Histrionic Personality Disorder as a Schizophrenia Spectrum Disorder that Cycles with Schizoidia

Histrionic Personality Disorder as a Schizophrenia Spectrum Disorder

In this paper, I conceptualize histrionic personality disorder as largely emerging from underlying schizotypal traits, particularly positive schizotypy and low negative schizotypy. I also hypothesise relationships between schizoid personality disorder and histrionics.

This dataset comes from a (n-3270) study I conducted several years ago. Participants were asked to rate several scales, each responding to each pd, and additionally autistic traits.

Using items from the used scales, positive, negative, and impulsive schizotypy factors were extracted [Table 1].

Table 1

F1	Borderline	Negative schizotypy	Impulsive schizotypy	Social anxiety	Positive schizotypy
When I feel ashamed, I think others often know why I feel that way.	-0.09	-0.11	-0.04	-0.02	0.45
I feel like I can predict the future or influence the world with my mind	0.24	0.22	-0.02	-0.33	0.48
I have had the momentary feeling that my body has become misshapen.	0.43	0.12	0.04	-0.12	0.35
I notice that in conversations, I tend to go round in circles.	0.13	-0.04	0.22	0.18	0.42
The thought that people are persecuting me plays on my mind.	0.41	-0.02	0.03	0.05	0.36
When others laugh from jokes on TV, I usually do not.	0.05	0.30	0.16	0.30	0.09
I’ve often been referred to by others as weird or eccentric.	-0.01	0.05	0.23	0.18	0.51
Most people have more friends than me.	0.04	-0.02	0.00	0.76	-0.02
I dread social situations due to how uncomfortable they make me feel.	0.14	0.06	-0.04	0.74	0.00
I rarely feel enjoyment from anything I do	0.51	0.38	0.12	0.17	-0.29
I almost always feel detached from my emotions	0.51	0.56	0.00	0.02	-0.16
It's hard for me to express love or anger towards others	0.13	0.59	0.01	0.19	-0.07
Peoples praise or criticism of me doesn’t affect me much	-0.06	0.66	0.16	-0.16	-0.05
I’m pretty much asexual	-0.12	0.39	0.01	0.19	0.12
I prefer to do things on my own	-0.13	0.39	-0.14	0.35	0.20
I’m often stuck in self analysis	0.27	0.09	-0.22	0.21	0.32
I rarely plan before I do something	-0.14	0.08	0.78	-0.09	0.04
I don’t really care for my own health and safety, and this sometimes concerns others	0.33	0.15	0.48	-0.04	0.01
I’m not very responsible in reference to my financial, work, or educational obligations	0.02	0.05	0.74	0.08	-0.02
I have made desperate efforts to avoid feeling abandoned or being abandoned (e.g., repeatedly called someone to reassure myself that they still cared, begged them not to leave me, clung to them physically)	0.51	-0.36	0.10	0.06	0.12
Many of my closest relationships have been troubled by a lot of arguments or repeated breakups	0.50	-0.15	0.19	0.09	-0.06
I have often felt that I had no idea of who I am or that I have no identity	0.65	0.09	-0.03	0.05	0.00
I have had at least two problems with impulsivity (e.g., eating binges and spending sprees, drinking too much, verbal outbursts) or addiction	0.40	-0.12	0.31	-0.03	0.17
I have deliberately hurt myself physically (e.g., punched myself, cut myself, burned myself) or have made a suicide attempt	0.54	-0.10	0.05	0.05	0.11
I have often been very moody	0.55	-0.31	0.08	0.18	0.02
I have chronically felt empty	0.72	0.15	-0.11	0.08	-0.10
I’m prone to fits of rage	0.48	-0.14	0.23	0.02	0.01
I have frequently felt unreal or as if things around me were unreal?	0.62	0.22	-0.06	-0.15	0.19

After this, principal components analysis was used to determine the structure of positive, negative, and impulsivity and StPD. BPD, Schizoid personality, histrionic personality, compulsive personality, and antisocial personality. Shown in table 1 and figure 1.

