What’s the Difference Between Narcissistic and Histrionic Personality Disorders?

NPD and HPD are similar personality disorders, but there are distinct differences. Here’s what you need to know.

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What are histrionic personality disorder and narcissistic personality disorder?

According to the American Psychiatric Association, in order for someone to be diagnosed with a personality disorder, their behavior and thinking must not only differ from the “expectations of culture,” but must also have a negative impact on one’s life, causing the individual distress and impairing their functioning. This can affect their relationships, work, or school.

There are various types, or clusters, of personality disorders. Histrionic personality disorder and narcissistic personality disorder are similar in that they are both Cluster B personality disorders. Aside from HPD and NPD, the other personality disorders in Cluster B are borderline personality disorder and antisocial personality disorder.

The common link between all of these disorders is that the individual may be very emotional or dramatic, and exhibit ways of behaving or thinking that are unpredictable. Signs of a personality disorder (including HPD or NPD) typically show up during the teen or young adult years.

Knowing these very broad similarities, let’s dive into what makes each personality disorder unique

Histrionic personality disorder is characterized by someone being very dramatic, overly emotional, attention seeking, and over-the-top. People with HPD crave –– and need –– validation, as they don’t have positive self-esteem on their own. They need approval and reassurance from others in order to feel good about themselves. Furthermore, if they aren’t the center of attention, they feel uncomfortable.

According to The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), someone must have at least five of these traits in order to be diagnosed with HPD:

• Feels discomfort if they aren’t the center of attention
• Acts provocatively or seductively 
• Displays shallow emotions which may shift quickly
• Purposely draws attention to themself with their appearance
• Has speech that’s vague or impressionistic
• Exhibits exaggerated and dramatic emotions
• Is easily influenced by other people
• Thinks their relationships are more intimate or closer than they actually are 

Narcissistic personality disorder is characterized by someone acting grandiose, having an inflated sense of self, feeling self-important and entitled, and lacking empathy. Since narcissists often feel like they are better than other people, they feel that they deserve attention and admiration. 

According to The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), someone must have at least five of these traits in order to be diagnosed with NPD:

• Displays grandiosity –– feeling self-important and superior to others, often embellishing their talents or achievements 
• Fantasizes about things like power, success, and beauty 
• Feels like they are one-of-a-kind and that only other special or high-power people can understand them
• Needs constant admiration 
• Feels entitled to special treatment 
• Exploits others and takes advantage of them for their own personal gains 
• Is not empathetic and doesn’t consider other people’s needs or emotions
• Gets jealous of others, and thinks other people are jealous of them
• Is arrogant and egotistical 

Both disorders commonly co-occur with other mental health conditions, such as:

• Depression
• Bipolar disorder
• Substance use disorder
• Anxiety disorders or panic attacks

Furthermore, it’s common to be diagnosed with more than one personality disorder. It’s even possible for someone to be diagnosed with both NPD and HPD. Additionally, someone with either of these may also receive a diagnosis of borderline personality disorder or antisocial personality disorder. 

What are the key differences between narcissistic personality disorder vs. histrionic personality disorder?

As you can see, there are some noticeable similarities between NPD and HPD. However, there are also some key differences between narcissistic personality disorder vs. histrionic personality disorder. 

Statistically, these differences include:

• HPD is more rare, occurring in an estimated 1% of the general population, compared to NPD which affects up to 5% of the population.
• Men are more likely to be diagnosed with NPD, while women are more likely to be diagnosed with HPD.

When it comes to traits and symptoms, differences include:

• A lack of empathy or being unable to empathize with others is a key trait of people with NPD, but not necessarily for people with HPD. Folks with HPD may be better able to relate to other peoples’ emotions.
• Due to lack of empathy, people with NPD are more likely to act maliciously and say or do hurtful things without regard for how their actions make someone feel.
• People with HPD may display rapid shifts of dramatic emotions, while this is usually not the case for people with NPD. 
• Although both conditions lead to people needing attention, the motives are different. People with NPD think they deserve attention –– specifically positive attention –– due to their inflated sense of self and thinking they are better than others. However, people with HPD crave attention because they need outside validation to build up their self-esteem. They do not feel on their own that they’re great in the same way that people with NPD do. 
• People with HPD are more likely to act out in obvious attention-seeking manners. 
• People with NPD want attention in the form of praise, whereas people with HPD crave any type of attention, even if it isn’t the most positive attention.
• People with NPD may think they’re above everyone else and on their own level. On the other hand, people with HPD are easily influenced by other people and long to fit in or get approval. 
• Specific co-occuring conditions such as somatic symptom disorder and conversion disorders are more likely to be associated with HPD.
• Threats of suicide, specifically in order to get attention, are more likely in people with HPD. 

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What Causes HPD and NPD? 

