Psychotherapy for Histrionic Personality Disorder: The Evidence

Psychotherapy for histrionic personality disorder (HPD) is the standard treatment for the condition: MedlinePlus, from the U.S. National Library of Medicine, says that talk therapy is the best treatment for the disorder itself and that medicine may help the symptoms^[1]. People with histrionic personality disorder often first seek help for depression or anxiety after a failed romantic relationship or other interpersonal conflicts^[1].

The research base is unusually thin. A 2023 study in Clinical Psychology & Psychotherapy called HPD an under-researched diagnosis and said that, to the authors' knowledge, no studies of psychological treatment in HPD samples existed^[2]. Most of what is known comes from one uncontrolled clinical study, a handful of trials that pooled HPD with other personality disorders, and single-patient case studies^[2].

The approaches studied so far are clarification-oriented psychotherapy, schema therapy, cognitive analytic therapy, functional analytic psychotherapy and mindful hypnotherapy. Cognitive behavioral therapy (CBT), psychodynamic therapy and supportive therapy have been studied across personality disorders in general^[6][7]. No approach has yet been tested in a controlled trial limited to HPD^[2].

Very little. A U.S. estimate cited in the 2023 study puts lifetime prevalence at 1.8%, which makes HPD less rare than its research record suggests^[2]. The HPD condition page covers how common it is and who is diagnosed.

Trials of personality disorder treatment rarely enroll many people with HPD. In a Dutch multicenter trial of schema therapy, only 2 of the 320 analyzed patients had HPD as their primary diagnosis; most had avoidant, obsessive-compulsive or dependent personality disorder^[3]. The authors analyzed paranoid, histrionic and narcissistic personality disorder as one combined group^[3].

Because of this, conclusions about HPD rest on three kinds of evidence: one large uncontrolled study, mixed-diagnosis trials, and case studies. Each has limits. The sections below report what each study measured and how far its results can be taken.

Clarification-oriented psychotherapy

Clarification-oriented psychotherapy (COP) is an integrative treatment for personality disorders that is widely practiced in Europe and focuses on self-regulation and motivation in relationships^[2]. In the 2023 study, 159 patients with HPD received 48 to 78 sessions supervised by the method's developers, and their scores on HPD-specific and general symptom measures fell significantly from intake to discharge^[2]. The study had no control group, so it cannot show how much of the change came from the therapy^[2].

The same study found that improvement in the patient-therapist relationship tracked outcome more consistently than other process measures^[2].

Schema therapy

Schema therapy works through painful past experiences and uses the therapeutic relationship to meet unmet emotional needs^[3]. In the 2014 trial, 81.4% of patients in schema therapy had recovered at 3 years, compared with 60.0% in COP and 51.8% in usual care^[3]. Results did not differ by personality disorder diagnosis, but with only 2 primary HPD cases the trial says little about HPD specifically^[3].

Cognitive analytic therapy

One 2007 single-case study tracked a patient with HPD daily for 357 days through 24 sessions of cognitive analytic therapy and 4 follow-up sessions^[5]. Three of 5 HPD measures improved significantly, including focus on physical appearance and feelings of emptiness^[5].

Mindful hypnotherapy, CBT and DBT

A 2026 randomized trial assigned 120 adults with histrionic, narcissistic, antisocial or borderline personality disorder to mindful hypnotherapy or to an active control built from selected CBT and DBT skills, each given as 8 weekly 60-minute sessions^[4]. Mindful hypnotherapy produced larger reductions in histrionic symptoms (partial η² about .16 to .21 across the histrionic, narcissistic and antisocial scales)^[4]. Both groups received treatment, so the trial compares two therapies; it does not test CBT or DBT against no treatment.

Functional analytic psychotherapy, psychodynamic therapy and group therapy

Functional analytic psychotherapy has improved HPD features in single-subject reports, but no controlled outcome data exist^[2]. Psychodynamic and supportive therapies have improved outcomes across mixed personality disorder samples^[6][7]. This review found no trial testing them, or group therapy, in an HPD-only sample.

Studies of mixed personality disorders give context for HPD. A 1999 review of 15 studies covering psychodynamic, cognitive behavioral, mixed and supportive therapies found that all of them reported improvement, with large average pre-post effect sizes of 1.11 on self-report and 1.29 on observer measures^[6]. In four of those studies, 52% of patients who stayed in therapy no longer met full criteria for a personality disorder after a mean of 1.3 years^[6].

From those data, the authors estimated a recovery rate of 25.8% per year of therapy, about seven times the 3.7% yearly rate in a natural-history model of borderline personality disorder^[6]. That comparison comes from a modeling estimate, not a head-to-head trial.

A 2003 meta-analysis of 14 psychodynamic and 11 CBT studies found large overall effect sizes of 1.46 for psychodynamic therapy and 1.00 for CBT^[7]. Its authors called the conclusions preliminary and asked for studies of specific therapies for specific personality disorders^[7].

Many people with HPD function well socially and at work, and they often come to treatment for depression or anxiety rather than for the personality pattern^[1]. That can make the personality disorder easy to miss as the treatment target.

The relationship with the therapist is both the main tool and a source of friction. The 2023 study's authors described the challenge as meeting the patient's basic need for recognition without reinforcing the dysfunctional behavior used to get it^[2].

Ending therapy is another documented pressure point. In the 2007 case study, symptoms deteriorated suddenly when therapy ended, then recovered, and the gains held through follow-up^[5]. Dropout is a concern across personality disorders: in the 2014 trial, 25.8% of schema therapy patients, 22% of COP patients and 37.8% of usual-care patients left treatment early^[3].

Related Cluster B conditions show similar patterns; the narcissistic personality disorder page and the article on covert narcissism cover overlapping traits.

MedlinePlus says medicine may help symptoms, while talk therapy treats the condition itself^[1]. The same source notes that people with HPD often seek treatment because of depression or anxiety, and lists depression and suicidal thoughts among the disorder's possible complications^[1].

No medication trial in an HPD-only sample turned up in this review. In the 2014 schema therapy trial, the schema therapy advantage held after controlling for medication use, and medication use itself was not significantly linked to recovery^[3].

Studied treatments ranged from 8 weekly sessions in the 2026 hypnotherapy trial to 48 to 78 sessions of COP^[4][2]. The 2014 schema therapy protocol was 50 sessions, and the 2007 case study used 24 sessions plus 4 follow-ups spread over 6 months^[3][5].

Whether HPD resolves depends on how recovery is measured. In mixed personality disorder samples, about half of patients who stayed in therapy no longer met full diagnostic criteria after an average of 1.3 years^[6]. MedlinePlus says HPD can improve with talk therapy and sometimes medicines, and that untreated HPD can cause problems in personal life and at work^[1].

No study has followed people treated for HPD alone long enough to report long-term remission rates.