Overview
Dependent Personality Disorder is characterized by a disproportionate reliance on others, marked by difficulties in making basic decisions, submissiveness, and a constant need to be looked after. This dependency is not a product of circumstance or compulsion, and is not appropriate to the age or developmental stage of the individual.
Symptomatic manifestations of Dependent Personality Disorder can significantly hamper functionality, by rendering the individual unable to lead an autonomous life, and have negative outcomes that can lead to further psychological distress.
The disorder is considered to be more prevalent among females, though the effect of gender roles in its assessment is widely contemplated.
Etiological factors such as genetic factors, temperamental traits including neuroticism and agreeableness, dominant parenting styles, abuse and trauma, and early illness and separation anxiety during childhood have been associated with the disorder.ย
Psychotherapy is considered to be the most effective treatment for Dependent Personality Disorder, and its use and efficacy can depend on various factors.
Signs and Symptoms
The signs and symptoms of Dependent Personality Disorder are:
- Being unable to make simple daily decisions without help from someone else
- Wanting others to claim responsibility for every choice in the main areas of oneโs life
- Excessive need for advice and reassurance
- Being submissive and following others (often one person in particular)
- Difficulty in expressing disagreement or opposing views
- Finding it hard to take on new tasks by oneself and without help
- Refraining from taking on a responsibility for the fear that someone else can do it better
- Believing that one will be abandoned upon learning to do something independently
- Willingly tolerating abuse in order to maintain relationships (even in the presence of alternate options)
- Feelings of discomfort and helplessness when alone
- Immediately forming other close attachments after a relationship ends to seek support and care
- Constantly and irrationally worrying about being abandoned
- Not being able to handle criticism
Risk Factors
A female preponderance is generally observed in the prevalence of Dependent Personality Disorder, and is considered to be attributable to the higher likelihood of traits such as neuroticism and agreeableness among females.
Gender roles and expectations may also play a part in the sex-based differences, with the possibility of dependent behavior sometimes being fostered among females based on certain societal norms.ย
Genetic correlates of Dependent Personality Disorder are considered, but are also often looked at in the context of trait predisposition, that is to say that genetic factors also influence the appearance of neuroticism and agreeableness, which are associated with the disorder.
Vulnerabilities caused by genetic patterns may also lay down the framework for their interaction with environmental influences, such as parenting styles that are dominating and overbearing and impede the development of adequate self-efficacy, as well as trauma, childhood maltreatment, and early illness. Fearful attachment styles have also been linked to the development of the disorder.
A considerable possibility for comorbidity with other personality disorders exists, and there is often an overlap between the presentation of Dependent Personality Disorder and personality disorders such as Avoidant Personality Disorder, Histrionic Personality Disorder, and Borderline Personality Disorder.
While there may be observable similarities in the manifestation of symptoms, clinical differences can be detected upon conduction of thorough evaluations.
Mood disorders, anxiety disorders, somatic disorders, and eating disorders can also co-occur, and can also be a product of stress and interpersonal disruptions that may arise due to the symptoms of Dependent Personality Disorder.
Diagnosis
The diagnosis of Dependent Personality Disorder is determined after a thorough evaluation that may consist of clinical interviews, questionnaires and assessment tools.
The DSM-5 outlines the following diagnostic criteria for Dependent Personality Disorder:
An excessive and persistent need to be taken care of, leading to submissiveness and fear of separation, beginning in early adulthood and present in various contexts, marked by at least five of the following:
- Difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
- Needing others to assume responsibility for most major areas of oneโs life.
- Difficulty expressing disagreement with others because of fear of loss of support or approval. (Not including realistic fears of retribution).
- Difficulty initiating projects or doing things on oneโs own (due to a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).
- Going to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
- Feeling uncomfortable or helpless when alone because of exaggerated fears of being unable to care for oneself.
- Urgently seeking another relationship as a source of care and support when a close relationship ends.
- Unrealistically preoccupied with fears of being left to take care of oneself.
It is important to consider that dependence borne out of need, or instilled due to abusive conditions does not warrant for a diagnosis of Dependent Personality Disorder.
Treatment
Psychotherapy can be effective in the treatment of Dependent Personality Disorder. Cognitive Behavioral Therapy works identifying maladaptive behaviors such as dependency that arise from harmful beliefs regarding the self, and bringing about stronger perceptions about the self, working on increasing self-efficacy, and reinforcing effective behaviors that promote autonomy.
Psychodynamic modes of treatment will target unconscious conflicts and try to make them more accessible, in order to increase awareness of dependent motives, evaluate them, and act on them in a mindful way. Supportive environments can help individuals deal with any form of anxiety or defensiveness that may arise out of the process.
It is important to consider that the nature of the manifestation of Dependent Personality Disorder can affect the therapeutic framework, as the patient may idealize and become dependent on the therapist. Conversely, the readiness to accept external cues and take advice may be conducive to the efficacy of psychotherapy.
There are no reports of pharmacological interventions specifically directed towards Dependent Personality Disorder. Medication may be prescribed to comorbid disorders, such as depressive disorders or anxiety.
Differential Diagnosis
1. Other mental disorders and medical conditions: Dependent personality disorder must be distinguished from dependency arising as a consequence of other mental disorders and other medical conditions.
2. Other personality disorders and personality traits: Other personality disorders may be confused with dependent personality disorder because they have certain features in common. Namely, borderline personality disorder, histrionic personality disorder, avoidant personality disorder. It is therefore important to distinguish among these disorders based on differences in their characteristic features.
3. Personality changes due to another medical condition: Dependent personality disorder must be distinguished from personality change due to another medical condition, in which the traits that emerge are a result of the effects of another medical condition on the central nervous system.
4. Substance use disorders: Dependent personality disorder must also be distinguished from symptoms that may develop as a result of persistent substance use.
Specialist
Psychiatrists or clinical psychologists with experience dealing with personality disorders may be involved in the diagnosis of Dependent Personality Disorder. Depending on the mode of therapy, a qualified therapist with adequate expertise may manage treatment.
In Conclusion
Most commonly found in females, Dependent Personality Disorder stems from societal norms where women are expected to be submissive, dependent, and under the influence of strong male dominance. This disorder affects personal and professional growth, does not allow a person to have growth ambition, and affects overall confidence and personality.
Therapy helps in identifying the root cause of this disorder, and helps in gradually building confidence in an individual.
If untreated, dependent personality disorder can lead to anxiety and sadness. However, a mental health specialist can assist you in developing new coping mechanisms for challenging circumstances. You can develop your independence and self-assurance. Although it could take some time, a provider can make you feel better.
Book your session and start your journey to feeling independent.
