Borderline and histrionic personality disorder

Histrionic vs. Borderline Personality Disorder — Talkspace

Personality disorders are a type of mental health condition that involves unhealthy patterns of thoughts, behavior, and functioning. These disorders are divided into three groups referred to as “clusters.” Borderline and histrionic personality disorder are both considered cluster B disorders, which are associated with dramatic, unpredictable, and emotionally volatile behavior.

When comparing the symptoms of histrionic personality disorder vs BPD, you’ll likely notice some major commonalities. For example, it can be difficult for people with either condition to maintain healthy relationships, and both conditions are associated with emotional outbursts.

Despite these similarities, HPD and BPD are distinct conditions with a number of differences. One of the biggest differences between histrionic and borderline personality disorder is that people with HPD are primarily motivated by a desire for attention, while those with BPD are primarily motivated by a fear of abandonment and rejection.

Keep reading to learn more about borderline and histrionic personality disorders.

What Is Histrionic Personality Disorder (HPD)?

People with histrionic personality disorder (HPD) struggle with low self-esteem and are dependent on the approval of others, similar to dependent personality disorder. These feelings give them an intense desire to be the center of attention. They may engage in dramatic, provocative, or inappropriate behaviors in an attempt to be noticed.

Although research shows that women are more likely to be diagnosed with histrionic personality disorder than men, the condition isn’t necessarily more common in women. Women may be more likely to display overt symptoms or seek treatment for the condition.

Symptoms of HPD

Many people with this cluster B personality disorder have strong social skills and can charm the people around them. It’s their distorted thought patterns and erratic behavior that can make it difficult for them to form and maintain close relationships with others.

Signs of HPD include:

Experiencing discomfort when not the center of attention
Engaging in provocative or dramatic behavior
Frequent mood swings
Over-the-top displays of emotion
Seeking reassurance or validation from others
Extreme sensitivity to criticism or rejection
Impulsive behavior
Easily influenced by others
Shallow or insincere emotions
Caring deeply about physical appearances
A lack of concern for others
Believing that relationships with others are closer than they actually are

What Is Borderline Personality Disorder (BPD)?

Borderline personality disorder (BPD) can make it difficult for people to regulate their emotions. This can lead to impulsive or destructive behaviors and interfere with the ability to have healthy relationships with others. Many people with BPD have an intense fear of abandonment and a tendency to view others in a black-and-white manner. Their views are often in absolutes — that is, they tend to see people as all good or all bad. Renowned American psychologist Theodore Millon identified four types of BPD:

Petulant BPD
Discouraged BPD
Self-destructive BPD
Impulsive BPD

People who live with BPD can struggle with negative thoughts and are at increased risk for self-harm and suicidal behaviors. Borderline personality disorder symptoms typically appear during young adulthood. While some BPD symptoms can improve with age, BPD still has the potential to be a devastating condition, especially without the proper BPD treatment.

Symptoms of BPD

One of the main characteristics of borderline personality disorder is emotional instability. The way that people with BPD feel about themselves and others can change rapidly, often with little to no warning.

Common BPD symptoms include:

Struggling to regulate emotions (emotional dysregulation)
Strong fear of abandonment
Self-destructive and impulsive behaviors
Inconsistent self-image
Jealousy tendencies
Difficulty maintaining relationships
Paranoid ideation and suspicious thoughts
Frequent and intense mood swings
Explosive and intense anger
Feelings of emptiness
Suicide ideation and thoughts of self-harm

Similarities

Borderline and histrionic personality disorder have many similar symptoms. Mood swings, impulsive behavior, and emotional outbursts are strongly associated with both conditions. Due to the overlap in symptoms, though, patients may initially be misdiagnosed when they seek treatment.

Further complicating the process of getting an accurate HPD or BPD diagnosis, HPD and BPD often coexist with other mental health conditions, such as anxiety disorders. Studies also show that women are significantly more likely to be diagnosed with HPD or BPD. Since both conditions can cause tremendous damage to interpersonal relationships, anyone who shows symptoms of either condition should seek professional treatment as soon as possible.

