Dependent personality disorder

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Dependent personality disorder
BPD 1.png
Specialty Psychiatry, clinical psychology
Symptoms Avoidance of decision-making, fear of abandonment, passive and/or clingy behavior, low social boundaries, oversensitivity to criticism
Complications Codependent or abusive relationships
Risk factors Overprotective strict parenting or authoritarian parenting
Differential diagnosis Borderline personality disorder, Separation anxiety, Avoidant personality disorder
Treatment Psychotherapy

Dependent personality disorder (DPD) is a personality disorder characterized by a pervasive psychological dependence on other people. This personality disorder is a long-term condition [1] in which people depend on others to meet their emotional and physical needs. Dependent personality disorder is a cluster C personality disorder, [2] which is characterized by excessive fear and anxiety. It begins prior to early adulthood, and it is present in a variety of contexts and is associated with inadequate functioning. Symptoms can include anything from extreme passivity, devastation or helplessness when relationships end, avoidance of responsibilities, and severe submission.

Contents

Signs and symptoms

People who have dependent personality disorder are overdependent on other people when it comes to making decisions. They cannot make a decision on their own as they need constant approval from other people. Consequently, individuals diagnosed with DPD tend to place needs and opinions of others above their own as they do not have the confidence to trust their decisions. This kind of behavior can explain why people with DPD tend to show passive and clingy behaviour. These individuals display a fear of separation and cannot stand being alone. When alone, they experience feelings of isolation and loneliness due to their overwhelming dependence on other people. Generally people with DPD are also pessimistic: they expect the worst out of situations or believe that the worst will happen. They tend to be more introverted and are more sensitive to criticism and fear rejection. [3]

Risk factors

People with a history of neglect and an abusive upbringing are more susceptible to develop DPD, specifically those involved in long-term abusive relationships. Those with overprotective or authoritarian parents are also more at risk to develop DPD. Having a family history of anxiety disorder can play a role in the development of DPD as a 2004 twin study found a 0.81 heritability for personality disorders collectively. [4]

Causes

While the exact cause of dependent personality disorder is unknown, [5] a study in 2012 estimated that between 55% and 72% of the risk of the condition is inherited from one's parents. [6] The difference between a "dependent personality" and a "dependent personality disorder" is somewhat subjective, which makes diagnosis sensitive to cultural influences such as gender role expectations. [7]

Dependent traits in children tended to increase with parenting behaviours and attitudes characterized by overprotectiveness and authoritarianism. Thus the likelihood of developing dependent personality disorder increased, since these parenting traits can limit them from developing a sense of autonomy, rather teaching them that others are powerful and competent. [8]

Traumatic or adverse experiences early in an individual's life, such as neglect and abuse or serious illness, can increase the likelihood of developing personality disorders, including dependent personality disorder, later on in life. This is especially prevalent for those individuals who also experience high interpersonal stress and poor social support. [8]

There is a higher frequency of the disorder seen in women than men; hence, expectations relating to gender role may contribute to some extent. [8]

Diagnosis

Clinicians and clinical researchers conceptualize dependent personality disorder in terms of four related components:

American Psychiatric Association and DSM

The Diagnostic and Statistical Manual of Mental Disorders (DSM) contains a dependent personality disorder diagnosis. It refers to a pervasive and excessive need to be taken care of which leads to submissive and clinging behavior and fears of separation. This begins prior to early adulthood and can be present in a variety of contexts. [10]

In the DSM Fifth Edition (DSM-5), there is one criterion by which there are eight features of dependent personality disorder. The disorder is indicated by at least five of the following factors: [11]

  1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
  2. Needs others to assume responsibility for most major areas of their life.
  3. Has difficulty expressing disagreement with others because of fear of loss of support or approval.
  4. 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).
  5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
  6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves.
  7. Urgently seeks another relationship as a source of care and support when a close relationship ends.
  8. Is unrealistically preoccupied with fears of being left to take care of themselves. [12]

The diagnosis of personality disorders in the fourth edition Diagnostic and Statistical Manual of Mental Disorders , including dependent personality disorder, was found to be problematic due to reasons such as excessive diagnostic comorbidity, inadequate coverage, arbitrary boundaries with normal psychological functioning, and heterogeneity among individuals within the same categorial diagnosis. [13]

World Health Organization

The World Health Organization's ICD-10 lists dependent personality disorder as F60.7 Dependent personality disorder: [14]

It is characterized by at least 4 of the following:

  1. Encouraging or allowing others to make most of one's important life decisions;
  2. Subordination of one's own needs to those of others on whom one is dependent, and undue compliance with their wishes;
  3. Unwillingness to make even reasonable demands on the people one depends on;
  4. Feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself;
  5. Preoccupation with fears of being abandoned by a person with whom one has a close relationship, and of being left to care for oneself;
  6. Limited capacity to make everyday decisions without an excessive amount of advice and reassurance from others.

