HPD traits & BPD

Ok, so I am diagnosed with BPD, and it is definitely the label that sticks. I hit all criteria from self-harm to rage to emotionality and unstable relationships.... And although the recognition of the diagnosis was upsetting, I have come to terms with it and am moving forward.

But now it would seem that that is not all... I also have HPD traits as well. I did know this before as I realized when researching PDs in general that I definitely ring the bell on several of the criteria for HPD as well, but it never felt like it fully fit the way BPD did as with that diagnosis I rang all of them.

However in reading up on the correlation between HPD & BPD I discovered that there is a great deal of overlap between BPD and HPD features, so much so that some experts believe that HPD may not actually be distinguishable from BPD.

https://www.verywell.com/histronic-personality-disorder-425425

While some clinicians argue that the qualities of these symptoms are different in HPD versus BPD, for example, that the rapidly shifting emotions in HPD are not experienced with the same depth and intensity as those in BPD, other experts have argued that HPD and BPD are not necessarily distinct disorders. However, despite predictions that the HPD diagnosis would be dropped in DSM-5, it was not, and so it remains its own, specific and unique diagnosis. - Histrionic Personality Disorder and BPD : Understanding HPD and its relationship to BPD
By Kristalyn Salters-Pedneault, PhD | Reviewed by Steven Gans, MD

Imagine my surprise to realize that there was overlap....

How Often Do HPD and BPD Co-Occur?
There are only a few studies that have examined the co-occurrence of HPD and BPD.
One particularly rigorous study found that about 15 percent of patients with BPD also meet the diagnostic criteria for HPD. In another study that used a community sample, about 10 percent of people with BPD also met criteria for HPD. - Histrionic Personality Disorder and BPD : Understanding HPD and its relationship to BPD
By Kristalyn Salters-Pedneault, PhD | Reviewed by Steven Gans, MD

So I guess I am one of the 10-15% of people for whom I also meet the criteria for HPD. I don't have a formal diagnosis of this.... yet. However, I fit the criteria so obviously that it is rather redundant to even say so. But for the moment I am calling it merely traits, even though I can definitely claim 6 of the symptoms which under the DSM-V only 5 are required to constitute a diagnosis. And the criteria that I meet?

1. Discomfort in situations in which he or she is not the center of attention

2. Interaction with others that is often characterized by inappropriate sexually seductive or
provocative behavior

3. Consistently uses physical appearance to draw attention to self

4. Style of speech that is excessively impressionistic and lacking in detail

5. Shows self-dramatization, theatricality and exaggerated expression of emotion

6. Considers relationships to be more intimate than they actually are

the last 2 criteria I left out do not really apply to me, but that is rather irrelevant I suppose as the vast majority do. So along with the all 9 BPD criteria I meet and these 6 criteria, well I am just one messed up dirty cupcake it would seem. And all of a sudden I have tumbled down the rabbit hole to Wonderland and find myself sipping tea with the Mad Hatter. Only my Alice is a seductive Drama Queen with suicidal tendencies, massive abandonment issues and a penchant for self-harm.

"One lump or two?"

They are very overlap, very comorbid.
The similarities in the behaviour are so much.
That i am thinking HPD as just a subset of borderlines.

Just a personal set of theories (these are just purely opinions, from my own experiences, backed by nothing)...

First, that behind cluster B disorders is a common matter. Poor implicit self-esteem, but (and this is a big 'but'), I do think some researchers, understandably, don't differentiate between -

1.) Some people have had their implicit self-esteem damaged, severely.
2.) Some people with cluster B personalities have easily triggered implicit self-esteem issues, but not because of damage, because they grew up learning they are entitled, and then once out there in the world among others, can't cope with not everyone agrees they are special just cause.

These two are very different motivations, though outwardly they can appear the same. Both can end up highly reactive to perceived/real ego threats, but they are utterly different in nature. There is some hope for type #1, and probably much less for type #2. Type #1 is running from pain, and type #2 is running toward that deep seated belief they are entitled to be free of ego challenge, and threats.

It's understandable that researchers don't differentiate because that is not their job, their job is to observe and categorize behavior, what is seen outwardly.

Second, there is a difference between implicit self-esteem, and explicit self-esteem. The former is formed during our early years, and cannot be altered, though it can be moderated to some degree using our intellect. It is foundational though, and cannot fundamentally be changed. Explicit self-esteem is something we have control over as adults. We can build it up, or down. We can build it via accomplishments, recognition, we can build it through taking pride in meeting some goal, various different ways, and it's what we choose here that separates the cluster B types into different personalities and that leads into...

Third, I am going to make a generalization, and again it's not provable, but it's how I mentally sort the cluster B types -

BPD - These types are consumed by their implicit self-esteem damage, and don't have much in the way of coping mechanisms to hide from themselves. In many ways, I perceive the BPD types as the most self-honest.

NPD - Have adopted the cover up implicit self-esteem damage with explicit self-esteem attempts and beliefs. These types have learned to build explicit self-esteem through accomplishments, real or imagined. These types are sometimes driven to prove their social worth, but also, and this is key, they tend to be very selective in whose approval they seek (if anyone) because approval from highly ranked others is proof of greater worth than approval from those of lower social ranking. These types can therefore end up being loners, always looking up the ladder of social approval.

