Dependent Personality Disorder
Basic Information
Dependent personalities exhibit a strong need to be taken care of, marked by excessive separation anxiety, a lack of self esteem, fear of disagreements and a refusal to appreciate competency in themselves even when it is there. Dependent personalities often present a submissive mien, going along with activities that can be humiliating, demeaning or even abusive in order that the approval and emotional support they seek does not disappear. They base their behavior so as not to offend but only please those upon whom they are dependent, fearing abandonment and being alone. This leads to a denial or repudiation of their individuality and in fact precludes them from having a separate identity apart from others. Allowing others to assume responsibilities and decision-making, the dependent personality can blossom socially, displaying tenderness and affection which will meet the approval of most onlookers. However, when the support he or she craves is withdrawn, the dependent personality can become confused, depressed and forlorn.
The DMS-3 (Diagnostic and Statistical Manual of Mental Disorders) published by the American Psychiatric Association in 1980 has described features of dependence that point to general lack of self-confidence (which can take on physical characteristics in voice, posture and manner), their placating manner, denigration of any achievements or attractive qualities they possess, and their desperate need for approval greatly manifested in times of stress. Statements that are self-effacing or self-denigrating usually have no real basis and are used as a tool to elicit praise and sympathy, which allows them to ignore responsibilities and independent behavior which they fear. By self- doubting and exhibiting helplessness they hope to find protection and escape from autonomy.
The dependent personality often suffers anxiety disorders, not surprisingly since his or her well-being is in the hands of another. If their competency is threatened, they may be subject to agoraphobic attacks in which they panic at the idea of leaving familiar places, especially the home. Separation anxiety can be overwhelming and the loss of a significant person can induce major depression.
The dependent personality often is described as seeing life in a Pollyanna-like way in which difficult events are covered by an unrealistic light dismissal often apparent in his or her tone of voice and choice of appropriately sweet or benign words to describe an upsetting situation.
Symptoms
Besides exhibiting symptoms described above, dependent personalities will often present an incredible passivity in which the choice of livelihood they undertake, the way they dress or behave or their actual residence is determined entirely by another, most often a parent or spouse. They will go to all lengths to avoid showing anger or disagreeing with the dominant personality and if the relationship with the dominant personality comes to an end they will often haphazardly and frantically rush into a new relationship in which they can become passive, submissive and reliant on another.
Diagnosis/Treatment
In diagnosing a dependent personality disorder it is important to distinguish that the behavior is not reality-based, excessive and not part of the patient's cultural norm. Most of these symptoms need to be present for diagnosis:
- feeling of helplessness when alone
- difficulty or inability in independent decision-making
- difficulty or inability to assume responsibility
- usually non-competitive, docile, does not want social conflict
- Pollyanna attitude toward interpersonal problems
- does not initiate projects well
- inability to be self-assertive
- self-sacrificing
- looks to others to take over leadership and direction
- has difficulty being alone for any substantial length of time
- submergence of individuality
- fear of failure
- loss of self-respect
- fear of hostile or antagonistic behavior
- anxiety in the face of new challenges
Multiple diagnoses are possible, especially the dependent-avoidant mixed personality in which the patient is self-effacing and needs others for security but is withdrawn and filled with resentment towards those who might withdraw nurture.
A family history is important in considering genetic factors which at this time have not been identified but may exist or considering the adult dependent's history of childhood nurturing which usually will include parental overprotection, lack of encouragement and self-assertion and, as the child grows, an inability to see himself or herself apart from his or her parents and an inability to define his or her own strengths and weaknesses. Sometimes aggressive siblings may cause the future dependent to withdraw from competing or positive comparisons but perpetuate the self-deprecation and clinging behavior that does not serve to foster independence in adulthood.
There is the possibility that neural characteristics or organization may account for poor coping mechanisms in stressful situations and be responsible for increased fear and anxiety than are present in the average individual. As well as these imbalances there may be physicochemical factors which prohibit enough flow of adrenalin to cope with anxiety.
By taking a detailed family history an experienced health care provider and/or therapist can help identify the path from childhood dependence to adult dependency, revealing the fears, anxieties and coping mechanisms that the dependent personality uses in sublimating himself or herself to a more dominant partner or spouse. Women are more likely than men to be diagnosed with this personality disorder.
Prognosis with appropriate treatment is generally good for this personality disorder due to the fact that the dependent personality was raised in an atmosphere of love and security and the fact that this personality type needs to establish personal relationships with others and is not likely to withdraw into a world of self-preoccupation. Usually they will be able to open up to a therapist even if they tend to pedestalize and become dependent on the therapist for emotional support. The goal of independence can be quite slow however as the patient is encouraged to strengthen his or her own feeling of autonomy, competency and self-assurance. Pharmacological treatment may be indicated. The use of anti-depressant or anti-anxiety medication may prompt a sense of strength and forward momentum which may counteract a generalized feeling of aloneness, inadequacy and lack of vigor. Learning new social skills and an ability to nurture oneself as opposed to going to outside sources are concrete and, in most cases, plausible goals.
If you have questions or concerns about dependent personality disorder, please consult with your health care provider.