A man’s desire to attract attention in a social setting, his concern with his appearance, flirtatiousness, or strong expression of emotion does not, in itself, indicate histrionic personality disorder. What characterizes histrionic personality disorder is a persistent pattern, beginning in early adulthood and recurring across different areas of life, marked by excessive emotional expression, a need to be the center of attention, and significant impairment in interpersonal functioning. In the DSM-5-TR, histrionic personality disorder is still classified among the Cluster B personality disorders. The ICD-11, by contrast, increasingly evaluates personality disorders not primarily through the question of “which type does this belong to?” but through the severity of impairment in self and interpersonal functioning and the individual’s predominant personality traits. For this reason, the “histrionic man” does not constitute a separate psychiatric diagnosis. Rather, the term is used here as a clinical framework for understanding how histrionic personality traits, or histrionic personality disorder, may be organized and expressed in a man.
Being Visible, or Being Truly Seen?
On the surface of the histrionic pattern, there is often a message that says, “Notice me.” Yet the psychoanalytic perspective is concerned less with the behavior itself than with its psychological function. The question that needs to be asked is: Why does the person need to be seen so persistently? In some histrionic organizations, attention from others is not merely a pleasant experience; it becomes one of the central regulators that sustains self-worth. Being admired, desired, perceived as impressive, or leaving a powerful impression in a social environment may create a temporary sense of inner cohesion. When attention diminishes, feelings of emptiness, worthlessness, shame, anger, or abandonment may become more pronounced. For this reason, dramatic behavior in the histrionic man does not necessarily arise from “excessive self-confidence.” On the contrary, beneath an elaborate or striking self-presentation, there may be a fragile system of self-esteem. Contemporary theories of personality likewise focus not only on externally visible symptoms but also on identity integration, self-direction, empathy, and the capacity for intimacy. In recent years, the convergence between the psychodynamic object relations perspective and contemporary models of personality has been especially emphasized.
Why Might the Histrionic Pattern Look Different in Men?
Histrionic personality disorder has historically been associated more strongly with women. However, it remains debated to what extent this association reflects a genuine difference in prevalence and to what extent it reflects diagnostic and cultural biases. Contemporary clinical sources note that women may receive the diagnosis more frequently, whereas some epidemiological studies suggest that prevalence rates in women and men may be relatively similar. Therefore, the claim that “histrionic personality is specific to women” cannot be scientifically defended. Social norms surrounding masculinity may also alter the clinical presentation. Attention-seeking that might appear more overtly in a woman as theatrical emotionality or seductiveness may, in some men, be expressed through different channels such as charisma, status, physical appearance, displays of achievement, occupying the center of a social circle, romantic conquests, competitiveness, or exaggerated displays of self-confidence. An important distinction is necessary here: none of these features is pathological in itself. From a psychoanalytic perspective, what matters is whether the person feels compelled to use them to regulate self-worth, avoid the experience of rejection, or control the relationship.
Psychoanalytic Origins: From “Hysteria” to Histrionic Personality
The historical roots of the concept of histrionic personality extend back to early psychoanalytic studies of “hysteria.” Today, however, it would be incorrect to use hysteria and histrionic personality disorder as synonymous terms. In classical psychoanalytic literature, hysteria refers to a much broader field of conflict, defenses, and symptoms, whereas modern histrionic personality disorder describes a specific personality pattern. The contribution of the contemporary psychodynamic perspective is that it does not reduce histrionic behavior to simple “attention-seeking.” The search for attention may often be the outward expression of deeper relational schemas. Within the person’s inner world, being lovable and being desirable may become confused with one another. Implicit beliefs such as “If they want me, I am valuable,” “If they do not notice me, I am insignificant,” or “The intensity of a relationship proves that it is love” may begin to organize relationships. In such a case, the individual’s way of relating may come to serve less as a means of genuinely knowing and being curious about the other person and more as a way of producing a particular sense of self through the other person’s gaze.
Defense Mechanisms
In histrionic personality organization, defenses classically associated with the pattern include repression, denial, dissociative processes, regression, sexualization, and acting out. In more severe levels of personality organization, more primitive defenses such as splitting, idealization, and devaluation may also become part of the clinical picture. There is, however, an important point to consider: the same “histrionic” behavior may arise from different structural levels in different individuals. One person may have a relatively integrated identity at a neurotic level while displaying prominent histrionic features; in another person, a similar outward presentation may coexist with more severe identity diffusion and primitive defenses. For this reason, in Kernberg’s object relations approach, the name of the personality disorder is less important than the degree of identity integration, the defenses used, the capacity for reality testing, and the internalized relational patterns. Contemporary studies indicate that this structural approach to assessment overlaps substantially with the DSM alternative model for personality disorders and the ICD-11 approach to personality functioning.
