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Personality / Styles

Hysterical–Histrionic Personality Style

People with this style feel things intensely and live toward other people. McWilliams describes them as warm, energetic, intuitive “people people,” highly reactive, often anxious, and drawn to drama and risk. They may thrive in visible roles such as acting, teaching, preaching, or politics (McWilliams, 2011, p. 313). At their best they combine feeling and sensory impressions with logic in ways that can be remarkably creative (McWilliams, 2011, p. 313).

The central theme, in the psychodynamic account, is power and safety in relationships, often organized around gender. Beneath an expressive surface, many people with this style feel small and fearful in a world run by others who seem stronger, more exciting, and more dangerous (McWilliams, 2011, p. 320). The PDM-3 describes an unconscious sense that people of one’s own gender are weaker and people of the other gender are powerful, exciting, frightening, and enviable (McWilliams & Shedler, 2026, p. 685).

The names carry baggage. The PDM-3 acknowledges that “hysteric” and “histrionic” are redolent of patriarchy and offensive to many, but argues that the pattern itself is real, appears reliably in research, and is not limited to the cisgender women it was long associated with (McWilliams & Shedler, 2026, p. 685). Freud himself regarded himself as somewhat hysterical, and one of his earliest papers was about hysteria in a man (McWilliams, 2011, p. 312). Outside the areas of conflict, people with this style are often capable of warm, stable attachments (McWilliams & Shedler, 2026, p. 686).

Everyone has a personality style, and most people blend several. This page describes a pattern, not a verdict on anyone.

Style, Disorder, and the Space Between

The two names reflect a difference in level. Before DSM-III, most psychoanalytic writers used “hysterical” for people organized at the neurotic level and “histrionic” or “hysteroid” for those at the borderline and psychotic levels (McWilliams & Shedler, 2026, p. 686). Elizabeth Zetzel’s paper on the “so-called good hysteric” stressed how far apart the healthier and more troubled members of this group are (McWilliams, 2011, p. 312). The PDM-3 puts hysteric personality among the styles most often found at healthy or neurotic levels (McWilliams & Shedler, 2026, p. 655).

Signs that a style has become a disorder include rigid, repeated patterns across relationships, real suffering or damage, emotional storms that crowd out reflection, and little ability to step back from them. On the PDM-3 prototype, a rating of 4 or 5 means a personality disorder applies (McWilliams & Shedler, 2026, p. 687).

The DSM-5-TR diagnosis, histrionic personality disorder, requires five of eight criteria, including discomfort when not the center of attention, rapidly shifting and shallow emotional expression, use of appearance to draw attention, impressionistic speech, theatricality, suggestibility, and seeing relationships as more intimate than they are. Estimates of prevalence run from about 0.4% to 1.8%, and women are diagnosed about four times as often as men, which may partly reflect bias (Torrico et al., 2024). ICD-11 has no separate personality disorder types, only severity ratings and trait qualifiers (Gecaite-Stonciene et al., 2021). McWilliams criticizes the DSM-IV version for emphasizing dramatic behavior at the expense of its meaning. In her view, the most pressing inner feature of the style is anxiety (McWilliams, 2011, p. 317).

Inner World

Temperament seems to matter. Many writers describe people with this style as intense, hypersensitive, and sociable from the start, like the baby who shrieks with frustration and squeals with delight. They seek stimulation but are easily overwhelmed by it. McWilliams notes an affinity with schizoid sensitivity, except that people with a hysterical style move toward others rather than away (McWilliams, 2011, p. 313). The PDM-3 says they fear overstimulation from inside: their own feelings and desires make them anxious (McWilliams & Shedler, 2026, p. 686). Research reviewed by Blatt and Levy places them on the relationship-focused, “anaclitic” side (McWilliams, 2011, p. 313).