Associated features may include perceiving oneself as helpless, incompetent, and lacking stamina.

Includes:

  • Asthenic, inadequate, passive, and self-defeating personality (disorder)

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria [ broken anchor ].

SWAP-200

The SWAP-200 is a diagnostic tool that was proposed with the goal of overcoming limitations, such as limited external validity for the diagnostic criteria for dependent personality disorder, to the DSM. It serves as a possible alternative nosological system that emerged from the efforts to create an empirically based approach to personality disorders – while also preserving the complexity of clinical reality. [11] Dependent personality disorder is considered a clinical prototype in the context of the SWAP-200. Rather than discrete symptoms, it provides composite description characteristic criteria – such as personality tendencies. [11]

Based on the Q-Sort method and prototype matching, the SWAP-200 is a personality assessment procedure relying on an external observer's judgment. It provides:

The traits that define dependent personality disorder according to SWAP-200 are:

  1. 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.
  2. Since they tend to be ingratiating and submissive, people with DPD tend to be in relationships in which they are emotionally or physically abused.
  3. They tend to feel ashamed, inadequate, and depressed.
  4. They also feel powerless and tend to be suggestible.
  5. They are often anxious and tend to feel guilty.
  6. These people have difficulty acknowledging and expressing anger and struggle to get their own needs and goals met.
  7. Unable to soothe or comfort themselves when distressed, they require involvement of another person to help regulate their emotions. [11]

Psychodynamic Diagnostic Manual

The Psychodynamic Diagnostic Manual (PDM) approaches dependent personality disorder in a descriptive, rather than prescriptive sense and has received empirical support. The Psychodynamic Diagnostic Manual includes two different types of dependent personality disorder: [11]

  1. Passive-aggressive
  2. Counter-dependent [11]

The PDM-2 adopts and applies a prototypic approach, using empirical measures like the SWAP-200. It was influenced by a developmental and empirically grounded perspective, as proposed by Sidney Blatt. [11] This model is of particular interest when focusing on dependent personality disorder, claiming that psychopathology comes from distortions of two main coordinates of psychological development:

  1. The anaclitic/introjective dimension.
  2. The relatedness/self-definition dimension. [11]

The anaclitic personality organization in individuals exhibits difficulties in interpersonal relatedness, exhibiting the following behaviours:

Introjective personality style is associated with problems in self-definition. [11]

Differential diagnosis

There are similarities between individuals with dependent personality disorder and individuals with borderline personality disorder, in that they both have a fear of abandonment. Those with dependent personality disorder do not necessarily exhibit impulsive behaviour or unstable affect experienced by those with borderline personality disorder, differentiating the two disorders. [15]

Treatment

People who have DPD are generally treated with psychotherapy. The main goal of this therapy is to make the individual more independent and help them form healthy relationships with the people around them. This is done by improving their self-esteem and confidence. [16]

Medication can be used to treat patients who suffer from depression or anxiety because of their DPD, but this does not treat the core problems caused by the disorder. [16]

Epidemiology

Based on a recent survey of 43,093 Americans, 0.49% of adults meet diagnostic criteria for DPD (National Epidemiologic Survey on Alcohol and Related Conditions; NESARC; Grant et al., 2004). [17] Traits related to DPD, like most personality disorders, emerge in childhood or early adulthood. Findings from the NESArC study found that 18 to 29 year olds have a greater chance of developing DPD. DPD is more common among women compared to men as 0.6% of women have DPD compared to 0.4% of men. [3]

A 2004 twin study suggests a heritability of 0.81 for developing dependent personality disorder. Because of this, there is significant evidence that this disorder runs in families. [4]

Children and adolescents with a history of anxiety disorders and physical illnesses are more susceptible to acquiring this disorder. [18]

Millon's subtypes

Psychologist Theodore Millon identified five adult subtypes of dependent personality disorder. [19] [20] Any individual dependent may exhibit none or one or more of the following:

