Histrionic Personality Disorder vs. BPD: What Are the Differences?

Histrionic personality disorder (HPD) is a personality disorder that tends to co-occur with other personality disorders, particularly borderline personality disorder (BPD), narcissistic, and dependent personality disorders. There is a great deal of overlap between BPD and HPD features, so much so that some experts believe that HPD may not be distinguishable from BPD.

Learn more about the differences between histrionic personality disorder and BPD. If you have symptoms of either condition, be sure to talk to your healthcare provider.

Symptoms

There is a marked overlap between the symptoms of HPD and BPD. For example, both share the features of rapidly shifting and reactive emotions, impulsive behavior, and strong expression of emotion.

There is some argument about whether the two are genuinely distinct conditions. However, the two conditions remain separate diagnoses in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5-TR).

Causes

The exact causes of HPD and BPD are not fully understood, but experts believe that several factors can contribute to the development of these conditions, including:

• Genetics: Both histrionic and borderline personality disorder tend to run in families, so there is most likely a genetic connection. Like other mental disorders, people may inherit a predisposition to these conditions, which might then be triggered by some type of environmental factor.
• Childhood trauma and abuse: BPD is strongly associated with abuse and trauma that occurs during childhood. Histrionic personality disorder may also be linked to early trauma and abuse, although more research is needed.
• Brain differences: People with BDP may have differences in areas of their brains that manage emotions, although findings exploring this possibility have shown varying results. Such differences may also play a part in HPD, but more research is needed.
  

Some research has also linked personality disorders to maladaptive parenting styles. In one study, permissive parenting was associated with an increased risk for histrionic personality disorder.

Diagnosis

HPD is one of 10 personality disorders recognized in the fifth edition of the DSM. HPD and BPD are Cluster B disorders, characterized as dramatic, overly emotional, and/or erratic.

Histrionic Personality Disorder

The DSM-5 defines histrionic personality disorder as a pattern of extreme emotionality and attention-seeking behavior that begins by early adulthood and is obvious in different situations. In addition, you must have five or more of the following signs or symptoms to be diagnosed with HPD:

• Discomfort in situations in which you're not the center of attention
• Interaction with others that's often characterized by inappropriate sexually seductive or provocative behavior
• Rapidly shifting and shallow expression of emotion
• Consistently uses physical appearance to draw attention to self
• Style of speech that is excessively impressionistic and lacking in detail
• Shows self-dramatization, theatricality, and exaggerated expression of emotion
• Is easily influenced by others or by circumstances
• Considers relationships to be more intimate than they actually are
  

Borderline Personality Disorder

The DSM characterized BPD as a chronic pattern of instability that affects self-image, emotions, behaviors, and relationships that begins by early adulthood. To be diagnosed with BPD, the DSM-5-TR indicates that a person must display five of the nine following symptoms:

• Attempts to avoid real or imagined abandonment
• Chronic feelings of emptiness
• Emotional instability
• Problems with identity and self-image
• Risky, impulsive behaviors that affect at least two life areas
• Transient dissociative or paranoid symptoms
• Intense and inappropriate anger
• Patterns of unstable relationships
• Self-harming or suicidal behaviors
  

Treatment

While there is no cure for histrionic personality disorder and borderline personality disorder, there are treatments available that can help reduce symptoms and improve coping.

HPD

Research suggests that psychotherapy can help people better manage the symptoms of histrionic personality disorder. Individual therapy is preferred since the attention-seeking and grandiose symptoms of HPD can be problematic in group therapy or family therapy settings.

Medications are also sometimes prescribed to help people manage symptoms of mood swings, depression, and anxiety.

BPD

Research suggests that BPD treatments can be effective in helping people manage the symptoms of their condition. Psychotherapy is the first-line treatment, but medications are sometimes also prescribed to help people manage specific symptoms. 

Dialectical behavior therapy (DBT) is an approach specifically developed to treat BPD. It is a form of cognitive behavior therapy (CBT) that teaches people to recognize and change emotions. It also incorporates strategies to regulate emotions, manage distress, and improve relationships.

Prevention

While neither condition can generally be prevented, there are things that people can do to improve functioning and reduce the negative impact symptoms may have on their life and relationships.

Summary

Histrionic and borderline personality disorder share common symptom patterns but are considered separate conditions. In general, the rapidly shifting emotions in HPD are not experienced with the same depth and intensity as those in BPD.

BPD is believed to be caused by factors including brain differences, genetics, and childhood abuse/trauma. HPD may have similar causes, but more research is needed. Both conditions can be managed with psychotherapy, so it is important to talk to a doctor or mental health professional to get a diagnosis and treatment recommendations.

A Word From Verywell

When looking at the symptoms of histrionic personality disorder vs. BPD, it is easy to see that they share many things in common. However, the right treatment depends on getting an accurate diagnosis, so it is essential to consult a qualified healthcare professional for further evaluation.

Symptoms can be managed with treatment, which can improve your relationships, reduce distress, and make it easier to function in different areas of your life.