CLINICAL CHALLENGES AND PSYCHOTHERAPEUTIC APPROACHES IN THE TREATMENT OF HISTRIONIC PERSONALITY DISORDER

Abstract

Histrionic Personality Disorder (HPD), which is part of Cluster B, is characterized by a pervasive pattern of excessive attention-seeking and heightened emotionality, significantly affecting interpersonal relationships. This article, based on a review of the scientific literature from 2006 to 2026 in the PubMed and StatPearls/NCBI databases, synthesizes and analyzes the evidence on the clinical challenges and psychotherapeutic approaches in the treatment of HPD. Clinical management is complex due to the high rate of psychiatric comorbidities, including Bipolar I Disorder and sexual disorders, and the patient's propensity for dissociative states, which can be intensified by treatments such as esketamine. Structurally, HPD is linked to high levels of extroversion and low conscientiousness (Big Five Factor Model). The main challenge lies in the "chameleon-like" nature of the patient, who tends to transform therapy into a "performance." Effective treatment is multimodal, combining pharmacotherapy for comorbidities with structured psychotherapies (such as transition programs to outpatient care), which demonstrate favorable responses. Therapeutic efficacy is mediated by the development of mentalization functions and the reduction of impulsivity. The focus of the intervention should be on strengthening the ego, maintaining clear boundaries set by the clinician, and translating superficial emotions into genuine feelings, aiming to reduce dependence on external validation.