SubtypePersonality Traits
Disquieted dependent (Including avoidant features)Restlessly perturbed; disconcerted and fretful; feels dread and foreboding; apprehensively vulnerable to abandonment; lonely unless near supportive figures.
Selfless dependent (Including masochistic features)Merges with and immersed into another; is engulfed, enshrouded, absorbed, incorporated, willingly giving up own identity; becomes one with or an extension of another.
Immature dependent (Variant of "pure" pattern)Unsophisticated, half-grown, unversed, childlike; undeveloped, inexperienced, gullible, and unformed; incapable of assuming adult responsibilities.
Accommodating dependent (Including histrionic features)Gracious, neighborly, eager, benevolent, compliant, obliging, agreeable; denies disturbing feelings; adopts submissive and inferior role well.
Ineffectual dependent (Including schizoid features)Unproductive, gainless, incompetent, meritless; seeks untroubled life; refuses to deal with difficulties; untroubled by shortcomings.

History

The conceptualization of dependency, within classical psychoanalytic theory, is directly related to Sigmund Freud's oral psychosexual stage of development. Frustration or over-gratification was said to result in an oral fixation and in an oral type of character, characterized by feeling dependent on others for nurturing and by behaviors representative of the oral stage. Later psychoanalytic theories shifted the focus from a drive-based approach of dependency to the recognition of the importance of early relationships and establishing separation from these early caregivers, in which the exchanges between the caregiver and the child become internalized, and the nature of these interactions becomes part of the concepts of the self and of others. [11]

Related Research Articles

A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.

<span class="mw-page-title-main">Borderline personality disorder</span> Personality disorder of emotional instability

Borderline personality disorder (BPD) is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, a distorted sense of self, and intense emotional responses. People diagnosed with BPD frequently exhibit self-harming behaviours and engage in risky activities, primarily due to challenges regulating emotional states to a healthy, stable baseline. Symptoms such as dissociation, a pervasive sense of emptiness, and an acute fear of abandonment are prevalent among those affected.

<span class="mw-page-title-main">Histrionic personality disorder</span> Personality disorder involving excessive emotionality and attention-seeking

Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early adulthood, including inappropriate seduction and an excessive desire for approval. People diagnosed with the disorder are said to be lively, dramatic, vivacious, enthusiastic, extroverted and flirtatious.

<span class="mw-page-title-main">Narcissistic personality disorder</span> Personality disorder

Narcissistic personality disorder (NPD) is a personality disorder characterized by a life-long pattern of exaggerated feelings of self-importance, an excessive need for admiration, and a diminished ability to empathize with other people's feelings. Narcissistic personality disorder is one of the sub-types of the broader category known as personality disorders. It is often comorbid with other mental disorders and associated with significant functional impairment and psychosocial disability.

Antisocial personality disorder, often abbreviated to ASPD, is a mental disorder defined by a chronic pattern of behavior that disregards the rights and well-being of others. People with ASPD often exhibit behavior that conflicts with social norms, leading to issues with interpersonal relationships, employment, and legal matters. The condition generally manifests in childhood or early adolescence, with a high rate of associated conduct problems and a tendency for symptoms to peak in late adolescence and early adulthood.

<span class="mw-page-title-main">Codependency</span> Type of relationship where one person enables the others self-destructive tendencies

In psychology, codependency is a theory that attempts to explain imbalanced relationships where one person enables another person's self-destructive behavior such as addiction, poor mental health, immaturity, irresponsibility, or under-achievement.

<span class="mw-page-title-main">Schizoid personality disorder</span> Personality disorder involving extreme asociality

Schizoid personality disorder is a personality disorder characterized by a lack of interest in social relationships, a tendency toward a solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment, and apathy. Affected individuals may be unable to form intimate attachments to others and simultaneously possess a rich and elaborate but exclusively internal fantasy world. Other associated features include stilted speech, a lack of deriving enjoyment from most activities, feeling as though one is an "observer" rather than a participant in life, an inability to tolerate emotional expectations of others, apparent indifference when praised or criticized, all forms of asexuality, and idiosyncratic moral or political beliefs.

<span class="mw-page-title-main">Obsessive–compulsive personality disorder</span> Personality disorder involving orderliness

Obsessive–compulsive personality disorder (OCPD) is a cluster C personality disorder marked by a spectrum of obsessions with rules, lists, schedules, and order, among other things. Symptoms are usually present by the time a person reaches adulthood, and are visible in a variety of situations. The cause of OCPD is thought to involve a combination of genetic and environmental factors, namely problems with attachment.

