Histrionic vs narcissistic personality disorder—signs to look for
Key Takeaways
Personality disorders like histrionic personality disorder (HPD) are characterized by extensive, long-lasting abnormal patterns of thinking that ultimately influence how a person perceives, reacts, and relates to the world.
HPD and narcissistic personality disorder (NPD) are similar in some aspects, but different. Understanding their differences can help physicians in diagnosis and treatment.
Choosing a diagnosis of either HPD or NPD can be challenging, as they present with similar symptoms. Patient medical histories will provide valuable clues to arriving at the correct choice.
According to a 2018 study, personality disorders occur in about 12% of the general adult population living in Western countries.[]
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) categorizes the 10 known personality disorders into three distinct groups, or clusters.
Histrionic personality disorder (HPD) and narcissistic personality disorder (NPD) are part of the same cluster, which includes disorders characterized by heightened emotions and dramatic or unpredictable behaviors. While some aspects of HDP and NPD are similar, they’re two distinct disorders with unique treatment approaches.
Understanding the differences between HPD and NPD can help physicians more accurately diagnose each, hopefully leading to more effective treatment.
Differentiating personality disorders
Clinicians often distinguish personality disorders from other forms of mental illness due to their long-lasting nature.[]
Regardless of the diagnosis, personality disorders may present added challenges to patients compared to those with mental functioning. These disorders are characterized by persistent, pervasive abnormal thinking patterns that influence how a person perceives, reacts, and relates to the world around them.[]
As a result, people with personality disorders often experience profound difficulty with interpersonal relationships, including those at home, school, and work.
Personality disorders are grouped into three separate clusters:
Cluster A disorders present with symptoms appearing odd or eccentric and include paranoid, schizoid, and schizotypal disorders.
Cluster B disorders often appear dramatic, erratic, or excessively emotional and include both HPD and NPD, borderline, and antisocial personality disorder.
Cluster C disorders manifest symptoms centralized on anxiety and fear and include avoidant, dependent, and obsessive-compulsive personality disorders.
Personality disorders ultimately seem to result from problems with self-identity and interpersonal functioning.
In many cases, patients with personality disorders don’t recognize that there’s a problem. Instead, they may act in a manner which is inconsistent, puzzling, or frustrating to others.
They may have inappropriately high or low self-esteem with an unstable self-image and inconsistencies in appearance, goals, and values. In some cases, they’re abusive, detached, overly emotional, or very irresponsible.
HPD vs NPD
Most cases of HPD are diagnosed after age 18, since personality is still developing up to that point.[] HPD, also known as dramatic personality disorder, distinguishes itself from other personality disorders through patterns of persistent emotional dysregulation and attention-seeking behaviors.
People diagnosed with HPD may be described as charming, lively, impulsive, and manipulative.
Additionally, they may be inappropriately sexual in most situations, even if they aren’t sexually attracted to others around them. They often perceive closeness in relationships that’s not mirrored by others.
Other characteristics of those with HDP include:
Being very dramatic or emotionally expressive, even to the embarrassment of others
Being easily influenced, especially by those they admire
Being impressionable, gullible, or suggestible
In contrast, people diagnosed with NPD display a need for attention and admiration with a hyperinflated sense of grandiosity.[] They also tend to lack empathy for others. Comorbid conditions such as substance use disorder are common, making it difficult for them to successfully maintain interpersonal relationships.
NPD can be categorized into two distinct subtypes: grandiose and vulnerable. Symptoms of the grandiose type include easily observable grandiosity, boldness, and aggressiveness. A person diagnosed with vulnerable NPD may display hypersensitivity and defensiveness.
Diagnosing HPD
Arriving at an accurate diagnosis can be challenging, especially since someone with NPD may also display some symptoms of HPD (sexual aggressiveness may be misinterpreted as a symptom of NPD).
The patient’s medical history provides valuable clues about potential personality disorders, including specific manifestations of emotional dysregulation and attention-seeking.
A diagnosis of HPD may be made for patients meeting at least five of the following criteria:
Provocative or seductive behavior
Exaggerated or dramatic emotions
Tries to draw attention through their appearance
Uncomfortable if they’re not the center of attention
Thinks relationships are more intimate than they actually are
Vague and impressionistic speech
Shallow and shifting emotions
Easily influenced by others
After an HPD diagnosis is made, the treatment of choice is supportive or psychodynamic psychotherapy.
Family or group therapy is not usually recommended, as it may exacerbate the patient’s need to be the center of attention.
Though there isn't necessarily a "cure" for HPD, people in treatment can begin to function better in society, leading to more positive outcomes.
What this means for you
HPD differs from NPD, but it can be challenging to differentiate between the two. Knowing the specific diagnostic criteria for HPD, along with the patient’s personal medical history, can help you arrive at a timely and appropriate diagnosis.