Why Some People Need Constant Attention: Histrionic Traits and Attachment

Some people wonder why their partners need so much attention – so much that it disrupts their relationship and leads to building resentment. They may seem to act in overly dramatic ways, seek situations where they’re the center of attention, and appear uncomfortable when they’re not. For some people, this pattern may be linked to histrionic traits.

To be histrionic is defined as acting theatrically, whether in a literal sense on the stage, or in daily life. In daily life, being histrionic looks like being overly emotional and dramatic. This can be part of Histrionic Personality Disorder, or it can be a non-clinical personality trait.

Our early attachment experiences factor into how our personalities develop, and there’s a complex connection between attachment and personality disorders. In this article, we’ll explore the link between attachment and histrionism in detail, including the history and criticisms of Histrionic Personality Disorder and how we can manage histrionic behavior for healthier relationships.

Key takeaways:

• People with Histrionic Personality Disorder (HPD) are typically high in attachment anxiety, with anxious-preoccupied being the most common attachment style.
• Histrionic behaviors can arise from deep fears of abandonment.
• Everybody falls somewhere on the spectrum of histrionic traits, and those who have high histrionic traits don’t necessarily have HPD.
• Attention-seeking becomes a self-fulfilling prophecy as it eventually pushes people away.
• Evidence-based treatments like schema therapy, functional analytic psychotherapy, and cognitive analytic therapy can help build secure attachment patterns and manage histrionic traits.

Understanding Histrionic Traits: Beyond Attention Seeking

First, it’s important to understand the history behind histrionism and Histrionic Personality Disorder.

Histrionic Personality Disorder has been in the Diagnostic and Statistical Manual of Mental Disorders, a professional diagnostic tool published by the American Psychiatric Association, since its third edition (DSM-3) in 1980¹ (it’s currently on its fifth edition, with a text revision published in 2022, the DSM-5-TR²). Before then, it was called Hysterical Personality Disorder in the DSM-2 – its name was changed to avoid negative associations with the outdated term, hysteria.

Nonetheless, the idea of hysteria has informed Histrionic Personality Disorder as it is today. Hysteria, once thought to be caused by an empty womb, has historically been used as a catch-all for women’s physical, emotional, and cognitive symptoms. We now know better, and – to be clear – that it has nothing to do with the womb.

It was occasionally suggested that men could have hysteria too, but the idea of hysteria remains strongly associated with sexism in the medical field and highly stigmatized. Some psychologists have suggested that Histrionic Personality Disorder should be removed from the DSM altogether, to be replaced with an “exhibitionist” subtype of Narcissistic Personality Disorder.¹

Histrionic Personality Disorder vs. Histrionic Traits

Histrionic Personality Disorder (HPD) in the DSM-5-TR is defined as:

“A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts.”²

It also states that this is indicated by at least 5 of the following signs of HPD:

• Discomfort when not the centre of attention.
• Inappropriate sexually seductive or provocative behavior in interactions with others.
• Rapidly shifting and shallow emotional expressions.
• Consistently uses physical appearance to draw attention.
• An “impressionistic”, or vague style of speech lacking in detail.
• Dramatic and exaggerated expression of emotion.
• Easily influenced by others.
• Considers relationships to be more intimate than they actually are.

Prevalence estimates for HPD vary from 0 – 1.8%.² Recognizing these traits doesn’t necessarily mean you have HPD; personality traits exist on a spectrum, and all of us could relate to HPD traits to some degree. For personality disorders to be diagnosed, the relevant traits must be causing significant distress or difficulty functioning. Only a licensed mental health professional can diagnose HPD.

Attention seeking isn’t in itself a negative behavior – we will all seek attention when we feel we’re not getting enough, but a high threshold for “enough attention” and seeking it in harmful ways can cause problems.

It’s also important to consider cultural and situational factors that might come with different norms or bring out a “need to be liked”. If these traits arise from social pressure and competitive peer groups, they aren’t persistent enough to be considered HPD.

At times, we may refer to “histrionic traits” or “histrionism” – by this, we mean extreme expressions of the traits associated with HPD, whether or not they are part of a HPD diagnosis.

The Psychology Behind Histrionic Behavior

Genetics, childhood experiences, and environmental influences are all thought to influence the development of HPD.³ One theoretical framework used to hypothesize about HPD development is self-determination theory, or SDT, developed by Ryan & Deci in the 1980s.⁴

According to SDT, we need to meet 3 basic psychological needs to grow psychologically:⁵

Competence: we need to face challenges and overcome them by controlling ourselves and our environment to experience feeling competent.

