The Relationship Between Histrionic Personality Disorder and Depression: How Residential Treatment Can Help

Histrionic personality disorder, or HPD, is a difficult type of mental illness to treat. It causes dramatic, attention-seeking, and inappropriately provocative behaviors. It also puts individuals at a greater risk for developing depression. The dysfunction that HPD causes, as well as the inevitable failure to get desired attention, can trigger episodes of major depression. This is a complicated diagnosis. The best treatment approach is long-term therapy in a safe residential environment. Here, close work with therapists and other professionals can help a patient see and change their destructive behavior patterns.

Many people with personality disorders struggle to see that they need help. This is one of the biggest challenges of treatment. Another is co-occurring disorders, like depression. If you or someone you know is struggling with either of these mental health issues, residential treatment is a must. It provides comprehensive diagnosis, expert treatment from a multi-disciplinary team, and the time and focus needed to make lasting, positive changes.

Histrionic personality disorder is one of four types of personality disorder characterized by excessive emotional responses, dramatic behaviors, and unpredictable thinking and behaviors. Someone with HPD needs a lot of attention from other people. They may use emotions, sexuality, and dramatic behaviors that are inappropriate to get the attention they want. They also tend to be overly concerned with appearance in order to impress others.

Someone with this personality disorder may be loud and talkative with a lot of strong opinions and emotions. But their emotions are actually shallow and change rapidly and their opinions are thin and not backed up by any facts. They tend to believe their relationships with others are more meaningful and closer than they really are and they can be easily influenced by others.

To be diagnosed with HPD, a person must have a consistent pattern of attention-seeking behaviors and excessive emotions. They must also meet at least five of the following criteria:

  • Being uncomfortable when not getting enough attention
  • Inappropriate interactions with others, particularly those that are sexual or provocative
  • Shallow and quickly changing emotions
  • Preoccupation with physical appearance to get attention
  • Vague speech
  • Extravagant emotional expression and dramatic behaviors
  • Easily influenced by others and by trends
  • Believing relationships are more intimate than they are in reality

HPD Can Trigger Depression


Depression is a common co-occurring disorder with histrionic personality disorder. Someone with this condition feels a desperate need for attention from others, and when they don’t get it the result may be a depressed mood or actual, clinical depression. Failed relationships are also common with HPD, and these individuals don’t generally cope well with any type of loss or failure. All of this can lead to depression.

Diagnosing Co-Occurring Depression


People with personality disorders struggle to see their abnormal patterns of thinking and behaving as problematic. This makes it difficult to initiate treatment. Many patients end up in treatment for co-occurring conditions instead, like depression. Even those who do get diagnosed with HPD first can benefit from a complete mental health screening, because co-occurring conditions are common.

It is essential to get an accurate diagnosis for any and all mental illnesses, because the most effective treatment addresses all mental health needs. For someone with HPD who may have depression, criteria for a diagnosis include:

  • A persistent depressed mood
  • Loss of interest in activities
  • Changes in appetite or weight
  • Insomnia or oversleeping
  • Fatigue
  • Feeling worthless, guilty, or ashamed
  • Difficulty thinking and concentrating on tasks
  • Agitated or slowed movements
  • Persistent thoughts of death or suicide

For a full diagnosis of depression, a patient must have at least five of these symptoms that last for two weeks or longer and cause significant impairment.

How Histrionic Personality Disorder and Depression Are Treated


HPD is particularly difficult to treat, as are all personality disorders. People with these conditions rarely think they need help or that their behaviors are anything but normal. They tend to blame others for their problems. Depression is easier to recognize, and it may be the reason someone with a personality disorder seeks treatment, ultimately getting therapy for HPD as well.

Treatment for HPD depends on the individual, as there is no standard other than therapy. Therapy can help a patient recognize the negative patterns in the way they think and act. It can guide them to make positive, concrete changes, and help them develop stronger, healthier, and deeper relationships. Getting benefits of therapy for this condition requires persistence, so long-term treatment is essential.

Depression can also be treated with therapy, but medications are also useful. An expert team of therapists can do more than just treat depression in a patient with HPD. They can also guide the patient to see the connection between the two to help them better understand the importance of therapy and making positive changes.

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The Importance of Residential Treatment for Histrionic Personality Disorder and Depression


Each of these conditions separately can cause serious dysfunction and multiple complications. They can also be difficult to treat individually. This is why residential care for an extended period of time is important for someone with both. It allows for the necessary intensive therapy and treatment from a team of professionals with different areas of expertise. People with HPD resist treatment, so a long-term plan for care is usually necessary.

Treating depression at the same time is beneficial for several reasons. By ignoring a co-occurring disorder, a patient is at risk of recurrence. While learning to manage HPD may relieve depression temporarily, a relapse is always possible. A relapse of depression can then interfere with a person’s ability to keep managing HPD successfully.

Including depression treatment during therapy for HPD can also be a powerful tool for helping the patient see how destructive their behaviors and thinking are. To see the direct connection from their neediness and dramatic behaviors to symptoms of depression can provide an opening for more effective treatment of HPD.

Gail’s Story of Recovery from Histrionic Personality Disorder and Depression


When I sought treatment it was for depression. My last boyfriend had just broken up with me, and I also felt like my best friend was avoiding me and didn’t need me. I felt so bad that I actually contemplated suicide. I couldn’t live with myself, so I reached out for help from a therapist I had worked with previously. He encouraged me to try a residential facility, saying he believed that I had more issues than just depression.

I agreed to go, and I did get another diagnosis of histrionic personality disorder. I didn’t believe it at first. My boyfriend left because he couldn’t handle my outgoing personality, not because I flirted with other people or was too needy. When we started in on depression treatment, though, I started to see what my therapist meant. It did make sense that I was responsible for my feelings and behaviors, and that my actions had a direct impact on my mood.

My best friend was also a big help during my treatment. We have known each other since we were kids, and she came in to participate in therapy a few times. It helped so much to hear what she had to say. I learned that she really loves and cares for me, but that my behaviors sometimes make it hard to stick around. Together and with my therapist, we worked on some exercises that helped me be a better friend. I realized I never took into account her feelings enough. I know I can apply these lessons to relationships with other people in the future and our own will be deeper and better.

Living with histrionic personality disorder and depression presents a number of challenges and causes significant dysfunction, especially in relationships. But when individuals have at least one person who cares and can convince them to get treatment, residential care with therapy and other types of treatment can be life-changing.

Bridges to Recovery offers comprehensive treatment for people struggling with mental health disorders as well as co-occurring substance use disorders. Contact us to learn more about our renowned Los Angeles and San Diego-based programs and how we can help you or your loved one start on the path to lasting wellness.