Dependent - Mental Health Foundation

Dependent Personality Disorder

Dependent personality disorder (DPD), formerly known as asthenic personality disorder, is a fear-based disorder characterized by excessive reliance on others to meet one’s emotional and physical needs, and fear of abandonment, making independence difficult.

DPD can be conceptualized in terms of the following tetrad or group of four:

Cognitive: An image of oneself as helpless and weak, coupled with the belief that other people are powerful and strong in comparison.
Motivational: A craving to get and keep relationships with guardians, providers, and caregivers.
Behavioral: A trying to make personal and social relationships stronger to reduce the chance of rejection and abandonment.
Emotional: Anxiety regarding the opinions of authority figures, fear of abandonment, fear of rejection.

Prevalence

The onset of DPD is usually from childhood to the age of 29. 0.5% adults meet the diagnostic criteria for DPD, and it is 3:2 more common in females than it is in males.

Improvement is possible thanks to long-term therapy.

SYMPTOMS

Symptoms of Dependent Personality Disorder:

The symptoms of DPD include:

Complete passivity – non-resistant, pliable, deferent, meek; unable to express opinions, deal with conflict, or stand up for oneself; extreme submission; suggestible; few interpersonal boundaries
Devastation or helplessness when relationships come to an end
Avoidance of responsibilities
Avoidance of being alone, extreme fear of abandonment, clingy
Extreme emotional response to disapproval or rejection, inability to self-soothe or manage the response
Inability or great difficulty making decisions – would rather let others make them, even if they think their decisions are wrong, so as to avoid disapproval
Anxiety, guilt, shame, feelings of inadequacy, no self-confidence
Pessimistic

DIAGNOSIS

Diagnosing Dependent Personality Disorder:

A physical exam should be done to rule out any medical issues for the symptoms of passivity and listlessness, along with a full review of all mental health history for signs of past or present substance abuse or another personality disorder.

According to the DSM-5, at least five out of the following eight features must be present for a diagnosis of DPD to be made, and they must be persistent:

Difficulty making commonplace decisions without a surplus of input and reassurance from others
Needs others to take over their responsibilities for most major areas of their life
Finds it difficult to communicate a difference of opinion because of fear of loss of support or approval
Finds it difficult to start projects or complete things on their own – due to minimal self confidence in one’s abilities or decisions rather than due to a lack of motivation or energy
Goes to excessive lengths to obtain support and approval from others, to the point of volunteering to do things they don’t find enjoyable at all
Feels anxious or helpless when alone because of excessive fear of being incapable of caring for him/herself
Desperately seeks a new relationship as a source of care and support when a close relationship ends
Is engrossed with unrealistic fear about being abandoned and left to take care of him/herself

CAUSES

Causes of Dependent Personality Disorder:

The exact cause of DPD remains unknown; however, genetic and environmental factors are thought to be contributors. Those at increased risk of developing this condition include:

People with a family history of DPD or another anxiety disorder
Adverse childhood experiences such as neglect, abuse, or a life-threatening illness
History of long-term, abusive relationships, including overbearing, authoritarian, or overprotective parents
Cultural and religious influences and modeled family behavior — although some cultures value passivity and politeness, and these traits should not be classified as part of a mental disorder

COMPLICATIONS

Dependent Personality Disorder complications:

Complications of DPD include alcohol or substance abuse; major depressive disorder; increased likelihood of emotional, sexual, or physical abuse; suicidal behavior; and self-harm.

TREATMENT

Treatment for Dependent Personality Disorder:

Psychotherapy (talk therapy) is the mainstay of treatment for people with DPD. Due to the inflexibility of the fear-filled thoughts, long-term therapy is required while at the same time trying to avoid the person’s dependence on the therapist.

The main aims of this are to:

Make people with this condition more independent by teaching them how to make their own decisions and function without the need of input from others
Provide them with the tools to form healthy relationships with the people around them by improving self-esteem and boosting confidence

People with DPD are also more inclined to be in abusive relationships, and therapy and community help are needed to help encourage the person to get out of the relationship safely and stay out.

Medication

Medications can be prescribed to help with coexisting mood disorders such as depression or anxiety, but people with DPD are disposed to substance abuse, so medications must be monitored carefully.

SYMPTOMS