Histrionic Personality Disorder | The Signs

[Music] Do you know anyone who's overly attention-seeking, overly theatrical, or the life of the party? Well, according to Dr. Romini, that person could have histrionic personality disorder, or at the very least, histrionic traits. In this episode, you'll learn how to recognize the behaviors of the condition and how to cope with those behaviors.

On the break, I said this feels a lot like borderline personality disorder. It's very different, very different, very different. So, for a lot of our viewers who have watched our series on borderline personalities, let's—I really want to separate this for them. Remember borderline personality disorder: the dysregulated emotion, the emotions that shift rapidly, the real inner sense of torment. There is such a subjective sense of discomfort, the sense that they're going to be abandoned, and that's accompanied by a feeling of panicking. Borderline personality disorder, right? That's borderline. Yes. Okay, okay.

Now, where it can get confusing is that you might have an individual with borderline personality disorder who, in devaluing themselves so much and wanting so much to get into a relationship, they will be very sort of seductive and attention-seeking in their presentation, right? And they're hoping, in that looking like that, being like that, somebody won't leave them. So their motivation—it's not attention—it's to create this really all-encompassing union with somebody who won't leave them. Yes. And there's this chronic sense of panic. A person with histrionic personality disorder is not experiencing that torment, that panic, that fear of abandonment. They may—they would be very uncomfortable if they were alone. People with histrionic personality disorder need an audience. People with borderline personality disorder need a partner. Yes, you, you, I got it. When on the break when you said, Kyle, if you weren't giving me attention, I'll just go over here and get it. Yes, if I would, yes, I don't have to, it has yours. Yes, yes.

For histrionic personality, like I said, that's the idea of an audience. I don't care who's in the audience, as long as all eyes are on me. There may be someone in that audience I like a little better, but there's probably a few of them. For the person with borderline personality, they very much—they really get focused on that one person, their person. And it's like a mother, right? So that's a lot of what we look at in the earlier theoretical writings on borderline personality; it's about that there's something very interrupted in that early attachment of some kind. Histrionic personality likely has some of that attachment issue, but it's not with the depth and the torment. This is where, to meet borderline personality disorder clinically, it's such an important to understand this disorder or pattern because of how much torment the person is experiencing. They're in a lot of inner pain. I think a person with histrionic personality can get hurt if people are pushed back on it or rejecting of them, but it won't be that—I mean, um, literally suicidal pain. I mean, a person has—if I get rejected, there's an amount of hurt that's normal, that's normal. But it's the—you always want to look in any psychiatric pattern; you want to think also in terms of motivations, at least that's how I look at it, you know, with the personality patterns in particular. What are some of the motivators here? What are the key traits that are sort of playing out? And so it's different. This is really about getting attention, and now it's almost like you're—you only exist by your audience; like the more audience you've got, the more you exist. It's a bit of an existential conundrum.

Let's go right into the diagnostic criteria for histrionic personality disorder. The first one we've talked about: center of attention. And how does this manifest itself? They'll do whatever they need to do to get that attention; whether it's—usually it's their appearance, nine times out of ten it's their appearance. And it's—they, they often take a lot—very good care of themselves. They go to the gym and they work out. They might get, you know, cosmetic surgeries or modifications. Very careful with their appearance. They may dress very seductively or very expensively. But whatever they do, they're going to make sure all eyes are on them. Maybe also how they talk about themselves. They may talk about, "Oh, my celebrity friend, this," or, "I just came back from this grand adventure there," or—and they will exaggerate the truth a little bit to make sure their story is the biggest and the best. Is this done consciously? Yeah, I mean, they want to make sure they're getting attention. So if they're—if just the way they're dressed isn't working, then they're definitely going to—they're going to tell the story in a way that they keep ensuring the eyes are on them.

