Dependent Personality Disorder
What is Dependent Personality Disorder?
This disorder is characterized by a pervasive pattern of dependent and submissive behavior. Individuals with dependent personality disorder demonstrate a clinging helplessness and docility and are searching for support and reassurance.
Persons with this disorder subordinate their own needs to those of others, and in a submissive way get others to assume responsibility for major areas of their lives. They will appear self-deprecating. They feel a sense of inferiority and are willing to abdicate self-responsibility and self-control to others. They often times will tolerate intimidation and abuse in hopes of avoiding loneliness and abandonment. They may experience intense discomfort when left alone even for brief periods of time.
Freud described this type of personality as being characterized by pessimism, fear of sexuality, self-doubt, passivity, suggestibility, and lack of perseverance.
Persons with this disorder tend to avoid positions of responsibility and have difficulty making decisions without an excessive amount of advice and reassurance from others. They may become anxious if asked to assume leadership roles, as they prefer the submissive role.
It is more common in women than in men. Persons with chronic physical illness in childhood may be prone to this disorder.
How is it diagnosed?
History: The psychiatric interview and mental status exam are the primary methods utilized by the practitioner. The physician looks for symptoms of a pervasive and excessive need to be taken care of that lead to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts.
According to the DSM-IV, there are eight categories of identifiable behaviors called personality traits for the dependent personality. The individual must present five or more of the following eight personality traits to justify the diagnosis:
- has difficulty making everyday decisions with 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 others because 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);
- 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 alone because 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;
- or is unrealistically preoccupied with fears of being left to take care of himself or herself.
Physical exam is not helpful in diagnosing this disorder. Observation of the individual's orientation, dress, mannerisms, behavior and content of speech provide essential signs to diagnose the illness.
Tests: Various psychological tests can be performed to help identify and classify personality disorders. The interpretations of these tests are used in conjunction with the history.
How is Dependent Personality Disorder treated?
Treatment requires a trusting relationship between the therapist and patient. This can be difficult as motivation for treatment often comes from someone other than the person with the disorder.
Psychological treatment may include family and group therapy, group living situations and self-help groups.
Behavior-changing techniques involve the learning of social skills, reinforcement of appropriate behavior, setting limits on inappropriate behavior, learning to express feelings, self analysis of behavior and accepting accountability for actions.
Medications
No medication will cure or treat a personality disorder.
Drugs may be prescribed for treatment of additional illnesses:
- Antidepressants for depression; anxiety medications.
- Antipsychotic drugs for psychoses.
Prozac (Fluoxetine), Valium (Diazepam), Ativan (Lorazepam)
What might complicate it?
Individuals with dependent personalities require a relationship to feel validated. Complications will most likely occur when difficulty arises in relating to other people at work or at home. Loss of the person upon whom they are dependent can lead to an episode of major depression, generalized anxiety, or panic. At work, particular problems might arise if they are assigned to work independently or without close supervision. A coexisting psychiatric disorder (major depression, panic attacks, and general anxiety) may intensify their already dysfunctional behavior, as can the use of illegal substances.
Predicted outcome
In general, dependent personality disorder is one of the less severe types of personality disorders, comparatively speaking. Successful outcomes have been reported when one or more of the psychotherapies are utilized. The most common problem areas encountered in these individuals are with occupational problems and with relationships.
Alternatives
The personality traits found in the dependent personality are also found in many other psychiatric disorders especially histrionic and borderline personality disorders. Dependent behavior is also seen in persons with agoraphobia (fear of public places), but can be differentiated from dependent personality disorder by their high levels of anxiety and even panic.
Appropriate specialists
Psychiatrist or psychologist.
Last updated 3 April 2018