Autonomy: we need to be able to make our own decisions and feel free and in control of our lives.

Relatedness: we need to feel valued and appreciated by others.

It’s suggested that histrionic behavior arises when we experience need frustration – that is, unmet psychological needs, especially in autonomy and relatedness.

Findings on the impact of childhood experiences are mixed: one study found no link between HPD and childhood experiences,⁶ while another found that sexual abuse and physical neglect predict HPD in women and sexual, physical, and emotional abuse, as well as emotional neglect predict HPD in men.⁷ Another study found that trauma that didn’t involve high levels of betrayal was associated with histrionism, while trauma featuring betrayal wasn’t.⁸

Are Histrionic People Emotionally Manipulative?

We all attempt to influence other people’s emotions to some degree – for example, say your friend needs motivation to meet a deadline, you might remind them how close the deadline is to induce fear (that ultimately is intended to work to their benefit). In this way, manipulating others is a normal part of social interaction.

However, people with histrionic traits might be more likely to manipulate for more self-serving reasons than in the example above, and they might do it in more extreme ways.

Histrionic Traits and Your Attachment Style

In a forensic population study, HPD was linked with the anxious-preoccupied attachment style, high in attachment anxiety and low in attachment avoidance.⁹ Further, people with HPD were found to be less likely to have the dismissive-avoidant attachment style, which is low in attachment anxiety but high in attachment avoidance.

This study also found a link between HPD and the fearful-avoidant attachment style, high in both attachment anxiety and attachment avoidance, but this was not statistically significant. Although this could give us some clues, more research is needed to understand whether these findings can be generalized to broader populations.

TAKE THE ATTACHMENT STYLE QUIZ

As infants, the way our caregivers respond to us gives us information about our environment – if they’re unpredictable, then we must heighten our attachment systems to keep them close, since their unpredictability might indicate a dangerous environment. If they’re absent, then we must decrease our attachment systems and learn to rely on ourselves for survival.

The problem is, our attachment systems teach us how to understand ourselves and the world around us, and we take this information with us as we grow up and gain more control over our environment. Even though we might know we’re safe, abandonment or rejection can still feel threatening to an insecure attachment system.

Some psychologists have suggested that HPD can develop in part from unconscious reinforcement patterns in which attention seeking is rewarded, in much the same way we develop anxious attachment styles.¹ Beck (credited with the cognitive triad model of depression) and colleagues put forward that people with histrionic traits manipulate caregivers because they don’t trust them to meet their needs otherwise.¹

Anxious-Preoccupied Attachment: The Dominant Pattern in HPD

The anxious-preoccupied attachment style is associated with a fear of abandonment that drives clinginess, dependence, and a need for constant reassurance. It makes sense that this is the attachment style most linked with HPD, as the two share several parallels, including:

• Fear of abandonment
• Need for reassurance and validation
• Attention seeking is reinforced when needs are met

However, this doesn’t mean that having an anxious attachment style means you have HPD, or even histrionic traits. It also doesn’t mean that one causes the other – since they share potential causes, they could be caused by the same experiences. It does seem likely that, where both are present, they might each make the other more intense, as both can drive away close relationships and trigger the other.

Fearful-Avoidant Attachment in Histrionic Traits

Since the fearful-avoidant attachment style is high in attachment anxiety and attachment avoidance, it makes sense that this is still associated with histrionic patterns, but not as strongly.

The avoidance aspect of fearful-avoidance is the opposite of histrionic patterns: when attachment avoidance is high, we prefer to be independent and downplay the depth of connections with others, rather than exaggerating them.⁹ However, the anxiety aspect still shares the same similarities as in the anxious-preoccupied attachment style.

When we have a fearful-avoidant attachment style, we can experience a push-pull dynamic with partners, one moment wanting them close and the next wanting distance. This can become especially difficult for both you and your partner when histrionic traits are high, as the avoidant push can be more confusing and the anxious pull more extreme.

How Histrionic Traits Show Up in Relationships

Because people with histrionic traits know how to get someone’s attention, they can find it easy to get into relationships at first. The early stages of the relationship might feel exciting and intense, but as the relationship continues, the intensity and needs of the histrionic partner can grow.