The second one is being sexually seductive. Yes. How does that look? So that links into that first one, right? The way to get attention is to be seductive. But again, it's a—it's almost like a win, right? If you know, most people are—you know, we're not going to be ultra seductive, but a lot of it is—if it may not just be their style of dress, it's also going to be in how they talk about things, you know, that they're going to be, you know, almost talk about things moderately inappropriate, you know, talk about sexual things, be very sort of, you know, flirty in how they talk. That's definitely going to get you attention, you know, and they're sort of equal opportunity to flirt as well—for men, women, regardless of their sexual orientation. So, and then that way they really can own a room and get a lot of attention for that. So yeah, they're very—and it is, I would say, of all of the disorders we will ever hear about in med circle, the most seductive. This is the most—this is the most seductive in terms of how they present themselves. It is a seduction disorder. And if they are married, it doesn't keep them from—Oh, heck no. No. And it can really be—I mean, I've worked with couples like this where the one would say, "This is kind of uncomfortable, you know, like I think my wife—or I think my wife's gorgeous, but it's hard when like everyone's eyes are kind of popping out over her because she's dressed in this way." And so it's—it's kind of a mixed blessing, if you will. And so it's—there is that because it's not like they're being humble about it, like that person's working—thank you. No, they're working it; they're out. Now there are plenty of spouses who love when their spouse is the center of attention. Great. So could two people who have histrionic personalities be really compatible that way? You know, I think at some point there's just gonna be way too much air in the room; like it's just too much, you know? It's a—I, you know, the only reason it could potentially work is they're never really gonna talk about much; it's gonna really be kind of—and maybe neither one would be bothered by the superficiality of it all, right? But I will tell you this: in no couple is it ever going to be even, and the day one person's getting more attention than the other, all hell is going to break loose. So of course it's never—and this is where, like, for example, if you have two stars in a relationship, if one person's star is going up and the other one's not getting so many of the A-list gigs, that's going to cause friction. That's an example of what happens when two histrionic individuals get into a relationship. Fascinating.

Number three is shifting emotions. Yes. This is the one that made me think, "Oh, this is like borderline personality." The shifting emotions is sort of that one overlap trait that can give it some resemblance to a borderline personality pattern. By shifting emotions, because their emotion is so shallow, it can quickly go to meet whatever is happening in the room. An example I've used—maybe a lot of our viewers won't get this because they don't live in Los Angeles—the weather in Los Angeles is historically—a hot hot day, it'll still get cool at night because our—the way our weather is, it just doesn't hold it; it lacks depth because there's no humidity. It's like they don't have humidity; they—they will be with a friend who's kind of having a tough day, and they're able to be there and nod wisely, "Um, God, that sounds so hard. Yeah, I'm so sorry." And there'll be a little pouty, but then someone comes in the room whose attention they may like more, who's cheerful, and they'll pop right into cheerful. So they'll be, "Kyle, I'm so sorry, I'm so sorry. Hey, how—what?" And that's not normal; that's the shift. It's the shift in response, whereas in a person with borderline personality, that shift is happening internally. There's nothing in the environment; you're like, "Why did that just happen?" But for a person with histrionic personality, that shift is often in response to the external stimuli and demands in their environment.

We've talked about the next one a lot: physical appearance. They look good; they look good. They do, and they—and but the thing is, they invest so much time—like these are the people who are going to the gym because this is how they get attention. And even at the gym, they go to the gym in full hair and makeup. They buy—they spend more on their workout clothes than I think that I once upon a time did on a wedding dress. I mean, like it's like the—everything 500 exercise ensemble. And they look like—they look fantastic at the gym; everyone is staring at them. And it's like they're like a peacock on the treadmill, you know, because I used to go to a really expensive gym, and I was—because I'm basketball shorts and a T-shirt, right? And then I'm looking around; I go, "Oh yeah, I have to—oh yeah, get it together if I'm gonna go here." Yeah, yeah. So I have to go to a pre-gym so I'm acceptable enough to go to the real—the Showtime. Yeah. So yeah, very much physical appearance matters. And not only do they overvalue it in themselves, they overvalue it in other people. Oh yeah. So go into more detail. So they may not want a friend that's kind of frumpy or not well put together. Yeah, like they're like, you know, this is the person who will reject the bridesmaid for not being a size eight or under, you know? It's that—like my wedding's gonna look a certain way, so here's your diet, and I expect you to fit this dress. Or maybe we'll have you do a reading. Being—being a good person, is that important to them in—in somebody else? No, no, not as much. It's more about status, physical appearance, what you can do for them. Yes, yes.