“Histrionic and borderline personality disorder are both from Cluster “B” type personality disorders, which are identified in individuals who struggle with emotion dysregulation and have difficulty managing their emotions.”

Talkspace therapist Bisma Anwar, MA, MSc, LMHC

Differences

Although you’ll find many shared symptoms when comparing histrionic personality disorder vs BPD, it’s the motivations behind the behaviors that you’ll find to be very different.

“Individuals with borderline personality disorder have a fear of abandonment and often perceive others as rejecting them. With histrionic personality disorder, individuals often think that they’re not getting enough attention from others. Therapy can help these individuals learn to navigate the situations that make them feel this way and learn healthy ways to cope with erratic emotions.”

Talkspace therapist Bisma Anwar, MA, MSc, LMHC

Mood swings and emotional outbursts are associated with both personality disorders, but people with BPD may feel and express emotions more strongly. HPD, by contrast, is typically associated with shallow emotions. People with BPD can exhibit emotional responses that tend to be very deep and intense.

Even though low self-esteem is a hallmark of HPD, people with this condition generally can’t and don’t believe anything is wrong with them, meaning they’re unlikely to seek treatment on their own.

Treatment Options for BPD vs HPD

It’s common to treat both borderline personality disorder and histrionic personality disorder through a combined approach of psychotherapy and medication.

BPD

Dialectical behavioral therapy (DBT), a type of talk therapy that was designed for people with BPD, is an evidence-based treatment with a strong record of success. Other types of BPD therapy that may be recommended for treating those with BPD include:

Cognitive behavioral therapy (CBT)
Schema-focused therapy
Mentalization-focused therapy

“Dialectical Behavioral Therapy is a type of therapy that was developed to help individuals with these personality disorders. When looking for a therapist, it would be best to find someone trained in this particular type of therapy.”

Talkspace therapist Bisma Anwar, MA, MSc, LMHC

Currently, the Federal Drug Administration (FDA) has not approved any specific BPD medication. However, certain types of medications, such as antidepressants or mood stabilizers, might be beneficial in helping people with BPD regulate their emotions and reduce the severity of symptoms. The right medications can improve functioning, allowing people to benefit from other forms of treatment like therapy.

HPD

Although it can often be difficult to persuade someone with HPD to seek help, it’s possible to manage and reduce symptoms with the proper histrionic personality disorder treatment.

Psychotherapy is the main form of treatment for HPD, but some patients may be prescribed medication if they have comorbid (existing at the same time) symptoms of anxiety or depression.

One-on-one therapy sessions can be very helpful for those with HPD, but group therapy has the potential to make some symptoms worse. Since people with HPD are generally driven to seek attention, they might try to sabotage group treatment sessions, wanting the spotlight on them rather than on others in the group. Supportive therapy is often recommended for those with HPD, as is insight-oriented therapy. Talk therapy can make people more aware of their own behaviors and help them relate to others.

Get Professional Help for BPD or HPD with Talkspace

It’s easy to see the many similarities when comparing histrionic personality disorder vs BPD. Even though some of the symptoms of these conditions overlap, an accurate diagnosis is essential for treatment. If you or a loved one has shown symptoms associated with either condition, it’s important that you seek professional help.

Talkspace offers online therapy and psychiatry services, making it possible for you or a loved one to get the care that you need in a convenient, safe, and affordable setting. Treatment can give you insight into your behaviors, help you manage your condition, and dramatically improve your quality of life. Don’t hesitate to reach out for expert help today.

See references

Reichl C, Kaess M. Self-harm in the context of borderline personality disorder. Curr Opin Psychol.
Friborg O, Martinussen M, Kaiser S, Øvergård K, Rosenvinge J. Comorbidity of personality disorders in anxiety disorders: A meta-analysis of 30 years of research.
Biskin R, Paris J. Diagnosing borderline personality disorder.
May J, Richardi T, Barth K. Dialectical behavior therapy as treatment for borderline personality disorder.

Talkspace articles are written by experienced mental health-wellness contributors; they are grounded in scientific research and evidence-based practices. Articles are extensively reviewed by our team of clinical experts (therapists and psychiatrists of various specialties) to ensure content is accurate and on par with current industry standards.

