Differences Between the Narcissistic Personality Disorder and the Histrionic Personality Disorder

A personality is an individual’s “specific way of thinking, feeling, and behaving” that sets them apart from the rest of society. Each person's personality is unique, heavily influenced by their past experiences, their current environment, and their inherited characteristics. “A personality disorder is a way of thinking, feeling, and behaving that strays from the typical expectations of society”. There are currently ten diagnosed personality disorders labeled in the DSM-5; two of which are called Narcissistic Personality Disorder (NPD) and Histrionic Personality Disorder (HPD). Among these two, are also Antisocial, Avoidant, Borderline, Dependent, Obsessive-compulsive, Paranoid, Schizoid, and Schizotypal.

Unlike other psychiatric disorders, like anxiety or depression which can vary, decrease, or even be cured over time, these personality disorders are less flexible and much more long term. Within these ten disorders, three specific groups are formed, which are referred to as clusters. These three groups are defined in the Diagnostic Statistical Manual (DSM-5) as Cluster A, Cluster B, and Cluster C. These clusters are formed “based on the descriptive characteristics that define the disorders themselves”. NPD and HPD are both a part of Cluster B because of their shared characteristics. Each of these disorders have issues with their overwhelming need and desire for attention, and they both have trouble with their “emotional regulation and lack of impulse control”.

At the same time, these personality disorders have different ways of seeking attention, and they seek this attention with different methods. Someone with Narcissistic Personality Disorder will seek out praiseful attention in order to fulfill their ideas that they are above or more worthy than others, as well as their distorted desire for worship and approval. On the other hand, an individual living with Histrionic Personality Disorder will act out quite provocatively or seductively for their attention fix. Someone with HPD will appear more codependent than someone with NPD, who already has a huge sense of self-entitlement. These two disorders both seek an unhealthy amount of attention, but in different ways for seperate reasons.

People with Histrionic Personality Disorder “often strive to fit in or be part of a group”. “Unlike people with Narcissistic Personality Disorder, those with histrionic features do not have an outsized sense of their own self-worth”. People with HPD are commonly “uncomfortable when not the center of attention”, making them very dramatic individuals, often in a seemingly ‘theatrical’ style. It is not uncommon for someone with histrionic characteristics to dress in a revealing manner, on top of being overly “flirtatious, seductive, or provocative” towards others. Rather than being overly self-centered like someone with Narcissistic Personality Disorder, an individual with HPD will often over invest in others, causing them to overestimate their personal relationships or level of intimacy.

On the contrary, Narcissistic Personality Disorder is generally categorized as the pattern of being impressive on an especially pretentious level. People who have been diagnosed with NPD share the need for approval with those with HPD, but on a very different level. Someone with NPD will “constantly reference others in order to regulate their own self esteem”. For example, “comparing oneself to very favorable others” would be a clear demonstration of narcissistic behavior. More symptoms of Narcissistic Personality Disorder include grandiosity or feelings of severe self-entitlement, participating in superficial relationships with the single intent of getting ahead or receiving praise, as well as self-centeredness and firmly believing that oneself is better than others. Rather than being physically provocative in order to receive positive attention, like someone with HPD, an individual diagnosed with Narcissistic Disorder will attempt to get positive reinforcement through the belittlement of others in order to make themselves seem or feel better and more worthy. People with NPD are much less personable, often actually lacking society’s typically expected sense of empathy. Individuals with this disorder are often viewed as arrogant, self-centered, manipulative, and even demanding. Their narcissistic brain provides them with fantasies convincing them they deserve special treatment. This is almost the complete opposite of someone with HPD, who will typically have such a low self esteem that they physically and mentally need to be reassured and paid attention to.

Of course, one cannot simply rely on the internet to tell them if they have a personality disorder or not. One must be diagnosed by a doctor or specialist to know for sure if they truly have a disorder. It is said that in order to be diagnosed with Histrionic Personality Disorder, one must struggle with or show clear signs of at least five of the following characteristics: self-centeredness or uncomfortable when not the center of attention, inappropriately seductive appearance and/or behavior, constantly seeking approval, rapidly shifting emotions, easily influenced by others, excessive dramatics with exaggerated displays of emotion, overly concerned with physical appearance or using said appearance to draw serious attention to oneself, or the tendency to believe that relationships are more intimate than they actually are.

In order to be diagnosed with Narcissistic Personality Disorder, a doctor must agree that the individual clearly demonstrates at least five of the following: a grandiose sense of self-importance, arrogant attitude, fantasies of unlimited success, power, brilliance, or beauty, a concerning lack of empathy, exploitation of others, the belief that one is so special that they can only be understood by or associate with equally special individuals, an overwhelming sense of entitlement, or an excessive need for admiration. Researchers have reported clear associations between NPD and high rates of substance abuse as well as mood disorders, such as anxiety.

As far as treatment goes, it is difficult to make a personality disorder simply disappear. Depending on the disorder, there are some tactics and methods used to help treat specific personality disorders. Regarding Histrionic Personality Disorder, psychotherapy is highly recommended. That being said, therapy for someone struggling with HPD can be extremely difficult because they are highly likely to exaggerate their emotions and symptoms. The patient may also be extremely emotionally needy, and therefore attempt to challenge the boundaries set up by the therapist. Given that depression can be associated with the failure of romantic relationships, it is also common that someone with histrionic tendencies will seek therapeutic help because of symptoms of depression. For someone with NPD or narcissistic characteristics, therapy will also be very challenging, but for a different reason. People with this disorder typically demonstrate an excessive amount of grandiosity as well as defensiveness due to their large sense of self importance. This can make it very difficult to address and acknowledge issues as well as any vulnerabilities the patient might have. The narcissistic walls built up by the individual makes therapeutic assistance very difficult.

Overall, both Histrionic and Narcissistic personality disorders have the ability to overlap in the way they present their behaviors and symptoms. They often share some characteristics, as two disorders that are both a part of Cluster B in the DSM-5. Both of these disorders present as severely attention seeking and overly dramatic. Each of these mindsets cause the individual to think irrationally and act out in ways that today’s society does not see as ‘normal’. Histrionic tendencies are distinctively more provocative and needy, while demonstrations of narcissism are contrastly viewed as arrogant and self-righteous. Sharing their overwhelming need and desire for attention, both of these personality disorders cause the individual to appear unstable in comparison to your average functioning member of society.