What about speech style? Speech style is interesting. It's what we call that—it's the way we describe it diagnostically; it's highly impressionistic and it lacks detail. Okay, what that means is they say a lot of words, but they don't say anything. So yeah, I'm sort of feeling this energetic movement; there's a rise in me; I'm just trying to do me and feel it out and find me doing me, loving me. And you're like, "Oh wow, what is that like," you know? And so there is a—it's—it's very—there's a lot—a lot of there there, and you'll see this in people sometimes who are oversubscribed to sort of certain like healing communities, and like—there's just—what are you trying to do? And they're not able to clearly articulate a goal, an outcome, a process. Like if you're trying to get something done, this is not the person you want on your team, you know? That they'll talk very ephemerally about stuff, but there's not—so the—it's—and again there's—it's superficial, right? They—it's not—they cannot speak deeply because they do not really feel deeply. So it is this sort of—again, the style that's impressionistic. So I understand it; the speech pattern of this vagueness—it's vagueness. Exactly, comes from the fact that they don't feel deeply; they're not connected to that, you know? There's a—because they're not clear on their motives. You've got to remember this with a person with most Cluster B personality disorders, as we've talked about. Yeah, we haven't—we need to redefine Cluster B. Yeah. So Cluster B personality disorders are personality patterns that are characterized by dramatic, erratic emotional behavior, and very few of those patterns do the people have any insight; they lack insight. And this means narcissistic, borderline, antisocial, as we're talking about now, histrionic. But they're very unclear on their own motivations; they just don't know what they are. They're not even clear why they're doing what they're doing, because what they're not able to do is say, "Hey, the only thing that matters to me is everyone thinks I'm the hottest chick in the room." And guess who's going to say that, right? Because even they have enough insight to know that's not what you're supposed to say. And they're not in touch with that motive. So when you're not in touch with your motivations, you're not actually able to speak or behave clearly. So if they were running a business, could—and you said, "What's your goal for next year?" "I want to be the best cupcake store in Los Angeles," and they're like, "How are you going to—you know, we're posting on Instagram; we have a new chocolate cupcake." Yeah, just use it. It's very like, you know, they'll have these—and many times the kinds of businesses they're running are very much cupcakey—very superficially like cosmetics and accessories. I'm not saying those aren't important things; I know they matter to the people who make them, but they are very—you know, they're not trying to build carburetors, right? Okay. So it's very much that kind of like showy sort of a business. And so what they'll be—"We're going to put it on Instagram, and maybe I can get that billboard, and I'm going to try a new recipe, or this is going to be pink." You know, that's not a goal. Mm-hmm. You know? So it's very—it's almost like when a child makes a lemonade stand; it can all often have that sort of like childlike motivation to it, but it can get confusing if you're talking to them because you're like, "What are they saying? I can't—I don't understand what their point is," and you might actually over—misinterpret as being deep, you know, like, "Oh, they're talking about all this energy and stuff," and you're like, "Got it." Yeah, but instead you just really say, "What—come out and say like, what are you saying?" I'm so fascinated by the speech part of it. Yeah, I think that's because it's a probably a quicker way to—I mean, all these are really fast: center of attention, sexually seductive, shifting emotions, physical appearance, speech style; they're all surfacely already—all of these traits. Yep, yep.

Dramatic behavior. Dramatic behavior. So this would be like—they'll wear—these are people who wear capes and feathered boas. What's wrong with the cape and a feather boa? I don't know—trainer jokes. You know, there's a time and a place. So they definitely are very theatrical, and there's a lot of—you know, you feel like you're in a Wagner opera; like there's a lot of emotion. And what do you mean there aren't enough candles? We must have 82 on the cake. You know, there's a lot of this like operatic—"Can you please turn everything she just did into a GIF? Internet, I need to see all of that as much as possible." Okay, so they're very dramatic, very dramatic. It's like being in—it's like performance art when they come to your house. Okay, so let me tell you the story. I do so many of these interviews; I've exhausted my wardrobe. Okay, like I just—I don't have enough clothes. So I go and I'm looking online—another friend who's on camera, he sends me this website, and all of the clothes are pretty extravagant, and there's this one like pink furry shirt jacket, and I said it to him as a joke, like, "Wouldn't this be appropriate for me sitting down?" And he goes, "Oh yeah, you should get that." I go, "No, there's no way I could—that's to hear that—that's histrionic clothing." But there's a part of me though that would like—not for this, but if—if—if a friend was having a birthday, I'm like, "I'm gonna wear this; this is fun." Okay, but see then the pink jacket—but if you expected people to attend, like, let's say it wasn't a pink jacket party, you know, like it was a state affair, like a brunch at a high-end hotel, and you show up in your pink jacket, or you wore the pink jacket to a funeral where people weren't dressing like that, like it would show a lack of insight that you—what are you trying to show? But they're very—it's big, big gestures. They'll show up to a baby shower with a gift that's like seven feet tall. That's—preceding—they'll roll it in on a carriage. Like their gifts are big; their gestures are big, big, big, exciting, dramatic, and you'll often feel almost overwhelmed by it all. And sometimes people feel guilty, like, "Oh my God, they're giving me a seven-foot present; I should be nicer about this." Okay, and everyone—sometimes I just have to laugh. Okay, it's a lot of mental health to take in every week. Um, it's because I'm laughing because I know these people, right? I know this—I know—I'm literally thinking of this one woman. I go—"I didn't know before, but now I know." We all do. And yeah, I always—and when we talk about how to manage it, I do—it's a very compassionate take on it, you know.

