Sometimes, however, our natural propensity for attention seeking shifts from a place of healthy sociability and self-care to a symptom of serious psychological distress. In these cases, attention seeking can take the form of behaving in a loud, dramatic, or inappropriate manner, exhibitionism, exaggerating behaviors and emotions, sexual provocation or promiscuity, and engaging in blatant self-destructive acts like substance abuse or even self-injury. Too often, maladaptive attention-seeking behaviors are discounted as character flaws, a dramatic personality, or manipulation. However, these behaviors typically arise as a response to deeply painful trauma or psychological disturbance and reflect a desperate attempt to cope with overwhelming emotional turmoil. Rather than minimizing, trivializing, or ascribing malicious intent to these acts, it is vital that we search for meaning and understanding to help someone who is crying out in pain.
Excessive or maladaptive attention seeking is a central component in certain mental health disorder diagnoses, particularly Histrionic Personality Disorder and Borderline Personality Disorder. However, people with all types of psychiatric illnesses and histories of trauma may exhibit what could be identified as attention-seeking behaviors driven by a variety of complex causes. Hypersexuality, for example, may be a sign that someone is experiencing a manic episode within the context of bipolar disorder or acting out as the result of past sexual violation. Exaggerated tales of medical ailments may point to a factitious disorder that drives the person to seek out love, validation, and affection through invented illnesses. Self-injury undertaken in the depths of depression may be a very real and powerful coping mechanism, but it can also be a way of creating physical evidence of crushing despair and hoping that someone will recognize their pain. In other cases, attention seeking is “a brain wiring response to early developmental trauma caused by neglect,” causing people with formative experiences of emotional and physical neglect to continuously seek the nurturing and safety they were denied as children. Because a diagnosis cannot be made through a single symptom, diagnostic clarity can only be achieved after thoughtful evaluation by an experienced psychiatrist.