HPD - Have adopted the cover up implicit self-esteem damage with explicit self-esteem attempts and beliefs. These types have learned to build explicit self-esteem through being sexually or socially desirable. These types may be aware of social rank, and that can drive some, but where the NPD type may embrace 'being tough' is rewarding, for HPD types, 'being tough' is a mixed bag. In stereotypical terms, the thinking is 'It is better to be seen as a gracious host/hostess at the party, even if that means needing to be gracious to the annoying guests'. Social approval is still a key motivator, but the perception of role to play is different than that of the NPD type.

AsPD - Have adopted the cover up implicit self-esteem damage with 'I don't care'. This can be thought of as a kind of opposite of BPD. Turn all feelings off, don't care, problem solved.

xdude wrote:1.) Some people have had their implicit self-esteem damaged, severely.
2.) Some people with cluster B personalities have easily triggered implicit self-esteem issues, but not because of damage, because they grew up learning they are entitled, and then once out there in the world among others, can't cope with not everyone agrees they are special just cause.

The concepts of co-morbidity is why I think some theorists have developed sub-types (Millon, Gabbard,others.) et). The goal in this type of labeling is trying to capture the foundational elements of what it is that drives, motivates behavior, but recognizing the nuances of how that motivation is then acted out or performed. Also recognizing that individuals and their personality are very complex. No one true definition exists for what is considered normal or healthy.

We also can get caught in that murky area where one is subjected to judgment of right or wrong by third party "experts." And once those experts weigh in, people think they need to be fixed because everyone says they do. Is being a dramatic or theatrical personality wrong? Is being overly emotional? Hyper sensitive or stoic? Introversion versus extroversion. Narcissism as a tool used for achievement?

Obviously if other people are impacted in negative ways and your own life is filled with internal distress, then these issues become a problem . If a person is unable to experience joy, or procure and engage in healthy inter-personal relationships or maintain emotional functioning, then of course we need to address those issues.

I think in your examples above-type 1 would correlate very well with the HPD/BPD dynamic, while type 2 would correlate well with HPD/NPD or even HPD/APD. However, we can never place anyone into a neat little box, and certainly would do more harm than good to suggest that. There are paradoxes in every personality. We are all prone to extremes at times, we are all prone to idealize/ devalue others and can be considered both a good and bad person depending on the circumstances.

So trying to sort all of that out, can create more of an emotional burden than an emotional release. Psychological science (and perhaps not a science at all really) can sometimes create more confusion then clarity. I do not think that these issues are mutually exclusive ,meant as HPD/BPD as completely separate issues that need to be addressed one by one. It would take two lifetimes for any emotional remedy to be achieved.

In my personal theory, and certainly not conclusive, is that everything we do as adults is based on the foundational mirroring we received as children. Receive proper mirroring, and our adult experiences and ways we interact in those experiences would be considered healthy or, adaptive. Have improper mirroring and we need compensations.

Said in simpler terms, our disorders, issues and personality quirks are all formed on the basic way we were treated as children. Hence the perceived self-esteem deficits, and then the compensations we form to make up for those starts here. Even grandiose structures are still compensations. Being idealized does as much harm as being dismissed or abused as a child. Two sides of a similar coin. So, address these issues, and perhaps the ways we compensate are reduced as well.

Whether an individual is considered to be attention seeking or narcissistic, people are simply trying to get their needs met. And often times those are arrested childhood needs which are foundational to healthy functioning. Deal with those, and I am not so sure that overlapping behaviors between say HPD and BPD are the main focus.

Hey Mark,

To clarify my thinking on the #1 vs #2 types...

Something I found interesting is various articles on simple versus compensatory narcissism. There are other pairs of words used to describe this difference, but interesting for multiple reasons. As you explained, nobody exactly fits one or the other, but the important part is identifying there is a core difference in underlying motives.

Compensatory essentially means compensating for core self-esteem damage. Maintaining some semblance of self-esteem is the core struggle.

Simple essentially means a fundamental deep seated belief that one is superior, always right, entitled etc., Challenge from others is the core struggle.

I also find it interesting that it is harder to find articles that ponder, does the same apply to BPD, HPD, and AsPD? I don't have an answer, but it is a question I ponder.

For AsPD types, it is common belief that their motives are simple in nature, and less common to question, do some act out of primarily compensatory motives? More on that below...

Similarly, for BPD and HPD, it is common belief that their motives are compensatory in nature, and less common to question, do some act of primarily simple motives? Example, what if someone has grown up with a far above average amount of attention, and then later in the life, their key challenge is that other adults/peers are less attentive? Or what if someone has grown up with a far above average amount of emotional support, but then later in life, their key challenge is that other adults/peers are less supportive (i.e., expect the person to be more self-supporting)?

Of course with AsPD types who commit crimes, it's perfectly understandable that we are outraged, and not very sympathetic to the reasons why, but not everyone who is diagnosed as AsPD commits crimes. If we take crime out of the picture, does that change our thinking? Understandably not if they present a cold, aloof, manipulative, etc., persona, it's also hard to be sympathetic, even though their reasons for being so, if compensatory, we still talking about someone who is struggling with core self-esteem damage under the hood.

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Sorry for the thread derail. To the OP, yes I think there is overlap between the cluster B types, because there is much overlap in the core motives. How they act and react to those motives varies quite a lot, but it can be helpful to look past the coping mechanisms to the motives behind them.