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Histrionic Personality Disorder Treatment Approaches at Catalina
Histrionic personality disorder, often shortened to HPD, is a mental health condition that affects emotional expression, self-image, communication, and relationships. Some people with HPD experience a strong need for attention or reassurance, rapidly shifting emotions, or repeated relationship difficulties. These patterns can create distress at home, at work, and in social settings.
Treatment for Histrionic Personality Disorder can help a person understand these patterns, express needs more directly, manage emotions, and develop healthier relationships. Psychotherapy is the primary form of treatment. The plan should reflect the person’s symptoms, goals, co-occurring conditions, and need for support.
Catalina Behavioral Health provides effective behavioral health care for adults in Tucson, Arizona. An assessment can help determine whether Catalina’s current services are appropriate for an adult seeking help with HPD symptoms, another mental health condition, substance use, or a combination of concerns.
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What Is Histrionic Personality Disorder?
HPD involves a persistent pattern of excessive emotionality and attention seeking that begins by early adulthood and occurs across different settings.
Under the Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR), a diagnosis requires at least five of eight features (American Psychiatric Association, 2022):
- Discomfort when the person is not the center of attention
- Interaction that is inappropriately sexually seductive or provocative
- Emotions that shift quickly or appear shallow
- Repeated use of physical appearance to attract attention
- Speech that is impressionistic and lacks detail
- Theatrical behavior or exaggerated emotional expression
- Suggestibility, or being readily influenced by other people or circumstances
- A tendency to view relationships as more intimate than they are
Many people occasionally display one or more of these traits. HPD is considered only when the pattern is long-standing, appears in different areas of life, and causes significant distress or impairment.
Clinical terms such as “attention seeking” describe patterns of behavior. They do not define a person’s character, worth, or intentions. A thoughtful evaluation considers what happens before and after a behavior, what need the person is trying to meet, and how the pattern affects daily life.
How Common Is HPD?
Prevalence estimates vary because studies have used different diagnostic methods and populations. The Merck Manual Professional Edition estimates that HPD affects fewer than 2 percent of the general population (Merck Manual Professional Edition, 2026).
Earlier reports often described HPD as more common in women. Current clinical guidance notes that referral patterns and diagnostic bias may have influenced that finding. HPD can occur in people of any sex or gender.
What Causes Histrionic Personality Disorder?
No single cause of HPD has been established. Personality develops through a combination of temperament, biology, relationships, learning, culture, and life experience. The balance of these influences differs from one person to another.
During an assessment, a clinician may ask about family relationships, trauma, attachment experiences, and other events that shaped the person’s development. This history can identify concerns that need attention in treatment. It does not necessarily explain why HPD developed.
When trauma symptoms are present, the treatment team can evaluate them separately and consider trauma-focused care when appropriate. The same principle applies to depression, anxiety, substance use, and other co-occurring concerns.
How Is HPD Diagnosed?
A licensed mental health professional diagnoses HPD through a clinical evaluation. The process may include interviews, symptom measures, and a review of the person’s psychiatric, medical, social, and substance use history. With the person’s permission, information from family members or previous treatment providers may add useful context.
The clinician also considers other conditions that can involve similar symptoms. The differential diagnosis may include:
- Borderline personality disorder
- Depressive disorders
- Narcissistic personality disorder
- Somatic symptom disorder
- Dependent personality disorder
- Substance-related conditions
- Bipolar disorders
- Anxiety disorders
- Symptoms caused by medication or a medical condition
More than one diagnosis may be present. Accurate diagnosis matters because each condition may call for a different treatment focus.
Culture, gender, age, and circumstances also shape how people communicate and express emotion. Expressiveness alone is not evidence of a personality disorder. The clinician looks for a persistent pattern and its effect on functioning.
How is Histrionic Personality Disorder Treated Effectively?
Psychotherapy is the main treatment described in current clinical guidance. HPD has received less treatment research than several other personality disorders, so care is usually individualized rather than based on one standard protocol.
The person and clinician may establish goals related to relationships, self-esteem, emotional expression, impulsive behavior, mood symptoms, or other concerns. Goals can change as treatment progresses and the person gains a clearer understanding of recurring patterns.
Psychodynamic Psychotherapy
Psychodynamic psychotherapy is a commonly recommended approach for HPD (Merck Manual Professional Edition, 2026). It examines recurring emotions, expectations, defenses, and relationship patterns. Over time, the person can develop greater awareness of these patterns and practice more flexible responses.
This work may include learning to put emotions and needs into words, noticing how expectations shape interactions, and recognizing situations that trigger familiar responses. The focus remains on present functioning even when earlier experiences are discussed.
Cognitive and Behavioral Strategies
Cognitive and behavioral strategies can address specific treatment goals. A person might learn to identify assumptions about rejection, pause before acting on an intense emotion, communicate a need directly, or test a belief about how another person will respond.
