Dependent Personality Disorder

Dependent Personality Disorder (DPD) is a neurological condition that renders victims unable to function normally due to their need to be taken care of and their excessive reliance on the affirmation of their peers to make seemingly ordinary life choices. It is known that humans ordinarily value the opinions of their peers (Hughes, Leong, Shiv, & Zaki, 2018), however those afflicted with the disorder lack autonomy to the degree where they will develop potentially harmful symptoms and habits due to the anxiety related to look out for oneself. Some of these habits as outlined in the DSM-IV include “pessimism and self doubt”, “[tendency] to belittle [one’s] abilities and assets”, and an inclination to “refer to themselves as stupid” (American Psychiatric Association, 2000, p. 666). Such habits indicate a poor self image for the person suffering with DPD, and this disorder does lead them to increasingly rely on the approval of others in order to maintain a sense of belonging. Such a need to belong can lead the victim to force themselves into potentially harmful relationships that could become overprotective and dominant, simply to offset the anxiety that they may feel towards being alone (DSM-IV-TR, 2000, p. 666). The dangers of being in these types of relationships go beyond one’s mental health; those with DPD who find themselves within a system that encourages brutality or abuse will refuse to leave and thus force themselves to suffer from violence inflicted on them or potentially feel that they must inflict violence upon others. Such abuses may include suffering from “verbal, physical, or sexual abuse” (DSM-IV-TR, 2000, p. 666), as well as remaining in relationships where the balance of power is very clearly shifted towards the abuser rather than the victim. Such unfortunate acts are permitted by the afflicted due to the intense need to maintain these relationships - no matter how damaging - perhaps because to them the alternative is far worse.

Dependent Personality Disorder shares many qualities with and has comorbidity with other mood disorders such as Borderline and Avoidant Personality Disorders (DSM-IV-TR, 2000, p. 667). Comorbidity is defined by Bornstein (1995) as the co-occurrence of symptoms among different disorders, and although he points out that the psychiatric use of the term has a looser definition than the medical terminology, the essential definition remains the same (p. 288). Research has shown that DPD does in fact have comorbidity with Axis I disorders on the DSM-IV, and it has been stated that “significant positive correlations [can be] found between severity of DPD symptoms and severity of eating disorder symptoms” (Bornstein, 1995, p. 291). Therefore, it has been shown that the intense need to be cared for and sense of inadequacy that sufferers of DPD struggle with may coincide with the fatigue and decreased appetite that those with an eating disorder may experience. In addition, DPD does share comorbidity with Axis II disorders, namely borderline, avoidant, and schizoid personality disorders (Bornstein, 1995, p. 293). The links between these disorders quite tangible, with the majority of these disorders causing the victims to fear abandonment and engage in self-destructive behaviors. It is due to these similarities that those charged with diagnosing DPD in individuals must be wary of the parallels with other Axis I and II disorders. For instance, many personality disorders can be diagnosed by dependent behavior and an overreliance on others, however, Dependent Personality Disorder is unique due to the highly submissive behavior patterns exhibited by those with the condition (DSM-IV-TR, 2000, p. 667). Additionally, those with DPD react differently to feeling abandonment; an example given in the DSM-IV (2000) is that of someone with Borderline Personality Disorder reacting to losing a relationship with “feelings of emotional emptiness, rage, and demands” while someone with DPD will react with “increasing appeasement and submissiveness” (p. 667).

