Dependent Personality Disorder
Dependent personality disorder (DPD) is a mental health condition characterized by unhealthy and rigid patterns of thought and behavior. These include a fear of being alone, feeling unable to care for oneself, being unable to make decisions or start projects without input and reassurance from others, and being needy and clingy in relationships. Someone with DPD feels extremely dependent on others and struggles to function normally at home, socially, at work, or at school. Intensive treatment with therapy is crucial for learning to change the negative thoughts and to develop healthier relationships.
What is Dependent Personality Disorder?
Any personality disorder is a mental health condition that causes patterns of thoughts, behaviors, and functioning that are not healthy and that are rigid and difficult to change.
Personality disorders make it challenging for a person to relate to others, to have healthy relationships and social lives, or to function at work or in school. Treatment is difficult for these mental health conditions, because those struggling with them often cannot see that the way they think and behave is negative or problematic.
Dependent personality disorder (DPD) is one of 10 personality disorders organized into three clusters by their dominant traits. DPD is categorized as a Cluster C disorder, referring to those characterized by fear and anxiety.
DPD causes a person to feel dependent on others to meet their needs and to fear being abandoned or left alone. It is difficult for someone with DPD to make decisions without reassurance from others. This condition causes someone to be very clingy and needy, which makes relationships difficult.
Types of Dependent Personality Disorder
The official diagnostic criteria for DPD do not list any types or subtypes of the condition. However, psychologist Theodore Millon has written extensively on personality disorders and subtypes and developed a theory of five types of dependent personality disorder:
- Accommodating. This type causes a person to be ingratiating, always trying to please and be submissive to others.
- Disquieted. Disquieted DPD causes a strong need for security and a sense of dread and restlessness.
- Immature. Someone with immature features behaves in a childlike way and may struggle with independence and life skills.
- Ineffectual. This type is characterized by fatigue, lethargy, lack of expression and empathy, and a sense of fatalism.
- Selfless. The selfless type is similar to accommodating, but also causes a person to try to merge their identity with that of another and to want to be an extension of someone else rather than have an independent identity.
Facts and Statistics
Dependent personality disorder is not the most common personality disorder, but it causes some of the greatest disability, affecting all areas of life from relationships to work and more.
- Heritability of dependent personality disorder is as high as between 55 and 72 percent.
- The prevalence of DPD in women and men is similar but may be slightly higher in women.
- The prevalence of any personality disorder in U.S. adults is almost 15 percent, but DPD is one of the least common, with a prevalence of less than one percent.
- Comorbidity between dependent and avoidant personality disorders is common.
- While dependent personality disorder is among the least common of personality disorders, it is one of the types most often addressed in mental health settings.
- DPD is one of the personality disorders that causes the greatest amount of disability and dysfunction.
Symptoms and Diagnosis of Dependent Personality Disorder
In order to get good treatment for DPD and to restore a greater degree of function, an individual must get a professional diagnosis. A psychiatrist or other mental health professional uses medical history, medical examinations, interviews, and observations to determine if a personality disorder like DPD can be diagnosed.
There are several characteristic symptoms of dependent personality disorder that are used to diagnose patients. These include the diagnostic criteria for any personality disorder, which also must be met, including:
- Serious and significant impairments in forming an identity, in self-direction, and in functioning in relationships, often including struggles with empathy and intimacy
- The presence of pathological personality traits, which differ depending on type
- Stability and consistency in these traits and the impairment they cause, over time and in different types of situations
- Traits and impairments in personality and functioning that cannot be explained in a better way by another type of mental illness, a developmental phase, a medical condition, or substance abuse
The diagnosis of DPD must include the above characteristics of a personality disorder. There also must be specific symptoms that are consistent with the criteria for DPD. To be diagnosed, a person must experience several of these symptoms that cause impairment and dysfunction:
- Difficulty making decisions, even simple decisions, without getting reassurance or input from other people
- Asking others to take care of responsibilities and avoiding personal responsibilities
- An inability to start a project or do tasks without having someone else’s support
- Being afraid of disappointing or disagreeing with other people—a fear of doing anything that will risk disapproval
- An extreme and excessive need to get approval and support from others
- Accepting imposition from others and tolerating poor, even abusive treatment, to avoid disapproval or being rejected or abandoned
- Clinginess and neediness in relationships
- Feeling frightened, helpless, and vulnerable when alone
- Obsessive and fearful thoughts of being alone or abandoned
- Seeking out relationships as soon as one has ended
- A pessimistic outlook on life
- Lack of self-confidence, specifically feeling unable to care for oneself
- Submissive and passive behaviors toward others
The symptoms of DPD can also cause serious complications related to an inability to establish healthy relationships and function in various aspects of one’s life. One very serious potential complication is abuse. Someone with DPD is vulnerable to abuse, because they may be submissive and afraid to disappoint anyone or risk being left alone. Other possible complications include poor academic or work performance, isolation, and damaged relationships.
Causes and Risk Factors
The cause of a personality disorder like DPD for any one person is not possible to determine. There are likely many factors that contribute to the development of a personality disorder, like genetics. Family history is known to be a strong risk factor for DPD, which indicates that genetics play a role in causing it. There is also some evidence that parenting styles that are overprotective or authoritarian may trigger the development of DPD.
Other risk factors for DPD include a family history or personal history of any mental illness, childhood traumatic experiences, and chronic physical illness during childhood. Having certain personality traits may also increase the risk of developing DPD: anxiety specifically over separation, low self-esteem, or passivity.
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It is not uncommon for someone with a personality disorder like DPD to have co-occurring disorders, typically other mental illnesses or substance use disorders. Substance abuse is fairly common in people diagnosed with personality disorders, either because they self-medicate with drugs or alcohol or because the misuse of substances trigger symptoms of a latent personality disorder.
Mental illnesses that may co-occur with DBD include depression and social anxiety disorder or any anxiety disorder. Personality disorders in particular often co-occur. One of the most common comorbidities is between dependent and avoidant personality disorders. Avoidant personality disorder belongs to the same cluster of personality disorders and causes social inhibition and an excessive sensitivity to being criticized. It causes a strong fear of rejection and low self-esteem in social situations.
Treatment and Prognosis of Dependent Personality Disorder
DPD and other personality disorders can cause severe impairment in a person’s life. Long-term, residential care is considered the best option for treatment for most people affected by this condition. The symptoms that DPD causes not only make it very difficult for a person to function independently but also to have the healthy and supportive relationships that they crave. Someone with DPD finds it hard to believe there is anything wrong with their thinking, making treatment difficult. A longer, more intense and dedicated treatment plan can help.
There is no medication that treats personality disorders, but some patients may benefit from certain psychiatric drugs, like antidepressants or anti-anxiety medications. The main focus of treatment is therapy. Several types of therapies may be used to help patients, but behavioral therapies are most common. These are therapies that first aim to help the patient realize that their thinking is skewed and then helps them make positive changes to their thinking and behaviors.
Therapeutic treatment for DPD must also rely heavily on developing and managing healthy relationships. For this reason, treatment usually involves couples or family therapy, as well as family psychoeducation, which helps family members learn more about personality disorders and how to support their loved one at home. In addition to therapy, patients in residential care can benefit from a whole range of holistic treatment, including alternative therapies, physical fitness, nutrition, social support, and learning coping strategies.
While recognizing, treating, and managing DPD is challenging, it is possible. The first step is to get a diagnosis, so that an individualized treatment plan can then be implemented. With dedication to treatment, the prognosis for DPD is good and patients can learn to function and have healthier relationships.