Suggestibility. Yeah. So I mean, these are the people who—who go in for the sucker bet every single time. They are—it's very easy to convince them of magical things. In this way, they're dangerously vulnerable to things like cults or organizations that are trying to recruit members that almost like have a pyramid scheme feel to them. They're very—they'll buy whatever you're selling. They can be drawn into sort of fringe religious communities, that kind of thing. They're very—again, there's an innocence to them. You mentioned time shares. Time shares. Any kind of a bad investment? Oh, heck yeah. Histrionic people fall for that in a second; like you're going to get to go on a cruise with all of your other cosmetic-selling friends. You know, it's culty. They're drawn to that kind of stuff, and they're—because they're suggestible, just like a child would be. And think about it: a child is still learning their emotional depth; that's why we can trick them into Santa Claus and tooth fairies and all of those fantasies. They're still impressionable. As they get a greater capacity for critical thinking, the child tends to reject that on their own. I've noticed that, by and large, many people with histrionic personality disorder lack as much of a capacity for critical thinking as would be expected for someone at their stage, so that they'll fall for conspiracy theories online; they'll fall for ridiculous bargains online, and that can put them in trouble financially; they can put themselves at harm or risk, give away their information, waste time, waste something. A person who gets an email from the prince of some African country—maybe not—you know, what their—their—their suggestibility is often happens in a self-serving way. It could be the African country—"Look, someone wants to give me a million dollars"—but it can also be like—let's go back to that vague kind of style of speech—"These people are going to help me harness all my inner energy and let my demons go so I can love"—I don't know what is that like? What group is this? And they're asking you 10 grand for that—for 10 grand, "I'll do that for you too," right? You know? And so it's—there is this sense of getting drawn into schemes, and—and—and a lot of people take advantage of that; like they can—it's almost like you can see them coming; their eyes are a little wider; they're more vulnerable to that. Again, they don't think critically because there's almost a childlike quality to this.