According to various sources, it appears that the cause of DPD is still somewhat of a mystery. However, one potential cause as proposed by Ploskin (2017) is that people with the disorder are born with “a biological, inborn temperament, sometimes referred to as harm avoidance” that causes the person to fret over outcomes that an average person might not. These high levels of stress are characteristic of other illnesses such as generalized anxiety disorder, and this shared fear of seemingly ordinary events could potentially explain the shared characteristics of DPD and other Axis I disorders. Ploskin (2017) also points out a tendency for the families of those with DPD to “overcontrol their children and discourage their independence,” thus creating an environment where dependency is simply natural and not a product of genetic predisposition. This style of overparenting coupled with some of the previously mentioned anxiety-like symptoms could plausibly lead someone to become reliant on authority figures in their lives and develop Dependent Personality Disorder. Keeping in line with outside influences, it is important to note that diagnosing DPD has a great deal to do with an individual's culture and surroundings. The DSM-IV (2000) states that “age and cultural factors need to be considered in evaluating the diagnostic threshold of each criterion” (p. 667). Essentially this means that what is characterized as dependent behavior in a society that promotes autonomy like that of the United States could potentially seen as normal in more collectivist societies. For example, a behavior that may be considered overly dependent in an individualistic society yet normal in a collectivist society would be to allow one’s parents to decide who they should engage with romantically and eventually marry. Arranged marriages are commonplace in nations such as Pakistan and Afghanistan, and thus cannot be considered overly dependent behavior in these cultures. Therefore, a diagnosis of DPD must indicate that the person’s fears of abandonment are exorbitant and unfounded when considering their current cultural and personal circumstances (DSM-IV-TR, 2000, p. 667).

Beitz & Bornstein (year) propose a guideline for detecting and diagnosing DPD that is guided by the following three principles: “dependency is not always characterized by passivity,” “self-reports do not always give a true picture,” and “dependency levels vary over time and across situations” (p. 232). The first principle of dependency serves as a reminder that although passivity is quite common as a sign of dependency, it is not the only form it takes. Other ways that a dependent individual may maintain a relationship that they feel is necessary is through intimidation and threats (Beitz and Bornstein, year, p. 232). This may particularly be the case when the individual with DPD is a heterosexual male who is dependent upon his relationship with his wife or girlfriend, and rather than allow her to control whether or not she can leave him he instead uses violent tactics such as physical abuse to keep her in the relationship and prevent her from leaving. The second principle affirms that a person’s own self assessment may not be entirely reliable when attempting to diagnose them with DPD. Beitz & Bornstein (year) accurately capture this point by stating that individuals - particularly men - tend to not admit that they have dependent traits likely because dependence is seen as a sign of weakness (p. 232). On the other hand, it is entirely possible that someone could believe that they have symptoms of DPD and confuse their natural desire to be with others for dependency. Therefore, it seems that a third party account - while not absolutely necessary - is preferable when trying to diagnose someone with Dependent Personality Disorder. The final principle as outlined by Beitz & Bornstein (year) is that levels of dependence change as time goes on (p. 232). In context, this essentially means that a adolescent, elderly person, or someone suffering from an illness feels a certain degree of dependence that a normal, functioning adult would not. Therefore, it would be unwise to diagnose a teenager who asks their parent for advice on where to go to college or an elderly person who moves in with their children as having DPD when they are simply exhibiting normal human behaviors at that stage in their life.

While DPD can be treated with medication, it is often treated by helping the victim act with autonomy and overcoming their dependency through various methods of therapy. One method of treating DPD is behavioral health therapy, of which the goal is to “help the person become more active and independent, and to learn to form healthy relationships” (“Dependent Personality Disorder: Management and Treatment,” n.d.). Gotter (2016) defines behavioral therapy as an umbrella term for different therapeutic methods meant to alter potentially self-destructive behaviors. In addition, behavioral health therapy consists of various different methods, with one prominent one being system desensitization, where fear in response to a stimulus is gradually replaced by other emotions (Gotter, 2016). Behavioral therapy has been shown to be quite effective, with approximately 75% people suffering from a variety of mental disorders reporting that they benefited from the experience (Gotter, 2016). In addition, pharmaceuticals are occasionally used to treat DPD, however this is most common with those who share symptoms of other severe mental illnesses such as depression or anxiety (“Dependent Personality Disorder: Management and Treatment,” n.d.).