What is Histrionic Personality Disorder?

The trial of Jerry Sandusky, the former Penn State football coach accused of sexually abusing young boys, has already taken a surprising turn: Courtroom reports indicate that Sandusky’s defense attorneys may present evidence that he has histrionic personality disorder (HPD).

Public reaction to this news has been a collective “Huh?” HPD isn’t well known outside mental health circles. And even within the field, it’s a controversial diagnosis. In fact, an expert panel has recommended that it be dropped as a specific personality disorder from DSM-5, the forthcoming update of the standard diagnostic guide used by mental health professionals.

Using current diagnostic criteria, it’s estimated that 1 to 3 percent of adults have HPD. These individuals behave in an overly emotional and dramatic way that attracts the attention they desperately crave. Inappropriately seductive behavior is a textbook symptom. Child molestation is not. So it will be interesting to see how the HPD defense, if presented, will play out for Sandusky.

As a trial watcher, here’s what you need to know.

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HPD 101

Personality disorders are long-term patterns of thought and behavior that cause serious disruption in everyday life. In HPD, there’s a pattern of being excessively emotional and seeking constant attention. This longstanding pattern starts by early adulthood, and it creates turmoil in relationships as well as problems at home, work, or school.

People with HPD could have several of the following symptoms:

• wanting to always be the center of attention
• acting inappropriately seductive toward others
• dressing in a very flamboyant or sexy manner
• overdramatizing things or exaggerating emotions
• talking with theatrical flair but being vague on details
• showing quickly changing emotions that seem shallow to others
• being easily influenced by other people and outside events
• believing that relationships are more intimate than they actually are

Learn Even More About Histrionic Personality Disorder 

Any Connection to Pedophilia?

Although people with HPD may be sexually provocative, there’s scant evidence suggesting a link to child sexual abuse. In a commentary on the Sandusky trial, Susan Cornbluth, an adjunct psychology professor at Temple University, noted: “Let’s get one thing clear, ‘acting and looking seductive’ usually has to do with how one dresses and acts toward other adults.”

A 2010 review article in the Journal of Clinical Psychology identified only a few studies that looked at this subject. One study of male pedophiles found that they scored higher than non-sex offenders on tests for all types of personality disorders. However, the connection to HPD was weaker than for many of the other disorders. In another study, child molesters actually scored lower than non-sex offenders on a histrionic personality scale.

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Too Much Drama in Relationships

In relationships with other adults, people with HPD often form new bonds easily. But constant drama, compulsive flirtatiousness, and a never-ending need for attention may soon take a toll. Many of these relationships don’t survive for long.

Those with HPD are frequently insecure about how much other people love, desire, or appreciate them. They’re always looking for reassurance and approval. And they may be super-sensitive to any criticism or disapproval, real or imagined.

In short, healthy relationships aren’t the strong point of people with HPD. Yet there’s a big difference between someone who has an excessive thirst for attention and affection and someone who is a sexual predator. In the Sandusky trial, if an HPD defense is presented, the key question will probably come down to which of these categories the former coach falls into.

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