Treatment of Histrionic Personality Disorder
Psychotherapy is the primary treatment for histrionic personality disorder, with structured psychodynamic or cognitive-behavioral approaches delivered in phases focusing first on stabilization, then deeper psychological work, and finally reintegration.
Primary Treatment Approach
Psychotherapy as First-Line Treatment
Structured psychotherapy should be implemented as the primary intervention for histrionic personality disorder, following a phase-oriented approach 1, 2.
The treatment structure should include three distinct phases 1:
- Phase I (Stabilization): Focus on patient safety, reduction of self-regulation problems, and improvement of emotional, social, and psychological competencies
- Phase II (Deeper Processing): Address underlying psychological patterns and maladaptive schemas
- Phase III (Reintegration): Consolidate treatment gains and support adaptation to current life circumstances
Specific Psychotherapy Modalities
Clarification-oriented psychotherapy has demonstrated effectiveness in treating HPD, with improvements in relationship processes between patients and therapists systematically related to positive outcomes 3.
Cognitive Analytic Therapy (CAT) shows promise for HPD presentations, with evidence of clinically significant change in personality integration and reduction of depressive symptoms over 24 sessions plus follow-up 4.
Psychodynamic approaches using configurational analysis can be effective when tailored to the individual's states of mind, defensive control processes, and person schemas 5.
Pharmacotherapy Considerations
Limited Role of Medications
Avoid antidepressants or benzodiazepines as initial treatment for depressive symptoms unless a formal depressive episode or disorder is diagnosed 1.
Anxiolytics and hypnotics should be used with extreme caution and only as part of a comprehensive treatment plan, not as standalone interventions 1.
Pharmacotherapy should only serve as adjunctive treatment to psychotherapy, not as primary intervention, consistent with evidence from personality disorder treatment more broadly 2.
Treatment Duration and Monitoring
Expect 24+ sessions for meaningful change, with additional follow-up sessions spread over 6 months post-therapy to maintain gains 4.
Monitor for deterioration at termination, as sudden worsening can occur when ending therapy with HPD patients, requiring careful termination planning and follow-up support 4.
Track specific HPD features including focus on physical appearance, feelings of emptiness, and emotional regulation throughout treatment 4.
Critical Clinical Pitfalls
Do not accept self-reported diagnoses at face value - some individuals with HPD may claim learning disabilities or other conditions as part of their presentation, requiring objective assessment 6.
Avoid institutionalization and regression by maintaining appropriate therapeutic boundaries and not reinforcing maladaptive help-seeking behaviors 6.
The evidence base for HPD treatment is limited compared to other personality disorders like borderline personality disorder, requiring clinicians to adapt evidence-based approaches from related conditions 2.