Dependent Personality Disorder (DPD) is characterized by a pervasive pattern of dependent behaviors that impair ordinary life function. Individuals with DPD feel the need for others to care for them. They prefer others to make everyday decisions on their behalf. They may have little self-confidence, fear abandonment, feel helpless and act submissively. DPD is typically treated with Cognitive Behavioral Therapy.
What Is Dependent Personality Disorder?
DPD is characterized by feelings of worry, lack of self-confidence, and being conflict averse.1 Due to the extent of their constant anxiety, individuals with DPD feel an extreme need to be cared for and nurtured. They often submit to others’ desires even if it harms them. Family members, partners, or friends can experience DPD individuals as immature, clingy, needy, fragile and helpless.
DPD brings with it a myriad of fears: fear of abandonment, fear of being alone, fear of making wrong decisions, and fear of being criticized. If an overprotective person takes excessive care of, and assumes responsibility for, a child or an adult, it contributes to his or her dependency. This can create a cycle of dependency. Being overprotected reduces their skillfulness and confidence, thus they feel helpless and in need of care.
DPD vs. Social Anxiety Disorder
Dependent personality disorder is difficult to differentiate from other disorders. Social anxiety disorder shares characteristics with DPD. Individuals who have SAD are 10 times more likely to develop DPD.2
DPD vs. Borderline Personality Disorder
DPD characteristics also overlap with borderline personality disorder’s fear of abandonment, attachment issues, dependency and suicidality. Individuals with borderline personality disorder are 30-40% more likely to have co-occurring DPD.2 Avoidant personality disorder(APD) and DPD are also closely related with 59% of DPD individuals meeting criteria for APD.3
Signs of Dependent Personality Disorder
Dependent personality is much more than short periods of dependency. It is an overall, unrelenting state of helpless submissiveness, often defined as clingy by others. People with DPD feel as if they cannot be responsible for their own lives. Even a simple decision about what to wear can throw them into worry, tears and panic.4
Their severe dependency makes them vulnerable to exploitation, abuse and emotional misery.5 Individuals with DPD are often caught up in domestic violence, or other damaging situations. Their behavior is not a sign of weakness, it is due to learned helplessness. Individuals learn dependency just as they learn independence and interdependence.3 Therapy can provide new learning and confidence building to change ineffective behaviors.
Here are common signs of dependent personality disorder:6
- Avoidance of personal responsibility.
- Difficulty being alone.
- Feeling worthless and incompetent.
- Fear of abandonment and a sense of helplessness when relationships end.
- Oversensitivity to criticism.
- Pessimism and lack of self-confidence.
- Trouble making everyday decisions.
- Submission and not being able to say no.
- Never offering a dissenting opinion.
- Volunteering to do things they don’t want to.
- Struggling to do things on their own.
- Difficulty starting new projects.
- Appearing helpless, incapable, or ingratiating.
- Overly clingy and reliant on others.
- Idealizing the person on whom they depend.
- Catastrophic thinking.
Symptoms of Dependent Personality Disorder
In the DSM-5 there is one criterion and eight features of dependent personality disorder.
Dependent Personality Disorder is characterized pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, as indicated by five (or more) of the following features:7
- Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
- Needs others to assume responsibility for most major areas of their life.
- Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Does not include realistic fears of retribution.)
- Has difficulty initiating projects or doing things on their own (because of a lack of self confidence in judgment or abilities rather than a lack of motivation or energy).
- Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
- Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves.
- Urgently seeks another relationship as a source of care and support when a close relationship ends.
- Is unrealistically preoccupied with fears of being left to take care of themselves
Causes & Triggers of Dependent Personality Disorder
The causes of DPD are largely unknown. There is little empirical research on this disorder. Lack of information is often attributed to the history of this disorder and its low prevalence.2 It is hard to quantify dependence severity. Delineating the boundary where normalcy ends and pathology begins is nearly impossible. Therefore, controversy in the psychiatric community over the validity of DPD remains.8
Several theories assert that DPD is most likely due to the interaction of genetics, family upbringing, childhood development, and environmental influences. Some research has shown that individuals with DPD have experienced abuse or other trauma. It is possible DPD individuals may have faced serious childhood illness during which they were dependent.
Being raised in a family where one parent has DPD can influence the likelihood of DPD.6 Also, people who are raised in highly restrictive environments, like cults or religious groups where reliance on an authority is required (often leading to religious trauma), are susceptible to DPD.6
There is evidence that parenting style has an influence on the development of DPD. Authoritarian parents who don’t allow children the freedom to learn from failure can prevent independent development.3 An overprotective parent can also contribute to DPD as the child relies too heavily on the parent for his or her everyday needs.3 As a child becomes more dependent, the parent becomes more protective and a self-reinforcing cycle occurs.
Appropriate attachment to a parent is an important part of personality development. To a child, attachment means nurturance, safety and security. It provides a lifeline that allows freedom to explore and build self-confidence. Without the safety of parental attachment, a child doesn’t have a healthy model to emulate. They may lack the sense of security needed to become independent. Fear of loss, neglect or abandonment can endure into adulthood becoming one of the underlying causes of pathological personality.
Triggers of Dependent Personality Disorder
DPD clients can be triggered by events that prey on their fears. When a significant person breaks off a relationship that person must quickly be replaced. DPD fears prevent them from tolerating being alone.
If individuals with DPD face criticism or feel alone and neglected it can push them to the brink of panic, drug use, or suicidality. Most triggers are based on the underlying need to be taken care of, and when a caretaker disappears it is felt as a catastrophe. Such loss can feel like there is no reason to live for an individual with DPD.
When Is Dependent Personality Disorder Diagnosed?
