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DEPENDENT PERSONALITY DISORDER
 


Prediction: Lasts For Decades

      Occupational-Economic:
  • Avoids positions of responsibility and becomes anxious when faced with decisions
      Wisdom vs Irrationality: N/A
      Courage vs Negative Emotion:
  • Separation anxiety, dependence on others, submissiveness, inability to handle conflict
  • Social life limited to those few people on whom the individual is dependent
      Community vs Detachment: N/A
      Moderation vs Disinhibition: N/A
      Justice vs Antagonism: N/A
      Medical: N/A


SYNOPSIS

Dependent Personality Disorder F60.7 - ICD10 Description, World Health Organization

Dependent personality disorder is characterized by pervasive passive reliance on other people to make one's major and minor life decisions, great fear of abandonment, feelings of helplessness and incompetence, passive compliance with the wishes of elders and others, and a weak response to the demands of daily life. Lack of vigour may show itself in the intellectual or emotional spheres; there is often a tendency to transfer responsibility to others.
Dependent Personality Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with dependent personality disorder needs to show at least 5 of the following criteria:

  • 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 his or her life.

  • Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)

  • Has difficulty initiating projects or doing things on his or her 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 himself or herself.

  • 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 himself or herself.
Like all personality disorders, dependent personality disorder is a deeply ingrained and enduring behaviour pattern, manifesting as an inflexible response to a broad range of personal and social situations. This behavior represents an extreme or significant deviation from the way in which the average individual in a given culture relates to others. This behaviour pattern tends to be stable. It causes subjective distress and problems in social performance.

Core Features & Social Functioning

Individuals with this disorder grow up having excessive separation anxiety. They have an excessive need to be taken care of that leads to submissiveness, clinging behavior and fears of separation. The core feature of this disorder is negative emotion (separation insecurity, anxiousness, submissiveness). This disorder is only diagnosed if: (1) it begins no later than early adulthood, (2) these behaviors occur at home, work, and in the community, and (3) these behaviors lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Lack Of Social Skills And Personality Disorders

There are social skills that are essential for healthy social functioning. Individuals with dependent personality disorder lack the essential social skills of independence, assertiveness, and peacemaking.

    Social Skills That Are Lacking In Dependent Personality Disorder

    SOCIAL SKILL LOW LEVEL HIGH LEVEL
    Independence Dependence on others Freedom from the control, influence, or support of others; not fearing separation from others
    Assertiveness Submissiveness Being confident and direct in claiming one’s rights or putting forward one’s views
    Peacemaking Inability to handle conflict Skillfully preventing (or handling) conflict within a group or family

Dependent personality disorder and avoidant personality disorder are so closely related that they are referred to as the "negative emotion" cluster of personality disorders.

    Social Skills That Are Lacking In The "Negative Emotion" Cluster Of Personality Disorders

    PERSONALITY DISORDER LACKING LACKING LACKING
    Avoidant Personality Self-Confidence (instead has feeling inferior or shy) Optimism (instead has pessimism or expecting the worst) Belonging (instead has fearing rejection by others)
    Dependent Personality Independence (instead has dependence on others) Assertiveness (instead has submissiveness) Peacemaking (instead has inability to handle conflict)

Dependent Traits

Dependency and separation anxiety are developmentally appropriate in children and adolescents. However, in some, the dependency and separation anxiety becomes excessive. Most adolescents grow out of their dependency and separation anxiety; however, for some it increases. By early adulthood, if this dependency and separation anxiety becomes very pervasive and persistent; it is diagnosed as being dependent personality disorder. Individuals with this disorder fear rejection/separation, are submissive, and are unable to handle conflict. These individuals do not trust their own ability to make decisions. They go to great lengths, even suffering abuse, to stay in a relationship. They usually have feelings of inadequacy, hypersensitivity to criticism, and an excessive need for reassurance.

    Dependent Traits
    • 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 his or her life.
    • Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)
    • Has difficulty initiating projects or doing things on his or her 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 himself or herself.
    • 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 himself or herself.

Effective Therapies

The effectiveness of treatment for this disorder is unknown because there are no randomized controlled trials. However, amongst clinicians, there is a consensus that improvements are usually seen only with long-term therapy. Cognitive behavior therapy and interpersonal therapy are believed to be partially effective. Antidepressant medication may help treat the anxiety and depression that often accompanies this disorder.

Which Behavioral Dimensions Are Involved?

The ancient Greek civilization lasted for 1,300 years (8th century BC to 6th century AD). The ancient Greek philosophers taught that the 5 pillars of their civilization were: wisdom, courage, community, moderation, and justice. Psychiatry named the opposite of each of these 5 ancient themes as being a major dimension of psychopathology (i.e., irrationality, negative emotion, detachment, disinhibition, and antagonism). (Psychology named these same factors the "Big 5 dimensions of personality": "intellect", "neuroticism", "extraversion", "conscientiousness", and "agreeableness")

    Dependent Personality Disorder: Negative Emotions
            Wisdom vs Irrationality: N/A
            Courage vs Negative Emotion:
      • Separation anxiety, dependence on others, submissiveness, inability to handle conflict
      • Social life limited to those few people on whom the individual is dependent
            Community vs Detachment: N/A
            Moderation vs Disinhibition: N/A
            Justice vs Antagonism: N/A

Prevalence

Dependent personality disorder is more frequent in females, and is present in about 0.6% of the general population.

Course

Dependent personality disorder usually has a chronic course. Chronic physical illness and separation anxiety disorder in childhood or adolescence predisposes the individual to develop this disorder.

