Cognitive Therapy for Histrionic Personality Disorder

Let's take a look at cognitive behavioral therapy and how it can help in treating histrionic personality disorder. This is a different approach that can be extremely useful in treating difficult disorders.
Cognitive Therapy for Histrionic Personality Disorder

Last update: 05 October, 2021

People with histrionic personality disorder (HPD) have a pattern of excessive emotional reactions and attention-seeking behavior. It begins in early adulthood and affects the person in various contexts, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Cognitive therapy is one treatment option for histrionic personality disorder.

Professionals will diagnose this personality disorder if the person exhibits five or more of the following traits:

  • They feel uncomfortable in situations where they’re not the center of attention.
  • When they interact with others, they’ll often behave inappropriately. For example, they may be sexually seductive or provocative.
  • They experience rapid mood changes and often express their emotions extremely directly.
  • They use their physical appearance to attract attention.
  • Their speaking style tends to be based on extreme views and lacking in detail.
  • They self-dramatize, and are prone to theatricality, and exaggerated expression of emotions.
  • They’re suggestible. In other words, they’re easily influenced by others or by circumstances. Furthermore, they consider their relationships to be closer than they really are.

With these symptoms, it’s quite conceivable that you might view a person with HPD as immature, with a low tolerance of frustration. Rather like a child who throws tantrums. Furthermore, they’re excessively dependent on others and lack empathy. They also don’t tolerate being contradicted or not getting their own way.

In addition, a person with HPD feels the need to attract the attention of everyone around them. They do this using their appearance and shallow behavior. For example, they tend to choose clothing that grabs attention, such as bright colors or unique patterns.

A woman looking at herself in a mirror.

Additional characteristics

Apart from the diagnostic criteria we mentioned above, there are also some other interesting traits of people with HPD. Although the disorder is more common in women, some men also have HPD.

Women often wear heavy makeup, high heels, and seductively try to gain others’ affection and attention. For their part, men also try to exaggeratedly demonstrate their virility or manliness. For both sexes, the ultimate goal is conquest, which then reinforces their self-esteem.

However, once the person has won someone over, they don’t know how to continue the relationship. They feel the need to escape and embark on another. As a matter of fact, they aren’t satisfied by the relationship itself, but rather by the excitement of flirting or seduction.

Cognitive-behavioral therapy (CBT) is a current treatment method for HPD. It can help to modify unconscious thought-processes, change behavior, and adjust how the person views their relationships with others.

More traits of histrionic personality disorder

One fundamental trait that stems from HPD is fear of possible rejection. This is because a person with HPD has extremely low self-esteem. However, instead of giving in to it, they try to overcompensate. This goes hand in hand with trying to show off their supposed ‘qualities’ such as their physical appearance or charm.

A person with HPD may conclude that they’re incapable of taking care of themselves. This can be due to thoughts such as: ‘I’m inadequate and unable to handle life on my own.’ Thus, they need to find a way to get others to take care of them. That’s why they actively seek attention and approval. They’re trying to make sure other people meet their needs.

The person may get carried away with their desire for attention and theatricality. When that happens, they lose sight of the real goal (meeting their needs). Then they may start seeking stimulation and drama just for the sake of it.

However, later, when the relationship demands a deeper level of commitment, the person has no idea how to deal with it. This is why their relationships are almost always shallow and trivial.

Cognitive therapy for histrionic personality disorder

Using cognitive behavioral therapy to treat HPD isn’t easy. That’s because a person with HPD is generally unaware they even have a problem and may find it difficult to believe. As a matter of fact, they may only look for treatment when they’ve hit rock bottom and don’t know where else to go.

With this condition, the therapist mustn’t take on the role of becoming the patient’s ‘savior.’ However, this can be difficult because the patient is used to having that kind of person in their life. Therefore, the therapist must take great care to avoid the trap of being seduced by the patient to adopt that role. Because naturally, if the therapist fails, the therapy won’t produce results.

The therapist must encourage the patient’s ability to pay attention to detail during their treatment sessions. The patient also needs to learn to be assertive. As a matter of fact, many patients tend to digress or lose themselves in their thoughts while speaking. Therefore, they need to learn to focus on details and be more specific.

Setting goals

One of the goals in using cognitive behavioral therapy to treat HPD is for the patient to learn to focus attention on a specific problem. Starting with a list of topics can help the therapist to begin teaching the patient to focus their attention.

A young woman at a therapy session.

The patient needs to set genuine goals that are important to the patient and that allow them to see immediate benefits. This is essential because the patient may drop out of therapy if they don’t see any changes. Much in the same way they back out of other relationships, for example. For this reason, they usually need constant encouragement. Of course, they mustn’t lose sight of their long-term goals either.

A common technique in cognitive behavioral therapy is imagining what the patient’s life would be like if they changed the way they treated others. The goal is to organize their ideas around who they’d like to be.

Another therapy technique is voicing thoughts. The therapist speaks the patient’s irrational thoughts aloud. Then, the patient says aloud what they would like their thoughts to become.

This verbal therapy may be easier for the patient if they use their own words to express themselves. For instance, they might say ‘I have a meeting with the dragon today,’ instead of ‘I have a meeting with my boss today.’

Finally, the therapist will emphasize training in problem-solving, especially in means-end analysis. The goal is for the patient to stop using manipulation as a problem-solving strategy. Instead, they learn to consider using other options that bring greater benefits.

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  • American Psychiatric Association (APA) (2014): Manual de Diagnóstico y Estadísitico de los Trastornos Mentales, DSM5. Editorial Médica Panamericana. Madrid.
  • Beck, A., Freeman, A., Davis, D. Terapia cognitiva de los trastornos de personalidad. Paidós. 2º edición (2015)