How to Cope with a Loved One Who Has Histrionic Personality Disorder
This is clearly something that matters to you, and before you open up a whole new line of questioning about your life, it helps to settle your own mind first. The personality disorder support site Out of the Fog reports that roughly 9% of American adults, about 1 in 11 people, fit the DSM-IV criteria for some kind of personality disorder.
So what is histrionic personality disorder, exactly? Plenty of people have never heard the name. It is a serious mental illness marked by relentless attention-seeking and extreme emotional reactions. Someone living with it tends to crave notice constantly while behaving in ways that are erratic and hard to predict. The condition usually shows up in early adulthood, anywhere from the late teens into the late twenties, though it can surface at any point in life.
The symptoms rarely stay in one corner of a person's life. They tend to spread across everything: friendships, the family they grew up in, the way they parent, a marriage, even a job. A person with the disorder may dress provocatively or in ways that fit the occasion poorly. Mood swings arrive without warning. Approval from others becomes something they chase, they are easily swayed by whoever is around, and criticism tends to land badly. They may also read a relationship as far closer and more serious than it actually is.
Caring for someone like this is hard, and part of the reason is simple: many people with histrionic personality disorder do not accept that anything is wrong with them. If you love someone who fits this description and you are trying to figure out how to handle it day to day, the suggestions below give you some practical ground to stand on.
Staying calm is one of the most useful things you can do. A person with this disorder feeds on attention and on drama, so losing your temper when they say or do something upsetting plays right into what they are looking for. Your composure takes the fuel away. Say your histrionic sibling flares up because you won't do what they want. Meeting that with anger only rewards it. Step back from the conversation instead, leave the room if you need to, and give them space to settle down. You can listen to what they have to say, but don't feed the behavior with questions or encouragement, because that only pours gasoline on it.
Breathing helps too, as basic as that sounds. When your loved one starts coming apart, move away and take several slow, deep breaths. Keep going until you feel steadier. Don't argue, don't engage, and don't lash back while they are in the middle of acting out. Try to hold onto the fact that it is the condition driving the behavior, and that you love the person underneath it. Attempting to reason with someone during an episode tends to make things worse and encourages exactly what you're trying to defuse. People in this state often react by screaming, swearing, bullying, crying, or picking fights when they feel hurt or betrayed, so pick your words with care when you're around them.
Physical distance can also be a form of self-protection, whether you are standing or sitting. People with the disorder frequently struggle to read boundaries or interpret ordinary social cues. One person might stand too close, hug a stranger, or turn a friendly gesture into flirtation or a sexual remark. Another might swing the opposite way and decide that a harmless, kind gesture is somehow threatening or malicious. Keeping three or four feet of space, speaking only when you need to, and holding your interactions to what is necessary all cut down on the chance that something you do gets misread. Avoid anything that could be taken as suggestive.
Offering suggestions, gently, is another tool. If your loved one shows up in flashy or racy clothing that doesn't fit the setting, be it church, a formal event, work, or school, you can steer things without triggering a scene. Lead with a compliment. Something like: "Wow, that miniskirt and tank top are so cute. I bet they'd look great when we go out tonight. Why not save that for our night out and wear this for work? It makes you look really professional and put together." Praise first, then a helpful redirect, and the response you get back is usually far warmer.
Knowing the warning signs is its own kind of preparation, especially where suicide is concerned. If your loved one says they want to hurt or kill themselves, this is not a moment to play rescuer. Call 911 right away and let trained people get them to a hospital or psychiatric facility. Don't try to carry something that serious alone. If instead they make broad statements about ending their life with no plan and no timeline, watch closely for dangerous behavior, and don't hesitate to call the police if observing them on your own doesn't feel safe.
When someone is at risk of harming themselves or others, try to talk them toward counseling, a crisis hotline, or the police. You cannot force a competent adult into treatment, but a qualified mental health professional may be able to calm the moment or help arrange an intervention with family and friends. For your own sake, reach out to a counselor, a support group, the police, or a crisis line when you need backup.
- Dr. R. Y. Langham
References: Encyclopedia of Mental Disorders. (2015). Histrionic personality disorder. Out of the Fog. (2015). Personality disorder statistics. Psych Central. (2015). Histrionic personality disorder treatment.