The last one is overestimation of intimacy. Yes. The overestimation of intimacy one is a very interesting one, especially in our modern times. They think a relationship is much closer than it really is. They'll meet someone at a party; they'll exchange numbers, whether intimately or as friends, and they'll think, "We're best friends." So like the next day it's like, "Hey, love meeting you last night; coffee three o'clock." Or they'll get your address, and also you're getting gifts from them. They'll—in conversation with other people, they'll talk about you as though you are their best friend. They'll go on a date; they'll call the person their boyfriend. So there's this fast forward. And it's interesting; this dynamic can also play out, let's say they meet someone famous—they love famous people—they meet someone famous in, I don't know, a bar or club or an airport or hotel or something, and then they'll say, "Oh gosh, me and such and such are friends now," and they might even have a photograph they put on social media so that there's this—this assumed intimacy that isn't there, which can actually be a little destabilizing for you, who now thinks like, "Why is this person asking me to have coffee with them? Like we just happen to like the same book," you know? And so now all of a sudden the—and they're really—they'll keep texting you and saying, "Hey, you want to hang out? You want to do this? You want to do that?" It's as though they're—they're misreading the situation because, again, that's very superficial to them—"Hey, you gave me your phone number; we must be friends," right? Superficial. Yes, I get that. Yeah. Now do they have to have all of these? No. Typically, for any of these patterns in any diagnostic manual, it's usually—I think there's about nine; we talked eight or nine; we've talked about—usually it's five of those. Okay, so five—we have one, two, three, four, five, six, seven, eight. These are the eight. Yeah, four to five of them. Yeah, yeah, a little over half of them. And you'll see a lot of them cluster together: the physical seductiveness, the physical appearance, appearance, the getting attention—that's—that's the core of that. This is the core. Can someone have histrionic personality disorder and borderline personality? You know what would typically—what we'd see is that the histrionic patterns are largely getting subsumed under the borderline piece, and they're using the attention-seeking, seductive patterns as a way to create an overly intense attachment with another person. Okay. How long do these symptoms have to last? Well, we see that these are some—these are patterns that generalize. So this is what we don't want to do is—like, let's say somebody goes to college; they're desperately trying to fit in, or graduate school or some new job or new city; they're desperately trying to fit in, and they go and they buy the new wardrobe and they do themselves up and they're trying so hard, and then after a couple of months, "I give it up; like I've met my friends; I'm cool; it's good; it's"—this is not flash in the pan; these are patterns that are consistent across intimate relationships, family relationships, work relationships, in the world in general, and it characterizes much of their adult life, like this is not—does that make sense? It's not just a merry widow; this isn't depression where you have to have—no, no, no; it's not episodic; it's not—it's chronic. It's chronic. Now are there different types of histrionic personality disorder? You know, there is a—a famous, you know, and well-wanted personality theorist, a guy named Theodore Millon; he recently passed in the last couple of years, and he really had an incredibly well-articulated theory of personality and personality disorder patterns for most of them, whether it be borderline or histrionic. He would identify sort of sub-patterns, because we use this word broadly, but these patterns exist on a continuum from relatively benign to quite severe, and they can manifest in different ways. So, for example, one form that—uh, I believe that this might be in Theodore Millon's taxonomy—is this idea of the appeasing histrionic individual. So the appeasing histrionic individual will do anything to make sure everyone around them is happy and taken care of, and they are very solicitous, but it's almost like they look like the rescuer, like this—they're the leader of the tribe, and you know—and they almost a little bit anxious about all of that, you know? So there are different—there's also more of the—the vivacious histrionic; that's more of our classical histrionic; that's the life of the party, and "Give me all the attention, and you know, here I am, and looking fabulous, and I am fabulous." So he identifies those subtypes, and I think that's an—a wise distinction. What we see though is the way those subtypes line up; they actually then explain a lot of the overlap with the other personality patterns. For example, the more appeasing histrionic style looks like a different personality style that we call dependent personality style; the vivacious histrionic looks like a classical histrionic; and then I think he even talks about more of like—

I don't remember how he termed it, almost like a Solon or a, you know, kind of a histrionic. And these are people who get really brooding and resentful when they're not getting all the attention they want. That feels a little bit more like a borderline pattern. So you see now how this sort of, this, this blob called histrionic gets cut up into different pieces of pie that might overlap with other patterns. And these things are very heterogeneous; they're very nuanced because human beings are.

When will these symptoms start to display? Um, you'll start—here's where it gets tricky with histrionic. Many teenagers are, by definition, histrionic: "Look at me! You know, look at me! Look at me!" No, no, I have blue hair. No, no, I did this; I did that. Look at my social media. I always say you've got to let, you gotta let an adolescent bake for a little while before you pull it out of the oven. And so I would not overly get lost in the use of this term until maybe early to mid-20s, okay? And then see if it sustains. Because I've got to be frank with you, there are people in their 60s who are like this—like a woman, you know, in her 60s who will still go out sexy, seductive, and, you know, it—you know, she really will feel like she's past her prime, but she's still out there working it and getting the attention, you know. And so it's, it, it will sustain over the lifespan, but I would not bandy the term around until the person's found a little bit of their stride in adulthood to rule it out from just the anxiety of trying to find their place in the world.

You've talked a little bit about this. Do you find a lot of differences on how men display these symptoms versus women?

Yeah, I do think—I mean, there are histrionic men. And what makes it tricky is I wish this was called superficial personality disorder.

I totally agree.

