Dependent personality disorder

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Dependent personality disorder
Classification and external resources
ICD-10 F60.7
ICD-9 301.6
MedlinePlus 000941
MeSH D003859

Dependent personality disorder (DPD), formerly known as asthenic personality disorder, is a personality disorder that is characterized by a pervasive psychological dependence on other people. This personality disorder is a long-term (chronic) condition in which people depend on others to meet their emotional and physical needs, with only a minority achieving normal levels of independence.

The difference between a 'dependent personality' and a 'dependent personality disorder' is somewhat subjective, which makes diagnosis sensitive to cultural influences such as gender role expectations.

A study in 2012 found that two-thirds of this disorder stemmed from genetics while one-third came from the environment.[1]

Characteristics[edit]

View of others[edit]

Individuals with DPD see other people as much more capable to shoulder life's responsibilities, to navigate a complex world, and to deal with the competitions of life.[2] Other people appear powerful, competent, and capable of providing a sense of security and support to individuals with DPD. Dependent individuals avoid situations that require them to accept responsibility for themselves; they look to others to take the lead and provide continuous support.[3]

DPD judgment of others is distorted by their inclination to see others as they wish they were, rather than as they are.[4] These individuals are fixated in the past. They maintain youthful impressions; they retain unsophisticated ideas and childlike views of the people toward whom they remain totally submissive.[5] Individuals with DPD view strong caretakers, in particular, in an idealized manner; they believe they will be all right as long as the strong figure upon whom they depend is accessible.[6]

Self-image[edit]

Individuals with DPD see themselves as inadequate and/or helpless; they believe they are in a cold and dangerous world and are unable to cope on their own. They define themselves as inept and abdicate self-responsibility; they turn their fate over to others. These individuals will decline to be ambitious and believe that they lack abilities, virtues and attractiveness.[7][8]

The solution to being helpless in a frightening world is to find capable people who will be nurturing and supportive toward those with DPD. Within protective relationships, individuals with DPD will be self-effacing, obsequious, agreeable, docile, and ingratiating. They will deny their individuality and subordinate their desires to significant others. They internalize the beliefs and values of significant others. They imagine themselves to be one with or a part of something more powerful and they imagine themselves to be supporting others. By seeing themselves as protected by the power of others, they do not have to feel the anxiety attached to their own helplessness and impotence.[9]

However, to be comfortable with themselves and their inordinate helplessness, individuals with DPD must deny the feelings they experience and the deceptive strategies they employ. They limit their awareness of both themselves and others. Their limited perceptiveness allows them to be naive and uncritical.[10] Their limited tolerance for negative feelings, perceptions, or interaction results in the interpersonal and logistical ineptness that they already believe to be true about themselves. Their defensive structure reinforces and actually results in verification of the self-image they already hold.

Relationships[edit]

Individuals with DPD see relationships with significant others as necessary for survival. They do not define themselves as able to function independently; they have to be in supportive relationships to be able to manage their lives. In order to establish and maintain these life-sustaining relationships, people with DPD will avoid even covert expressions of anger. They will be more than meek and docile; they will be admiring, loving, and willing to give their all. They will be loyal, unquestioning, and affectionate. They will be tender and considerate toward those upon whom they depend.[2]

Dependent individuals play the inferior role to the superior other very well; they communicate to the dominant people in their lives that those people are useful, sympathetic, strong, and competent.[2] With these methods, individuals with DPD are often able to get along with unpredictable or isolated people.[11] To further make this possible, individuals with DPD will approach both their own and others' failures and shortcomings with a saccharine attitude and indulgent tolerance.[12] They will engage in a mawkish minimization, denial, or distortion of both their own and others' negative, self-defeating, or destructive behaviors to sustain an idealized, and sometimes fictional, story of the relationships upon which they depend. They will deny their individuality, their differences, and ask for little other than acceptance and support.[13]

Not only will individuals with DPD subordinate their needs to those of others, they will meet unreasonable demands and submit to abuse and intimidation to avoid isolation and abandonment.[14] Dependent individuals so fear being unable to function alone that they will agree with things they believe are wrong rather than risk losing the help of people upon whom they depend.[15] They will volunteer for unpleasant tasks if that will bring them the care and support they need. They will make extraordinary self-sacrifices to maintain important bonds.[16]

It is important to note that individuals with DPD, in spite of the intensity of their need for others, do not necessarily attach strongly to specific individuals, i.e., they will become quickly and indiscriminately attached to others when they have lost a significant relationship.[17] It is the strength of the dependency needs that is being addressed; attachment figures are basically interchangeable. Attachment to others is a self-referenced and, at times, haphazard process of securing the protection of the most readily available powerful other willing to provide nurturance and care.[18]

