Dependent personality disorder is a psychiatric disorder in which a person feels the compelling need to be psychologically dependent on other people for the most basic tasks and decisions.
What Is Dependent Personality Disorder (DPD)?
Dependent personality disorder (DPD) is a type of anxious personality disorder in which a person feels the compelling need to depend on others for day-to-day decision-making and basic functioning. People with this disorder display a long-term enduring pattern of passivity, submission, and fear of separation when it comes to relationships. It is also known as an altruistic personality disorder.
People with this psychiatric disorder suffer from low self-esteem, pessimism, low confidence, and fears of criticism and rejection. This cripples them from functioning normally in different social settings, forcing them to adopt maladaptive behaviors and practices. They compulsively rely on or cling on to other people for the most basic of tasks, validation, and approval.
They excessively attach themselves to their “caregivers” and display pathological “gratitude” in their avoidance or delegation of responsibilities. They also have distorted perceptions of reality, frequently suffering from severe insecurity and fears of separation and abandonment. Because of this, they strive to maintain these relationships at all costs, often going to great lengths of passivity, submission, unconditional obedience, and/or abuse.
Like any other personality disorder, DPD “manifests in patients as a comorbidity to other forms of mental illness”. Its patients suffer from poor and frequently broken relationships and this destabilizes their already fragile emotional and psychological resilience. In fact, studies 1 Reich J. (1991). Avoidant and dependent personality traits in relatives of patients with panic disorder, patients with dependent personality disorder, and normal controls. Psychiatry research, 39(1), 89–98. https://doi.org/10.1016/0165-1781(91)90011-d show that people with DPD, in the aftermath of unsuccessful relationships, display fears of loneliness or isolation, depressive moods, and self-harm tendencies. They also show suicidal tendencies and other life-threatening forms of self-inflicted violence.
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Understanding Dependent Personality Disorder (DPD)
Most cases of DPD have their diagnosis in late childhood or early adulthood. According to research 2 Dependent personality disorder. (n.d.). SpringerLink. https://link.springer.com/chapter/10.1007/978-0-387-28370-8_22 , it is more common in women and families with twins or siblings than men and single-child families.
DPD is a relatively new mental health disorder, having evolved from an abstract idea rooted in a historic and psychoanalytic context to a codified diagnosis 3 Disney K. L. (2013). Dependent personality disorder: a critical review. Clinical psychology review, 33(8), 1184–1196. https://doi.org/10.1016/j.cpr.2013.10.001 in psychiatric manuals. For instance, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists dependent personality disorder as a cluster C personality disorder, characterized by a pervasive psychological and physical dependence on other people that negatively affects the patient’s quality of life, careers, and social relationships.
Clinically, the dimensionality of dependent personality disorder involves:
- Attachment behaviors
- Dependent behaviors
Still many confuse a “dependent personality” with the “dependent personality disorder”, because of which DPD falls beneath the radar of timely or proper psychiatric diagnosis. DPD is also connected to a large number of suicide-related mental illnesses 4 Vaidyanathan, U., Patrick, C. J., & Iacono, W. G. (2011). Patterns of comorbidity among mental disorders: a person-centered approach. Comprehensive psychiatry, 52(5), 527–535. https://doi.org/10.1016/j.comppsych.2010.10.006 (like depression, anxiety disorders, bipolar disorders, etc.) and experts recommend its early precise diagnosis to prevent its more severe consequences. The disorder can be easily treated via a number of therapies, medication, and self-help strategies that increase a person’s sense of self-sufficiency and confidence.
What Are The Symptoms Of Dependent Personality Disorder (DPD)?
According to one 2004 study 5 Gude, T., Hoffart, A., Hedley, L., & Rø, Ø. (2004). The dimensionality of dependent personality disorder. Journal of personality disorders, 18(6), 604–610. https://doi.org/10.1521/pedi.18.6.604.54793 , “the criteria for dependent personality disorder (DPD) in DSM-4 appear to fall into two categories: dependent and attachment behaviors”. It further elaborates that the disorder is loaded on obsessive attachment and dependency that come with the fear of abandonment and functional incompetence. These factors vary in intensity in the signs of dependent personality disorders displayed by its patients, depending on the context and disabilities in adequate functioning.
