Spotlight on Personality Disorders: Narcissistic Personality Disorder vs. Histrionic Personality Disorder

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Spotlight on Personality Disorders: Narcissistic Personality Disorder vs. Histrionic Personality Disorder

Personality disorders describe ways of thinking, feeling, and behaving that contribute to the way a person interacts with the world.  Unlike other psychiatric disorders (e.g., mood disorders, anxiety) that may vary significantly over time, personality characteristics are less flexible.  

Narcissistic Personality Disorder and Histrionic Personality Disorder are two of the ten personality disorder diagnoses listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).  Although people with these diagnoses share several characteristics, there are important differences between these disorders.

Symptoms of Narcissistic and Histrionic Personality Disorder

Both Narcissistic Personality Disorder and Histrionic Personality Disorder have classically been considered “Cluster B” disorders because of their shared characteristics.  People with Cluster B diagnoses tend to have problems with emotional regulation and impulse control.

Narcissistic Personality Disorder

Narcissistic Personality Disorder is generally characterized by a pervasive pattern of grandiosity and a firm belief that one is better than everyone else.  This may include the following symptoms:

  • Excessive reference to other people to regulate self-esteem; this often includes comparing oneself very favorably to others
  • Need for approval from others
  • Difficulty recognizing the feelings or needs of other people, unless they pertain to oneself
  • Superficial relationships that primarily help the person get ahead or receive praise
  • Grandiosity, or feelings of entitlement
  • Attention seeking, which may include attempts to receive admiration or respect from others
  • Self-centeredness
  • A firmly held belief that one is better than others (e.g., more beautiful, brilliant, talented, deserving, etc.)

Histrionic Personality Disorder

People with Histrionic Personality Disorder share the need to receive others’ attention and positive regard.  However, they often strive to fit in and be part of the group.  Unlike people with Narcissistic Personality Disorder, those with histrionic features do not have an outsized sense of their own self-worth.  Common symptoms include:

  • Discomfort not being the center of attention
  • Inappropriate flirtatious, seductive, or provocative behavior
  • Shallow and volatile emotions
  • Dressing in a manner that draws attention, such as wearing low-cut tops or short skirts
  • Overly impressionistic and shallow speech
  • Excessive emotionality and theatrical style
  • Highly suggestible to others’ ideas, such as quickly adopting fads
  • Overestimating the level of intimacy in a relationship

Course and Prevalence of Personality Disorders

One of the key points of difference between these disorders is their gender distribution.  Men are three times as likely to be diagnosed with Narcissistic Personality Disorder than women (Ronningstam & Weinberg, 2013), while Histrionic Personality Disorder is more prevalent in women.

Features of both Narcissistic and Histrionic Personality Disorder typically begin in adolescence.  Although many adolescents have difficulty with emotional regulation, self-esteem, and self-control, when these symptoms persist into adulthood and interfere with everyday functioning, a personality disorder diagnosis may be warranted.

Treatment for Personality Disorders

Clients often mistakenly believe that personality is fixed and unchangeable.  However, personality simply reflects a pattern of interacting with the self and the world.  Like any other pattern of thoughts or behaviors, personality can be altered and adapted.

Treatment for personality disorders often focuses on individual therapy to help a person recognize the thoughts and feelings that contribute to problematic behavior.  By monitoring thoughts and reactions, a person with Narcissistic or Histrionic Personality Disorder can learn new responses and ways to effectively navigate the world.


Sources

  1. American Psychiatric Association (2013). Diagnostic and Statistical Manual for Mental Disorders: DSM-5. Washington, D.C.: American Psychiatric Association.
  2. Ronningstam, E., & Weinberg, I. (2013). Narcissistic personality disorder: progress in recognition and treatment. The Journal of Lifelong Learning in Psychiatry,11(2), 167-177.
  3. Beck, A.T., Davis, D.D., Freeman, A. (2014). Cognitive Therapy of Personality Disorders. New York, NY: Guilford Press.

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