Comparison with other PDs[edit]

Both DPD and HPD are distinguished from other personality disorders by their need for social approval and affection and by their willingness to live in accord with the desires of others. They both feel paralyzed when they are alone and need constant assurance that they will not be abandoned. Individuals with DPD are passive individuals who lean on others to guide their lives. People with HPD are active individuals who take the initiative to arrange and modify the circumstances of their lives. They have the will and ability to take charge of their lives and to make active demands on others.[18]

Epidemiology[edit]

Dependent personality disorder occurs in about 0.5% of the general population. It is more frequent in females.[19]

Diagnosis[edit]

The following questions when assessing individuals for DPD:[20]

  • Some people enjoy making decisions. Others prefer to have someone they trust guide them. Which do you prefer?
  • Do you seek advice for everyday decisions? (Are the decisions you make understood by the practitioner?)
  • Do you find yourself in situations where other people have made decisions about important areas in your life, e.g. what job to take?
  • Is it hard for you to express a different opinion with someone you are close to? What do you think might happen if you did?
  • Do you often pretend to agree with others even if you do not? Why? Do you think it could get you into trouble if you disagree?
  • Do you often need help to get started on a project?
  • Do you ever volunteer to do unpleasant things for others so they will take care of you when you need it?
  • Are you uncomfortable when you are alone? Are you afraid you will not be able to take care of yourself?
  • Have you found that you are desperate to get into another relationship right away when a close relationship ends? Even if the new relationship might not be the best person for you?
  • Do you worry about important people in your life leaving you?

American Psychiatric Association[edit]

The DSM-IV-TR contains a Dependent Personality Disorder diagnosis. It refers to a pervasive and excessive need to be taken care of which leads to submissive and clinging behavior and fears of separation. This begins by early adulthood and can present in a variety of contexts.:[21]

World Health Organization[edit]

The World Health Organization's ICD-10 lists dependent personality disorder as F60.7 Dependent personality disorder:[22]

It is characterized by at least 3 of the following:

  1. encouraging or allowing others to make most of one's important life decisions;
  2. subordination of one's own needs to those of others on whom one is dependent, and undue compliance with their wishes;
  3. unwillingness to make even reasonable demands on the people one depends on;
  4. feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself;
  5. preoccupation with fears of being abandoned by a person with whom one has a close relationship, and of being left to care for oneself;
  6. limited capacity to make everyday decisions without an excessive amount of advice and reassurance from others.

Associated features may include perceiving oneself as helpless, incompetent, and lacking stamina.

Includes:

  • asthenic, inadequate, passive, and self-defeating personality (disorder)

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Millon's subtypes[edit]

Psychologist Theodore Millon identified five adult subtypes of dependent personality disorder.[23][24] Any individual dependent may exhibit none or one of the following:

Subtype Description Personality Traits
Disquieted Including avoidant features Restlessly perturbed; disconcerted and fretful; feels dread and foreboding; apprehensively vulnerable to abandonment; lonely unless near supportive figures.
Selfless Including depressive features Merges with and immersed into another; is engulfed, enshrouded, absorbed, incorporated, willingly giving up own identity; becomes one with or an extension of another.
Immature Variant of “pure” pattern Unsophisticated, half-grown, unversed, childlike; undeveloped, inexperienced, gullible, and unformed; incapable of assuming adult responsibilities.
Accommodating Including masochistic features Gracious, neighborly, eager, benevolent, compliant, obliging, agreeable; denies disturbing feelings; adopts submissive and inferior role well.
Ineffectual Including schizoid features Unproductive, gainless, incompetent, useless, meritless; seeks untroubled life; refuses to deal with difficulties; untroubled by shortcomings.

Differential diagnosis[edit]

The following conditions commonly coexist (comorbid) with dependent personality disorder:[19]

Treatment[edit]

Adler[who?] suggests that treatment goals for all personality disorders include: preventing further deterioration, regaining an adaptive equilibrium, alleviating symptoms, restoring lost skills, and fostering improved adaptive capacity. Goals may not necessarily include characterological restructuring. The focus of treatment is adaptation, i.e., how individuals respond to the environment. Treatment interventions teach more adaptive methods of managing distress, improving interpersonal effectiveness, and building skills for affective regulation.[25]

For individuals with DPD, the goal of treatment is not independence but autonomy. Autonomy has been defined as the capacity for independence and the ability to develop intimate relationships.[26] Sperry suggests that the basic goal for DPD treatment is self-efficacy.[27] Individuals with DPD must recognize their dependent patterns and the high price they pay to maintain those patterns. This allows them to explore alternatives. The long-range goal is to increase DPD individuals' sense of independence and ability to function. Clients with DPD must build strength rather than foster neediness.[28]

