Dependent personality disorder (DPD) is a mental disorder characterized by a recurring pattern of needy behavior. Individuals suffering from this disorder have an uncontrollable need to be cared for or protected by others and develop socially deviant personality traits that are designed to encourage others to provide that support.
- This need for assistance usually derives from fear of abandonment and a lack of self-confidence.
The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), defines dependent personality disorder as a Cluster C (anxious/fearful) personality disorder that impairs an individual’s ability to make rational decisions, enjoy healthy self-esteem and exhibit enough independence to live a productive and satisfactory life.
Signs of dependent personality disorder typically emerge clinically in early adulthood (18+).Men and women can be diagnosed with DPD but the majority of DPD sufferers are women. Psychiatrists haven’t pinpointed the reasons behind development of DPD but theorize its establishment begins following abandonment in childhood by one or more parents/guardians, authoritarian parenting styles and/or general consequences of living in a dysfunctional environment. While other personality disorders may have genetic components (especially schizoid or obsessive-compulsive) dependent personality disorder appears to be less genetic and more psychosocial in nature.
According to the DSM-5, people suffering from dependent personality disorder show up to 8 distinct symptoms. These symptoms are:
- Have difficulty making most decisions without first receiving advice, input and/or reassurance from others
- Hesitate to start projects or disagree with others because they don’t want to risk disapproval or rejection
- Make excuses for not being responsible and completing tasks they should complete themselves
- Have an excessive need for constant attention, nurturance and emotional support from others
- Fear abandonment so much they often remain in dysfunctional or abusive relationships
- Are afraid of being alone, even for a short time
- Regularly requiring others to shoulder their responsibilities
- Unwillingness to disagree with others for fear of disapproval
- Inability to independently start activities or projects
- A willingness to allow others to impose rather than face any form of rejection
- Emotional vulnerability and helplessness
- Excessive need to enter a new relationship after the end of another
- Absolute conviction of inability to care for self or perform daily activities alone
- May be manipulative and untruthful to gain the constant support of others
These symptoms may manifest in many different ways, depending on the exact circumstances of the person suffering from the disorder. Two very common manifestations of these symptoms are self-deprecation and interpersonal relationships that can be described as “clingy”.
- Very often people suffering from this disorder do not maintain any meaningful relationships with anyone who does not provide some sort of support.
Dependent personality disorder is also commonly co-diagnosed with mood disorders, anxiety disorders and two other personality disorders called avoidant and histrionic personality disorder. People with avoidant personalities are shy, easily hurt by disapproval or criticism and tend to avoid jobs or activities involving contact with others. Histrionic personalities exaggerate the immature and attention-seeking qualities characterizing those with BPD, such as rapid mood shifts, exaggeration of emotions/situations, self-centeredness and making poor decisions.
A psychologist or psychiatrist can diagnose dependent personality disorder by providing patients with self-assessment tests, observing a patient’s verbal and non-verbal behavior and gathering a narrative history of the patient’s life. Interview-type evaluations commonly used to quantify dependent personality disorder include the Structured Interview for Diagnosis of Personality and the Structured Clinical Interview for DSM Personality Disorders.
- Dependent personality disorder is diagnosed in approximately 0.5% of the population.
While there are many environmental factors that can cause dependent personality disorder, children that experience separation anxiety disorder or any type of chronic physical illness are particularly likely to be predisposed to this disorder and more likely to be diagnosed with it at a later point in their life.
Diagnosis for dependent personality disorder generally requires a mental health professional. General practitioners may be able to identify basic signs, and pediatricians in particular are likely to be able to identify predisposition in a child if they are well informed, but only mental health professionals are able to accurately diagnose the disorder.
Like most personality disorders, this is because the symptoms of dependent personality disorder can be easily confused with similar disorders or with symptoms of certain types of substance abuse. Mental health professionals can make an accurate diagnosis after a psychological examination, either in a controlled setting, in the field, or sometimes in both settings.
According to clinical studies, the prevalence of personality disorders with alcoholism ranges from as low as 22-40% to as high as 58-78%. The studies have focused primarily on antisocial and borderline personality disorders, however, almost the whole spectrum of personality disorders can be encountered in alcohol dependence, such as the dependent, avoidant, paranoid and others.
An Oxford study indicated 40% or alcohol use disorder clients had at least 1 personality disorder. For more in-depth information, see this research alcohol & personality disorders.
People diagnosed with personality disorders have high rates of drug or alcohol addictions. A study involving 255 subjects with substance abuse problems found that participants with dependent, borderline, narcissistic or antisocial personality types represented nearly 85 percent of the study subjects. This study also offered addiction treatment but discovered people with one of these four personality disorders were more likely to terminate the treatment prematurely.
Self-medicating anxiety, panic at being alone and depression are the main reasons why someone with dependent personality disorder abuses addictive substances. In addition, people with DPD may also develop eating disorders (binging, purging and excessive eating) or become addicted to chat rooms and dating sites on the Internet to avoid feeling abandoned and alone. Treating the addiction with medically-managed detoxification and professional recovery programs must come first before the personality disorder can be addressed successfully.
In a study done in 2012 (In-depth study of personality disorders in first-admission patients with substance use disorders) they discovered 46% of the substance abuse (SUD) patients had at least one Personality Disorder (16% antisocial [males only]; 13% borderline; and 8% paranoid, avoidant, and obsessive-compulsive, respectively).
Cluster C disorders were as prevalent as Cluster B disorders. SUD patients with PDs were younger at the onset of their first SUD and at admission; used more illicit drugs; had more anxiety disorders, particularly social phobia; had more severe depressive symptoms; were more distressed; and less often attended work or school.
Treating DPD is a long-term process involving cognitive behavioral therapy; talk therapy and antidepressant (SSRI) medications. Psychodynamic therapy may be helpful to the patient for identifying past and present environmental factors contributing to their DPD and improving life and coping skills needed to raise their self-esteem and ability to act independent of others.
Like most personality disorders, the most effective treatment for dependent personality disorder treatment is long term psychotherapy. The symptoms of dependent personality disorder are a consequence of fear, which derives from a lack of trust. This statement is true for other personality disorders, like psychotypal personality disorder, but unlike most other personality disorders, this lack of trust doesn’t drive the person away from other people. Instead it drives them to an uncontrollable need to maintain those relationships at all cost.
- Treatment for dependent personality disorder is based on shoring up that lack of trust and helping the patient to understand that their relationships are not constantly at risk.
Once that trust is built, they are usually able to gain increased self-confidence and decreased need for constant support.
Finally, because this disorder fades with age in almost everyone who suffers it, in milder cases treatment may focus almost entirely on symptoms. Between medication (which is only meaningfully effective to treat secondary symptoms) and mental training, symptoms can be ameliorated, allowing the patient to live a reasonably normal lifestyle until they simply age out of the disorder.
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