Our goal at Talkspace is to provide the most up-to-date, valuable, and objective information on mental health-related topics in order to help readers make informed decisions.

Articles contain trusted third-party sources that are either directly linked to in the text or listed at the bottom to take readers directly to the source.

Talkspace mental health services

What is the Difference Between Borderline Personality Disorder & Histrionic Personality Disorder?

Personality disorders sometimes have overlapping symptoms, as many disorders involve some degree of instability in mood and/or coping mechanisms, impulsivity, motivation and energy, and more. In fact, many people with personality disorders have trouble keeping and maintaining social relationships, as their perceptions of themselves and others may be skewed or unstable at times. If you’ve been doing research on personality disorders, you’ll likely find the inescapable truth that it’s quite possible to be misdiagnosed – this overlap in symptoms can make it very hard for a healthcare professional to diagnose you accurately.

Many clinicians argue that both borderline personality disorder (BPD) and histrionic personality disorder are practically the same, but there are some key differences. Here is a short and simple breakdown of each:

Borderline Personality Disorder

Efforts to avoid real or imagined abandonment
Intense and unstable relationships with family
Impulsive behaviors
Unstable self-image
Mood swings

Histrionic Personality Disorder

Discomfort in situations where one is not center of attention
Inappropriate sexually seductive/provocative behavior
Rapidly shifting emotions
Self-dramatization and exaggerated expressions
Easily influenced by outside circumstances

A 2015 review published in The Lancet highlights the unfortunate reality that many people with personality disorders go years without being correctly diagnosed, making treatment ineffective or harmful at its worst – placing individuals at risk for developing other conditions alongside their current one. While it takes time and sometimes second opinions, evaluations are important for your mental health recovery journey.

Both disorders are based on severe mood swings, impulsivity, and difficulty with relationships, which means that one disorder could easily be misdiagnosed for the other. The National Institute on Mental Health (NIMH) has listed treatment for either of these disorders are psychotherapy approaches such as cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and medication to assist with mood swings, depression, and/or other troubling symptoms. If you’ve been diagnosed with BPD or histrionic personality disorder, speak with a professional from a reputable treatment center today to learn more about treatment programs and which may be the best option for you. Recovery is possible.

Learning to be is part of the process of trauma recovery. Stop the cycle of merry-go-round treatment and find the solution you’re looking for in trauma treatment. Through effective residential treatment, Khiron House helps you find the path you need toward health and wellness in recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

FGBNU NTsPZ. ‹‹Borderline mental disorders››

Hysterical personality disorder, or hysterical type of psychopathy. Hysterical reactions (stigmas, fainting, etc.) and other forms of hysterical behavior (extravagance, a tendency to dramatize trivial situations, the desire to be in the spotlight), characteristic of this type of psychopathy, are quite widespread and are often observed in psychopathic personalities of other types with the development of neurotic reactions or reactive psychoses. Hysterical psychopathy is characterized not only by psychogenic hysterical reactions and behaviors, but also by a certain personality type. These people are internally empty, sometimes empty and even miserable; external impressions play the greatest role in the balance of their mental life. They do not have their own opinion, their own established views on life; their judgments lack maturity, seriousness, and depth. Their behavior is not dictated by internal motives, but is calculated for an external effect. The desire to attract attention to oneself, the "thirst for recognition", a tendency to imitate, fiction and fantasies, capriciousness are noted in tantrums even in the preschool period. In adolescence and youth, along with this, their egocentrism, disorganization, a tendency to frivolous acts, wastefulness, and various adventures come out more clearly. They are incapable of systematic, hard work, prefer amateurish activity when choosing their occupation and succumb to tasks that require perseverance, thorough knowledge and solid professional training. Most of all, they like an idle life with external, ostentatious splendor, various entertainments, and frequent changes of impressions. They willingly and selflessly perform the rituals of festivities and banquets, strive to follow fashion in everything, attend successful performances, “idolize” popular artists, discuss sensational books, etc. nine0007

For the most part, they are gullible, easily attached to people. At the same time, a tendency to eroticize interpersonal relationships is often found [Yakubik A., 1982]; quickly fall in love, starting numerous, often short-lived novels, accompanied at first by violent manifestations of feelings. However, being fickle in their hobbies, they cool down just as quickly. In more rare cases, persistent ecstatic attachments are formed, which are formed according to the type of overvalued formations [Dubnitskaya E. B., 1979; Filts A. O., 1987].