As described anecdotally and in qualitative studies, partners of people with histrionic traits can find it impossible to meet their partner’s needs.¹⁰ When their partner’s needs aren’t met, they can act in ways that diminish the relationship in an attempt to get the attention they crave, such as creating arguments, manipulating, or crossing boundaries.

The Compulsive Need for Attention

At the core of histrionism is a need for attention by any means. In a relationship, this can look like a need to be constantly in contact, quickly becoming upset when they don’t feel they have their partner’s attention, or intentionally appearing to be weak, helpless, or sick.

Although this might work in the short term, it’s not sustainable in the long term and eventually drives partners away. Finding it impossible to meet their needs, the partners of people with high histrionic traits can feel exhausted, used, and frustrated in the relationship.

Dramatic Reactions and Emotional Volatility

The theatrical displays put on by people with histrionic traits can seem false or shallow, often because they seem to be quickly turned on or off. However, people with histrionic traits do report experiencing intense emotions that are very easily triggered.¹⁰ This could look like intense bouts of crying over minor conflicts, or rage over a small joke at their expense.

This can create confusion for partners and a feeling like they’re “walking on eggshells”. Communication can quickly break down in this scenario, leaving both partners frustrated and unsatisfied with the relationship.

The Histrionic Cycle: How Attention Seeking Pushes People Away

You may have noticed a common thread: the behaviors that arise from histrionic traits ultimately cause the outcomes the histrionic person fears. They act in theatrical or attention seeking ways to make sure people stick around, but these behaviors – that might be reinforced because they work in the first instance – are ultimately the reason their relationships don’t work.

The same can happen when we have an insecure attachment style. Attachment anxiety can drive us to cling to partners and accidentally push them away with our intensity, leading to our fear of abandonment coming true. On the other hand, attachment avoidance can drive us to create distance from others, reinforcing our ideas that others cannot be trusted to be there for us.

Treatment Approaches for Histrionic Personality

Despite the self-fulfilling nature of HPD, histrionic symptoms can be managed with appropriate treatment. A range of therapies, including cognitive-behavioral therapy (CBT) and schema-based therapies (schemas are the stories we tell ourselves) have been shown to reduce symptoms and improve daily life for people with HPD.^11,12 One study suggested that improvements in the relationship between the therapist and patient could be the driving force behind positive outcomes, highlighting the importance of attachment work.¹¹

Relationship-Based Therapies

There are lots of different kinds of therapy, and the right one for you can be different to the right kind of therapy for someone else. However, some have been shown to be particularly useful in HPD.

Functional Analytic Psychotherapy (FAP) is designed specifically to help people with difficulties in relationships.¹³ FAP assumes that problems that come up between the patient and therapist mimic the problems that come up in the patient’s other relationships, so by demonstrating the consequences of relationship-damaging behaviors and prompting more effective ones, the patient can learn to apply the same improvements outside of the therapy room.

Cognitive Analytic Therapy (CAT) is another talking therapy based on relationship difficulties. CAT has 3 phases:¹⁴

Reformulation: You and your therapist look at your past experiences to understand where your current difficulties are coming from and reach a mutual understanding of what you want to work on.

Recognition: Your therapist helps you to recognize these patterns both in therapy and in daily life. You gain a deeper understanding of how your early experiences affect you today.

Revision: You and your therapist practice new ways of thinking and responding to others. The goal is to be able to continue your journey on your own after therapy ends.

This therapy is time-bound, usually to around 16 sessions. In one case study, CAT reduced three HPD symptoms: focus on physical appearance, feelings of emptiness, and feeling like a ‘small child inside’.¹⁵

Schema Therapies

Schemas are like mental roadmaps of the world that develop based on our experiences – much like the internal working model. Maladaptive schemas are schemas that make life more difficult for us; for example, if we don’t receive a lot of support growing up and don’t develop high self-esteem, we might believe that we’ll fail at everything. This schema is maladaptive because it can stop us from trying new things and taking positive risks.

Schema therapies aim to shine a light on maladaptive schemas and change the behavior that comes with them. In one case study, schema therapy helped to improve symptoms and maladaptive schemas in a patient with HPD.¹⁶

Clarification-oriented psychotherapy (COP), which combines a focus on relationship difficulties with maladaptive schemas, has been shown to be able to help HPD in a study with 159 diagnosed patients.¹¹ In this study, the relationship between the patient and therapist was shown to be a significant factor in the success of the therapy.

