Dependent personality disorder is characterized by a pervasive, excessive need to be taken care of, leading to submissiveness and clinging behaviors. Diagnosis is by clinical criteria. Treatment is with psychotherapy and possibly antidepressants.
(See also Overview of Personality Disorders.)
In patients with dependent personality disorder, the need to be taken care of results in loss of their autonomy and interests. Because they are intensely anxious about taking care of themselves, they become excessively dependent and submissive.
Fewer than 1% of the general US population are estimated to have dependent personality disorder (1). It is diagnosed more often in females.
Comorbidities are common. Patients often also have a depressive disorder (major depressive disorder or persistent depressive disorder), an anxiety disorder, an alcohol use disorder, or another personality disorder (eg, borderline personality disorder, histrionic personality disorder).
General reference
1. Morgan TA, Zimmerman M: Epidemiology of personality disorders. In Handbook of Personality Disorders: Theory, Research, and Treatment. 2nd ed, edited by WJ Livesley, R Larstone, New York, NY: The Guilford Press, 2018, pp. 173-196.
Etiology of Dependent Personality Disorder
Information about the causes of dependent personality disorder is limited. Cultural factors, negative early experiences, and biologic vulnerabilities associated with anxiety and genetics are thought to contribute to the development of dependent personality disorder (1). Familial traits such as submissiveness, insecurity, and self-effacing behavior may also contribute (2).
Etiology references
1. Gjerde LC, Czajkowski N, Røysamb E: The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire.Acta Psychiatr Scand 126(6):448-457, 2012. doi: 10.1111/j.1600-0447.2012.01862.x
2. Bornstein RF: The dependent personality: developmental, social, and clinical perspectives. Psychol Bull. 112(1):3-23, 1992. doi: 10.1037/0033-2909.112.1.3
Symptoms and Signs of Dependent Personality Disorder
Patients with dependent personality disorder do not think they can take care of themselves. They use submissiveness to try to get others to take care of them.
Patients with this disorder typically require much reassurance and advice when making ordinary decisions. They often let others, usually 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.
These patients consider themselves inferior and tend to belittle their abilities; they take any criticism or disapproval as proof of their incompetence, further undermining their confidence.
It is difficult for them to express disagreement with others because they fear losing support or approval. 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 coworkers for fear of losing their support.
Because they believe they cannot do anything on their own, they have difficulty starting a new task and working independently, and they avoid tasks that require taking responsibility. They present themselves as incompetent and as needing constant help and reassurance. When reassured that a competent person is supervising and approving of them, these patients 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 avoid learning the skills of independent living.
These patients go to great lengths to obtain care and support (eg, doing unpleasant tasks, submitting to unreasonable demands, tolerating physical, sexual, or emotional abuse). Being alone makes them feel extremely uncomfortable or afraid because they fear they cannot care for themselves.
Patients with dependent personality disorder tend to interact socially with only the few people they depend on. When a close relationship ends, patients with this disorder immediately try to find a replacement. Because of their desperate need to be taken care of, they are not discriminating in choosing a replacement.
These patients fear abandonment by those they depend on, even when there is no reason to.
Diagnosis of Dependent Personality Disorder
Clinical criteria (Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision [DSM-5-TR])
For a diagnosis of dependent personality disorder (1), patients must have
A persistent, excessive need to be taken of, resulting in submissive and clinging behavior and fears of separation
This persistent need is shown by the presence of ≥ 5 of the following:
Difficulty making daily decisions without an inordinate amount of advice and reassurance from other people
A need to have others be responsible for most important aspects of their life
Difficulty expressing disagreement with others because they fear loss of support or approval
Difficulty starting projects on their own because they are not confident in their judgment and/or abilities (not because they lack motivation or energy)
Willingness to go to great lengths (eg, do unpleasant tasks) to obtain support from others
Feelings of discomfort or helplessness when they are alone because they fear they cannot take care of themselves
An urgent need to establish a new relationship with someone who will provide care and support when a close relationship ends
Unrealistic preoccupation with fears of being left to take care of themselves
Also, symptoms must have begun by early adulthood.
Differential diagnosis
Several other personality disorders are characterized by hypersensitivity to rejection. However, they can be distinguished from dependent personality disorder based on characteristic features, as follows:
Borderline personality disorder: Patients with this disorder are too frightened to submit to the same degree of control as patients with dependent personality disorder. Patients with borderline personality disorder, unlike those with dependent personality disorder, vacillate between submissiveness and rageful hostility.
Avoidant personality disorder: Patients with this disorder are also too frightened to submit to the same degree of control as patients with dependent personality disorder. Patients with avoidant personality disorder withdraw until they are sure they will be accepted without criticism; in contrast, those with dependent personality disorder seek out and try to maintain relationships with others.
Histrionic personality disorder: Patients with this disorder seek attention rather than reassurance (as do those with dependent personality disorder), but they are more disinhibited. They are more flamboyant and actively seek attention; those with dependent personality disorder are self-effacing and shy.
Dependent personality disorder should be distinguished from the dependency that is present in other psychiatric disorders (eg, depressive disorders, panic disorder, agoraphobia).
Diagnosis reference
1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR). Washington, DC, American Psychiatric Association, 2022, pp 768-771.
Treatment of Dependent Personality Disorder
Cognitive-behavioral therapy
Psychodynamic psychotherapy
Possibly antidepressants
General principles for treatment of dependent personality disorder are similar to those for all personality disorders.
Psychodynamic psychotherapy and cognitive-behavioral therapy that focus on examining fears of independence and difficulties with assertiveness can help patients with dependent personality disorder. Clinicians should be careful to avoid promoting dependency in the therapeutic relationship.
Evidence about pharmacotherapy for dependent personality disorder is sparse. There are no placebo-controlled studies for dependent personality disorder.
Benzodiazepines are not used because patients with dependent personality disorder have an increased risk of medication misuse.