Direct research on cognitive behavioral therapy for HPD remains limited. A clinician may still use cognitive or behavioral techniques when they fit the person’s needs and can be connected to clear, measurable goals.
Emotion-Regulation and Interpersonal Skills
Structured skills practice can help with mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These skills may be useful when emotional intensity or relationship conflict interferes with daily life.
Treatment might involve identifying an emotion before responding, using a grounding strategy during distress, asking for support clearly, or tolerating disappointment without escalating a conflict. Skills become more useful when they are practiced between sessions and reviewed with the treatment team.
Schema Therapy
Schema therapy combines cognitive, behavioral, experiential, and relational methods. It focuses on persistent beliefs and coping patterns that influence how a person understands themselves and other people.
A multicenter randomized trial compared schema therapy, clarification-oriented psychotherapy, and treatment as usual among 323 adults with several personality disorders, including some participants with HPD. Across the mixed personality-disorder sample, schema therapy produced favorable clinical outcomes (Bamelis et al., 2014). A clinician considering schema therapy for HPD can assess whether the model fits the person’s needs and whether a properly trained provider is available.
The Therapeutic Relationship
Consistency, collaboration, respect, and clear boundaries provide a useful foundation for personality-disorder treatment. Relationship patterns that affect life outside therapy may also appear during sessions, giving the person and clinician a chance to understand them in real time.
In a naturalistic study of 159 people diagnosed with HPD, improvements in several patient and therapist relationship processes were associated with reductions in general and HPD-related symptoms during clarification-oriented psychotherapy (Babl et al., 2023). The study supports careful attention to the working relationship while adding to a still limited HPD research base.
Group Therapy
Group therapy can offer a structured place to practice communication, listen to feedback, and observe interpersonal patterns. Participants may work on expressing emotions clearly, respecting boundaries, tolerating disagreement, and understanding how their behavior affects others.
Readiness for group therapy depends on current symptoms, safety, treatment goals, privacy concerns, and group composition. The treatment team can determine whether group care is suitable and how it should be combined with individual services.
Family or Partner Involvement
Family or partner sessions may be helpful when relationship conflict, communication, or continuing-care planning is central to treatment. Sessions can focus on specific interactions, clearer boundaries, realistic expectations, and ways to offer support.
Participation depends on the person’s consent and clinical needs. Some people benefit from family involvement, while others make better progress without it. Safety and confidentiality remain part of the decision.
Are Medications Used for HPD?
There is no medication approved specifically for HPD. Medication may be considered when a person has a separately diagnosed condition such as major depression or an anxiety disorder.
A medical professional should evaluate the target symptoms, health history, current medications, expected benefits, possible adverse effects, and follow-up needs. Psychotherapy remains the main treatment for the enduring emotional and interpersonal patterns associated with HPD.
Treating Co-Occurring Conditions
As we touched on above, people with HPD may also experience depression, anxiety, another personality disorder, somatic symptoms, or a substance use disorder. These conditions can affect safety, relationships, treatment participation, and daily functioning.
A coordinated treatment plan identifies each concern and sets related goals.
For example, a treatment plan at Catalina might address alcohol use, depressive symptoms, sleep, interpersonal conflict, and emotion regulation at the same time. Coordination helps clinicians understand how progress or setbacks in one area affect the others.
HPD Assessment and Care at Catalina Behavioral Health
Catalina Behavioral Health serves adults with mental health, substance use, and co-occurring concerns. Available levels of care include residential treatment, partial hospitalization, intensive outpatient programming (IOP), outpatient services, and aftercare planning.
When an adult contacts Catalina, the admissions process begins with a discussion of current symptoms, treatment history, safety, substance use, daily functioning, and practical needs. Further clinical assessment helps clarify diagnoses, treatment goals, and the appropriate level of care.
Depending on current services and the person’s treatment plan, care may include:
- Individual counseling
- Group counseling
- Skills practice related to coping, communication, and emotional regulation
- Assessment and treatment of co-occurring conditions
- Medication management when clinically indicated
- Family participation when appropriate and authorized
- Discharge and continuing-care planning
Prospective clients can ask the admissions team which services and clinical approaches are currently available. Program schedules, eligibility, and insurance coverage can vary.
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Choosing a Level of Care
The appropriate setting depends on symptoms, safety, functioning, co-occurring conditions, home support, treatment history, and the person’s ability to participate consistently.
Residential Treatment
Residential treatment provides a structured living environment with continuous support. It may be appropriate when symptoms or co-occurring conditions substantially interfere with functioning, when a stable treatment environment is needed, or when outpatient support is not sufficient.
Partial Hospitalization
A partial hospitalization program, or PHP, provides structured daytime treatment while the person lives outside the program. It may suit someone who needs frequent clinical support but can remain safe and stable outside treatment hours.
Intensive Outpatient Treatment
An intensive outpatient program, or IOP, provides scheduled treatment with more flexibility than PHP. It can serve as an entry point or a transition from more intensive care. Participants need a workable living environment and the ability to manage outside program hours.
