SAM PAGED ME at 9 p.m., crying. It had started with his hair, which he was convinced was falling out. And although his work as a teacher’s aide had “filled him with love and joy,” he was sure his boss had given him a nasty look at the lunch break, and he felt utterly sick inside. Later Sam had phoned his partner, who had seemed distant. Afraid he was about to be dumped, Sam locked himself in the staff bathroom and cried for almost an hour, failing to finish his work and preventing others from using the facilities.

Sam is a drama queen—a person who reacts to everyday events with excessive emoton and behaves in theatrical, attention-grabbing ways. This type is the friend who derails a casual lunch to tell you a two-hour story about the devastating fight she had with her partner or the co-worker who constantly obsesses about how he is about to lose his job and needs your support to make it through the day. The drama queen worships you one minute and despises you the next, based on overreactions to minor events.

Living or working with drama queens can be draining and disturbing. Such a colleague can curtail your own productivity at the office or even shut down teams as everyone tries to contain the chaos. If you live with a drama queen, you may be bombarded daily with accusations and showy attempts to apologize, leaving you feeling angry, guilty and exhausted. Some drama queens are violent toward others, cut themselves or threaten suicide. The extreme behavior can lead to depression or anxiety in family members and colleagues.

Scientists have begun to understand some of the causes of these destructive traits, which are difficult to change without professional help. At the extreme end of the spectrum, if this behavior pervades most areas of a person’s life, he or she may be diagnosed with a personality disorder. Individuals with borderline personality disorder (BPD), for example, are extremely volatile and impulsive and have wildly tumultuous relationships; those with histrionic personality disorder are highly emotional and attention seeking, with an excessive need for approval. Nevertheless, if you are in a relationship with, or otherwise connected to, a drama queen, a few simple tactics can help you avoid being sucked into his or her spinning world of emotion.

Trauma to Drama
What drives the drama? Childhood trauma might be a trigger in some cases. Psychiatrist Bruce Perry of the ChildTrauma Academy in Houston has found that children who experience trauma—from abuse to natural disasters—undergo changes in brain chemistry affecting regions that make them moody, oversensitive to stimulation, and unable to accurately assess certain social and environmental cues.

Childhood neglect could also be a factor, experts in the field believe. If parents or guardians habitually ignore, discount or dismiss a child’s thoughts, feelings and experiences, the child may decide that dramatic presentations—from dressing provocatively to telling stories of wild adventures or crises—are necessary to get attention.

Genes could contribute as well. Excessive behavior runs in families, according to a 2004 study led by psychiatrist John Gunderson of Harvard Medical School. Gunderson’s team found that 27 percent of the relatives of BPD patients displayed aspects of the disorder’s problematic relationship style as compared with just 17 percent of the relatives of people with other personality disorders. Shared environmental factors—say, particular parenting practices that a child learns—could play a role in this pattern, although Gunderson theorizes that as yet undiscovered genetic variations may also predispose some family members to difficulties with attachment and mood regulation.

Altered Circuitry
Whatever the roots of their personality, the brains of drama queens seem to be constructed differently from those of calmer people. In 2007 psychiatrist Emily Stern and her colleagues at Weill Cornell Medical College used functional magnetic resonance imaging to measure the brain activity of 14 healthy individuals and 16 people with BPD while they performed a task that required reacting to negative, positive and neutral words. The BPD patients displayed diminished activity in part of the brain’s prefrontal cortex that controls planning and emotional reactions when they had to inhibit a response—in this case, pressing a button—to a negative word.

Thus, seriously afflicted drama queens seem to have weaker circuitry for inhibiting inappropriate reactions to negative emotions, making it difficult for them to stop themselves from acting out. Drama queens may also have more intense emotions: the amygdala, an area of the brain that processes feelings, was hyperactive in the BPD patients in the Cornell study.

The results of such faulty wiring leave a trail of distress. The volatility gets in the way of efficiency and congeniality at work and prevents stable, happy relationships at home. Dealing with such people can be difficult, although accepting the theatrics as ingrained in the brain, among other strategies, may help you distance yourself from them and temper the consequences.