10. Dependent personality disorder

Dependent personality disorder is characterized by a lack of self-confidence and an excessive need to be taken care of. The person needs a lot of help to make everyday decisions and needs important life decisions to be taken for him or her. He or she greatly fears abandonment and may go to considerable lengths to secure and maintain relationships. A person with dependent personality disorder sees him- or her-self as inadequate and helpless, and so abdicates personal responsibility and puts his or her fate in the hands of one or more protective others; he or she imagines being at one with these protective others whom he or she idealises as being competent and powerful, and towards whom he or she behaves in a manner that is ingratiating and self-effacing. People with dependent personality disorder often assort with people with a cluster B personality disorder, who feed from the unconditional high regard in which they are held.

Dependent Personality Disorder Symptoms

By PSYCH CENTRAL STAFF

Dependent personality disorder is characterized by a long-standing need for the person to be taken care of and a fear of being abandoned or separated from important individuals in his or her life. This leads the person to engage in dependent and submissive behaviors that are designed to elicit care-giving behaviors in others. The dependent behavior may be see as being “clingy” or “clinging on” to others, because the person fears they can’t live their lives without the help of others.
Individuals with Dependent Personality Disorder are often characterized by pessimism and self-doubt, tend to belittle their abilities and assets, and may constantly refer to themselves as “stupid.” They take criticism and disapproval as proof of their worthlessness and lose faith in themselves. They may seek overprotection and dominance from others. Occupational functioning may be impaired if independent initiative is required. They may avoid positions of responsibility and become anxious when faced with decisions. Social relations tend to be limited to those few people on whom the individual is dependent.
Chronic physical illness or Separation Anxiety Disorder in childhood or adolescence may predispose an individual to the development of dependent personality disorder.
A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture. The pattern is seen in two or more of the following areas: cognition; affect; interpersonal functioning; or impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.

Symptoms of Dependent Personality Disorder

Dependent personality disorder is characterized by a pervasive fear that leads to “clinging behavior” and usually manifests itself by early adulthood. It includes a majority of the following symptoms:

• Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
• Needs others to assume responsibility for most major areas of his or her life
• Has difficulty expressing disagreement with othersbecause of fear of loss of support or approval
• Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy)
• Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant
• Feels uncomfortable or helpless when alonebecause of exaggerated fears of being unable to care for himself or herself
• Urgently seeks another relationship as a source of care and support when a close relationship ends
• Is unrealistically preoccupied with fears of being left to take care of himself or herself

Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year.
Dependent personality disorder is diagnosed in between 0.5 and 0.6 percent of the general population.
Like most personality disorders, dependent personality disorder typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s.

How is Dependent Personality Disorder Diagnosed?

Personality disorders such as dependent personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood or genetic tests that are used to diagnose dependent personality disorder.
Many people with dependent personality disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.
A diagnosis for dependent personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.

Causes of Dependent Personality Disorder

Researchers today don’t know what causes dependent personality disorder. There are many theories, however, about the possible causes of dependent personality disorder. Most professionals subscribe to a biopsychosocial model of causation — that is, the causes of are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children.

Treatment of Dependent Personality Disorder

Treatment of dependent personality disorder typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to help with specific troubling and debilitating symptoms. For more information about treatment, please see dependent personality disorder treatment.

Dependent Personality Disorder

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Dependent personality disorder (DPD) is one of the most frequently diagnosed personality disorders. It occurs equally in men and women, usually becoming apparent in young adulthood or later as important adult relationships form.

What Are the Symptoms of DPD?

People with DPD become emotionally dependent on other people and spend great effort trying to please others. People with DPD tend to display needy, passive, and clinging behavior, and have a fear of separation. Other common characteristics of this personality disorder include:

• Inability to make decisions, even everyday decisions like what to wear, without the advice and reassurance of others.
• Avoidance of  adult responsibilities by acting passive and helpless. Dependence on a spouse or friend to make decisions like where to work and live.
• Intense fear of abandonment and a sense of devastation or helplessness when relationships end. A person with DPD often moves right into another relationship when one ends.
• Oversensitivity to criticism.
• Pessimism and lack of self-confidence, including a belief that they are unable to care for themselves.
• Avoidance of disagreeing with others for fear of losing support or approval.
• Inability to start projects or tasks because of a lack of self-confidence.
• Difficulty being alone.
• Willingness to tolerate mistreatment and abuse from others.
• Placing the needs of their caregivers above their own.
• Tendency to be naive and to fantasize.

What Causes DPD?