The familiar charge of “shallow affect” misses what is going on. McWilliams argues that these are people with intense feelings that frighten them (McWilliams, 2011, p. 315). Having often been infantilized or dismissed, they do not expect their feelings to be taken seriously. So they exaggerate them to get past their anxiety, while signaling that they aren’t really serious, which leaves a way to take it back if the setting turns out to be unsafe. “I was SOOOO furious!” is real anger drenched in conflict (McWilliams, 2011, p. 322). Attention-seeking, in the same way, can be a search for reassurance that one is acceptable, and especially that one’s gendered body is appreciated; McWilliams calls the exhibitionism “counterdepressive” (McWilliams, 2011, p. 322). Philip Bromberg framed the dilemma as a “tragic inability” to convince others that one’s inner experience is authentic (as quoted in McWilliams, 2011, p. 322).

The thinking style tends to be global and impressionistic rather than detailed. David Shapiro’s work on neurotic styles described this, and the PDM-3 suggests it may protect against seeing something frightening too clearly (McWilliams, 2011, p. 313; McWilliams & Shedler, 2026, p. 686). People who are astute in other ways may still be impressionistic about other people (McWilliams, 1999, p. 128).

Self-esteem often depends on feeling as powerful as the people one fears. Being attached to, or seen with, an admired person can provide a borrowed sense of worth (McWilliams, 2011, p. 320). Rescue is another route: caring for others who are frightened or at risk, or trying to heal a dangerous partner (McWilliams, 2011, p. 321). One of McWilliams’ clients put the core belief simply: “When I feel strong, I feel like a man, not a strong woman” (McWilliams, 2011, p. 321). When attractiveness has carried too much of a person’s worth, aging can be especially painful (McWilliams, 2011, p. 321; Del Corno & Plotkin, 2026, p. 943). McWilliams notes that contemporary gender theory rejects the old equation of assertiveness with masculinity, but that such images can keep their force in the unconscious (McWilliams, 2011, p. 321). The PDM-3 similarly describes binary images of gender held unconsciously, whatever the person’s intellectual views (McWilliams & Shedler, 2026, p. 686).

Although people with this style can come across as manipulative, McWilliams stresses that their maneuvering serves a search for safety and acceptance rather than pleasure in getting the better of others (McWilliams, 2011, p. 320). The PDM-3 prototype adds a suggestible quality, a tendency to take on the attitudes of admired others, storybook ideas of perfect love, and, beneath the surface, fears of being alone or abandoned (McWilliams & Shedler, 2026, p. 687).

These themes touch the capacity for affect regulation and the capacity to regulate self-esteem. In the PDM-3’s M axis, histrionic pathology sits toward the undercontrolled end of the capacity for impulse regulation (Lingiardi, Muzi & Bornstein, 2026, p. 725).

Defenses

McWilliams lists repression, sexualization, and regression as the characteristic defenses, along with counterphobic acting out and dissociation (McWilliams, 2011, p. 315).

They also use narcissistic defenses such as idealization and devaluation, usually in specific, gender-linked ways (McWilliams, 2011, p. 329). In hysterically organized clients, idealizing or devaluing others protects against perceptions that would stir fears of being overwhelmed or injured (McWilliams, 1999, p. 129). Conflict may also show up in the body as medically unexplained symptoms (McWilliams & Shedler, 2026, p. 686). In healthier people with this style, the loving parts of the personality stay in visible conflict with the defensive ones. One of McWilliams’ patients, for example, felt real guilt about the effects of her behavior (McWilliams, 2011, p. 322).

Relationships

People with this style are strongly oriented to others and talk readily about their feelings toward them (McWilliams, 2011, p. 323). The trouble comes in the area of gender, sex, and power. Some people go through repeated cycles of overvaluing and then devaluing partners, with power sexualized but sexual satisfaction oddly missing (McWilliams, 2011, pp. 319–320). The PDM-3 prototype mentions romantic triangles, attraction to unavailable partners, and difficulty feeling tender and sexual feelings toward the same person (McWilliams & Shedler, 2026, p. 687). Others may find them charming and warm, or may dismiss them as dramatic, which wounds people who are highly sensitive to such cues (McWilliams, 2011, p. 324).