As K. Jaspers (1923) points out, one of the main properties of hysterics is the desire to appear larger than they really are, to experience more than they are able to survive. Some try to emphasize their talent, while operating with very superficial information from various fields of science and art, others exaggerate their social position, hinting at close ties with high-ranking officials; others, without stinting on promises, talk about their vast possibilities, which in fact turn out to be the fruit of their rich imagination. Hysterics use everything possible to be in the spotlight: eccentricity in clothing, “flashy” forms of external behavior, unusual actions that contrast with generally accepted views, allegedly mysterious symptoms of an unknown illness, fainting, etc. nine0007

A feature of the hysterical psyche is also the absence of clear boundaries between the products of one's own imagination and reality. Focusing on this property, P. B. Gannushkin emphasizes that the real world for a person with a hysterical psyche acquires a peculiar bizarre shape; the objective criterion for him is lost, which often gives those around him a reason to accuse such a person, at best, of lying and pretense. The hysteric perceives the processes in his own body and his own psyche in the same way. Some experiences completely escape his attention, while others, on the contrary, are evaluated extremely thinly. Because of the brightness of some images and ideas and the pallor of others, a person with a hysterical mentality very often does not see the difference between fantasy and reality, between what happened in reality and what was seen in a dream, or, more precisely, is not able to do it. nine0007

The prognosis for hysterical psychopathy in general cannot be considered unfavorable. In adulthood, with good social conditions and a working environment, in most cases, long-term and stable compensation is possible [Semke V. Ya., 1988]. During this period, the pathocharacterological structure of hysterical psychopathy largely coincides with the accentuated personalities of the “demonstrative” type described by K. Leonhard (1968). Compensated hysterical psychopathic personalities are infantile, youthfully graceful, with emphasized plasticity and expressiveness of movements. Among them there are people with a certain stage talent, artistic natures, but also poseurs and "dandies", dressed with exaggerated elegance. With age, they become smoother and more serious, acquire the necessary labor skills, but the elements of theatricality in behavior remain; First of all, this is reflected in the ability to make a good, favorable impression for oneself, to arouse sympathy, and if necessary, sympathy. Most fully in hysterical psychopathy, compensation processes occur in the case of a predominance of psychopathic manifestations of a tendency to various autonomic and hysterical paroxysms (spasms, a feeling of suffocation during excitement, globus hystericus, nausea, vomiting, aphonia, tremor of the fingers, numbness of the extremities and other sensitivity disorders). Already by the age of 30-35, such psychopathic personalities are sufficiently adapted to the real situation, they can correct their behavior. In life, these are emphasized obligatory people, diligent, successfully coping with their professional duties, maintaining fairly strong family ties. However, with such variants of hysterical psychopathy, the risk of decompensation at involutionary age is more likely, which is often associated with a deterioration in the somatic condition (hypertension, coronary artery disease and other diseases) and menopause. Manifestations of decompensation (usually in the form of emotional instability, violent hysterical reactions and paroxysms) in more severe cases correspond to the clinic of involutional hysteria [Geyer T. I., 1925]. Along with increasing depression, asthenia, tearfulness, anxious fears for one's health, more persistent hypochondriacal symptoms, accompanied by various algias, conversion and vegetative disorders, may come to the fore.