Building Secure Attachment Patterns

One way in which the patient-therapist relationship could lead to positive change for the patient is by building earned secure attachment. Earned secure attachment is the idea that, through positive experiences with others, we can learn a secure attachment style that we didn’t have before.

DISCOVER YOUR ATTACHMENT STYLE

This doesn’t just mean better relationships with others, but an ability to regulate emotions more successfully and trust in yourself. As you develop more realistic expectations for relationships, you might also seek out more secure partners and friends, continuing to build security from these new foundations.

Responding to Histrionic Behavior in Relationships

If you recognize patterns of histrionic traits in your partner, it’s important to prioritize your own needs. Their behavior may stem from deep fears and intense emotions, but this doesn’t mean it’s okay when it causes harm.

Not everyone with histrionic traits will have HPD, but it’s still important to take their impact seriously. Setting gentle, consistent boundaries can help you and your partner to build a healthier relationship.

Setting Boundaries with Attention-Seeking Behavior

It can be difficult to set boundaries with someone with histrionic traits, but trying to set appropriate boundaries gives you, them, and your relationship a fair chance. For example, if you feel you need more time to look after yourself, you might suggest scheduling a time in your weekly routine in which you’ll spend time with friends or alone and won’t respond to your phone.

Although this may still be difficult for someone with abandonment fears, scheduling in regular time apart can be more predictable than taking it when you need it (especially if this is usually after an argument). It can also be helpful for your partner to agree on a time that you’ll resume contact – boundaries can be a discussion, not a demand, and they can look different for every relationship.

When to Seek Professional Help

If histrionic patterns are causing you or your partner significant distress, therapy can help – even if there’s no HPD diagnosis, and even if you’re not the histrionic partner. Therapy is for everyone and anyone who can benefit from it. There are many more options than those listed earlier in this article, and it’s okay to shop around until you find a therapy and therapist that feels right for you.

Can Histrionic Personality Change?

Studies on therapies for HPD have found that histrionic symptoms can improve. If you recognize your own histrionic patterns and want to change, then you’re already several steps ahead. Mental health professionals can help you to take the next steps; remember, behavior change takes time and there will be lots of trial and error, but the results will be worth it.

Conclusion

Understanding histrionic patterns through the lens of attachment theory helps us to understand how our early experiences can influence the thoughts, feelings, and behaviors behind histrionism. Even though they can stem from learned survival strategies and real emotions, this doesn’t make histrionic behaviors that cause harm – to you or others – okay.

Histrionic patterns can change with motivation, intent, effort, and time. Qualified mental health practitioners can help anyone affected by histrionic traits or HPD, including those close to somebody with histrionic traits.

Frequently Asked Questions

Q: What causes someone to develop histrionic personality traits?

Histrionic personality traits can be influenced by genetics, childhood experiences, and our environment.

Q: Can people with histrionic personality disorder have healthy relationships?

People with HPD can learn to manage their symptoms through therapy and develop healthy relationships.

Q: What’s the difference between histrionic and borderline personality disorder?

HPD and BPD are similar, but HPD is more focused on being universally loved and the centre of attention, while BPD typically involves fixations on one or a few close relationships.

Q: What attachment style do people with histrionic personality have?

One forensic study found people with HPD typically had the anxious-preoccupied attachment style. They may also be fearful-avoidant, but they were less likely to be secure or dismissive-avoidant.

Q: Can histrionic personality traits change over time?

Histrionic personality traits can change over time, particularly if the person with histrionic traits wants to change them and makes the effort to.

Q: How do you set boundaries with someone who has histrionic traits?

Boundaries can be a discussion, not a demand – you may need to compromise, which is fine as long as you still feel comfortable with the agreement. It can be difficult for someone with histrionic traits not to feel abandoned when you need to set boundaries, so approaching them gently and with compassion and reassurance can help.

Q: What’s the connection between childhood trauma and histrionic personality?

Some studies have found that sexual, emotional, and physical childhood traumas can be associated with HPD.

Q: Can therapy help someone with histrionic personality disorder?

Lots of therapies, including relationship-focused and schema therapies, are available to help someone with HPD.

Q: How do I know if I have histrionic traits?

If you recognize the typical histrionic traits in yourself (strong need for attention, dramatic emotions, easily influenced, inappropriate sexual behavior), then you may have histrionic traits. This doesn’t mean that you have histrionic personality disorder, but a professional can help you discuss this diagnosis if you feel it would be helpful.

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