Theories of origin should be read as hypotheses, not verdicts on families. Freud proposed a combination of early unmet needs and later oedipal struggles (McWilliams, 2011, p. 314). Later clinicians pointed to families that gave the sexes different power and value, such as a girl who sees her brothers favored, or a boy whose masculinity is mocked (McWilliams, 2011, pp. 318–319). Several writers, including Easser and Lesser, observed fathers who were both frightening and seductive (McWilliams, 2011, p. 318). The PDM-3 lists a seductive parent, boundary violations in the family, or feeling rejected because of one’s gender (McWilliams & Shedler, 2026, p. 686). Attachment researchers have linked histrionic personality disorder to anxious-resistant attachment, and hysterical psychology with significant early trauma to disorganized attachment, marked more by helplessness and compulsive caregiving than by hostility (McWilliams, 2011, p. 312). McWilliams explains the higher frequency of the style in women by two facts any child notices: men have held more power in the wider culture, and men have done less of the hands-on care of infants, which makes them seem more exciting and “other” (McWilliams, 2011, p. 319). The PDM-3 adds that some people with this style flaunt their sexuality to counter unconscious shame and fear, while others, especially where modesty is prized, are sexually avoidant (McWilliams & Shedler, 2026, p. 686).

Culture shapes the surface. The PDM-3 notes that overtly hysterical presentations are more visible where gender roles are strict and hierarchical. The DSM picture of a self-dramatizing person may fit Western cultures better than cultures that value modesty, where people with the same dynamics may seem shy and reserved, as Freud’s Viennese patients often did (McWilliams & Shedler, 2026, p. 686).

In Therapy

Transference is the set of feelings and expectations from earlier relationships that a person brings, often unknowingly, into a new one. Countertransference is the therapist’s own emotional response. Transference was first discovered with patients whose problems were hysterical (McWilliams, 2011, p. 323).

Transferences tend to be vivid and shaped by the gender of both people. Women with this style may be excited, intimidated, and defensively seductive with male therapists, and subtly competitive with female therapists. Even high-functioning clients can have transferences so intense that they feel almost psychotic, and some flee therapy early when the intensity outruns their trust (McWilliams, 2011, pp. 323–324). When the intensity is too much, a change to a therapist who seems less like the original frightening or devalued figure can work out well (McWilliams, 2011, p. 324). The PDM-3 adds that power dynamics in therapy tend to echo the gendered power arrangements of the person’s family, that the therapist’s own conflicts about gender, power, and sexuality may surface, and that therapists of the devalued gender may feel irritated and belittled, while those of the overvalued gender may feel flattered at first and later “played” (McWilliams & Shedler, 2026, pp. 686–687).

Common countertransference traps include mocking the person’s apparent drama, or the opposite, treating them like a helpless child. McWilliams warns that playing “Big Daddy” confirms the person’s sense of weakness: “Being afraid and being incompetent are not the same thing” (McWilliams, 2011, p. 325). Sexual boundary violations by therapists are disastrous. What helps is the experience of having strong desires that are not exploited by the person they are aimed at (McWilliams, 2011, pp. 325–326).

What tends to help:

With adolescents whose style is more impulsive and histrionic, the PDM-3 describes swings between idealizing the therapist and angry devaluation, and therapists who feel admired at first and later used, overwhelmed, or exasperated; it calls psychodynamic therapy the most appropriate treatment for these teens (Tanzilli & Sharp, 2026, pp. 508–509). With older adults, it recommends understanding and interpreting seductiveness rather than rejecting it, remembering the failed or superficial relationships that often lie behind stories of past success (Del Corno & Plotkin, 2026, p. 944).

Variations

How Different Thinkers See It

Charcot and Janet

Jean-Martin Charcot studied hysteria at the Salpêtrière as a neurological condition whose impairment was dynamic and produced by unconscious mental processes (Novais et al., 2015). His student Pierre Janet defined hysteria as a “malady of the personal synthesis,” marked by a narrowing of personal consciousness and a tendency for systems of ideas and functions to split off from the personality (Janet, 1907, p. 332). Janet’s account is arguably the root of the modern dissociative view.

Breuer and Freud

In 1893 Josef Breuer and Freud wrote that “hysterical patients suffer principally from reminiscences” and that the splitting of consciousness seen in dramatic cases exists in a rudimentary form in every hysteria (Breuer & Freud, 1893/1924, pp. 29, 34). Freud later made repression, conversion of conflict into bodily symptoms, and sexual conflict central, and moved from trauma toward fantasy (McWilliams, 2011, pp. 315–316).

