they want or into doing something for them.
Almost bi-polar in their emotions, one minute extremely happy and high and the next screaming, crying or throwing themselves in a heap on the ground in a childish tantrum.
Naïve or Innocent:
Very childlike in their speech, words or actions and may genuinely have a very innocent and vulnerable approach to the world.
Will be hurt by criticism even if it is very mild and will take offense to anyone saying anything even slightly detrimental to them.
They may have either fake or very real panic attacks or full-blown meltdowns and these often take place when there is an audience watching.
May deliberately hurt or damage relationships with family or friends by saying cruel things or acting in shocking ways and they may even try to sabotage other people’s relationships or belongings.
Dresses in an inappropriate or deliberately provocative way by flaunting sexuality solely to gain attention. Behavior is highly flirtatious to manipulate or destabilize other people or to impress them so that affection or admiration is given.
They may have addictions, or self-harm or behave in ways that turn people against them.
Everything is focused around image, so they say whatever they think will achieve the best response for themselves and they dress in ways to impress other people, specifically by using brand names to make themselves appear “better” or more superior than others.
Doubts other people’s intentions and finds it very difficult to trust.
They will push people to extremes to test their “love” as they often feel this proves whether someone loves them or not.
Regularly makes threats, whether it is to harm themselves or to harm other people’s lives. They may swing from threatening to vulnerable behavior within moments.
They take great pleasure in receiving praise for their appearance and often go to great lengths to keep their looks maintained, which includes cosmetic surgery and spending excessive amounts of money on clothes, make up and accessories.
The key to working on traits that are harmful to either one’s self or to others is to remain fully conscious of all actions and the consequences of them.
Although labels can be detrimental, gaining a diagnosis or having a framework that helps us to understand either ourselves or other people on a deeper level can be beneficial for all involved, especially if the person with the personality disorder is willing to work on changing, or if they wish to seek support and guidance.
I wrote this article, not so that people can be negatively judged or condemned for displaying these traits, but so that compassion and understanding can be used in relating with these individuals. Often histrionics are not even aware that their behavior is harmful to themselves or others and they also may not know how to change.
One of the key traits of people who have personality disorders is that they lack personal insight and are not self-aware, which makes it very difficult for change to occur and is one of the reasons they go through life attracting the same types of relationships and repeatedly stumbling on the same obstacles.
Relationships with people with a personality disorder can work, although, for them to be healthy and long-term both partners need to remove any expectations they may have of what a “normal” relationship should look like, and focus their attention on building firm foundations for the relationship they have. This includes putting firm boundaries in place about what is acceptable and what is not. When we are working on an unconditional loving relationship, it can be difficult to understand how boundaries can work, as it almost seems a contradiction.
Boundaries in these types of relationships can be built around shared morals and values. For example, for the relationship to work there may be an understanding that compulsive lying, cheating, emotional abuse or violence is not tolerated. The people involved in the relationship can then work out ways to work together on all other issues without negative judgment or resentment creeping in, but if the main boundaries are broken, it can be very difficult to maintain a healthy, nourishing relationship. If they are broken, the person who breaks them should be held accountable, otherwise, they will very quickly mean very little and it may set up a precedent for them to be regularly flaunted.
It is also possible for the person who does not have a personality disorder to understand that the way their partner is acting is not a personal assault on them. The behaviors they are expressing have often been repeated over and over for so many years that they eventually feel that’s the natural way to exist, and it will take time and effort to re-train them to new ways of reacting and responding. It is an unlearning process of everything they have spent their lives learning, so miracles cannot be expected and patience and compassion coming from the non-personality disorder partner will be essential.
There are many support systems in place in a lot of communities and also on the internet, so I would recommend that advice from a counselor or therapist is sought, whether together or separately. If the person with the personality disorder is willing to take measures to work on the relationship and take accountability for their behavior, this in itself is a major step and as long as it is genuine, and not done just for temporary relief in the relationship, or to gain in any way, there is a chance that the relationship can thrive.
The difficulty with dealing with someone with a personality disorder is that unless we are a mental health professional, it is not our place to diagnose anyone, nor should we be judgmental or put someone down who we believe to have a Cluster B (characterized by dramatic, overly emotional or unpredictable thinking or behavior) personality. Neither is it our place to “fix” someone, because unless they want to change, there will be very little we can do.
We can put on the table as much logic and reason as we think will alter things, but seriously, unless the other person’s mindset is open and receptive, no aspect of their personality is likely to change. It is quite common for those with a personality disorder to refuse to change believing they are perfectly happy exactly the way they are. They may even say, “This is who I am, accept me as I am or not at all.” It is then our choice. As the saying goes, when someone shows us who they are, we should believe them.
One of the most difficult aspects of these types of relationships is knowing whether what we are experiencing is genuine love or co-dependency. There has been much written about personality disorders and the belief that they are not capable of “love” however, this is not true. It is not possible to define millions of people with an array of traits and characteristics and say whether they are capable of love or not.
What I do believe though is that these relationships are often based on many illusions and when everything has a veil over it, it is complicated to see whether what is being displayed beneath the veil is love. When we remain consciously aware of exactly what we are dealing with and we have a sound understanding of Histrionic Personality Disorder, it will be far easier to see the expressions as a cry for help, whether we perceive that as right or wrong.
I believe that all expressions are either a desire to show love or a desire to be loved. That being said though, I also know my capabilities and also where my boundaries are. This is why I firmly believe it is an entirely personal choice as to whether someone is willing to put themselves through the ordeals that arise when in these relationships or not. What I may put up with is likely very different to what someone else may put up with.
When we have a profound understanding of ourselves and what we have to offer in a relationship, we can then make a decision as to whether staying in one where there are difficulties caused by personality disorders is likely to cause us the pleasure we are hoping for or a consistent and insidious feed of harm.
We must drop all expectations that we “deserve” to be loved a certain way, as when we are in a dynamic with someone with a personality disorder, their actions are not a reflection of who we are, they are a reflection of who they are. When we remember that the hurt and betrayal we experience will immediately and dramatically reduce.
I think it is essential that we stop classifying all people with personality disorders as “unlovable” and as though they should be placed in the trash can. Everyone, absolutely everyone, deserves love—it’s just that some people can only be loved from a distance. We should always know our own limits of what we can handle, especially before we are pushed and tested by anyone else’s.
I believe the most important thing to remember of all is that sadly we cannot just “love” someone better. However hard we try.
Relephant video bonus:
Author: Alex Myles
Editor: Travis May
Photo: Flickr/DualD Flip Flop
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