People with a HPD view themselves as sociable, friendly, and agreeable, and, in fact, they are often perceived as very charming at the beginning of a relationship. However, as the relationship continues, the charm seems to wear thin and they gradually are seen as overly demanding and in need of constant reassurance. Given that being direct involves the risk of rejection, they often use more indirect approaches such as manipulation to try to gain attention but will resort to threats, coercion, temper tantrums, and suicide threats if more subtle methods seem to be failing.

Histrionic people are so concerned about eliciting external approval that they learn to value external events over their own internal experience. With so little focus on their own internal life, they are left without any clear sense of identity apart from other people and see themselves primarily in relation to others. In fact, their own internal experience can feel quite foreign and uncomfortable to them and at times they actively avoid self-knowledge, not knowing how to deal with it. Having some vague sense of the superficial nature of their feelings may also encourage them to shy away from true intimacy with another person for fear of being “found out.” Because they have paid little attention to their own in- ternal resources, they have no idea how to respond when depth is required in a relationship. Thus, their relationships tend to be very shallow, superficial, and based on role playing.