Although the exact cause of DPD is not known, it most likely involves both biological and developmental factors. Some researchers believe an authoritarian or overprotective parenting style can lead to the development of dependent personality traits in people who are susceptible to the disorder.

How Is DPD Diagnosed?

A diagnosis of DPD must be distinguished from borderline personality disorder, as the two share common symptoms. In borderline personality disorder, the person responds to fears of abandonment with feelings of rage and emptiness. With DPD, the person responds to the fear with submissiveness and seeks another relationship to maintain his or her dependency.

If most or all the (above) symptoms of DPD are present, the doctor will begin an evaluation by taking a thorough medical and psychiatric history and possibly a basic physical exam. Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests to rule out physical illness as the cause of the symptoms.

If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist, psychologist, or other health care professional trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder.

How Is DPD Treated?

As is the case with many personality disorders, people with DPD generally do not seek treatment for the disorder itself. Rather, they might seek treatment when a problem in their lives -- often resulting from thinking or behavior related to the disorder -- becomes overwhelming, and they are no longer able to cope. People with DPD are prone to developing depression or anxiety, symptoms that might prompt the individual to seek help.

Dependent Personality Disorder

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How Is DPD Treated? continued...

Psychotherapy (a type of counseling) is the main method of treatment for DPD. The goal of therapy is to help the person with DPD become more active and independent, and to learn to form healthy relationships. Short-term therapy with specific goals is preferred when the focus is on managing behaviors that interfere with functioning. It is often useful for the therapist and patient together to pay attention to the role of therapist in order to recognize and address ways in which the patient may form the same kind of passive reliance in the treatment relationship that happens outside of treatment.  Specific strategies might include assertiveness training to help the person with DPD develop self-confidence and cognitive-behavioral therapy (CBT) to help someone develop new attitudes and perspectives about themselves relative to other people and experiences.  More meaningful change in someone's personality structure usually is pursued through long-term psychoanalytic or psychodynamic psychotherapy, where early developmental experiences are examined as they may shape the formation of defense mechanisms, coping styles, and patterns of attachment and intimacy in close relationships.  

Medication might be used to treat people with DPD who also suffer from depression or anxiety. However, medication therapy must be carefully monitored because the person might become dependent on or abuse the drugs.

What Are the Complications of DPD?

People with DPD are at risk for depression, anxiety disorders, andphobias, as well as substance abuse. They are also at risk for being abused because they may find themselves willing to do virtually anything to maintain the relationship with a dominant partner or person of authority.

What Is the Outlook for People With DPD?

With psychotherapy (counseling), many people with DPD can learn how to make more independent choices in their lives.

Can DPD Be Prevented?

Although prevention of the disorder might not be possible, treatment of DPD can sometimes allow a person who is prone to this disorder to learn more productive ways of dealing with situations. 

The development of personality structure is a complex process that begins from an early age.  Psychotherapy aimed at modifying personality may be more successful when begun early, when the patient is highly motivated for change, and when there is a strong working relationship between the therapist and patient.

Dependent personality disorder is a mental health condition in which people depend too much on others to meet their emotional and physical needs.

Causes

Cause of dependent personality disorder is unknown. The disorder usually begins in childhood. It is one of the most common personality disorders and is equally common in men and women.

Symptoms

People with this disorder do not trust their own ability to make decisions. They may be very upset by separation and loss. They may go to great lengths, even suffering abuse, to stay in a relationship.

Symptoms of dependent personality disorder may include:

• Avoiding being alone
• Avoiding personal responsibility
• Becoming easily hurt by criticism or disapproval
• Becoming overly focused on fears of being abandoned
• Becoming very passive in relationships
• Feeling very upset or helpless when relationships end
• Having difficulty making decisions without support from others
• Having problems expressing disagreements with others

Exams and Tests

Dependent personality disorder is diagnosed based on a psychological evaluation that assesses the history and severity of the symptoms.

Treatment

Talk therapy is considered to be the most effective treatment. The aim is to help people with this condition make more independent choices in life. Medicines may help treat other mental health conditions, such as anxiety or depression, that occur along with this disorder.

Outlook (Prognosis)

Improvements are usually seen only with long-term therapy.

Possible Complications

• Alcohol or drug abuse
• Depression
• Increased likelihood of physical, emotional, or sexual abuse

When to Contact a Medical Professional

See your health care provider or a mental health professional if you or your child has symptoms of dependent personality disorder.

References

Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA. Personality and personality disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Elsevier Mosby; 2008:chap 39.

Update Date: 11/17/2012

Updated by: Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.