<span class="mw-page-title-main">Avoidant personality disorder</span> Personality disorder

Avoidant personality disorder (AvPD) or anxious personality disorder is a Cluster C personality disorder characterized by excessive social anxiety and inhibition, fear of intimacy, severe feelings of inadequacy and inferiority, and an overreliance on avoidance of feared stimuli as a maladaptive coping method. Those affected typically display a pattern of extreme sensitivity to negative evaluation and rejection, a belief that one is socially inept or personally unappealing to others, and avoidance of social interaction despite a strong desire for it. It appears to affect an approximately equal number of men and women.

Paranoid personality disorder (PPD) is a mental disorder characterized by paranoia, and a pervasive, long-standing suspiciousness and generalized mistrust of others. People with this personality disorder may be hypersensitive, easily insulted, and habitually relate to the world by vigilant scanning of the environment for clues or suggestions that may validate their fears or biases. They are eager observers and they often think they are in danger and look for signs and threats of that danger, potentially not appreciating other interpretations or evidence.

Dysthymia, also known as persistent depressive disorder (PDD), is a mental and behavioral disorder, specifically a disorder primarily of mood, consisting of similar cognitive and physical problems as major depressive disorder, but with longer-lasting symptoms. The concept was used by Robert Spitzer as a replacement for the term "depressive personality" in the late 1970s.

<span class="mw-page-title-main">Peter Pan syndrome</span> Term for a socially immature adult

Peter Pan Syndrome is a pop psychology term used to describe an adult who is socially immature. It refers to “never-growing” adults who have reached an adult age, but cannot face their adult sensations and responsibilities. The term is a metaphor based on the concept of not growing up and being trapped in childhood. Individuals with Peter Pan Syndrome display behaviours associated with immaturity and a reluctance to grow up. They have difficulties in social and professional relationships because of their irresponsible behaviours and narcissistic properties. While it has often only been associated with males in the past, it can affect anyone, regardless of sex or gender.

<span class="mw-page-title-main">Complex post-traumatic stress disorder</span> Psychological disorder

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

<span class="mw-page-title-main">Sadistic personality disorder</span> Former personality disorder involving sadism

Sadistic personality disorder is an obsolete term for a proposed personality disorder defined by a pervasive pattern of sadistic and cruel behavior. People who fitted this diagnosis were thought to have a desire to control others and to have accomplished this through use of physical or emotional violence. The diagnosis proposal appeared in the appendix of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), however it was never put to use in clinical settings and later versions of the DSM had it removed. Among other reasons, psychiatrists believed it would be used to legally excuse sadistic behavior.

Self-defeating personality disorder was a proposed personality disorder. As a descriptor for "Other personality disorder" it was included in the DSM-III in 1980.. It was discussed in an appendix of the revised DSM-III-R in 1987, but was never formally admitted into the manual. The distinction was not seen as clinically valuable because of its significant overlap with other personality disorders. Both the DSM-III and DSM-III-R separated the condition from sexual masochism.

Theodore Millon was an American psychologist known for his work on personality disorders. He founded the Journal of Personality Disorders and was the inaugural president of the International Society for the Study of Personality Disorders. In 2008 he was awarded the Gold Medal Award For Life Achievement in the Application of Psychology by the American Psychiatric Association and the American Psychological Foundation named the "Theodore Millon Award in Personality Psychology" after him. Millon developed the Millon Clinical Multiaxial Inventory, worked on the diagnostic criteria for passive-aggressive personality disorder, worked on editions of the Diagnostic and Statistical Manual of Mental Disorders, and developed subtypes of a variety of personality disorders.

<span class="mw-page-title-main">Narcissism</span> Excessive preoccupation with oneself

Narcissism is a self-centered personality style characterized as having an excessive preoccupation with oneself and one's own needs, often at the expense of others. Narcissism, rooted in Greek mythology, has evolved into a psychological concept studied extensively since the early 20th century, highlighting its relevance across various societal domains.

Psychopathy, or psychopathic personality, is a personality construct characterized by impaired empathy and remorse, in combination with traits of boldness, disinhibition, and egocentrism. These traits are often masked by superficial charm and immunity to stress, which create an outward appearance of apparent normalcy.

Personality disorders (PD) are a class of mental health conditions characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture. These patterns develop early, are inflexible, and are associated with significant distress or disability. The definitions vary by source and remain a matter of controversy. Official criteria for diagnosing personality disorders are listed in the sixth chapter of the International Classification of Diseases (ICD) and in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).

Passive–aggressive personality disorder, also called negativistic personality disorder, is characterized by procrastination, covert obstructionism, inefficiency, and stubbornness. The DSM-5 no longer uses this phrase or label, and it is not one of the ten listed specific personality disorders. The previous edition, the DSM-IV, describes passive–aggressive personality disorder as a proposed disorder involving a "pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance" in a variety of contexts. Passive–aggressive behavior is the obligatory symptom of the passive–aggressive personality disorder.