However, some of the symptoms of dependent personality disorder are uniform, including:
- Excessive attachment
- Over–dependency and clingy behavior
- Excessive fear of abandonment/separation
- Excessive anxiety
- Extreme passivity
- Severe submission
- Despair or helplessness in the aftermath of a relationship breakup
- Avoidance of responsibilities
- Tendency to seek validation from others
- Excessive fear of rejection and loneliness
- Oversensitivity to criticism
- Pessimism
- Lack of self–confidence
- Social avoidance
- Inability to make simple decisions
- Poor interpersonal relationships
Read More About Loneliness Here
What Causes Dependent Personality Disorder (DPD)?
The various dependent personality disorder causes include:
1. Childhood Trauma
Research 6 Kane, F. A., & Bornstein, R. F. (2018). Unhealthy dependency in victims and perpetrators of child maltreatment: A meta-analytic review. Journal of clinical psychology, 74(6), 867–882. https://doi.org/10.1002/jclp.22550 shows that “dependency may be both a precipitant of child maltreatment and consequence of victimization”. Therefore, people who have a history of childhood trauma 7 Grover, K. E., Carpenter, L. L., Price, L. H., Gagne, G. G., Mello, A. F., Mello, M. F., & Tyrka, A. R. (2007). The relationship between childhood abuse and adult personality disorder symptoms. Journal of personality disorders, 21(4), 442–447. https://doi.org/10.1521/pedi.2007.21.4.442 , involving physical, emotional, and sexual abuse sometimes excessively lean on the support of others for their wellbeing. In the process, they develop a higher risk of a DPD diagnosis.
Read More About Emotional Abuse Here
2. Parental Abuse
DPD is also linked to experiences of overprotective and authoritarian parental behavior and parenting strategies. Conversely, according to a 2019 study 8 Steele, K. R., Townsend, M. L., & Grenyer, B. (2019). Parenting and personality disorder: An overview and meta-synthesis of systematic reviews. PloS one, 14(10), e0223038. https://doi.org/10.1371/journal.pone.0223038 , “maladaptive parenting, including childhood maltreatment, abuse and neglect” also fuels risks of DPD. Dependency is also learnt behavior, and so family histories 9 Gjerde, L. C., Czajkowski, N., Røysamb, E., Orstavik, R. E., Knudsen, G. P., Ostby, 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. https://doi.org/10.1111/j.1600-0447.2012.01862.x of DPD also make people vulnerable to it.
3. Abusive Relationships
People who have been in abusive relationships or experienced abusive behavioral patterns like bullying, financial abuse, and intimate-partner abuse tend to develop DPD. In fact, cases of DPD are particularly high amongst individuals with high interpersonal stress and poor social support.
4. Chronic Illness
People with disabilities or chronic illnesses often rely on others for their everyday functioning and, hence, they tend to develop the traits and symptoms of dependent personality disorder.
5. Personality Traits
Studies has confirmed the presence of dependent personality disorder traits in people diagnosed with the disorder. People are more prone to DPD when they have personalities inclined to negativity, including:
- Low self-esteem
- Lack of confidence
- Impulsivity
- Intimacy avoidance
- Attention seeking
- Detachment and withdrawal
- Depressive
- Anxiety
- Separation insecurity
Read More About Anxiety Here
6. Cultural Influences
Individuals may develop DPD due to cultural or religious practices that put mandatory emphasis on social hierarchies and dictate over-reliance on authority. For instance, research 10 Tyrer, P., Mulder, R., Crawford, M., Newton-Howes, G., Simonsen, E., Ndetei, D., Koldobsky, N., Fossati, A., Mbatia, J., & Barrett, B. (2010). Personality disorder: a new global perspective. World psychiatry : official journal of the World Psychiatric Association (WPA), 9(1), 56–60. https://doi.org/10.1002/j.2051-5545.2010.tb00270.x links gender role expectations to high incidences of DPD in women, in comparison to men.
What Is The Diagnosis For Dependent Personality Disorder (DPD)?
The diagnostic coding listed for dependent personality disorder in the DSM-5, the International Classification of Diseases (ICD-11), and the Psychodynamic Diagnostic Manual (PDM) have been frequently used by clinicians, medical practitioners, and researchers. These conceptualize dependent personality disorder in terms of four related components: cognitive, motivational, behavioral, and emotional.