The prognosis is less favorable in the case of a predominance in the structure of the hysterical personality of a tendency to pathological fantasizing. Such psychopathic personalities are distinguished by some authors into a separate group - pathological swindlers and pseudologists according to A. Delbruck (1891), mythomaniacs according to E. Durpe (1909), liars and deceivers according to E. Kraepelin (1915), pathological liars according to P. B. Gannushkin (1964). These people lie from a young age, sometimes without any reason or meaning. Some get so used to the situations created by their imagination that they themselves believe in them. Some can enthusiastically talk about journeys into the remote taiga as part of a geological expedition in which they have never participated; others, having no medical education, describe as if they performed complex surgical operations. Fantasies sometimes turn into self-incrimination with confessions to fictional crimes and even murders. Decompensation, usually quite frequent, occurs either already in the school years, or somewhat later, with the transition to independent activity. For the first time after starting a job or moving to a new place, they impress others as thoughtful, conscientious, enterprising, gifted specialists. However, their complete failure is soon discovered. They are extremely frivolous about the assigned work, incapable of systematic work, instead of real problems, they are busy with fantastic fictions. Compared to ordinary hysterics, as G. E. Sukhareva points out, pseudologists are more active in their desire to realize their plans. It's not always an innocent lie. More often, certain selfish goals are pursued, which leads to a collision with the law. A motley gallery of petty swindlers, soothsayers, marriage swindlers, charlatans posing as doctors, or extortionists who accept valuable gifts and cash advances for services that they can never provide is formed from among the pseudologists. nine0007

Some taxonomies (DSM-IV) distinguish narcissistic personality disorder, having in common with hysterical psychopathy. The definition of "narcissus" goes back to Greek mythology (Narcissus fell in love ¹ with his own reflection in the water and died while trying to hug him). Conceptualization of the concept "narcissistic" belongs to Z. Freud. Later, the concept of narcissism developed in the context of psychoanalytic research. The term "narcissistic personality disorder" was introduced by H. Kohut in 1968. Narcissistic and hysterical personality disorder bring together the features of demonstrativeness, a tendency to dramatize, a thirst for recognition, but significant differences are also found. Narcissistic personalities are characterized by pathological ambition, conceit, arrogance, a sense of superiority over others. "Narcissists" are always confident in their significance, correctness, cannot stand criticism, tend to exaggerate their knowledge and achievements (narcissistic falsification of reality according to H. Kohut, 1971). The ability to work effectively is often combined with the pursuit of universal attention and admiration. The choice of progression also corresponds to this goal: they are not satisfied with activities that do not promise quick fame and public recognition. If hysterical personalities retain the ability to care for their neighbors and love them, then narcissists are devoid of empathy, indifferent to the interests and feelings of others, “perceive others as a faceless applauding mass” [Svrakic D. M., 1989].

How to recognize and deal with histrionic personality disorder

August 7, 2020 Likbez Health

Stress will help to heal, and in order to start therapy, it is enough to detect five out of ten signs.

If you have 100 acquaintances, about two of them have hysterical personality disorder. Most likely, these two are women.

Histrionic personality disorder is diagnosed four times more often in women than in men.

But there is an assumption that in the case of men, hysterical traits - demonstrative behavior, a thirst for recognition, emotional outbursts, communication in raised tones - simply seem acceptable to society, natural, therefore, they do not seem to require correction and treatment to a doctor. However, in fact, both men and women are hysterical with equal frequency. nine0007

Actually, for this reason, in English-language literature, the concept of “hysterical” (hysterical) was abandoned in favor of “dramatic, simulated, theatrical” (histrionic). The word "hysteria" comes from the ancient Greek "womb", which means that only women can suffer from a hysterical disorder. Histrionic disorder is not related to gender.

Recognizing a "dramatic" violation is quite difficult. This conduct disorder (which is how the International Classification of Diseases ICD-10 defines hysterical personality disorder) often looks like openness, originality, a kind of cute expression characteristic of charming creative characters. nine0007

However, there are important clues that the person has crossed the line that separates eccentricity from mental impairment.

What are the symptoms of histrionic personality disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists 10 key features of this disorder. To suggest a hysterical personality disorder, it is enough to notice at least five of them in a person’s behavior.

1. Egocentricity

A person feels the need to be in the center of attention, to outshine others. If for some reason this is objectively impossible, he will try to attract attention by all available means.

For example, if a histrionic is a student at a lecture, he will interrupt the lecturer with questions, and if, let's say, he is just a guest at a party with a star, he will deliberately laugh out loud or even intentionally break something.

