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Dependent Personality Disorder: Signs and Treatment


Dependent Personality Disorder (DPD) is the first one out of three in the cluster C of the personality disorders (PDs). This cluster includes PDs that are described as anxious and fearful personalities. The core characteristics of DPD are indecisiveness, helplessness, and tendency to submissive behaviors.

Prevalence

The prevalence of this disorder in the general population is suggested to be under 1%, however it should be noted that there is a lack of literature on the matter. It appears that prevalence is higher in females than in males, but this has been argued to be caused because the diagnostic criteria has been formulated from a masculinist perspective. Some reports indicate that there are no differences in prevalence rates between genders. Interestingly, the reports suggest that DPD is more often diagnosed in collectivist cultures, than individualist ones, indicating the cultural effect on the development of this PD.

The prevalence rates of this disorder are higher in the clinical populations, given that DPD is often diagnosed together with other disorders. Commonly DPD is diagnosed together with other cluster C PD, anxiety disorders, depression, and eating disorders. (links to respective disorders articles).

Causes

The causes of this PD are unknown, but as it is the case with other PDs, research suggests that both biological and environmental factors play a role in developing the DPD.

Biosocial theory on developing DPD suggests that the inherited traits, namely harm avoidance, novelty-seeking and reward dependence play a role in developing this PD. Through inherited tendency and learned behaviors individuals learn to not only avoid harm, but also novelty, which results in worrying, shy, and dependent personalities.

In addition, family environment and parenting styles are suggested to be predictors of developing DPD. The families where fearful attachment styles were dominant were correlated with higher rates of DPD. It has been also proposed that an overprotective and authoritarian parenting style has been linked to the development of DPD, however the latter lacks empirical evidence.

Symptoms

The DPD is a life-long condition, however the course of it is not homogeneous and with successful treatment individuals can go into remission. The symptoms severity can vary based on individual basis and age. Some case reports suggest that the symptom severity can increase even late in life, or the onset of the symptoms can appear in late stages of life. The diagnosis of DPD is rarely assigned before the individual reaches maturity, i.e. 18 years of age, with some signs being evident before this age. People with DPD will exhibits several or more of the bellow characteristics:

  • Extreme sensitivity to criticism (however met in a passive way, not with anger)
  • Indecisiveness (even in every-day situations, for example, what to wear)
  • Constant need of reassurance from others
  • Constant need of advice, or someone telling them what to do (in both personal, professional, educational settings)
  • Adversity to responsibilities (for example, relying on partner or close other on decisions where to work, live, what to do as a hobby)
  • Helplessness
  • Extreme fear of abandonment (constant need of romantic partnership, for example feeling devastation after the relationship ends, but moving into a new relationship quickly)
  • Tolerate mistreatment or even abuse
  • Submissiveness
  • Extreme lack of self-confidence (either in school, every-day life, work, relationships)
  • Fear and avoidance of confrontation
  • Difficulty being alone
  • Extreme altruism, where the needs of other (regardless bad (i.e., abuse) or good are placed above self needs, well-being)

Treatment and help

The primary treatment for DPD is Cognitive Therapy. Medications, if any, are usually prescribed only for comorbid conditions such as depression and anxiety. The clinical reports indicate that individuals with DPD are highly compliant with the selected treatment plan. However, it might take some time for the patient to start sharing their true feelings, given their fear of being judged by the therapist or the sense that their feelings are unacceptable. It is important to note that this difficulty in sharing feelings is more pronounced in males with DPD than women. Finally, individuals with DPD might have difficulty terminating treatment when it is no longer needed. Luckily, cluster C PDs are reported to be among the most treatable PDs in comparison with cluster A and Cluster B PDs.

Given the characteristics of DPD, they are at increased risk of self-harm and unhealthy relationships. It is important to seek out help as early as possible. Individuals with DPD are unlikely to reach out for help alone; therefore, if you believe that your loved one is exhibiting several or more of the described symptoms, encourage them to seek help. Given the nature of DPD, your insistence on seeking medical attention and support through the therapeutic process will be extremely helpful.

Individuals with DPD can be fully functional in society and build healthy relationships, maintain successful careers, or complete their education with a commitment to treatment. It is suggested that in some cases, individuals with DPD can learn to cope with the PD symptoms and go into remission; however, it is useful to maintain regular checkups with a clinician.

Conclusion

If untreated, dependent personality disorder can lead to anxiety and sadness. However, a mental health specialist can assist you in developing new coping mechanisms for challenging circumstances. You can develop your independence and self-assurance. Although it could take some time, a provider can make you feel better.

Key Takeaways

If they receive therapy from a mental health professional, someone with DPD can live an emotionally healthy life.

Healthy interactions may aid in preventing the child from later developing DPD, according to studies.

Your doctor may recommend medication if your DPD results in anxiety or depression. You might use antidepressants like fluoxetine (Prozac®). Or your doctor might suggest sedatives like alprazolam (brand name Xanax).

A DPD diagnosis is more likely for people with a history of abusive relationships.

A person with DPD frequently relies on loved ones to meet their emotional or physical needs. They could be labeled as clinging or needy by others.

References:

Disney, K. L. (2013). Dependent personality disorder: a critical review. Clinical Psychology Review, 33(8), 1184-1196.

Heintz, H. L., Freedberg, A. L., & Harper, D. G. (2021). Dependent personality in depressed older adults: a case report and systematic review. Journal of Geriatric Psychiatry and Neurology, 34(5), 445-453.

Volkert, J., Gablonski, T. C., & Rabung, S. (2018). Prevalence of personality disorders in the general adult population in Western countries: systematic review and meta-analysis. The British Journal of Psychiatry, 213(6), 709-715.

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