Definition

            Persons with dependent personality disorder subordinate their own needs to those of others, get others to assume responsibility for major areas in their lives, lack self-confidence, and may experience intense discomfort when alone for more than a brief period of time.

Epidemiology:

This disorder is more common in women than in men. One study diagnosed 2.5 percent of all personality disorder patients as falling into this category. It is more common in young children than in older children. Persons with chronic physical illness in childhood may be most prone to the disorder.

Clinical Features :

Dependent personality disorder is characterized by a pervasive pattern of dependent and submissive behavior. Persons with the disorder are unable to make decisions without an excessive amount of advice and reassurance from others.

Dependent personality disorder patients avoid positions of responsibility and become anxious if asked to assume a leadership role. They prefer to be submissive. When on their own they find it difficult to persevere at tasks but may find it easy to perform those tasks for someone else.

Persons with this disorder do not like to be alone. They seek out others on whom they can depend, and their relationships are thus distorted by their need to be attached to that other person. Pessimism, self-doubt, passivity, and fears of expressing sexual and aggressive feelings characterize the behavior of the dependent personality disorder patients. An abusive, unfaithful, or alcoholic spouse may be tolerated for long periods of time in order not to disturb the sense of attachment.

Course and Fate. Little is known about the course of this disorder. There tends to be impaired occupational functioning, as there is an inability to act independently and without close supervision. Social relationships are limited to those on whom the persons can depend, and many suffer physical or mental abuse because they cannot assert themselves. They risk major depression if they sustain the loss of the person on whom they are dependent. The prognosis with treatment, however, is favorable.

Diagnosis:

            In the interview the patients appear to be very compliant. They try to cooperate, welcome specific questions, and look for guidance.

Dependent personality disorder patients usually have a long-standing relationship with one person on whom they are dependent.

Treatment:

Psychotherapy:

Insight-oriented therapies enable patients to understand the antecedents of their behavior, and with the support of a therapist, the patients can become more independent, assertive, and self-reliant.

A pitfall in the treatment may occur when the therapist encourages the patients to change the dynamics of a pathological relationship (e.g., that a physically abused wife seek help from the police). At that point the patient may become too anxious to be able to cooperate in therapy, and feel torn between complying with the therapist and losing a pathological external relationship. The therapist must show great respect for a dependent personality disorder patient’s feelings of attachment, no matter how pathological those feelings may seem.

Pharmacotherapy:

Pharmacotherapy has been used to deal with such specific symptoms as anxiety and depression, which are common associated features of this disorder. Those patients who develop panic attacks or who have high levels of separation anxiety may be helped by Imipramine. Benzodiazepines have also been useful. If the patients’ depression or withdrawal symptoms respond to psycho-stimulants, they may be used.