Dependent Personality Disorder (DPD) is characterized by a chronic pattern of fearing separation and an inability to be self-reliant. Individuals with DPD often display an urgent need to be taken care of and to maintain significant relationships, which can result in submissive and needy behavior.
Anxiety and apprehension to an excessive degree characterize DPD, a cluster C personality disorder. Manifesting in numerous contexts, it originates before young adulthood and is correlated with substandard performance.
Research suggests that there is a variance in the prevalence of DPD among men and women, with some studies indicating a slightly higher occurrence in women. However, it’s important to approach these statistics with caution due to potential biases in reporting and societal expectations affecting the diagnosis rates.
Dependent Personality Disorder Symptoms
Individuals diagnosed with dependent personality disorder exhibit an excessive reliance on others for decision-making authority. They are incapable of independent decision-making because they require incessant approval from others.
As a result, people who have been diagnosed with DPD have a tendency to prioritize the opinions and requirements of others over their own, as they lack the self-assurance to stand by their own judgments. This may account for the tendency of individuals with DPD to exhibit clinging and passive behavior.
These individuals are unable to endure solitude and exhibit a dread of separation. They experience feelings of isolation and loneliness when they are alone as a result of their excessive reliance on others.
People with DPD are typically pessimistic as well: they anticipate or believe that the worst will occur. They are typically more introverted, dread rejection, and are more sensitive to criticism.
Diagnosis and Comorbidity
Dependent personality disorder has been defined under the Diagnostic and Statistical Manual of Mental Disorders (DSM). It denotes an extreme and all-encompassing desire for care, characterized by clingy and submissive conduct as well as apprehensions regarding isolation.
The disorder is indicated by at displaying least five of the following factors:
- 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 their life.
- Has difficulty expressing disagreement with others because of fear of loss of support or approval.
- Has difficulty initiating projects or doing things on their 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 alone because of exaggerated fears of being unable to care for themselves.
- 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 themselves.
The Shedler-Westen Assessment Procedure (SWAP-200) is a diagnostic instrument that was introduced in an effort to address shortcomings in the DSM, including the restricted external validity of the diagnostic criteria for dependent personality disorder. It was developed as a potential alternative nosological system as a result of endeavors to establish an approach to personality disorders grounded in empirical evidence; it maintains the intricate nature of clinical practice.
Dependent personality disorder is regarded as a clinical prototype within the SWAP-200 framework. It provides composite description characteristic criteria, such as personality tendencies, as opposed to discrete symptoms.
The traits that define dependent personality disorder according to SWAP-200 are:
- They tend to become attached quickly and/or intensely, developing feelings and expectations that are not warranted by the history or context of the relationship.
- Since they tend to be ingratiating and submissive, people with DPD tend to be in relationships in which they are emotionally or physically abused.
- They tend to feel ashamed, inadequate, and depressed.
- They also feel powerless and tend to be suggestible.
- They are often anxious and tend to feel guilty.
- These people have difficulty acknowledging and expressing anger and struggle to get their own needs and goals met.
- Unable to soothe or comfort themselves when distressed, they require involvement of another person to help regulate their emotions.
Dependent personality disorder is sometimes confused with other conditions due to shared characteristics. Its separation from conditions such as borderline personality disorder and avoidant personality disorder is critical, as they all fall under Cluster C personality disorders.
One key difference is that individuals with DPD may not display the impulsivity or fear of abandonment associated with borderline personality disorder. In contrast, the intense anxiety about being criticized or rejected that characterizes avoidant personality disorder differentiates it from the dependence on others seen in DPD.
The shyness and withdrawal in social situations, often encountered in DPD, may suggest comorbidity with anxiety disorders. The diagnosis process requires a thorough evaluation to differentiate symptoms that overlap with these disorders. A familial predisposition to anxiety disorders may contribute to the development of DPD, as a twin study conducted in 2004 identified a 0.81 heritability for personality disorders as a whole.
Etiology
The specific cause of dependent personality disorder remains unknown. A 2012 twin study found that between 55% and 72% of the risk of the illness is inherited from one’s parents.
Identical twins share 100% of the genetic material, while fraternal twins share on average 50% — meaning that they are genetically similar to other siblings. By comparing how similar the two types of twin pairs are on a particular trait, researchers can determine how much of the variation between individuals can be explained by genes and environment, respectively.
The researchers discovered that genes could account for two-thirds of the variation in avoidant and dependent personality disorder features, with the most relevant contextual factors being unique to each twin. Environmental impacts can include anything that contributes to the differences between twins in a pair, such as the influence of different friends, teachers, activities, or life events.
“It is important to emphasize that the term heritability does not refer to individuals per se. Heritability is a statistic that relates to the population as a whole, and is expressed as a proportion of how much the total variation in a trait, such as personality disorders, is influenced by genes,”
said PhD first author of the study Line C. Gjerde. This also does not mean that personality disorders are not treatable. Gjerde emphasized that the strong genetic influence found in the study does not imply any form of determinism.
