Histrionic personality disorder (HPD) and narcissistic personality disorder (NPD) both involve attention-seeking behavior, but they differ in a fundamental way: people with HPD crave any kind of attention, positive or negative, while people with NPD specifically seek admiration that confirms their sense of superiority. That core distinction shapes how each disorder looks in relationships, emotional expression, and daily life.
The Core Motivation Behind Each
Both disorders fall within the same diagnostic cluster (Cluster B personality disorders), which is why they’re so often confused. They share a tendency toward dramatic, exhibitionistic, and seductive behavior. But the engine driving that behavior is different.
With HPD, the central need is to be noticed. People with this disorder feel uncomfortable when they’re not the center of attention, and they’ll use emotional displays, physical appearance, or provocative behavior to draw people in. The type of attention matters less than its presence. Negative attention still satisfies the underlying need.
With NPD, the central need is to feel superior. People with this disorder have a grandiose sense of self-importance and expect others to recognize them as exceptional, even without accomplishments to match. They seek positive attention specifically because it validates their inflated self-image, and they tend to react poorly to criticism or negative feedback. The attention isn’t the point; the confirmation of their specialness is.
Emotional Style and Expression
One of the most visible differences between the two disorders is how emotions show up. People with HPD are emotionally expressive to an exaggerated degree. Their feelings shift rapidly, come across as theatrical, and often seem shallow or performative to others. Their speech tends to be impressionistic and vague, heavy on emotion but light on detail. This creates an impression of someone who feels intensely in the moment but moves on quickly.
People with NPD present very differently. Their emotional style tends to be controlled, calculated, and often cold. Where someone with HPD might burst into tears at a party to recapture attention, someone with NPD is more likely to steer a conversation back to their achievements or quietly dismiss someone who isn’t offering enough admiration. The behavior of someone with NPD has a quality of being deliberate and goal-oriented, while someone with HPD is more spontaneous and reactive.
Empathy and Relationships
This is where the two disorders diverge most sharply. A lack of empathy is one of the defining features of NPD. People with this disorder struggle to recognize or care about what others feel, and they may exploit relationships to get what they want. They can be dismissive of people who don’t serve their need for validation, and they sometimes mistreat those who fail to admire them.
People with HPD, by contrast, are capable of genuine empathy, warmth, and concern for others, though their emotional expression can sometimes come across as performative. They tend to be warm and playful in relationships rather than cold or exploitative. They can also be dependent on others and highly suggestible, easily influenced by the people around them. One hallmark of HPD is perceiving relationships as more intimate than they actually are, which reflects a desire for closeness rather than a desire for control.
In short: someone with NPD might use a relationship as a tool. Someone with HPD might idealize a relationship beyond what it really is.
How Each Is Diagnosed
Both disorders require at least five characteristic traits to be present, beginning in early adulthood and showing up across multiple areas of life rather than in isolated situations.
For HPD, the eight possible traits include:
- Discomfort when not the center of attention
- Inappropriately sexual or provocative interactions
- Rapidly shifting, shallow emotions
- Using physical appearance to draw attention
- Vague, impressionistic speech
- Theatrical, exaggerated emotional expression
- Being easily influenced by others
- Viewing relationships as closer than they are
For NPD, the nine possible traits include:
- Grandiose sense of self-importance
- Fantasies of unlimited success, power, or beauty
- Belief in being “special” or unique
- Demanding excessive admiration
- Sense of entitlement
- Exploiting others
- Lack of empathy
- Envy of others, or believing others envy them
- Arrogant, haughty behavior
Gender and Diagnostic Bias
NPD is diagnosed far more often in men. In clinical settings, roughly 75% of NPD diagnoses go to men and 25% to women. In the general population, the split is less dramatic but still significant: about 7.7% of men compared to 4.4% of women. However, this gap likely reflects diagnostic bias rather than a true gender difference. The traits used to define NPD (entitlement, superiority, assertiveness) overlap heavily with stereotypically masculine behavior. Women who present with narcissistic traits may be misdiagnosed with HPD, borderline personality disorder, or dependent personality disorder because their symptoms map more closely onto traits associated with femininity, like emotional vulnerability or low self-esteem.
HPD has historically been diagnosed more frequently in women, though this too has drawn criticism as potentially reflecting gendered assumptions about emotional expressiveness and attention-seeking behavior. The overlap between these biases means some people may carry a diagnosis that reflects cultural expectations as much as their actual symptoms.
What Treatment Looks Like
Neither disorder has a quick fix, but both respond to long-term psychotherapy. The approaches differ because the underlying problems differ.
For HPD, one well-studied approach is clarification-oriented psychotherapy, which unfolds in stages. Early sessions focus on building trust between the therapist and patient. From there, the therapist helps the person recognize their own patterns, specifically how their attention-seeking strategies create problems in relationships. The central work involves uncovering the deeper thought patterns and beliefs that drive the behavior, then gradually replacing them with healthier alternatives. The final stage focuses on practicing new ways of interacting with people in everyday life. A study of 159 patients who completed this approach found meaningful reductions in both general and disorder-specific symptoms.
For NPD, therapy is often more challenging because the disorder itself can make people resistant to the idea that something is wrong. Treatment typically involves helping the person develop greater awareness of how their behavior affects others, building the capacity for empathy, and addressing the fragile self-esteem that often lurks beneath the grandiose exterior. Progress tends to be slow, and maintaining a therapeutic relationship is itself part of the work, since people with NPD may devalue or drop therapists who challenge their self-image.
Can Someone Have Both?
Yes. Personality disorders frequently co-occur, and someone can meet the diagnostic criteria for both HPD and NPD simultaneously. When they overlap, you might see a person who is both emotionally theatrical and grandiose, craving attention while also insisting on being seen as superior. In practice, clinicians look at which traits are most prominent and causing the most difficulty, then tailor treatment accordingly. The presence of empathy (or its absence) is often one of the clearest signals for distinguishing which disorder is primary.