At Red Ribbon Recovery Indiana, we understand that personality disorders are often surrounded by misunderstanding and stigma—especially when symptoms affect relationships, emotional regulation, and self-image. Histrionic Personality Disorder (HPD) is one such condition, marked by unstable emotions, an overwhelming need for attention, and a tendency to speak dramatically or act theatrically in social settings.
Histrionic personality disorder: a differential diagnosis
While many people in the general population occasionally seek reassurance or approval, individuals with HPD experience a more persistent pattern that can cause significant distress in their daily lives. These behaviors are not always easy to identify or understand, which is why differential diagnosis—ruling out other mental health conditions such as Borderline Personality Disorder or somatic symptom disorder—is essential.
Risk factors may include genetic predisposition, early attachment disruptions, or environmental influences, all of which may shape the development of HPD during early adulthood. Family history and upbringing play a role as well, and family members are often deeply affected by the interpersonal challenges that can arise.
With compassionate, trauma-informed care, individuals can gain insight into their behaviors, cultivate emotional resilience, and improve symptoms through effective therapies designed to support long-term healing. At Red Ribbon Recovery Indiana, we are committed to walking alongside individuals as they work toward greater stability, healthy personality change, and more fulfilling relationships.
What is histrionic personality disorder (HPD)?
Histrionic personality disorder (HPD) is a mental health condition characterized by a pervasive pattern of excessive emotionality, dramatic behavior, and an overwhelming desire for attention and validation. Individuals with HPD often feel uncomfortable when they are not the center of attention and may behave dramatically, express strong opinions with minimal detail, or use their physical appearance to gain approval in social settings.
This condition is classified as a Cluster B personality disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Previously referred to as a DSM-IV personality disorder, HPD is now recognized for its overlapping features with other personality disorders, including Borderline Personality Disorder and Narcissistic Personality Disorder.
While these behaviors may appear deliberate or manipulative, they are often rooted in unconscious emotional needs developed during early adulthood or childhood—frequently influenced by genetic factors, child abuse, inconsistent parenting, or early emotional neglect.
Common signs and symptoms of histrionic personality disorder
People with HPD may seem socially adept and outgoing, but they often experience difficulty forming deep, authentic connections. Despite their charm or expressiveness, their emotional range may be shallow, and their self-esteem is frequently tied to external validation rather than a stable internal sense of self.
Typical symptoms include:
- A need to be the center of attention at all times
- Shallow emotions that shift rapidly in tone or intensity
- Speaking in a dramatic or exaggerated manner without substance
- Relying heavily on physical appearance to gain approval or attention
- Being easily influenced by others or by circumstances
- Perceiving relationships, especially romantic relationships, as more intimate than they actually are
- Intense sensitivity to perceived criticism or rejection
- Occasional suicidal behaviors, suicide attempts, or emotional crises in response to interpersonal conflict
Some individuals may also present with somatic complaints or physical symptoms without a clear medical cause, often linked to emotional distress.
These histrionic traits can significantly impact relationships, work, and daily life. A professional mental health evaluation is essential to diagnose Histrionic Personality Disorder and to distinguish it from other mental disorders that may share overlapping symptoms, such as Functional Neurological Symptom Disorder or Somatic Symptoms Disorder.
At Red Ribbon Recovery Indiana, we offer expert support to help individuals better understand their own behavior, build insight into emotional patterns, and move toward meaningful, lasting change.
What risk factors and causes exist for histrionic personality disorder?
The development of Histrionic Personality Disorder (HPD) is believed to stem from a combination of genetic, psychological, and environmental influences. Like many personality disorders, HPD doesn’t have a single, identifiable cause—instead, it often reflects a complex interplay of factors that shape emotional expression, self-worth, and interpersonal behavior.
Several contributing risk factors may include:
- Family history of HPD or other personality disorders, such as Narcissistic Personality Disorder or Antisocial Personality Disorder
- Inconsistent parental reinforcement, where caregivers alternated between over-praise and criticism, leaving the child unsure of how to earn affection
- Emotional neglect, childhood trauma, or early experiences that rewarded external validation over emotional depth
- Growing up in environments that overemphasize appearance, exaggerated expression, or dramatic behavior as a means of acceptance
- Cultural or societal factors that normalize attention-seeking behavior or idealize being overly concerned with attractiveness or approval
These early life influences may teach children to associate their self-worth with how others respond to them, potentially fostering traits like exaggerated emotions, overly seductive behavior, or being easily influenced in adulthood. For some, symptoms may overlap with or be misdiagnosed as Conversion Disorder or other somatic disorders, particularly when emotional needs are expressed through physical symptoms.
In clinical settings, diagnosis and treatment require a trained mental health professional, who can differentiate HPD from other personality disorders and tailor care accordingly. Psychodynamic psychotherapy, in particular, may help individuals uncover the unconscious emotional patterns that drive their behaviors, while fostering healthier self-concepts and interpersonal boundaries.
