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 they behave submissively in an attempt to have others 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
Dependent personality disorder 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 it’s 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 there 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 anxiety disorder, 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.
Treatment
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 so 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?
References
- Harvard Mental Health Letter: Dependent personality disorder
- Merck Manual Professional Version: Dependent personality disorder
- Wikipedia: Dependent personality disorder
Other personality disorders in the What Is… series
- Cluster A:
- Cluster B:
- Cluster C:
The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
I appreciate the clarity in this post, especially the concrete difference between dependency and codependency. It’s a difficult distinction to explain sometimes.
I agree.
I wonder how this changes during life as people age? I wouldn’t say it was DPD, but it did instantly make me think of this girl I new in school, a friend of mine. She was taller than me but she and her nan would ask me to walk by her house in the mornings to walk with her to school. This went on up to high school so around age 13. She would deflect all the time with homework and get me to help her. Anything she did, she made out like she couldn’t do and wanted me to do or help her with it.
She was doted on by her mum and nan, who’d take her on holidays, buy more expensive things than my family could afford, ensure she’d picked up after school so she never walks on her own (wise, but she was still like this age 16). I think some dependency was nurtured by her family. She’d make me feel guilty if I didn’t help her and she could be pretty passive aggressive. Again, not DPD but it makes me wonder what she’s like now. I’ve no idea.
You’ve covered this really well as always, Ashley. You should re-write all the psych textbooks I used to have in college & for my degree. xx
Aw, thanks! ❤️
That’s a really interesting story. Neglect probably messes kids up more, but sheltering a kid too much isn’t healthy either.
This is what I was wondering: can this behaviour be trained into a child. Would a child with a parent with a proxy disorder like Munchausen develop these kinds of traits and responses?
That’s a very interesting question. I couldn’t find anything that specifically linked those two, but it certainly seems like it would make sense.
I need reassurance a lot. To be transparent. It’s just something I require. Thanks for sharing about this disorder. Though, too, I don’t think I have it. It was interesting reading about it.
Nothing wrong with reassurance. And if anything, you’re someone who tries do as much as they possibly can.
Thanks on both counts.
For something to be considered a personality disorder, it has to be an inflexible pattern that causes distress and/or impairs functioning. Leading an “alternative” kind of lifestyle is likely flexible, in the sense that it’s a conscious choice, and it doesn’t cause distress or impair someone’s ability to live their life the way they want to live it.
Lol
I appreciate the distinction between dependency and codependency.
Is there any psychology behind…a sort of expecting sympathy and trying to get all the attention in some of the cases?
Interesting read.
Thank you Ashley
It sounds like early relationships with caregivers has a big impact, and the person comes to see themselves as needy and helpless while attachment figures are seen as competent. Freud thought it was a fixation at the oral stage of psychosexual development.
Thank you Ashley
I suppose the perfect marriage would be when a DPD and a benevolent Codependent. I wonder how often this occurs. I suppose that two people who are not abusive would have a wonderful marriage if they needed each other for psychological fulfillment. It appears that those who have long enduring marriages must experience these feelings of dependency, especially as they get older. Where does normal end and abnormal begin in absence of some other regressive trait?
I think to be diagnosed with DPD, or at least diagnosed appropriately, the dependence is to such an extreme that it makes it very difficult for them to maintain social relationships. My parents have been married almost 50 years and I would say they’re interdependent in quite a balanced way.