2. Demonstrative behavior

This is, for example, the habit of talking loudly, active gestures, exaggerated display of emotions. For example, if such a person sees a friend, he will not limit himself to a simple “Hello!” He throws himself on his neck and kisses him. nine0007

3. The tendency to consider relationships with people closer than they are

Familiarity is another characteristic feature of histrionics. A person really wants to be loved and accepted, so he unconsciously seeks to show that everywhere and for everyone he is “his own”.

Histrionic easily pours out his soul, sometimes even to casual acquaintances. True, he speaks only on a limited number of topics: for example, how many trials he passed with dignity, how he was admired, or, on the contrary, how callously and vilely he was betrayed. nine0007

4. Love for provocative outfits

Unusual, eye-catching clothing is one of the easiest ways to stand out from the crowd and attract attention. And the histrionic uses it to the fullest, choosing things in bright colors, adding abundant decorations and creating provocative sets.

5. Inappropriately seductive appearance or behavior

If the histrionic is a woman, she is a vamp. If a man is a mysterious macho. A person with this disorder needs compliments and knows that the easiest way to "squeeze" them from the opposite sex. Hence the undisguised sexuality that permeates the entire image. nine0007

6. An obsessive thirst for recognition and approval

A Histrionic should be admired - only then will he be complacent and satisfied. If he is not noticed or, even worse, criticized, he will make a dramatic scandal and leave, wringing his hands theatrically, slamming the door in parting.

7. Frequent and rapid mood swings

A person with a hysterical disorder is very emotional, and the most insignificant factors can cause a violent change of emotions. For example, a histrionic may sob sincerely when he loses a twenty or discovers that someone has not washed his cup again. But in a minute he will laugh just as sincerely when he hears an insipid anecdote from a significant person. nine0007

8. Hypersensitivity to criticism

It is difficult to discuss conflict issues with a histrionic, whether domestic or work. The slightest dissatisfaction or a request not to do this again, he immediately takes into account. And he begins to defend himself, often according to the principle "the best defense is an attack."

The search for a compromise turns into a quarrel with raised voices and becomes hopeless.

9. Suggestibility

Critical thinking, fact-checking, analysis are not about histrionics. His point of view is based on emotions: “It’s close to me, so it’s true.” nine0007

A huge influence on the formation of the views of a person with a hysterical disorder is exerted by authorities, that is, people who are personally significant to him. He perceives their words completely uncritically, often as the ultimate truth.

10. Deterioration in the quality of life due to behavioral characteristics

This is a common symptom of behavioral disorders: they ruin a person's life.

For example, an overly emotional histrionic, prone to dramatization, cannot build stable personal or business relationships: partners run away from him after the very first theatrical scandals. nine0007

Or another angle: because of his gullibility and love for revealing outfits, a histrionic every now and then gets into risky situations.

Here's another example: due to the inability to be critical of himself, he cannot draw conclusions from past mistakes, so he steps on the same rake again and again, blaming anyone but himself for his problems.

What to do if a person has histrionic personality disorder

The most effective treatment for histrionic disorder is psychotherapy. The problem is that histrionics, as a rule, do not consider their behavior to require correction and are often not ready to turn to a psychotherapist. nine0007

The easiest way is to proceed as follows. Sooner or later, the histrionic once again gets hit on the forehead by life. Against this background, he experiences severe stress, anxiety, sometimes he develops depression. It is at this moment that it is worth taking a person by the hand and leading him to a specialist. To begin with, to solve the “stress” problem, and after it, deal with histrionic disorder.

Most likely, the doctor will choose the so-called psychodynamic approach to work with the patient. It is based on psychoanalysis: with the help of a specialist, a person learns to understand what exactly makes him perform certain actions. nine0007

In the first step, the therapist will ask the patient to replace active behavior with words. For example, if a histrionic wants to throw himself on someone's neck, he should stop and explain to himself what is happening: "I'm glad to meet you." This deciphering of emotions, which should become a habit, helps to understand yourself and learn to communicate less theatrically with others.

Next, the psychotherapist will help the histrionic to realize that drama, excessive emotionality is just a way to attract attention, to feel significant.

Learn more