Personality disorders, like other mental health disorders, are not diagnosed during childhood. Children meet developmental criteria at different rates and behaviors change over time. It is especially difficult to distinguish personality disorder behaviors from teenage social development and individuation. Also, diagnosing personality disorders in children can cause stigmatization. DPD is generally evident by the age of 29 and can be diagnosed after age 18.5
Diagnosis of personality disorders requires assessment, a thorough history, a physical exam that eliminates a medical cause, and personality tests.4 An accurate diagnosis is challenging since there are a number of diagnoses that could be in play. It may take time to rule out a variety of diagnoses due to overlapping symptoms. It is also likely that the client has more than one diagnosis that requires treatment. It is important to have a knowledgeable, skilled practitioner to ensure the most accurate diagnosis possible.
Treatment of Dependent Personality Disorder
Medication is often used to treat symptoms of commonly co-occurring disorders. Modalities of therapy used to treat it include cognitive behavioral therapy and psychodynamic therapy.
Medication
There are currently no US Food and Drug Administration approved medications for personality disorders, including DPD. Medications are most often used to treat symptoms of co-occurring disorders like major depression and anxiety.2 A psychiatrist or psychiatric nurse practitioner can work with the individual to diagnose and prescribe according to his or her needs. There is a caveat to medication for DPD: due to their dependency issues DPD individuals can persistently complain about symptoms; they often pursue unneeded medication on which they can become dependent.3 Care must be taken.
Therapy
One of the challenges for the DPD therapist is balancing warm acceptance while working towards the client’s independence. DPD clients can easily attach to the therapist seeing him or her as a nurturer. Clients work hard to please the therapist instead of working on becoming self-sufficient. Without excellent boundaries and clear directives, the therapist can become another dependent relationship in the client’s life.
Cognitive Behavioral Therapy
The most common treatment for DPD is Cognitive Behavioral Therapy (CBT).1,2 The CBT goal is to gain autonomy and assertiveness by challenging negative thoughts and beliefs. The CBT model encourages insight into the development of ineffective internal belief systems.
CBT teaches skills to support new adaptive thoughts, emotions and behaviors. The therapy relationship is supportive and encouraging while holding the client accountable. There can be role playing and problem solving in session. Clients complete homework to enable them to generalize skills outside of therapy. It can be very successful.
Psychodynamic Therapy
Psychodynamic therapy has also been found to be helpful; however, it is usually longer-term therapy.1,2,3 The client is guided to causes that underlie dependent behaviors, such as abandonment, trauma, and overprotection. As these issues are addressed, the client learns new skills to deal with triggering events that activate neediness.
Due to the long-term nature of this therapy, there can be difficulty with client transference (making the therapist the client’s object of affection or neglect). Therapist countertransference can also be a problem (the therapist finds the client to be unlikeable due to the client’s helplessness).
How to Get Help for Dependent Personality Disorder
Finding a qualified therapist to treat DPD is not too difficult. Be aware that not all therapists are qualified to treat DPD. It is important to seek professionals with specialized training and experience with treating personality disorders. Inept treatment is worse than no treatment at all. Creating a balanced relationship, directive treatment, and ending therapy with a client suffering with DPD takes special skill.
Do not be afraid to ask therapists about their education, training, certifications, experience and treatment philosophy. It is important to have the right fit. Clients and therapists want to meet treatment goals within a safe environment in as short a time frame as possible. Look for referrals on therapist directories.
There are several online groups created for individuals with personality disorders, but they are not specific to DPD. The groups can be informative and encouraging. They remind people that they are not alone and not as “weird” as they imagine. Because so many characteristics of DPD overlap with other personality disorders there is a lot to learn from various personality disorder resources.
Example of DPD
I had a client who was incarcerated in jail. It was a first offense, and he had no concept of the legal system or doing jail time. He was very distraught his first day so I met with him to help alleviate his distress. His first tearful statement was, “I have never been away from my wife in 25 years, except for work. I don’t know what to do without her. I am lost. Don’t put me in a cell by myself. I can’t be alone.”
His misery did not abate, although it commonly does for most people after a few days of adjustment. He insisted on seeing me frequently and cried throughout the sessions. He continually said, “Help me decide what to do, I can’t get hold of my wife. What am I supposed to do?”
During our conversations, he acted helpless and incapable of taking even small steps without advice or “permission.” Luckily for him, his family bailed him out, which also reinforced his dependence. I have not seen him since.
Dependent Personality Disorder Statistics
Personality disorders account for higher utilization of health care, higher rates of absences from work, larger numbers of drug and alcohol addictions, greater disability, more self-harm, and significant risk of suicide.9 The purpose of a 2018 meta-analysis was to find an accurate rate of personality disorders as estimates have varied widely from 4% to 15% depending on the source.9 Without accurate information, it is difficult to assess the need for mental health services and research.
Consider the following statistics about Dependent Personality Disorder:3,5,9
- The Mental Health Foundation states that personality disorders occur in 10% of the general population, but DPD accounts for only .5% percent of those with personality disorders
- Earlier sources from 2000 – 2009 suggested overall personality disorders in the general population varied from 2% to an astonishing 55%
- After reviewing studies from seven Western countries, they found a 12.16% rate of personality disorders in the general population
- Dependent personality disorder has the lowest rate of occurrence at .78%. Obsessive-compulsive personality disorder has the highest rate 4.32%
Final Thoughts on DPD
When one feels worthless and dependent there is a feeling of always being stuck. The costs of victimization can be overwhelming; in Dependent Personality Disorder being a victim is very real, degrading, and sometimes dangerous. Coping with Dependent Personality Disorder is impossible if you don’t know what it is. Personality disorders are all encompassing. The key to a better life is knowing about dependent personality disorder so that positive changes can be made.
