Substance abuse is considered to be a condition associated with histrionic personality disorder (HPD). Anecdotal evidence supplied by HPD patients, as well as by people who have been close to someone with HPD, suggests that persons with HPD often abuse drugs and alcohol.
However, personality disorders in general are poorly understood at best, and HPD is a complicated diagnosis even among personality disorders. It is difficult to say with precision exactly why people with HPD tend to abuse drugs, but aspects of the disorder may suggest possible explanations.
What Is Histrionic Personality Disorder?
HPD is one of the Cluster B personality disorders, also known as dramatic personality disorders. This group also includes antisocial personality disorder, borderline personality disorder and narcissistic personality disorder. HPD usually first appears in early adulthood and affects four times as many women as men.
Persons with HPD are highly emotional and dramatic, crave stimulation and approval from others and have a need to be the center of attention. They usually appear to have good social skills, but they often use these skills to manipulate others.
Women with HPD in particular are often sexually seductive in nature, dress provocatively and may even engage in exhibitionism. They may have frequent romantic relationships but difficulty in maintaining long-term intimacy, and they often suffer serious depression when romantic relationships end. They tend to crave excitement, place themselves in risky situations and have difficulty staying focused on a job, resulting in frequent job or career changes.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) lists the following criteria for a diagnosis of HPD:
- A need to be the center of attention
- Sexual seductiveness
- Rapidly shifting emotions
- Obsession with physical appearance and tendency to use physical appearance to gain attention from others
- A style of speech that generalizes, lacks detail and is geared toward gaining acceptance from others
- Dramatic behaviors and exaggerated emotions
- Suggestibility
- Tendency to overestimate the level of intimacy in a relationship
HPD is difficult to diagnose and may be misdiagnosed because it often resembles other closely-related Cluster B personality disorders. HPD can also co-occur with any of these disorders, further complicating diagnosis and treatment.
HPD and Drug Abuse
Although HPD is not fully understood, certain characteristics of the disorder may shed light on its role in connection with substance abuse. The need for excitement and stimulation can lead to a desire to engage in risky behavior, such as using drugs or combinations of drugs.
In seeking approval from others, persons with HPD typically conform to the standards, values and behaviors of those with whom they are associating at any given moment. If the group they are with uses drugs, people with HPD are likely to use drugs as well and may even exaggerate the level of their experience with the group’s drug of choice. Of course, the suggestibility associated with HPD can contribute to drug abuse.
Treating HPD and Addiction
Personality disorders are notoriously difficult to treat, and HPD may be even more problematic than others in Cluster B. Persons with HPD typically do not recognize their own problems and are usually well-practiced in denial and justification, blaming all of their problems on others. This tendency can seriously impede treatment for drug abuse and addiction. It is important to find a therapist with training and experience treating HPD.