The exact causes of histrionic personality disorder (HPD) are not yet fully understood. However, research suggests that a combination of genetic, environmental, and social factors may play a role.

Some studies have shown that people with HPD may have a family history of personality disorders, suggesting a genetic component. Environmental factors, such as childhood abuse, neglect, or trauma, may also increase the risk of developing HPD.

Additionally, some experts believe that social and cultural factors may contribute to the development of HPD. For example, individuals who grow up in environments that value attention-seeking behavior or place a high importance on physical appearance may be more likely to develop HPD.

Similarly, there is not definitive clinical consensus about the causes of narcissistic personality disorder, but research suggests that–like histrionic personality disorder–a combination of genetic, environmental, and social factors are at the root of the disorder.

Research has found that there may be a genetic component to NPD, as it often runs in families. However, environmental factors also play a role in the development of the disorder, such as childhood experiences of emotional neglect, abuse, or trauma.

Additionally, certain cultural and societal factors may play a role in the development of NPD. For example, growing up in a society that places outsize emphasis on individualism, success, and achievement over empathy and social connection may increase the risk of developing NPD.

In general, personality development is influenced by a person's early relationships and experiences. For example, some experts believe that overindulgence and overvaluation of a child's abilities and accomplishments by their parents or caregivers may contribute to the development of NPD.

The most important takeaway regarding the causes of both histrionic and narcisstistc personality disorders is that they are complex. There is often no single explanation for why someone develops a personality disorder, which also contributes to the difficulty of their diagnosis. 

What are the treatments for histrionic personality disorder and narcissistic personality disorder?

Regardless if someone has narcissistic personality disorder or histrionic personality disorder, the course of treatment is very similar. 

There is no one-size-fits-all cure or universal method of treatment for either personality disorder. Usually, it’s a combination of things, such as therapy and medication, that helps someone manage their disorder.

However, due to the unique nature of disorders like NPD and HPD, people with these conditions likely do not think there’s anything wrong with them. They may not see their own behavior as problematic. In fact, they might think that it’s the people around them who are in the wrong. Because of this lack of self-awareness, it’s rare for folks with NPD or HPD to seek out personality disorder treatment on their own.  

Rather, people with either personality disorder might end up seeking treatment for a co-occurring mental health condition, such as anxiety or depression. When they’re seeing the mental health professional and getting evaluated, the expert may take note of signs of a personality disorder, and make a diagnosis of narcissistic personality disorder or histrionic personality disorder based on their symptoms, behaviors, and history. 

In other cases, someone’s loved one or family member might try to intervene, urging them to seek treatment if they notice that problematic behavior is worsening and causing negative consequences. However, this should be approached gently and sensitively as someone with either NPR or HPD can feel offended. But if you can get a narcissist or someone with HPD to admit that their behavior is problematic and agree to stick with treatment, help certainly is available and positive changes can be made. 

The mainstay in treatment for both personality disorders is some form of long-term psychotherapy. Therapy will help someone gain insight into what thoughts and behaviors are unhelpful and unhealthy, and then on the flip side learn healthier ways to behave and think.

Several types of therapy are used to treat personality disorders.

Therapy modalities helpful for HPD and NPD include:

• Cognitive behavioral therapy (CBT)
• Dialectical behavior therapy (DBT)
• Mentalization-based therapy
• Psychoanalytic therapy
• Psychodynamic therapy
• Schema-focused psychotherapy
• Transference-focused psychotherapy

Mentalization-based therapy, transference-focused psychotherapy, and schema-focused psychotherapy are more likely to be used for NPD. 

Although there isn’t a medication specifically indicated to treat HPD or NPD, various medications are usually prescribed in these cases to help lessen symptoms and address any co-occurring conditions.

Examples of meds that might be prescribed are:

• Antidepressants
• Antipsychotics
• Mood stabilizers 

Treatment for someone with a personality disorder is individualized depending on how their NPD or HPD presents, as well as any mental health conditions that are present. A team of professionals, such as a therapist and a psychiatrist, might work together to collaborate on a patient’s treatment plan involving therapy and medication management.

How can Charlie Health help people with histrionic personality disorder or narcissistic personality disorder?

If you think someone in your life has HPD or NPD and/or struggles with any other mental health conditions, Charlie Health may be able to help. 

We know that everyone faces their own unique mental health journey depending on their symptoms and the difficulties they face. Our personalized intensive outpatient program provides mental health treatment for people and families dealing with a variety of struggles, including histrionic personality disorder, narcissistic personality disorder and any other co-occurring conditions.

At Charlie Health, every client is matched with a therapist who fits their specific needs, and will also be matched with a group of peers who are from similar backgrounds with similar struggles. 

Coping with a personality disorder can be very difficult, but it is certainly possible for people with HPD or NPD to experience a higher quality of life and improved mental health –– help is here now. Get started.