In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is dependent personality disorder.
Dependent personality disorder (DPD) falls within cluster C, the anxious/avoidant personality disorders, in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). People with DPD believe they’re unable to care for themselves, and behave submissively in an attempt to have others to take care of them and make decisions for them. This is different from actually requiring care due to decreased ability to care for oneself; DPD is about decreased perceived ability.
Symptoms in the DSM-5 include:
- “A persistent, excessive need to be taken of, resulting in submissiveness and clinging”
- Difficulty with daily decisions without +++ reassurance/advice from others
- Needing others to take responsibility for most areas of their life
- Reluctant to disagree with others out of fear of losing their approval
- Difficulty initiating projects because they don’t trust their own judgment/abilities
- Willing to go to significant/unpleasant lengths to get support from others
- Feel helpless when alone due to fear of not being able to care for oneself
- When one close relationship ends, there is a sense of urgency to find a replacement relationship
- Unrealistic, excessive focus on the idea of not being able to take care of oneself
It’s perfectly normal to have some of these symptoms to some extent some of the time. It only rises to the level of a disorder when there’s a significant impact on overall functioning. Like any personality disorder, it starts to appear early and is well-established by adulthood, and is consistent over time.
It’s worth mentioning that dependency is not the same as codependency. Codependency is the need to feel that someone else depends on you. If I have a partner with an addiction and I feel the need to play the caregiver role for him, that’s codependency, whereas if he feels like he needs me to take care of him, that’s dependency.
Prevalence and risk factors
DPD occurs in less than 1% of the population. Symptoms are consistent across time and across situations. Some studies have shown that it’s more common in women than men, while others have shown it’s pretty much equal.
There’s no clear cause, but there appears to be a mix of biological and environmental factors that can contribute. Twin studies have suggested here is a heritable component. People with DPD often have a history of childhood abuse or neglect. Having overprotective or authoritarian parents is also a risk factor, as is a family history of anxiety disorders.
People with DPD commonly have another comorbid condition, such as depression, anxiety, alcohol use disorder, or another personality disorder. They may develop social phobia, as they don’t like to leave people and places that feel safe. They may also develop separation anxiety, as they feel abandoned when their support people aren’t present.
Psychodynamic psychotherapy and cognitive behavioural therapy (CBT) can be helpful, although it’s important to avoid establishing dependency in the therapeutic relationship. There’s some indication that antidepressants may help somewhat. Benzodiazepines shouldn’t be used in this population due to the risk of developing an addiction.
I didn’t come across this very often as a nurse, if at all. People who were dependent, sure, but DPD, not much. I’m a very independent person, and even trying to conceptualize in my head what this might feel like just does not compute. It sounds like a very difficult way to go through life.
Is this something you’ve ever come across?