According to one 2020 study, this diagnostic criteria has been abbreviated as “A-L-T-R-U-M-I-S-T-I-C” and involves:
- A: Adjustment mood disorder association
- L: Love of attachment for validation or worthiness
- T: Terror of abandonment
- R: Relationships that are self-initiated for over-dependency
- U: Unconscious and unpredictable behavior
- M: Major depressive symptoms
- I: Inability to deal with loneliness or broken relationships
- S: Suicidal ideation or tendencies of self-harm
- T: Taking on victimhood to gain empathy support for worthlessness
- I: Inability to independently care for oneself
- C: Cyclical and emotional lability
Diagnostic Instruments For Dependent Personality Disorder (DPD)
Even though DPD is a relatively new mental health disorder, a large number of clinical tools are developed and readily available for its differential diagnosis. Because it is one of the disorders in the broad spectrum of personality disorders (PD), screening tests 11 Morse, J. Q., & Pilkonis, P. A. (2007). Screening for personality disorders. Journal of personality disorders, 21(2), 179–198. https://doi.org/10.1521/pedi.2007.21.2.179 related to PD are often used to diagnose patients of DPD. These include:
- Dependent Personality Questionnaire (DPQ 12 Tyrer, P., Morgan, J., & Cicchetti, D. (2004). The Dependent Personality Questionnaire (DPQ): a screening instrument for dependent personality. The International journal of social psychiatry, 50(1), 10–17. https://doi.org/10.1177/0020764004038754 )
- Shedler-Westen Assessment Procedure (SWAP-200 13 Wood, J. M., Garb, H. N., Nezworski, M. T., & Koren, D. (2007). The Shedler-Westen Assessment Procedure-200 as a basis for modifying DSM personality disorder categories. Journal of abnormal psychology, 116(4), 823–836. https://doi.org/10.1037/0021-843X.116.4.823 )
- Dependent Personality Inventory (DPI)
- Big Five Inventory (BFI 14 Soto, C. J., & John, O. P. (2017). The next Big Five Inventory (BFI-2): Developing and assessing a hierarchical model with 15 facets to enhance bandwidth, fidelity, and predictive power. Journal of personality and social psychology, 113(1), 117–143. https://doi.org/10.1037/pspp0000096 )
- IIP Personality Disorder Scales (IIP-PD 15 Stern, B. L., Kim, Y., Trull, T. J., Scarpa, A., & Pilkonis, P. (2000). Inventory of Interpersonal Problems Personality Disorder scales: operating characteristics and confirmatory factor analysis in nonclinical samples. Journal of personality assessment, 74(3), 459–471. https://doi.org/10.1207/S15327752JPA7403_9 )
- Temperament and Character Inventory (TCI-SD 16 Preiss, M., Kucharová, J., Novák, T., & Stepánková, H. (2007). The temperament and character inventory-revised (TCI-R): a psychometric characteristics of the Czech version. Psychiatria Danubina, 19(1-2), 27–34. )
- Iowa Personality Disorder Screen (IPDS 17 Beitel, M., Peters, S., Savant, J. D., Cutter, C. J., Cecero, J. J., & Barry, D. T. (2015). The psychometric properties of the iowa personality disorder screen in methadone-maintained patients: an initial investigation. Journal of personality disorders, 29(1), 131–144. https://doi.org/10.1521/pedi_2013_27_081 )
- Interpersonal Relations Assessment (IRA 18 Stepp, S. D., Pilkonis, P. A., Yaggi, K. E., Morse, J. Q., & Feske, U. (2009). Interpersonal and emotional experiences of social interactions in borderline personality disorder. The Journal of nervous and mental disease, 197(7), 484–491. https://doi.org/10.1097/NMD.0b013e3181aad2e7 )
What Is The Treatment For Dependent Personality Disorder (DPD)?
Dependent personality disorder treatment has no specific methodology and the disorder is usually treated via a combination of psychotherapy, medication, and self-help strategies. For instance, a 2020 study 19 Ramsay, G., & Jolayemi, A. (2020). Personality Disorders Revisited: A Newly Proposed Mental Illness. Cureus, 12(8), e9634. https://doi.org/10.7759/cureus.9634 recommending how to treat dependent personality disorder states that mental health service providers should “stabilize patient mood with medications, provide individual cognitive therapy with coping mechanism strategy instruction, and encourage group therapy.”
