From time to time, we all want to be looked after, especially when we're feeling unwell or down in the dumps. However, for people with dependent personality disorder, the need to be taken care of is constant, excessive, and overwhelming.
This article explores the causes, symptoms, and treatments available for dependent personality disorder.
- People with dependent personality disorder (DPD) have an overwhelming and excessive need to be taken care of, often resulting in excess submissiveness and clinginess.
- The causes of dependent personality disorder are poorly understood. Genetic, environmental, health, and sociocultural factors may play a role in the development of DPD.
- There are limited effective treatments available for people with dependent personality disorder. Some forms of psychotherapy may offer benefits tailored to individual circumstances.
.jpg?v=1748358613)
Understanding dependent personality disorder
Dependent personality disorder (DPD) is a Cluster C personality disorder (once known as Axis II disorders) characterized by an excessive and overwhelming need to be taken care of, resulting in significant submissiveness, neediness, and fear of losing close relationships. Importantly, DPD affects multiple aspects of an individual’s daily functioning. [1]
Other Cluster C personality disorders include avoidant personality disorder (involving social avoidance for fear of negative appraisal by others) and obsessive-compulsive personality disorder (a pervasive need for perfectionism). Some form of psychological reliance on the actions or opinions of others characterizes all Cluster C personality disorders. [2]
How common is dependent personality disorder?
It is estimated that 0.4% to 0.6% of the U.S. population has dependent personality disorder. DPD appears to be more common in women than in men. [1][3] DPD is also more common in younger people, appearing in 0.9% of individuals aged 18-29 and only 0.3% of people over the age of 65. [1]
How does it differ from separation anxiety?
Dependent personality disorder is often confused with separation anxiety disorder. Separation anxiety involves significant distress brought on by the possibility of being away from a loved one. These feelings are typically directed at one or two close attachment figures at a time, with symptoms often relieved in their presence. [4]
This differs from DPD, where the need to be taken care of (less so anxiety about being apart) is constant and may apply to most people that they regularly interact with. These behaviors are a fundamental part of the individual’s unique personality.
Symptoms of dependent personality disorder
The symptoms of dependent personality disorder can best be demonstrated by looking at the diagnostic criteria used by mental health professionals and the expected observations from a Mental Status Examination (MSE).
Diagnostic symptoms of DPD
The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5-TR) is the standard classification tool used by mental health professionals to assist in the diagnosis of a mental health condition. Listed symptoms of DPD include: [5]
- Difficulty with making everyday decisions without excessive advice and reassurance from others.
- The need for others to assume responsibility for most major aspects of their life.
- Difficulty expressing disagreement (for fear of loss of approval and support).
- Having a hard time doing things independently.
- Going to excessive lengths to receive support from others.
- Being uncomfortable or helpless when alone, feeling unable to take care of themselves.
- Seeks constant relationships as a source of care.
- They are preoccupied by fears of being left to take care of themselves.
Mental state examination of someone with DPD
DPD is a personality disorder, meaning that it motivates most aspects of a person’s behavior. Healthcare professionals would expect to note the following observations when interviewing someone with DPD: [1]
- Appearance: May dress according to others’ choices.
- Behavior: Frequently asking for approval.
- Speech: May be quiet and shy.
- Affect (emotional state): Anxious or uncomfortable.
- Thought content: Fear of losing support.
- Thought process: Thoughts are structured to seek maximum approval from others.
- Cognition: No expected impairment.
- Insight: Limited insight into their condition.
- Judgment: Poor judgment that is unduly influenced by others.
Causes of dependent personality disorder
There is no single cause of dependent personality disorder, and research evidence is currently limited and inconsistent. However, experts have identified a range of risk factors that may contribute to the development of DPD: [1][2][6]
- Genetics: There is a lack of high-quality genetic studies on DPD. However, genetic factors that influence the development of other personality disorders are likely also to apply to DPD.
- Chronic illness: People with a history of childhood or teenage chronic illness (or separation anxiety) are more likely to develop DPD later in life.
