Dependent Personality Disorder

Primer

Dependent Personality Disorder is a personality disorder characterized by clingy and submissive behavior. Individuals are passive and allow others to direct their lives because they are unable to do so themselves. Other people such as spouses or parents make all the major life decisions, including where to live and what type of employment to obtain. These patients fear separation and tend to be indecisive and unable to take the initiative. They are often preoccupied with the thought of being left to fend for themselves, and want others to assume responsibility for all major decision making. They have difficulty expressing disagreement because they fear abandonment.

Epidemiology
  • Prevalence estimates range from 0.49 to 0.6%[1][2][3]
  • Males and females are generally equally diagnosed
Prognosis
  • Individuals have great difficulty making every day decisions, and rely on others assume responsibility for most major areas of their lives.
  • Because of this reliance on others, they may not learn the skills of independent living, thus perpetuating dependency.
Comorbidity
Risk Factors

DSM-5 Diagnostic Criteria

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following:

  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 his or her life
  3. Has difficulty expressing disagreement with others because of fear of loss of support or approval (Note: Do not include realistic fears of retribution.)
  4. 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)
  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 himself or herself
  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 himself or herself

Psychopathology

Differential Diagnosis

  • Other mental disorders and medical conditions
    • Dependent personality disorder must be distinguished from dependency arising as a consequence of other mental disorders (e.g. - depressive disorders, panic disorder, agoraphobia) and as a result of other medical conditions.
  • Borderline personality disorder (BPD)
    • Both dependent personality disorder and BPD are characterized by fear of abandonment. However, in BPD, one reacts to abandonment with feelings of emotional dysregulation, emptiness, rage, and/or demands, whereas in dependent personality disorder one reacts with increasing appeasement and submissiveness. In dependent personality, the individual also urgently seeks a replacement relationship to provide caregiving and support. BPD can further be distinguished from dependent personality disorder by a chronic pattern of intense and unstable relationships.
  • Histrionic personality disorder
    • Individuals with histrionic personality disorder, similar to dependent personality disorder, have a strong need for reassurance and approval and may appear clingy. However, unlike dependent personality disorder, which is has self-effacing and docile behavior, histrionic personality disorder is characterized by flamboyant behaviours and active demands for attention.
  • Avoidant personality disorder
    • Both dependent personality disorder and avoidant personality disorder are characterized by feelings of in adequacy, hypersensitivity to criticism, and a need for reassurance. However, individuals with dependent personality disorder will seek and maintain connections to others, rather than avoiding and withdrawing. In contrast, individuals with avoidant personality disorder have such strong fears of rejection that they withdraw until they are certain they will be accepted.
  • Personality change due to another medical condition
    • Dependent personality disorder should be differentiated from personality change due to another medical condition (e.g. - traumatic brain injury), where traits are attributable to the effects of another medical condition on the central nervous system.
  • Substance use disorders
    • Dependent personality disorder should be differentiated from symptoms that may develop from persistent substance use.
  • Appropriate dependency
    • The fears exhibited by the individual must be excessive and unrealistic. For example, an elderly woman diagnosed with cancer who moves into her son's house for care is exhibiting dependent behavior that is entirely appropriate given this person's life circumstances.

Treatment

Psychotherapy focuses on helping the individual gain independence. Cognitive behavioural therapy can be used to help challenge negative thoughts and to encourage independent behaviors.

Recommended Reading

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Guidelines

Personality Disorder Guidelines

Guideline Location Year PDF Website
World Federation of Societies of Biological Psychiatry (WFSBP) International 2009 - Link

Resources

For Patients
For Providers
Articles
Research

References

1) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
2) Lenzenweger, M. F., Lane, M. C., Loranger, A. W., & Kessler, R. C. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological psychiatry, 62(6), 553-564.
3) Hasin, D. S., & Grant, B. F. (2015). The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Social psychiatry and psychiatric epidemiology, 50(11), 1609-1640.
4) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.