Reich and Fenichel

Wilhelm Reich gave one of the first psychoanalytic portraits of the hysterical character, noting coquetry, fickle reactions, and strong suggestibility paired with ready disappointment. Otto Fenichel added “pseudo-hypersexuality,” a tendency to sexualize nonsexual relationships (as summarized in Novais et al., 2015).

Zetzel, Easser and Lesser, and Kernberg

These writers separated healthier from more disturbed forms. As Novais and colleagues summarize them, Easser and Lesser contrasted the hysterical personality with a “hysteroid” (borderline) form, and Zetzel distinguished “good” hysterical patients who function well from those with weak egos and poor relationships (Novais et al., 2015). McWilliams cites Zetzel’s paper for the great distance between the healthier and more impaired members of this group (McWilliams, 2011, p. 312). Kernberg, as McWilliams and the PDM-3 report, used “hysterical” for the healthier form and terms such as “infantile” or “histrionic” for the more primitive form, placing them at neurotic and borderline levels (McWilliams, 2011, p. 312; Tanzilli & Sharp, 2026, p. 507). The DSM later used “histrionic” for the more disturbed end, which McWilliams finds confusing (McWilliams, 2011, p. 312).

Shapiro, Horowitz, and cognitive style

David Shapiro described a global, impressionistic hysterical way of thinking (McWilliams, 2011, p. 313). Mardi Horowitz later linked the style to a bias in how information is processed (Novais et al., 2015), and his approach to therapy combines relationship and interpretation (McWilliams & Shedler, 2026, p. 687).

Feminist critiques

Critics argued that the hysterical personality looked a lot like an exaggerated picture of femininity. Harriet Lerner argued that the socialization of girls pushes them toward the very cognitive and personality styles that get labeled hysterical (Lerner, 1974). Richard Warner found that clinicians given identical case descriptions tended to call a man antisocial and a woman hysterical (Warner, 1978). Ford and Widiger found sex bias in diagnoses, though not in how clinicians rated individual criteria (Ford & Widiger, 1989). McWilliams accepts the gender skew but disputes Warner’s conclusion that hysteria and psychopathy are the same condition (McWilliams, 2011, p. 328).

Empirical approaches

The PDM-3 prototype is empirically derived from clinician-rated SWAP data (McWilliams & Shedler, 2026, pp. 666, 687). But the DSM category has fared poorly. In one large Norwegian sample of 2,289 day-hospital patients, histrionic personality disorder was rare (0.4%), overlapped heavily with other diagnoses, and had low internal consistency, leading the authors to propose deleting it (Bakkevig & Karterud, 2010). The PDM-3’s answer is to treat the style and the level of severity as separate questions (McWilliams & Shedler, 2026, pp. 655–656).

Examples

The theater student

A graduate student in theater arts, raised by a loving but unpredictably explosive father, fell for one male teacher after another and worked hard to become each one’s favorite. When they responded, she felt a rush of excitement and power, then fear and guilt. Her maneuvering was limited to men in authority and full of conflict. She was painfully aware of her effect on them and felt guilty toward their wives.

Nancy McWilliams, Psychoanalytic Diagnosis (2nd ed., 2011), pp. 320, 322

Jim, Jamie, and Jay

A supervisee of McWilliams named James began treating a young woman whose father had swung between intrusiveness and rejection. In her first months of therapy she had a series of romances with men named Jim, Jamie, and Jay. McWilliams uses the case to show how feelings too frightening to bring to the therapist can be lived out with stand-ins.

Nancy McWilliams, Psychoanalytic Diagnosis (2nd ed., 2011), p. 324

Blanche DuBois (fiction)

McWilliams points to Blanche DuBois in Tennessee Williams’s A Streetcar Named Desire as a portrait of the pain of aging when a person has felt that her only power lay in being attractive. Her point is clinical: anyone with this style is helped by developing other sources of self-esteem.