Yeah, yeah. The word histrionic is a gendered term. Like I said, as a feminist, I really dislike this term. Holy, I think it, I think it pathologizes women, which I have a problem with. I think anyone can be attention-seeking. For men with histrionic personality style, what you see is they'll often use money, wealth, and the trappings of that—Lamborghini sports car, forty-thousand-dollar watch, fancy man shoes.

Right.

You know, fancy man shoes. Yeah, I need some of those. Goodness, you know, fancy man clothes, like the labeled clothes and the suit cut just so, and bottle service. I'm gonna spend four thousand dollars, and everyone's gonna see how great I am. Come give me attention in the bar, the club. That's—in some ways, men display the histrionic through more of their trappings because it's a little odd for a man. I mean, men don't have cleavage, do they? You know, I mean, and it's a little cliché and sort of Studio 54-ish to have your shirt unbuttoned and that kind of thing. But like, you know, they may, but they may really spend a lot of time at the gym so they can go and sort of be glisteny and abby and all of that, you know. They like going to resorts where they can show off their bodies—all of that. You'll see that in men. So, some similar to women, but the attention-seeking might take more of the wealth, power, possession kind of a path.

And what about for women?

For women, they're going to—they may use straight-up appearance. Like a woman can use cosmetics and accessories and color in a different way. I mean, it would be unusual for a heterosexual man to go out in a magenta shirt and high heels. Yes, like that would be—um, so for, you know, for women, they may really be able to—like they'll use style of dress, seductiveness of dress, um, you know, a cosmetic enhancement of their bodies, which isn't as much something you'd see in a man—that kind of thing. So I think it's both appearance, but for women, it might be literally their physical appearance, while for men, it might be the trappings around that physical appearance.

What are the common comorbid, uh, or co-occurring disorders that you see?

Interestingly, I think with histrionic personality, it would not be unusual to see substance use disorders—all this sort of socializing, you know, and attention-seeking. You're definitely going to increase the disinhibition, if you will, if you keep drinking. In addition, this is—you can't always have all the attention unless you really are celebrity, celebrity superstar, superstar. All eyes are not always going to be on you. And so when that doesn't happen, it's not unusual to see depressive symptomatology in folks with histrionic personality. You may also see some comorbid anxious symptomatology. I actually don't know the literature on this, so I'm going to spitball on this one: you might possibly see disordered eating patterns—maybe not a full-blown eating disorder, but in the, in this quest to look a certain way, there may be, if not like body dysmorphic symptoms, eating disorder symptoms of restriction or over-exercise or something like that as a way to maintain a certain physio-physical appearance. You might see that as well.

And you're going to see patterns from other personality disorders. In our example therapy session where you were attempting to see if I had a narcissistic personality disorder, did you ever think, "Oh, but he's histrionic?" You know, the—I mean, if I'm going to call you out straight on this one, Kyle, is that the—you're in a, you're in a performance-based industry, right? So you can turn it on and off, and I've seen you been able to do that. We'll be chatting; you'll be on your phone, and you'll be like, "Three, two, one, here I am." So that on-off-ness, that sort of—it can, it can smell like histrionic.

Over the past many months, you and I have gotten to know each other.

Yes. You see what I'm saying? So I would not—if all I had done was judge you on the first 30 minutes I met you when you were in and out of a shoot, okay, I might be like, "What's his story?" And you're in the media. Okay, two strikes. Yeah. But then I got to know you, and we've gotten to know each other quite well. I know the depth of your inner world; I know the stuff that you're about. So no, so it—but that, that superficial kind of like, you know, that can really make people think that, and I, you know, it's like the glee club people. Yeah, you know, you gotta kind of talk to them and make sure because, you know, I have kids who are in the choir, and they're whatever the opposite of histrionic is—my kids—but they were in that world, and they would always sort of look shocked at the other glee club-esque people, you know. So I do remember that. So I do think that you can be—I mean, I've been working in the media for a long time, too. I've even met people who do the kind of stuff I do; are they can be like, and jazz handsy, like sort of jazz hands therapist, and you know, it, it really is. But then you get to know the person, and you realize that they're able to sort of hold a room, but they are also able to be present with you and keep out the distractions, and they don't care that they're no longer the center of—it's the center of attention.

Important to note that in our next episode, Dr. Romney is going to explain how to make sure that you get the right diagnosis because you don't want to be treated for something that you don't have. That and more as we continue this fascinating discussion on histrionic personality disorder. [Music]