Histrionic and borderline personality disorders often feature overlapping symptom themes. As personality disorders belonging to the same group classification, they can both involve intense, emotional, and erratic behaviors.

Personality disorders (PDs) are defined by long-term, inflexible patterns of behavior that stray significantly from societal and cultural standards. These disorders feature unusual, pervasive thoughts, feelings, and perceptions that shape an unconventional inner experience of the world.

This article will look into the difference between histrionic personality disorder (HPD) and borderline personality disorder (BPD), both in how they’re classified and treated.

Understanding mental health classifications

Many different types of PDs exist. They’re classified diagnostically by their prominent characteristics into three main categories:

Histrionic personality disorder (HPD) and borderline personality disorder (BPD) both fall under the cluster B classification because they share patterns of behavior that are often changeable and unpredictable.

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HPD and BPD are separate personality disorders (PDs), though they do have some similarities.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), an internationally used clinical guidebook for diagnosing mental health conditions, indicates that HPD and BPD both involve:

  • Emotional instability: intense and often unpredictable shifts in emotions that can lead to intense fluctuation of emotions, spontaneous emotions or reactions, and difficulty regulating emotions
  • Impulsivity: the tendency to act on immediate urges without considering possible consequences or outcomes
  • Attention-seeking: behaviors and actions intended to gain the engagement, approval, or validation of others
  • Relationship challenges: difficulty in long-term relationships due to erratic and unpredictable behaviors
  • Self-image distortion: inaccurate or fluctuating perceptions of self that can lead to challenges like identity confusion, fear of abandonment, exaggerated ego, or disproportionate self-worth

At the core, the essential features of HPD and BPD are different. HPD is defined by attention-seeking behaviors. According to the DSM-5-TR, people living with HPD may feel unappreciated or uncomfortable when they aren’t the center of attention.

BPD’s essential features stem from an intense fear of abandonment, emotional reactivity, and identity confusion. Living with BPD means you may regularly experience shifting values, goals, and sense of self. At times, you may even feel as though you don’t exist at all.

According to the DSM-5-TR, BPD is primarily differentiated from HPD by prominent experiences of self-destructiveness, angry disruptions in close relationships, persistent feelings of deep emptiness, and identity disturbance.

While HPD and BPD share overarching themes, such as interpersonal relationship challenges and emotional unrest, specific thought and behavior patterns also set these conditions apart.

Emotional instability

In HPD, emotional instability may be presented as emotional intensity. Emotions often appear shallow and shift rapidly, even if they’re expressed intensely for attention.

In BPD, emotional instability primarily presents as emotional reactivity and excessive, spontaneous emotional responses to positive and negative stimuli.

Impulsivity

Impulsivity in HPD comes in the form of suggestibility. People living with HPD may be easily steered or influenced toward certain thoughts and actions that bring them attention.

Impulsive behaviors in BPD are usually self-destructive and don’t have to be influenced by others. For a diagnosis of BPD under DSM-5-TR criteria, at least two potentially self-damaging impulsive behaviors must be present.

Attention-seeking

Attention-seeking is centric to HPD, and these behaviors stem from the perceived validation that comes from being the focus of those around you.

For people living with BPD, attention-seeking behaviors may arise from deep abandonment fears.

Relationship challenges

The shifting emotions, often presented with intensity, of people living with HPD can cause others to feel as though the person is insincere or “fake,” which can make it difficult for them to form or maintain long-term relationships.

For people living with BPD, sudden outbursts and extreme emotional reactivity toward others can damage existing relationships and impair the ability to form long-term connections.

Self-image distortion

When you live with HPD, your appearance may be a means to gain the attention of others. For this reason, excessive time spent on appearance is common in HPD, and living with HPD can mean being hypercritical of your looks while also having an inflated opinion of yourself.

Self-image distortion in BPD focuses on identity confusion, or not clearly having a sense of self, and goes hand-in-hand with abandonment fears. The DSM-5-TR indicates that people who live with BPD may associate feeling abandoned with being perceived by others as “bad.”

Can you have both BPD and HPD?

Two PDs may be diagnosed simultaneously, including PDs within the same diagnostic cluster. When this happens, it’s called a “comorbidity.”

Older research from 2010, still cited in current literature, indicates that while the overall prevalence of HPD is low, it appears to be highly comorbid with other PDs such as BPD, narcissistic, and dependent PDs.

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PDs may be challenging to treat. If you’ve lived most of your life thinking and responding in a certain way, acknowledging unsupportive patterns can be difficult.

Wanting to embrace change can be even harder, but you don’t have to do this work alone.

Changing the behaviors and thoughts related to PDs happens through psychotherapy. Also known as “talk therapy,” psychotherapy approaches are therapist-guided sessions that use conversation to build a relationship of trust between you and a mental health professional.

Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are proven psychotherapy frameworks often used to treat PDs. CBT works to challenge and restructure underlying thoughts and behaviors to promote change, while DBT emphasizes acceptance, mindfulness, and the development of coping skills.

A therapist creates a treatment plan based on the diagnosis and your individual goals. Community support programs and other psychotherapy formats, like family therapy or group therapy, may also be a part of your plan.

Learn more about finding the right therapist for you.

Getting a mental health diagnosis

If you’re not sure where to begin when it comes to mental health, help is available to you by phone or online. The following resources can help you learn more about PDs or access care in your area:

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HPD and BPD are separate diagnoses that share overlapping themes of spontaneous, intense, and emotional behaviors.

Despite their similarities, the core features of these conditions are different. HPD is defined by attention-seeking behaviors, while BPD involves dominant symptoms of emotional reactivity, identity confusion, and self-destructive impulses.

Individualized psychotherapy can help you learn ways to change unsupportive thoughts and behaviors related to PDs.