References

  1. ↑ "Dependent Personality Disorder". www.mentalhealth.com. Archived from the original on 2015-02-16. Retrieved 2018-08-09.
  2. ↑ "What are Cluster C Personality Disorders? - Online Psychology Degree Guide". Online Psychology Degree Guide. Archived from the original on 2018-08-09. Retrieved 2018-08-09.
  3. 1 2 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. pp. 230–237. doi:10.1007/978-0-387-28370-8_22. ISBN   978-0-387-28369-2. S2CID   142569348.
  4. 1 2 Coolidge, F.L.; Thede, L.; Jang, K.L. (2 December 2013). Are personality disorders psychological manifestations of executive function deficits? Bivariate heritability evidence from a twin study. Behavior Genetics (2004), pp. 34, 75-84, cited in Nolan-Hoeksema, Abnormal Psychology (6th. ed.), pp. 273, McGraw Hill Education (2014). McGraw-Hill Education. ISBN   978-0-07-803538-8.
  5. ↑ Sederer, Lloyd I. (2009). Blueprints psychiatry (5th ed.). Philadelphia, Pennsylvania: Wolters Kluwer/Lippincott Williams & Wilkins. p. 30. ISBN   9780781782531. Archived from the original on 2018-09-15. Retrieved 2019-01-31.
  6. ↑ Gjerde et al. 2012.
  7. ↑ Klonsky, E. David; Jane, J. Serrita; Turkheimer, Eric; Oltmanns, Thomas F. (November 2002). "Gender Role and Personality Disorders". Journal of Personality Disorders . 16 (5). New York City: Guilford Press: 464–476. doi:10.1521/pedi.16.5.464.22121. PMC   4364134 . PMID   12489312.
  8. 1 2 3 Simonelli, Alessandra; Parolin, Micol (2017). "Dependent Personality Disorder". Encyclopedia of Personality and Individual Differences. Springer, Cham. pp. 1–11. doi:10.1007/978-3-319-28099-8_578-1. ISBN   978-3-319-28099-8. S2CID   202238251.
  9. ↑ Beitz, Kendra; Bornstein, Robert F. (2006). "Dependent Personality Disorder". Practitioner's Guide to Evidence-Based Psychotherapy. Springer, Boston, MA. pp. 230–237. doi:10.1007/978-0-387-28370-8_22. ISBN   978-0387283692. S2CID   142569348.
  10. ↑ "Dependent Personality Disorder". Archived from the original on 2015-02-10. Retrieved 2019-01-31.
  11. 1 2 3 4 5 6 7 8 9 10 11 12 Simonelli, Alessandra; Parolin, Micol (2017). "Dependent Personality Disorder". Encyclopedia of Personality and Individual Differences. Springer, Cham. pp. 1–11. doi:10.1007/978-3-319-28099-8_578-1. ISBN   978-3-319-28099-8. S2CID   202238251.
  12. ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
  13. ↑ Clark, Lee Anna (2007). "Assessment and Diagnosis of Personality Disorder: Perennial Issues and an Emerging Reconceptualization". Annual Review of Psychology . 58 (1). San Mateo, California: Annual Reviews: 227–257. doi:10.1146/annurev.psych.57.102904.190200. ISSN   0066-4308. PMID   16903806. S2CID   2728977.
  14. ↑ Dependent personality disorder - International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Archived 2006-04-27 at the Wayback Machine
  15. ↑ Murphy, Michael; Cowan, Ronald (2009). Blueprints Psychiatry. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins. ISBN   978-0781782531. Archived from the original on 2018-12-17. Retrieved 2019-01-31.
  16. 1 2 Goldberg, Joseph. "Dependent Personality Disorder". WebMD. Archived from the original on 2018-08-10. Retrieved 2019-01-31.
  17. ↑ Beitz, Kendra (2006). "Dependent Personality Disorder". Practitioner's Guide to Evidence-Based Psychotherapy. Boston, Massachusetts: Springer. pp. 230–237. doi:10.1007/978-0-387-28370-8_22. ISBN   978-0-387-28369-2. S2CID   142569348.
  18. ↑ Nolen-Hoeksema, Susan (2014). Abnormal Psychology (6th ed.). McGraw Hill Education. ISBN   978-0-07-803538-8.
  19. ↑ Millon et al. 2004, p. 290.
  20. ↑ Millon 2006.

Sources

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