Complications

Dependent personality disorder has an increased risk of: depression; alcohol or drug abuse; physical, emotional, or sexual abuse.

Comorbidity

Some other disorders frequently occur with this disorder:

    Non-Personality Disorders

            Depressive Disorders:
      • Persistent depressive disorder (dysthymia)
            Anxiety Disorders:
      • Separation anxiety disorder, panic disorder, agoraphobia

    Personality Disorders

            Negative Emotion Cluster:
      • Avoidant personality disorder Note: Avoidant and dependent personality disorders are closely related since they both share the same core feature of negative emotion [anxiousness]. If an individual has one of these personality disorders, they are very likely to have the other.
            Antagonistic Cluster:
      • Borderline and histrionic personality disorders

Associated Laboratory Findings

No laboratory test has been found to be diagnostic of this disorder.

Primate Evolution

There appears to be three different ways in which primates have evolved socially:
  • The chimpanzees have evolved to be socially antagonistic, competitive, callous, and manipulative. Thus chimpanzee social behavior most closely mirrors the antagonistic behavior of the antisocial-narcissistic-borderline-histrionic cluster of personality disorders.

  • In contrast, the bonobos have evolved to be socially anxious, peaceful, cooperative, and loving. Thus bonobo social behavior most closely mirrors the negative emotion (anxious) behavior of the avoidant-dependent cluster of personality disorders.

  • Another separate evolutionary path was followed by the orangutans. They evolved to become solitary hermits. Thus orangutan social behavior most closely mirrors the detached behavior of the paranoid-schizoid-schizotypal cluster of personality disorders.

Core Behaviors Of The Negative Emotion Cluster Of Personality Disorders

Charles Darwin In 1842 With His Eldest Son

Charles Darwin is one of the most influential figures in human history; yet he suffered from avoidant personality disorder. Darwin was eminent as a naturalist, geologist, biologist, and author; and is best known for his explanation of human and animal evolution. However, he so feared public speaking that his friends had to deliver many of his lectures. Likewise, Darwin would not attend public debates of his theories, in that controversy upset him so. For years, he delayed publishing his greatest work, "The Origin Of The Species", because he feared the controversy it would generate. When he died, Darwin was so well-respected that he was buried in Westminster Abbey, close to Isaac Newton. Darwin is an excellent example of how a person can rise above their personality disorder.

The core feature of the avoidant-dependent cluster of personality disorders is negative emotion (anxiousness). Individuals with these disorders suffer from: (1) social anxiety which makes them hypersensitive to rejection/embarrassment (so they avoid relationships), and/or (2) separation anxiety which makes them hypersensitive to separation/loss (so they become overly dependent). In adulthood, if the social anxiety predominates; they develop avoidant personality disorder. If the separation anxiety predominates; they develop panic disorder, depression, or dependent personality disorder.

    Negative Emotion: The Core Feature Of The Negative Emotion Cluster Of Personality Disorders

    • anxiousness:
      Most days in the past week, did you have intense feelings of nervousness, tenseness, or worry?
    • separation insecurity:
      Most days in the past week, did you fear rejection by - or separation from - the significant people in your life?
    • submissiveness:
      Most days in the past week, in a disagreement were you willing to give in to others because you feared their anger or rejection?

Parental Behaviors Which Increase The Risk Of Developing A Personality Disorder

Research has shown that genetic, environmental, and prenatal factors all play important roles in the development of personality disorder. Recent research has also shown that low parental affection and harsh parenting increase the risk of a child later developing a personality disorder.

"Low affection" was defined as: low parental affection, low parental time spent with the child, poor parental communication with the child, poor home maintenance, low educational aspirations for the child, poor parental supervision, low paternal assistance to the child's mother, and poor paternal role fulfillment. "Harsh parenting" was defined as: harsh punishment, inconsistent maternal enforcement of rules, frequent loud arguments between the parents, difficulty controlling anger toward the child, possessiveness, use of guilt to control the child, and verbal abuse.

Setting Goals In Therapy

    Questions To Ask When Setting Goals

    In The Past Week:
    • WHO: was your problem?
    • EVENT: what did he/she do?
    • RESPONSE: how did you respond to that event?
    • OUTCOME: did your response help?
    • TRIGGER: what did you do that could have triggered this problem?
    • GOAL: what life skill(s) do you have to work on? (from checklist)

    Example Of Setting Goals In Interviewing A Person With Dependent Personality Disorder

    In The Past Week:
    • WHO: was your problem?
      "My boyfriend."

    • EVENT: what did he/she do?
      "I just found out he's sleeping with my best girlfriend."

    • RESPONSE: how did you respond to that event?
      "I felt so angry at both of them. I couldn't stand for this, but I couldn't walk out on my boyfriend. So I don't know what to do."

    • OUTCOME: did your response help?
      "No, I'm paralyzed - I don't want to lose either my girlfriend or my boyfriend. But my doing nothing about this is making me sick."

    • TRIGGER: what did you do that could have triggered this problem?
      "This isn't the first time that my boyfriend has cheated on me, but I never do anything about it."

    • GOAL: what life skill(s) do you have to work on? (from checklist)
      "I want to work on: (1) Independence ("not fearing rejection, being alone, or being temporarily separated from loved ones"), and (2) Assertiveness ("being confident and direct in claiming one’s rights or putting forward one’s views")."

Description

Stories

Free Diagnosis Of This Disorder

Rating Scales


SWAP-200 DPD - measures the severity of dependent personality disorder

Treatment

Research

Other Web Pages

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