Cultural influences, such as gender role expectations, can have an impact on the accuracy of diagnosis, as the distinction between “dependent personality” and “dependent personality disorder” is in part subjective.
Dependent qualities in children have been found to be associated with overprotective and authoritarian parenting styles. Thus, the risk of developing dependent personality disorder increased because these parenting features can prevent kids from establishing a feeling of autonomy, instead teaching them that others are powerful and competent.
Early traumatic or unfavorable experiences, such as neglect and abuse or significant sickness, might raise an individual’s risk of developing personality disorders later in life, including dependent personality disorder. This is especially true for people who suffer high interpersonal stress and low social support.
Psychosocial Impact
People with dependent personality disorder often find their relationships heavily influenced by their dependency needs. They fear rejection and abandonment, which can lead to them being overly submissive and clingy in relationships. This behavior can strain partnerships and friendships, as the individual with DPD constantly seeks reassurance and support, often to an excessive degree.
- Fears of separation: May cause avoidance of disagreements, leading to unhealthy dynamics.
- Impacts on social life: Individuals may have a limited social circle, as their need for dependency and reassurance might be off-putting to others, causing social withdrawal or isolation.
In the workplace, their dependency can manifest as a reluctance to take on responsibilities, leading to challenges in professional growth. They may struggle with decision-making, needing constant guidance and reassurance from supervisors or colleagues.
- Work relationships: They may form attachment to specific coworkers or managers, looking to them to make decisions.
- Fear of abandonment: Can result in a reluctance to change jobs or take on roles that require autonomy, limiting career development opportunities.
Approaches to Treatment
Psychotherapy is the cornerstone of treatment for Dependent personality disorder. Several types of therapy may be beneficial:
Cognitive-behavioral therapy (CBT): Aims to address and restructure maladaptive thought patterns, empowering individuals to develop more adaptive behaviors and a healthier level of independence.
Psychodynamic psychotherapy: Focuses on exploring past experiences, emotional patterns, and unconscious processes that contribute to dependent behaviors, helping patients understand and change their relational dynamics.
These therapeutic modalities work by developing patients’ self-efficacy and autonomy. Research on treatment approaches for DPD indicates a variety of options, although concerns exist about the best methods for long-term efficacy.
While psychotherapy addresses the psychological aspects of DPD, medication may be used as an adjunct treatment, particularly when comorbid conditions such as anxiety or depression are present. Antidepressants could be prescribed to alleviate these symptoms. However, the use of medication must be carefully considered to avoid reinforcing dependent behaviors.
References:
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC
- Beitz, Kendra; Bornstein, Robert F. (2006). Dependent Personality Disorder. In Fisher, Jane E.; O’Donohue, William T. (eds.). Practitioner’s Guide to Evidence-Based Psychotherapy. Boston, Massachusetts: Springer ISBN 978-0-387-28369-2
- Bornstein, R. F. (1992). The dependent personality: Developmental, social, and clinical perspectives. Psychological Bulletin, 112, 3‐23
- Coolidge, F. L., Thede, L. L., & Jang, K. L. (2004). Are personality disorders psychological manifestations of executive function deficits? Bivariate heritability evidence from a twin study. Behavior genetics, 34(1), 75–84
- Faith, Chasidy (2009) Dependent Personality Disorder: A Review of Etiology and Treatment, Graduate Journal of Counseling Psychology: Vol. 1: Iss. 2, Article 7
- Gjerde, L. C.; Czajkowski, N.; Røysamb, E.; Ørstavik, R. E.; Knudsen, G. P.; Østby, K.; Torgersen, S.; Myers, J.; Kendler, K. S.; Reichborn-Kjennerud, T. (2012). The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire. Acta Psychiatrica Scandinavica. 126 (6): 448–457. doi: 10.1111/j.1600-0447.2012.01862.x
- Ng, H. M., & Bornstein, R. F. (2005). Comorbidity of dependent personality disorder and anxiety disorders: A meta‐analytic review. Clinical Psychology: Science and Practice, 12, 395‐406
- Perry, J. C. (1996). Dependent personality disorder. In Gabbard, Glen O.; Atkinson, Sarah D. (eds.). Synopsis of Treatments of Psychiatric Disorders. American Psychiatric Press ISBN 978-0-88048-859-4
- Simonelli, Alessandra; Parolin, Micol (2017). Dependent Personality Disorder. Encyclopedia of Personality and Individual Differences. Springer, Cham. ISBN 978-3-319-28099-8
- Zimmerman, Mark (1994). Diagnosing DSM-IV-R Psychiatric Disorders in Primary Care Settings: An Interview Guide for the Nonpsychiatrist Physician. Psych Products. ISBN 978-0-9633821-3-9