Table 1

	PC1	PC2	PC1 varimax	PC2 varimax
Negative schizotypy	0.32	-0.74	-0.07	-0.80
Impulsive schizotypy	0.56	0.45	0.70	0.12
Social anxiety	0.37	-0.45	0.11	-0.57
Positive schizotypy	0.55	0.01	0.48	-0.25
schizotypal:1	0.74	-0.14	0.58	-0.47
borderline:1	0.73	0.23	0.75	-0.14
schizoid:1	0.55	-0.68	0.16	-0.86
paranoid:1	0.70	0.13	0.67	-0.22
histrionic:1	0.58	0.51	0.75	0.17
compulsive:1	0.26	-0.39	0.04	-0.46
antisocial:1	0.71	0.24	0.73	-0.1237

Figure 1

A clear pattern from this emerged - while histrionic traits correlate to high positive and impulsive schizotypy, and negatively to negative schizotypy. Negative schizotypy correlates to schizoid and schizotypal personality disorder. Positive schizotypy is shared between schizoids, schizotypals, borderline, and histrionics.

Evidence for Overlap Between HPD and SSDs

Overlaps	Schizotypy
Creativity enhanced	Creativity enhanced	Furnham et al. (2015)
Unrestrained sexual behavior	Unrestrained sexual behavior	Cloudfindings (2023)
Anxious attachment style	Anxious attachment style	Timmerman & Emmellkamp (2005)
High openness	High openness	Furnham (2014)
Associated with hypomania	Associated with hypomania	Shashar et al .(2014) Kemp et al. (2019)
High mating effort, seductive efforts, mate value self enhancement	High mating effort, seductive efforts, mate value self enhancement	Cloudfindings (2023c) Dinsdale et al. (2013)

Using data from Cloudfindings (2024a), I conducted factor analysis on positive schizotypy, autistic traits, and histrionic traits, to determine if it relates to the schizotypy spectrum. This was supported, histrionic traits loading in the direction of negative schizotypy on the second factor. This provides additional evidence for histrionic personality involving a hyper mentalistic interpersonal style. Histrionic personality also correlated with openness.

Table [3]

Positive Schizotypy	-0.77	-0.28
Impulsive Schizotypy	-0.77	-0.36
Negative Schizotypy	-0.48	0.54
Disorganized schizotypy	-0.78	-0.25
Histrionic Personality	-0.40	-0.42
Autistic Interests	-0.47	0.59
Literal Language	-0.52	0.62

Histrionic personality is largely opposed to autism, which involves low extraversion and low openness, histrionic having the opposite pattern. Histrionic persons are hypersocial and sexually unrestrained; under the diametric model of autism and psychosis, this would clearly place HPD to the mentalistic, schizotypal side (Crespi & Badcock 2008) of the autism-schizotypy continuum. Histrionics enjoy social attention, enjoy flirting, tend to be interested in many people, prefer to have non monogamous relationships, are good at making others like and be attracted to them, and enjoy sexual attention. Many of these are opposed to autism (Cloudfindings 2024b), which involves a hypomentalistic cognitive style. This evidence suggests histrionics are hyper mentalistic. Negative schizotypal symptoms are unique to schizoidia and schizotypal, however positive symptoms are unique to schizotypal and histrionic.

Positive schizotypy and negative schizotypy have opposing effects from positive schizotypy to negative schizotypy, and appear opposite in some models that histrionic personality is inversely related to negative schizotypy (Cloudfindings 2023b). However, based on the factor analysis (Figure 1), there is a clear spectrum from positive to negative schizotypy, where histrionic traits are at high positive and low negative schizotypy, and schizoid traits are at low positive and high negative schizotypy. In between is positive schizotypy and StPD - perhaps the variation in phenotypes related to positive schizotypy can shift in negative schizotypy. 

I also hypothesize that schizotypal persons can shift between low and high negative schizotypy in response to external factors. Schizophrenic negative symptoms have been attributed to social defeat, and positive schizotypy is associated with higher rejection sensitivity, but also higher praise sensitivity (Torgersen et al. 2022), which can result in both depressive, avoidant, and delusional guilt states but also mania, grandiosity, etc (Crespi & Badcock 2008). I propose that, when high schizotypy individuals are experiencing positive social experiences that relieve feelings of social defeat, this can quickly or gradually change someone from having a more schizoid personality style to a histrionic style. I have observed this in many schizotypal individuals such as myself [Table 3].

To further demonstrate the relationship between histrionic and schizotypal traits, I report the profiles of 4 cases with elevated schizotypy [Table 3]. Overarching themes include cycling between high and low negative schizotypy, which is long term and responds to external cues - most mainly being liked or disliked (especially in a sexual context). Negative schizotypy emerges with perceived rejection, low social status, paranoia, lack of trust, and social failure - positive schizotypy and histrionic traits emerge with perceived praise, elevation of social status, sexual success, and perceived sexual desirability. The emergence of such extreme states may reflect hypermentalizing (Crespi & Badcock 2008). This cycling would likely be closely related to bipolar cycling.

