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Dependent Personality Disorder (DPD)

By Robert M. A. Hirschfeld, MD, DeWitt Wallace Senior Scholar and Professor, Department of Psychiatry, Weill Cornell Medical College

Dependent personality disorder is characterized by a pervasive, excessive need to be taken care of, leading to submissiveness and clinging behaviors.

  • People with dependent personality disorder do not think they can take care of themselves and use submissiveness to try to get other people to take care of them.

  • Doctors diagnose dependent personality disorder based on specific symptoms, including a person's need to be taken care of and fear of having to take care of self.

  • Psychotherapy that focuses on examining fears of independence can help.

Personality disorders are long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or impair the person's ability to function.

People with dependent personality disorder need to be taken care of and are extremely anxious about taking care of themselves. To get the care they want, they are willing to give up their independence and interests. They thus become excessively dependent and submissive.

Dependent personality disorder occurs in about 0.7% of the general population. It is more common among women.

Other disorders are also often present. People often also have one or more of the following:

Causes

Information about what causes dependent personality disorder is limited. Factors that may contribute include

  • Cultural factors

  • Negative early experiences

  • An inborn tendency to be anxious

  • Traits that run in families (such as submissiveness, insecurity, and self-effacing behavior)

Symptoms

Need for care

People with dependent personality disorder do not think they can take care of themselves. They use submissiveness to try to get other people to take care of them.

People with this disorder typically require much reassurance and advice when making ordinary decisions. They often let others, often one person, take responsibility for many aspects of their life. For example, they may depend on their spouse to tell them what to wear, what kind of job to look for, and with whom to associate.

People with dependent personality disorder tend to interact socially with only the few people they depend on. When a close relationship ends, people with this disorder immediately try to find a replacement. Because of their desperate need to be taken care of, they may not be discriminating in choosing a replacement.

People with dependent personality disorder have an excessive fear of abandonment by those they depend on, even when there is no reason to.

Excessive submissiveness

Because people with dependent personality disorder fear losing support or approval, they have difficulty expressing disagreement with others. They may agree to something they know is wrong rather than risk losing the help of others. Even when anger is appropriate, they do not get angry at friends and co-workers for fear of losing their support.

People with dependent personality disorder go to great lengths to obtain care and support. For example, they may do unpleasant tasks, submit to unreasonable demands, and even tolerate physical, sexual, or emotional abuse. Being alone makes them feel extremely uncomfortable or afraid because they fear they cannot take care of themselves.

Lack of confidence

People with dependent personality disorder consider themselves inferior and tend to belittle their abilities. They interpret any criticism or disapproval as proof of their incompetence, further undermining their confidence.

Lack of independence

Because people with dependent personality disorder are sure that they cannot do anything on their own, they have difficulty starting a new task and working independently. They avoid tasks that require taking responsibility. They present themselves as incompetent and needing constant help and reassurance. When reassured that a competent person is supervising and approving of them, people with dependent personality disorder tend to function adequately. However, they do not want to appear too competent lest they be abandoned. As a result, their career may be harmed. They perpetuate their dependency because they tend not to learn skills of independent living.

Diagnosis

  • A doctor's evaluation, based on specific criteria

Doctors usually diagnose personality disorders based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5—see Classification and Diagnosis of Mental Illness), published by the American Psychiatric Association.

For doctors to diagnose dependent personality disorder, people must have a persistent, excessive need to be taken of, resulting in submissiveness and clinging behavior, as shown by at least five of the following:

  • They have difficulty making daily decisions without an excessive amount of advice and reassurance from other people.

  • They need to have other people be responsible for most important aspects of their life.

  • They have difficulty expressing disagreement with others because they are afraid of losing support or approval.

  • They have difficulty starting projects on their own because they are not confident in their judgment and/or abilities (not because they lack motivation or energy).

  • They are willing to go to great lengths (for example, do unpleasant tasks) to obtain support from others.

  • They feel uncomfortable or helpless when they are alone because they fear they cannot take care of themselves.

  • When a close relationship ends, they feel an urgent need to establish a new relationship with someone who will provide care and support.

  • They are preoccupied with fears of being left to take care of themselves.

Also, symptoms must have begun by early adulthood.

Treatment

  • Cognitive-behavioral therapy

  • Psychodynamic psychotherapy

General treatment of dependent personality disorder is similar to that for all personality disorders.

Psychodynamic psychotherapy and cognitive-behavioral therapy that focus on examining fears of independence and difficulties with asserting themselves can help people with dependent personality disorder.

Whether drugs are useful is unclear. Some antidepressants, such as monoamine oxidase inhibitors (MAOIs), may be effective.