- Childhood experiences: Overprotective and overbearing parenting may contribute to the development of DPD. Equally, childhood neglect and abuse are thought to be risk factors for developing a personality disorder.
- Familial and cultural context: Both family dynamics and wider society shape our personalities as we grow. For example, some family structures place less importance on helping children and teenagers develop their independence.
Complications of DPD
Dependent personality disorder is an impactful condition that affects an individual’s ability to form and maintain relationships, sustain employment, and seize valuable opportunities. A minority of people with DPD are at greater risk of the following complications: [1]
- Men with DPD are more likely to perpetrate domestic abuse.
- Women with DPD are more likely to be victims of multiple abusive relationships.
- Someone with DPD is more likely to engage in child abuse than someone without DPD, regardless of their gender.
- Individuals with DPD are at greater risk of suicide and suicidal thoughts than those without the condition.
- People with DPD are at greater risk of developing a mood disorder, anxiety disorder, or another personality disorder than those without DPD.
If you or a loved one is concerned about suicidal thoughts, help is available. Contact the 988 Suicide & Crisis Lifeline for immediate support.Â
Dependent personality disorder and substance abuse
Studies exploring the relationship between dependent personality disorder and substance misuse are lacking. However, we know that substance use disorders are common amongst people with other personality disorders. People with DPD are likely at greater risk of substance misuse in an attempt to inappropriately self-medicate when faced with depression and anxieties related to their condition. [1]Â
Diagnosing DPD
The diagnosis of dependent personality disorder can be made by a suitably qualified mental health professional (usually a psychiatrist). The practitioner will conduct a comprehensive assessment, taking into account the symptoms reported by the individual, their apparent mental state, and information gathered from friends and family.
The DSM-5-TR diagnostic criteria state that an individual must display a pervasive and excessive need to be taken care of that leads to clingy and submissive behaviors with a fear of separation. This is demonstrated by the presence of five or more symptoms discussed earlier in the article. [5]
Symptoms must be present from early adulthood and consistent across various contexts for a formal diagnosis. [5]
Treatment for dependent personality disorder
Personality disorders, by definition, are an integral part of an individual’s unique personality and approach to life. As such, few treatments have been shown to be effective in lessening the overall symptoms of DPD. [1]
However, clinicians will work with the individual to suggest treatments that may provide relief from specific troubling symptoms. Common approaches include: [1][7]Â
- Medication: There are no medications that can treat the core symptoms of DPD. However, people with co-occurring anxiety or depression may benefit from being prescribed anti-anxiety and antidepressant medication.
- Psychodynamic therapy: This is a type of therapy that explores the unconscious mind and aims to understand how past experiences influence current behavior. Psychodynamic therapy may reduce distress and improve social functioning.
- Cognitive behavioral therapy (CBT): This therapy aims to identify negative thoughts and feelings and develop positive coping strategies. CBT can address maladaptive thinking patterns, enhance self-esteem, and improve social skills.
- Family therapy: This form of therapy examines current relationship dynamics and helps facilitate positive communication. It is becoming increasingly recognized as one of the most effective forms of treatment for people with DPD.
Living with dependent personality disorder
Studies have shown that most symptoms of personality disorders tend to lessen with age. However, for an individual currently living with DPD, their daily functioning can be significantly disrupted at any age. [1] People with DPD often lack insight into their condition and, ironically, rely on the support of loved ones to foster their independence. Without appropriate support, people with DPD may struggle to engage in education, employment, and external socialization. [1]Â
Living with someone with dependent personality disorder
There are both positive and negative consequences of living with someone with DPD. People with DPD can be extremely loyal and thoughtful when it comes to wanting to be involved in your life. However, the overbearing need to be cared for can also be a significant burden and a potential barrier to a healthy relationship.
It is crucial to keep in mind that the potential to take advantage of someone with DPD is high. Care should be taken to empower the person’s independence, while being sensitive to the distress that can be caused by it.