Table 3

Case 1	Experienced periods of high confidence or grandiosity, hypersexuality, creativity, and hypersociability, excessive flirtations, excessive attention to ones own attractiveness  with changing sexual attitudes, after experiencing consistent and large positive social feedback and responses; experiences low periods of depression, isolation, paranoia, social coldness after consistent negative social feedback; Individual went through multiple cycles
Case 2	Experience periods of hyper sociability, desire to fit in and be normal, attention to ones appearance and trying to look attractive, extraverted, engagement in parties and risk taking fun; Experience periods of social withdrawal, paranoia, insecurity, antagonomia and social detachment, desire for authenticity, high selectivity of people that are considered close; Largely responsive to external social validation and cues of acceptance/rejection
Case 3	Experienced periods of hyper-sociability, high creativity, high confidence, hyperemotionality while being perceived as likeable by others; Slow shift from this to extreme social withdrawal, paranoia, isolation, avoidance, reduced creativity after extended period of rejection and odd quasi-delusional beliefs about self. High scores on RMET despite self reported low cognitive empathy
Case 4	Is extraverted but has difficulty being close to or committing to others; Feels misunderstood and not able to be fully open with most friends; Experiences periods of socially withdrawn and hypersocial behavior. Flirations, draws appearance to ones body, grandiose sense of self, vague communication, antagonomia, paranoia, unusual perceptual experiences, eccentricity. Periods of promiscuity followed by restraint. Odd behavior in interpersonal relationships

Overall, the evidence is suggestive that histrionic personality disorder may represent a form of schizophrenia spectrum disorder involving high positive but low negative schizotypy. The outward presentation of these disorders changes as a result of social circumstances and events, which supports the social defeat model of schizophrenia (Jaya et al. 2022). While histrionic individuals are often considered to be shallow, in many aspects this appears to be a surface level interpretation - in my experience with histrionics they are often more than not particularly reflective, nonconforming, and have odd believes and intellectual engagement, however this is often hidden to a degree in most. This perhaps presents a new and important perspective on the mention of these disorders, and could aid in better understanding and diagnosing these disorders.

Figure 2: Simplex of relevant disorders

1. Furnham et al. (2015) The Bright and Dark Side Correlates of Creativity: Demographic, Ability, Personality Traits and Personality Disorders Associated with Divergent Thinking

2. Cloudfindings (2023a) Sexuality in Psychiatric Disorders

3. Timmerman & Emmellkamp (2005) The relationship between attachment styles and Cluster B personality disorders in prisoners and forensic inpatient

4. Furnham (2014) A Bright Side, Facet Analysis of Histrionic Personality Disorder: The Relationship Between the HDS Colourful Factor and the NEO-PI-R Facets in a Large Adult Sample

5. Shashar et al .(2014) HYPOMANIC SYMPTOMS PREDICT AN INCREASE IN NARCISSISTIC AND HISTRIONIC PERSONALITY DISORDER FEATURES IN SUICIDAL YOUNG ADULTS

6. Kemp et al. (2019) ASSOCIATION OF POSITIVE, NEGATIVE, AND DISORGANIZED SCHIZOTYPY DIMENSIONS WITH AFFECTIVE SYMPTOMS AND EXPERIENCES 

7. Cloudfindings (2024a) Explaining Paraphilia: A Novel Model Explaining A Wide Range of Sexual Interests Continuous With Normal Sexuality

8. Crespi & Badcock (2008) Psychosis and autism as diametric disorders of the social brain

9. Cloudfindings (2024b) I’m obsessed with you: Variants of ‘favorite persons’ in borderline personality, autism, narcissism, and psychopathy

10. Cloudfindings (2024c) Eating Disorders & Body Dysmorphia and Narcissism as Sex Differentiated Expressions of a ‘Mate Value Hyper-Enhancement Syndrome’

11. Dinsdale et al. (2016) The ‘extreme female brain’: increased cognitive empathy as a dimension of psychopathology

12. Cloudfindings (2023b) General Psychopathology Masks the Associations Between Psychiatric Disorders and Personality Traits

13. Jaya et al. (2022) Does social defeat cause negative symptoms? A prospective study in a multi-national community sample

14. Premkumar et al. (2012) Neural processing of social rejection: the role of schizotypal personality traits

15. Torgersen et al. (2002) Schizotypal personality disorder inside and outside the schizophrenic spectrum