As with other personality disorders, treatment goals should not be in contradiction to the basic personality and temperament of these individuals. They can work toward a more functional version of those characteristics that are intrinsic to their style. Oldham suggests seven traits and behaviors of the "devoted personality style", i.e., the non-personality-disordered version of DPD:[29]

  • ability to make commitments;
  • enjoyment of intimacy;
  • skills as a team player—without need to compete with the leader;
  • willingness to seek the opinions and advice of others;
  • ability to promote interpersonal harmony;
  • thoughtfulness and consideration for others; and,
  • willingness to self-correct in response to criticism.

Medication[edit]

There is little evidence to suggest that the use of medication will result in long-term benefits in the personality functioning of individuals with DPD.[30] DPD is not amenable to pharmacological measures; treatment relies upon verbal therapies.[31] It is recommended that target symptoms rather than specific personality disorders be medicated. One of these target symptoms of particular importance is dysphoria—marked by low energy, leaden fatigue, and depression. Dysphoria can also be associated with a craving for chocolate and for stimulants, e.g. cocaine. DPD is one of the most vulnerable personality disorders to dysphoria and some individuals with DPD respond well to antidepressant medications.[32]

People with DPD are prone to both depressive and anxiety disorders. Stone suggests that these individuals may respond well to benzodiazepines in a crisis.[31] However, clients with DPD are likely to abuse anxiolytics and their use should be limited and monitored with caution.[33]

Unfortunately, individuals with DPD tend to be appealing clients. They are not inclined to be demanding and provocative. This can be precisely why they are given benzodiazepines by psychiatrists who may feel both benevolent and protective. Their inclination to use denial and escape to manage their lives makes the use of sedative-hypnotics familiar and pleasant. Iatrogenic addiction is a serious concern.

See also[edit]

General:

References[edit]

Sources[edit]

Notes[edit]

  1. ^ http://www.fhi.no/eway/default.aspx?pid=240&trg=Content_6897&Main_6664=6894:0:25,7583:1:0:0:::0:0&Content_6897=6729:100497::1:6896:2:::0:0
  2. ^ a b c Millon, 1981, p. 114
  3. ^ Richards, 1993, p. 243
  4. ^ Kantor, 1992, p. 172
  5. ^ Millon & Davis, 1996, p. 333
  6. ^ Beck & Freeman, 1990, p. 44
  7. ^ Beck & Freeman, 1990, p. 290
  8. ^ Millon, 1981, pp. 113– 114
  9. ^ Millon & Davis, 1996, pp. 325–334
  10. ^ Millon & Davis, 1996, pp. 333–334
  11. ^ Kantor, 1992, p. 170
  12. ^ Millon, 1981, p. 113
  13. ^ Millon & Davis, 1996, p. 332
  14. ^ Millon, 1981, pp. 107–108
  15. ^ DSM-IV, 1994, p. 665
  16. ^ DSM-IV, 1994, pp. 665–666
  17. ^ DSM-IV, 1990, p. 666
  18. ^ a b Millon & Davis, 1996, p. 325
  19. ^ a b [1][dead link]
  20. ^ Zimmerman, 1994, pp. 118–119
  21. ^ "Dependent Personality Disorder". 
  22. ^ Dependent personality disorder - International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
  23. ^ Millon, Theodore; Carrie M. Millon; Seth Grossman; Sarah Meagher; Rowena Ramnath (2004). Personality Disorders in Modern Life. John Wiley and Sons. p. 290. ISBN 0-471-23734-5. 
  24. ^ Millon, Theodore (2006). "Personality Subtypes Summary". The Official Website for Theodore Millon, Ph.D., D.Sc. DICANDRIEN, Inc. Retrieved January 22, 2010. 
  25. ^ Adler, ed., 1990, pp. 26–28
  26. ^ Beck & Freeman, 1990, p. 291
  27. ^ Sperry, 1995, p. 86 - 91
  28. ^ Benjamin, 1993, p. 238
  29. ^ Oldham, 1990, p. 104
  30. ^ Perry, Gabbard & Atkinson, eds., 1996, p. 998
  31. ^ a b Stone, 1993, pp. 341–343
  32. ^ Ellison & Adler, Adler, ed., 1990, p. 53
  33. ^ Sperry, 1995, pp. 93–94
  • T. Millon with R. D. Davis (1996). Disorders of Personality: DSM-IV and Beyond. New York: John Wiley and Sons