Nancy McWilliams, Psychoanalytic Diagnosis (2nd ed., 2011), p. 321

How It Differs From Look-Alikes

Narcissistic personality
Both involve shame and a need for attention. But hysterical self-esteem problems are tied to gender or specific conflicts, the person is basically warm, and idealization often has a counterphobic quality (“this wonderful man wouldn’t hurt me”). People with a narcissistic style tend to rank everyone as better or worse without strong feelings toward them. McWilliams cites Kernberg’s observation that a hysterical woman tends to pick partners she has counterphobically idealized who turn out badly, while a narcissistic woman picks adequate partners and then devalues them; the hysterical person generally does well in traditional exploratory therapy, while narcissistic psychology calls for adaptations (McWilliams, 2011, p. 329). The PDM-3 adds that hysterical exhibitionism is limited to sexuality and gender (McWilliams & Shedler, 2026, p. 686).
Psychopathic personality
Both can be dramatic. Hysterical people are frightened, conflicted, and relationship-focused, and their manipulation serves safety. People with psychopathic dynamics equate fear with weakness. A show of the therapist’s strength engages someone with a psychopathic style but intimidates someone with a hysterical one (McWilliams, 2011, pp. 320, 328–329).
Dissociative psychology
The two overlap heavily. McWilliams finds that neurotic-level hysterical personality does not necessarily result from trauma and may have more to do with temperamental sensitivity, while in her view no one with diagnosable dissociative identity disorder has escaped severe trauma. Anyone with pronounced hysterical symptoms should be asked about dissociation. The distinction matters for therapy: with hysterical psychology the emphasis falls on recurring wishes, fantasies, and impulses, and with dissociative psychology on understanding a painful past (McWilliams, 2011, p. 355).
Emotionally dysregulated personality
The DSM’s borderline and histrionic categories are nearly indistinguishable in research. The PDM-3 treats the hysteric style as one thing and borderline-level severity as another (McWilliams & Shedler, 2026, pp. 655–656).
Context and physical illness
A woman who kept choosing domineering partners might look histrionic, but in one PDM-3 illustration her pattern made sense in light of social context, and she was understood as having a depressive style (Lingiardi & McWilliams, 2026b, pp. 47–49). Undiagnosed physical conditions can also be mistaken for hysteria (McWilliams, 2011, pp. 329–330).

History

“Hysteria” comes from the Greek word for the womb. Ancient writers blamed a “wandering womb,” medieval writers sometimes blamed demons, and only gradually did physicians from Thomas Willis to Pierre Briquet locate the problem in the nervous system and the person’s circumstances (Novais et al., 2015). In the late 19th century, Charcot, Janet, and Bernheim studied hysteria through hypnosis, and Freud’s questions about how someone can know and not know at the same time gave psychoanalysis its shape (McWilliams, 2011, p. 311). McWilliams credits Freud with taking seriously women whom other doctors dismissed as malingerers (McWilliams, 2011, p. 311).

The personality pattern was eventually separated from the dramatic symptoms. DSM-I (1952) had no hysterical personality category, and DSM-II (1968) did. DSM-III (1980) replaced “hysterical” with “histrionic,” following Paul Chodoff’s argument that the older description was pejorative (Novais et al., 2015). DSM-III also discarded hysteria as a diagnosis and separated conversion symptoms, now grouped with the somatoform disorders, from dissociation (Brand et al., 2016; Mundo, Muzi & Lingiardi, 2026, p. 810). McWilliams notes that an “infantile personality” category, describing people whose core strategy is regression, did not survive after DSM-II (McWilliams, 2011, p. 131). The DSM-IV raised the threshold from four to five criteria, and the number of people diagnosed fell (Novais et al., 2015).

Since then, the category has been questioned on two fronts: gender bias and empirical validity (Warner, 1978; Ford & Widiger, 1989; Bakkevig & Karterud, 2010). ICD-11 dropped specific personality disorder types altogether (Gecaite-Stonciene et al., 2021). Some, including Bollas, see in the modern borderline diagnosis a “return of the repressed” of hysteria (McWilliams, 2011, pp. 324–325). The PDM-3 keeps the style. It acknowledges that the names offend many people, but warns that objections to terminology should not blind clinicians to a real clinical phenomenon (McWilliams & Shedler, 2026, p. 685).

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