1. Psychotherapies
According to a 1998 study 20 Psychotherapy: Definitions, mechanisms of action, and relationship to Etiological models. (n.d.). SpringerLink. https://link.springer.com/article/10.1023/A:1022678622119 , psychotherapies involve “a modality of treatment in which the therapist and patients work together to ameliorate psychopathologic conditions and functional impairment”. This therapeutic relationship explores the patient’s attitudes, thoughts, affect, and behavior, and social context and development. For treatment of dependent personality disorder, medical practitioners often resort to different types of psychotherapy, including:
- Cognitive behavioral therapy (CBT)
- Dialectical behavior therapy (DBT)
- Acceptance and commitment therapy (ACT)
- Integrated therapy 21 Livesley J. (2008). Integrated therapy for complex cases of personality disorder. Journal of clinical psychology, 64(2), 207–221. https://doi.org/10.1002/jclp.20453 , etc.
These therapies address 22 Maccaferri, G. E., Dunker-Scheuner, D., De Roten, Y., Despland, J. N., Sachse, R., & Kramer, U. (2020). Psychotherapy of Dependent Personality Disorder: The Relationship of Patient-Therapist Interactions to Outcome. Psychiatry, 83(2), 179–194. https://doi.org/10.1080/00332747.2019.1675376 the maladaptive traits, tendencies of extreme dependence, depressive moods, and other complex thought processes in patients with DPD. In the process 23 Gabbard G. O. (2000). Psychotherapy of personality disorders. The Journal of psychotherapy practice and research, 9(1), 1–6. , the patients develop new perspectives and attitudes about themselves, other people, and their developmental experiences—thereby enhancing their quality of life. Psychotherapies, in DPD, work best when supplemented 24 Versaevel C. (2012). Personnalité dépendante et dépendance affective : stratégies psychothérapeutiques [Dependent patient and interpersonal dependency: psychotherapeutic strategies]. L’Encephale, 38(2), 170–178. https://doi.org/10.1016/j.encep.2011.08.006 by self-help techniques.
Read More About Cognitive Behavioral Therapy (CBT) Here
2. Medication
Research 25 Gitlin M. J. (1993). Pharmacotherapy of personality disorders: conceptual framework and clinical strategies. Journal of clinical psychopharmacology, 13(5), 343–353. shows that medication can effectively treat the symptom clusters within and across personality disorders and their subtypes. Recently, in severe cases of DPD, use of monoamine oxidase inhibitors, fluoxetine, and carbamazepine has shown great promise.
3. Self-help Strategies
According to experts, understanding how to overcome dependent personality disorder is both a personal realization and a situation in need of external support. Patients with DID are usually recommended specific strategies like assertiveness training, stress management techniques, and mindfulness strategies that help shape their:
- Self-sufficiency
- Coping styles
- Defense mechanisms
- Attachment and intimacy patterns
- Relationship dynamics
- Social skills
- Life skills, such as decision-making, self-reliance, assertion, etc.
Takeaway
Dependent personality disorder is a highly crippling mental health condition that makes it challenging for individuals to carry out everyday tasks. If left untreated, it impacts their careers and personal relationships. However, it can be effectively managed by availing of a large number of therapies, medications, and self-help techniques.
Dependent Personality Disorder At A Glance
- Dependent personality disorder (DPD) is a mental health disorder in which a person feels the compulsion to psychologically rely on other people for everyday functioning.
- Its symptoms include fear of abandonment, clingy behavior, submissiveness, low self-esteem, etc.
- It is caused by a number of factors: childhood trauma, parental abuse, chronic illness, etc.
- If untreated, it negatively impacts a person’s personal and professional lives and social relationships.
- It can be easily addressed by a combination of therapies, medication, and self-help strategies.
Frequently Asked Questions (FAQs)
1. What triggers a person with a dependent personality disorder?
Negative memories or experiences related to childhood trauma, parental abuse, and chronic illness can trigger a person with a dependent personality disorder.
2. What is an example of dependent personality disorder?
Lacking the confidence to make simple everyday decisions without reassurance or input from others is an example of dependent personality disorder.
3. Is dependent personality disorder considered a disability?
Dependent personality disorder (DPD) is a frequently diagnosed mental disorder fostering rigid and maladaptive dysfunctional traits that ‘disable’ a person’s everyday functioning. It causes serious impairments in occupational and social functioning.
4. Can DPD be cured?
Dependent personality disorder, like any other personality disorder, cannot be cured. It is a life-long condition with long-term consequences, but it can be easily managed with therapies, medication, etc.