Histrionic personality disorder and substance abuse
For many individuals living with Histrionic Personality Disorder (HPD), challenges with impulse control, intense emotional reactivity, and excessive sensitivity can increase the risk of turning to substances as a way to cope. These patterns often emerge during early adulthood, when a person’s personality continues to develop, and are closely tied to difficulties managing overwhelming emotions or maintaining healthy romantic relationships.
Because HPD often involves dramatic displays of emotion, rapidly shifting moods, and provocative behavior, it can contribute to unstable interpersonal dynamics, rejection sensitivity, and chronic dissatisfaction. These emotional highs and lows may lead some individuals to self-medicate using alcohol or drugs, further complicating their mental health and increasing the likelihood of dependency.
How substance abuse and HPD interact
- Emotional Escalation: Substances may be used to amplify or numb intense emotions, which can temporarily soothe feelings of emptiness or reinforce attention-seeking behaviors.
- Impulsivity: Individuals with histrionic personality disorders may act on impulse, especially in social settings, which increases the risk of substance misuse.
- Relationship Strain: Volatile romantic relationships paired with poor coping skills can lead to stress-induced substance use.
- Poor Boundaries: Individuals with HPD may be easily influenced, making them more susceptible to peer pressure or environments where substance use is normalized.
Integrated treatment is essential
At Red Ribbon Recovery Indiana, we recognize that treating co-occurring HPD and substance abuse requires a deeply compassionate and integrative approach. Our team addresses both the emotional dysregulation associated with personality disorders and the behavioral patterns that fuel substance use.
Our dual-diagnosis care includes:
- Impulse control training and emotional regulation strategies
- Integrated talk therapy and trauma-informed care
- Support for navigating interpersonal relationships and social triggers
- Safe, supervised detox and evidence-based substance abuse treatment
By addressing the underlying emotional and psychological patterns behind both conditions, individuals can develop healthier coping mechanisms, restore self-worth, and move forward with a more stable, grounded sense of self.
Dual diagnosis care for histrionic personality disorder
At Red Ribbon Recovery Indiana, we understand that treating histrionic personality disorder alongside substance use requires a thoughtful, individualized approach. Many individuals with HPD experience intense emotions, unstable self-image, and a deep need for approval—all of which can be magnified by or contribute to substance use. Our dual diagnosis program is designed to address both the emotional roots of HPD and the complexities of addiction recovery in one cohesive, compassionate setting.
How we treat histrionic personality disorder and co-occurring addiction
Integrated psychotherapy
Therapy is central to healing from HPD and substance use. Our licensed clinicians blend multiple evidence-based approaches to help clients:
- Build emotional awareness
- Reduce attention-seeking behaviors
- Develop healthier coping strategies
We incorporate:
-
Cognitive behavioral therapy (CBT) – to challenge exaggerated emotional responses and support stable self-worth
-
Psychodynamic therapy – to explore how early life experiences and attachment wounds may fuel both substance use and HPD traits
Group therapy with boundaries and support
Group settings offer a safe place to practice interpersonal skills, receive honest feedback, and build authentic connections without relying on dramatization or external validation. For many clients with HPD, this becomes a breakthrough space for real healing.
Medication management
While there is no medication specifically for HPD, we address co-occurring symptoms like anxiety, depression, or impulsivity with appropriate prescriptions when clinically indicated. Every plan is carefully monitored to support whole-person healing.
Holistic and trauma-informed care
We recognize that unresolved trauma often underlies both HPD and addiction. That’s why we include:
- Mindfulness and grounding strategies
- Emotion regulation tools from DBT
- Interpesronal effectiveness training
- Stress management technique
By addressing both diagnoses’ emotional, behavioral, and neurological components, we empower our clients to create lasting change without needing to perform or seek constant approval.
Recovery is possible
Living with Histrionic Personality Disorder can feel isolating, but you are not alone. At Red Ribbon Recovery Indiana, we believe every individual deserves compassionate care rooted in dignity, safety, and long-term healing. Our team of professionals specializes in helping individuals navigate personality disorders, including HPD, Borderline Personality Disorder, and other trauma-related disorders.
Whether you’re just beginning to seek help or have struggled for years, our evidence-based, trauma-informed approach can support your journey to greater self-understanding and emotional balance.
If you or a loved one may be living with Histrionic Personality Disorder, reach out to Red Ribbon Recovery Indiana today. Together, we’ll explore your story, uncover your strengths, and build a personalized path toward healing.
Give us a call, and let us help you rediscover life beyond the need for validation—because real healing starts within.
Works Cited
Substance Abuse and Mental Health Services Administration. Borderline Personality Disorder. U.S. Department of Health and Human Services, https://www.samhsa.gov/mental-health/what-is-mental-health/conditions/borderline-personality-disorder.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM–5–TR). https://www.psychiatry.org/psychiatrists/practice/dsm.
Sansone, Randy A., and Lori A. Sansone. “Histrionic Personality Disorder: A Review of the Literature.” StatPearls, StatPearls Publishing, 2023, https://www.ncbi.nlm.nih.gov/books/NBK542325/.
