Borderline vs Histrionic

by Andrea Blundell
Reviewed by Dr Sheri Jacobson

Now that a psychologist has declared to the world that Amber Heard apparently has borderline personality disorder and histrionic personality disorder, these two disorders are in the spotlight. But what are they exactly? And how do they differ?

First things first - what is a personality disorder?

If you have a personality disorder, you have a way of seeing yourself, others, and the world that is different from the norm. A perspective that you can't easily change, it causes you significant issues in your life, particularly with relating.

While we can all identify with some symptoms of personality disorders, if you really have one than your symptoms will consistently affect most if not all areas of your life. And they would have done so since early adulthood.

Things to remember when it comes to PDs

Personality disorders are not illnesses you can see under a microscope. They are simply terms created by mental health professionals to more easily describe groups of symptoms.

Not set in stone, these definitions can change, or even in some cases be disposed of entirely.

Note again that word ‘norm’, too. Societal norms change across time and by culture. For example, a man consistently feeling he is superior to all women and acting so was at one point the norm in Western society. Whereas nowadays he might end up seen as having a disordered personality.

Cluster B personality disorders

Personality disorders are divided into three groups, or ‘clusters’. Both borderline personality disorder and histrionic personality disorder are cluster ‘B’ types. Cluster B are disorders of emotions, also called ‘erratic disorders’, or dramatic, excitable, or volatile disorders.

What is Borderline personality disorder (BPD)?

There is actually nothing ‘borderline’ about BPD. It was an early name quickly recognised as a misnomer, but attempts to change it to the more accurate ‘emotionally unstable personality disorder’ didn’t take off.

The core symptom of BPD is emotional dysregulation (which means you can’t stop your emotions from going from zero to one hundred) driven by fear of rejection.

The recent version of America’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) requires that you show 5 of the following symptoms:

  • do anything to avoid abandonment
  • unstable and intense interpersonal relationships where you idealise than criticise the other
  • an unstable sense of self
  • impulsivity, such as binge eating, unsafe sex, reckless driving, overspending
  • threatening suicide, attempting it, or self-harming
  • chronic feelings of emptiness
  • inappropriate anger or outbursts
  • constant dissociation or paranoia
  • very reactive moods, such as feeling very good, then very bad, going quickly from one to the other.

The World Health Organisation’s manual, the ICD-11, which is used more than the DSM in the UK, offers pretty much the same set of symptoms.

And what is histrionic personality disorder?

It is seen as the ‘attention-seeking’ disorder, applied to those who use seduction and manipulation to feel special. Again, it’s cluster B, so it shares with BPD a symptom of emotional dysregulation (struggling to control your mood changes).

With histrionic personality disorder, according to the DSM-5, you need to exhibit at least five of the following symptoms:

  • not comfortable if you aren’t the centre of attention
  • prone to seductive or provocative behaviour
  • you use your appearance to get attention
  • you have shifting, not very deep or rooted emotions
  • and these emotions are big, exaggerated, or dramatic
  • your speech is vague, used to try to impress
  • others can easily influence you
  • and you often think relationships are more intimate than they are.

So what do they have in common?

They both involve erratic, out of control emotions, needing a lot of attention, seeking that attention in negative ways. This can include impulsive and manipulative behaviours.

The difference is that with BPD your main trigger is feeling rejected and abandoned. With HPD your main trigger is not feeling you are getting enough attention.

Sadly, both disorders raise your risk of suicide. While suicidal thoughts and self-harm are traditionally more related to BPD and are listed as a core symptom, the issue is not uncommon with those with HPD either. Their crucial need for attention can lead to threats or enactments of suicide.

Are histrionic personality disorder and BPD sexist?

It’s an interesting question, given that women account for 70% of BPD diagnoses in a clinical setting, and that over four times more women than men are diagnosed with histrionic personality disorder.

And it's true that these two disorders describe symptoms that parallel insults long used to belittle and control women. "Too emotional", "too needy", 'too sexy", "too dramatic", and on it goes. Psychologists Widiger and Gore point out in the Encyclopaedia of Mental Health, for example, that histrionic personality disorder in particular -

"...has been one of the more controversial of the PD diagnoses, given its close association with stereotypic feminine traits contributing to concerns regarding a potential gender bias."

Rumour even has it that histrionic personality disorder was almost removed from the recent edition of the DSM, as there is so little research to support it exists.

What if I think I have one of these disorders?

If you want a diagnosis, you can go straight to a psychiatrist. But this can be expensive and means you are judged based on only one or two sessions, which can feel belittling.

Another option would be to start working with a psychotherapist, as a psychiatrist will recommend you see one in any case (the current treatment for personality disorders is talk therapy). And all psychotherapists are trained in understanding the different personality disorders.

A good mental health practitioner always sees you as a unique individual, not as a diagnosis.

Your talk therapist can get to know you over the course of several weeks of working together. They can then give you their informed opinion, recommending you on to a psychiatrist if they think it’s necessary. In the meantime, if it’s not a personality disorder but just emotional issues, you will have gained coping skills that can help.

Want to speak to someone who knows all about personality disorders? Book a therapist now and finally feel understood.

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