Outpatient Care
Outpatient therapy may fit someone who can manage daily responsibilities and attend scheduled appointments without the structure of a higher level of care. Many people receive personality-disorder treatment in outpatient settings.
What to Expect During Treatment
Early sessions often focus on assessment, treatment goals, and the working relationship. The clinician and client may identify situations that create the most distress, explore how the person responds, and select a small number of goals to begin addressing.
As treatment continues, the person may practice new skills, review interactions that occurred between sessions, and notice patterns that were previously difficult to recognize. The clinician can track progress through symptom measures, changes in daily functioning, and the person’s own evaluation of relationships and quality of life.
Treatment plans benefit from regular review. When progress is limited, the team can reconsider the diagnosis, goals, therapeutic approach, level of care, or co-occurring conditions.
What Progress Can Look Like
The pace and course of treatment vary. Long-standing patterns often take time to understand and change, while some focused concerns may respond sooner.
Meaningful progress may include:
- Identifying emotions and needs more accurately
- Communicating needs more directly
- Responding to criticism or disappointment with greater flexibility
- Reducing impulsive or harmful behavior
- Developing a steadier sense of self-worth
- Recognizing repeated relationship patterns
- Maintaining clearer expectations and boundaries
- Improving work, school, family, or daily functioning
Progress is rarely perfectly linear. Stressful events may bring back familiar reactions. Continued practice and honest discussion with the treatment team can help the person respond to setbacks and refine the plan.
How Families Can Offer Support
Family members can encourage professional care, listen without reducing every concern to the diagnosis, and maintain calm, consistent boundaries. It is often more helpful to discuss a specific interaction and its effect than to label the person or assume a motive.
Supporters also need to protect their own health. Counseling, family education, or peer support can help them communicate clearly and decide what they can reasonably provide.
When Immediate Help Is Needed
A diagnosis of HPD does not mean that a person is suicidal or dangerous. Any report of suicide, self-harm, overdose, or immediate danger still requires prompt attention.
In Arizona and across the US, call or text 988 to reach the Suicide & Crisis Lifeline. Call 911 or go to the nearest emergency department for immediate danger or a medical emergency.
Questions to Ask a Treatment Provider
Before entering care, consider asking:
- How will the diagnosis be assessed or confirmed?
- Which concerns will the initial treatment plan address?
- What experience does the clinician have with personality disorders and relevant co-occurring conditions?
- Which therapies and services are available in the recommended program?
- How will goals and progress be reviewed?
- How are boundaries, confidentiality, and family participation handled?
- What happens if the treatment plan needs to change?
- What continuing care is recommended after the program ends?
- What insurance requirements and out-of-pocket costs may apply?
Contact Catalina Behavioral Health for HPD Treatment Options
Adults seeking help for mental health symptoms, substance use, or both can contact Catalina Behavioral Health to discuss current services and request an assessment.
Admissions staff can explain the available levels of care, review practical requirements, and help verify insurance benefits.
All calls are strictly confidential, so please reach out for support and assistance today.
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Frequently Asked Questions About HPD Treatment
What is the main treatment for HPD?
Psychotherapy is the primary treatment. The clinician and client select an approach based on the person’s symptoms, goals, co-occurring conditions, and response to care.
How long does treatment take?
There is no standard duration. Treatment length depends on the goals, severity of impairment, other diagnoses, therapeutic approach, and progress over time.
Can cognitive or DBT-informed skills be used in treatment?
Yes. Cognitive, behavioral, emotion-regulation, distress-tolerance, and interpersonal skills may be used to address specific concerns. The treatment plan should connect each technique to the person’s needs and goals.
Can schema therapy be used for HPD?
Schema therapy may be considered for some people. Research on mixed personality-disorder samples has included participants with HPD, and a qualified clinician can evaluate whether the approach is suitable.
Are medications prescribed for HPD?
No medication is approved specifically for HPD. A prescriber may recommend medication for a co-occurring condition after an individual evaluation.
Does HPD require residential treatment?
Not necessarily. The level of care depends on the person’s safety, symptoms, functioning, co-occurring conditions, treatment history, and available support. Many people receive treatment in outpatient settings.
Can family members participate?
Family or partner involvement may be useful when it supports treatment goals and the person receiving care authorizes it. The treatment team considers privacy, safety, and clinical needs.
References
- American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
- Babl, A., Gómez Penedo, J. M., Berger, T., Schneider, N., Sachse, R., & Kramer, U. (2023). Change processes in psychotherapy for patients presenting with histrionic personality disorder. Clinical Psychology & Psychotherapy, 30(1), 64–72
- Bamelis, L. L. M., Evers, S. M. A. A., Spinhoven, P., & Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171(3), 305–322.
- Merck Manual Professional Edition. (2026, January). Histrionic personality disorder (HPD).