The “Stage” in Romantic Relationships
Romantic relationships may initially be experienced with considerable intensity by a man with prominent histrionic traits. A partner may be rapidly idealized; the degree of intimacy may be perceived as deeper than it actually is, and the excitement of the early relationship may be interpreted as evidence of a “unique bond.” Difficulties may begin, however, when the relationship becomes more ordinary, calm, and routine. In some histrionic organizations, excitement does not merely provide pleasure; it may also function as proof of psychological aliveness. As the relationship settles, this calmness may be experienced as “the love is gone.” Creating new excitement, provoking jealousy, generating dramatic conflicts, or introducing the gaze of third parties into the relationship may then become, without full awareness, a way of reviving intimacy. There is a paradox here: the person may have a powerful need for closeness while simultaneously fearing the vulnerability that genuine intimacy requires. Seduction may initiate closeness, but when true emotional nakedness begins, mechanisms of escape may come into play.
Masculinity, Sexuality, and Self-Worth
For the histrionic man, sexuality may be more than a domain of pleasure; it may also become a domain for regulating identity and self-worth. The number of partners, sexual attractiveness, the sense of being a “desired man,” or romantic competition may all serve the function of helping the individual feel valuable. From a psychoanalytic perspective, it is important to examine the relationship between sexuality and love. The person may feel powerful when desired, yet vulnerable when genuinely loved, because love requires being seen beyond performance. For this reason, a clinical approach that focuses only on reducing flirtatious behavior remains superficial. The fundamental question is whether the person can still experience himself as valuable within a relationship when there is no performance to offer.
Transference and Countertransference
In psychodynamic therapy, histrionic patterns are often carried into the consulting room. The client may wish to gain the therapist’s attention, impress the therapist, believe that a uniquely special relationship has been established, or become “unforgettable” in the therapist’s eyes. This does not necessarily represent conscious manipulation; rather, it may be the re-emergence within the therapeutic relationship of a relational style the person has used throughout life. The therapist, in turn, may find themselves feeling impressed, entertained, seduced, pulled into a protective role, or at times exhausted or suspicious. In psychodynamic therapy, such countertransference reactions are not merely obstacles; they can be used as clinical data for understanding the client’s relational world. At the same time, the clear maintenance of therapeutic boundaries is especially essential.
The Aim of Treatment Is Not to Become “Less Dramatic”
Research specifically addressing treatment for histrionic personality disorder remains limited compared with that for some other personality disorders. Nevertheless, a recent psychotherapy study involving 159 patients diagnosed with histrionic personality disorder reported that positive changes in the patient-therapist relationship were systematically associated with treatment outcomes. In the broader personality disorder literature, scientific support for psychodynamic psychotherapy has strengthened in recent years. A comprehensive systematic review published in 2023 reported moderate-quality evidence for psychodynamic psychotherapy in personality disorders and identified it as an effective treatment option. The aim of psychoanalytic treatment is not to make the person less colorful, less emotional, or less attractive. Rather, the aim is to help the individual develop a more stable sense of self that does not depend entirely on attention and approval; to process emotions through thought and language rather than theatrical action; to differentiate love from admiration and intimacy from seduction; and to experience the other person in relationships not merely as a “mirror,” but as a separate subject. In contemporary psychodynamic approaches such as transference-focused psychotherapy, understanding defenses, internalized objects, and recurrent relational patterns as they unfold within therapy remains central to the work.
Conclusion: Who Remains When the Applause Stops?
To describe the histrionic man simply as “addicted to attention,” a “womanizer,” or “dramatic” would be to caricature a complex personality organization. From a psychoanalytic perspective, the central question is not how much attention the person attracts, but what happens to the sense of self when attention is absent. If being seen has become proof of existence, being desired proof of worth, and standing at the center of the stage proof of being loved, then beneath the performance may lie a profoundly fragile inner world. Therapy begins precisely here: in the creation of a new relational experience, in a room without applause, where the person can be seen without performing, can be lovable without captivating, and can exist without stepping onto a stage.
Kaynakça
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