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dependent personality disorder
Etiology:
1) psychoanalytic theory
- drawn to others to satisfy instinctual drive of dependency
2) social psychologic theory
a) dependency is a learned behavior
b) dependency displayed in the mother-child relationship is generalized to other interpersonal relationships
3) etiologic theory
a) dependency is a form of attachment (emotional bond)
b) a wish to be close to & in contact with dependent object
Pathology:
- primary symptoms are predominantly submissive, reactive & clinging behavior
Clinical manifestations:
1) unable to make everyday decisions without excessive amount of advice & reassurance from others
2) needs others to assume responsibility for most major areas of his or her life
3) difficulty expressing disagreement with others because of fear or loss of support or approval
4) difficulty initiating projects or doing things because of a lack of self-confidence rather than a lack of motivation
5) excessive effort to obtain nurturance & support from others, to the point of volunteering to do things that are unpleasant
6) feelings of uneasiness or helplessness when alone due to exaggerated fears of be unable to care for self
7) urgently seeks another relationship as a source of care & support when a close relationship ends
8) unrealistic preoccupation with fears of being left to care for self
9) do not typically display distress when they receive additional care [2]
10) more likely to become distressed when asked to perform more self-care [2]
11) do not tend to be verbally abusive or threatening toward caregivers [2]
Differential diagnosis:
1) borderline personality disorder
a) common symptom of fear of abandonment
b) borderline personality
1] reacts with feelings of emotional emptiness, rage & demands
2] unstable & intense relationships
c) dependant personality
1] reacts with increasing appeasement & submissiveness
2] urgently seeks replacement relationship
2) histrionic personality disorder
a) common symptoms
1] appears child-like & clinging
2] has strong need for reassurance & approval
b) differences
1] characteristics of histrionic personality
a] flamboyant
b] actively demands attention
c] gregarious & charming behavior
2] characteristics of dependent personality
a] self-effacing
b] docile
3) avoidant personality disorder
a) common symptoms
1] feelings of inadequacy
2] hypersensitivity to criticism
3] need for reassurance
b) differences
1] characteristics of avoidant personality
a] strong fear of humiliation & rejection
b] withdrawal unless acceptance is certain
2] characteristics of dependent personality
- seeking & maintaining connections to others rather than withdrawing from relationships
4) dependency as a consequence of axis 1 disorders
a) dependency also present in:
1] mood disorders
2] panic disorders
3] agoraphobia
b) distinguishing features of dependent personality
1] early onset, chronic course
2] dependency that is inflexible, maladaptive & cause significant functional impairment or subjective distress
Management:
1) individual psychodynamic therapy
a) develop trusting relationship with the patient & allow the patient to transfer dependent wishes onto the therapist
b) encourage expression of real feelings & wishes, endurance of anxiety of making decisions, acceptance of pleasurable experiences
c) allow the patient to make own decisions
d) conceptualize goals & encourage commitment to attaining these goals
e) limit sessions & self-empower the patient
2) cognitive behavior therapy
a) form techniques to foster accurate self appraisal & independent decision making behavior
b) define goals & set agendas for sessions
c) challenge dichotomous thinking of the patient
d) encourage in vivo exposure to anxiety-provoking situations
e) develop positive behavior schemas & constructive substitute behaviors to replace old dependency habits
3) pharmacotherapy
- treatment of concurrent axis 1 disorders
4) follow-up
a) long-term treatment of 3-5 years
b) tapering number of sessions, but still making them available
General
cluster C personality disorder
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 1102-1104
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022