Dependent Personality Disorder (DPD)
Overview
Dependent Personality Disorder (DPD) is characterized by “a pattern of submissive and clinging behavior related to an excessive need to be taken care of”.[1] It falls under Cluster C personality disorders, which are categorized as Anxious-Fearful. Individuals with this personality disorder often feel incapable of taking care of themselves as well as have a fear of separation.
Common indicators of DPD:
Overreliance on others to meet one’s needs
Excessively submissive and conforming
Sacrificing one's own well-being to obtain reassurance and support from others
Preoccupation with fears of being left to take care of self
In the United States, fewer than 1% of people have this disorder. While it is diagnosed more often in women, some studies show similar prevalence rates between men and women.[2]
DPD symptoms result in clinically-significant impaired functioning.
Signs and symptoms
Individuals with DPD use submissiveness to get others to take care of them.[3] They do not think they are capable of taking care of themselves and being alone leads to great distress. They let others take responsibility for many aspects of their life. An example of this would be depending on a spouse for advice on what to wear, what kind of job to apply for, and whom to associate with.[4]
People with DPD have difficulty working independently and starting a new task on their own.[5] Avoiding tasks that require responsibility, they may present themselves to others as incompetent, constantly needing help and reassurance.
Individuals with DPD view themselves as inferior, belittling their abilities. They do not take criticism well, viewing it as proof of their incompetence. They rarely disagree with others out of fear of losing their support or approval.[6] For instance, rather than risk losing the help of others, they may even agree to something they know is wrong.[7] Even in situations when anger is an appropriate response, they suppress this feeling out of fear of losing support from friends or coworkers. In an effort to obtain care and support from others, those with DPD may endure unpleasant tasks, submit to unreasonable demands, or tolerate abuse.[8]
Diagnosis
To diagnose this personality disorder, individuals must present with a need for an unusual amount of support, reassurance, and advice when making everyday and ordinary decisions (e.g., what to wear or eat).[9]
For a diagnosis of DPD, patients must have a persistent, excessive need to be taken care of, resulting in submissiveness and clinging behavior and fears of separation.[10]
This persistent need is shown by the presence of ≥ 5 of the following:[11]
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 (e.g., 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
Symptoms must have begun by early adulthood and be present in a variety of contexts.
Differential diagnosis
Other personality disorders (e.g., Borderline, Avoidant, and Histrionic) are also characterized by hypersensitivity to rejection.
In Borderline Personality Disorder and Avoidant Personality Disorder (AVPD), individuals are too frightened to submit to the same degree of control that people with DPD do. People with Borderline Personality Disorder fluctuate between submissiveness and hostility.[12] People with AVPD withdraw from others until they are certain they will be accepted without criticism.[13] On the other hand, individuals with DPD continue seeking others out and try to maintain relationships with them.
In Histrionic Personality Disorder (HPD), individuals seek attention rather than reassurance. Comparatively, hose with HPD are more extravagant and actively seek attention, while those with DPD are self-effacing and shy.[14]
Causes and risk factors
The etiology of DPD has not been studied extensively. Mental health experts believe it results from a combination of genetics, environment, and development.
The following factors are thought to contribute to the development of DPD:[15-17]
Certain cultural or religious behaviors that emphasize reliance on authority
Negative early experiences
Biological vulnerabilities associated with anxiety
Familial traits of submissiveness, insecurity, and self-effacing behavior
Family history of personality disorders, depression, or anxiety
Abusive relationships
Childhood trauma (child abuse or neglect)
History of neglect or abuse, especially as a child
Authoritarian or protective parenting styles
Parents who punished individual thinking
Chronic and life-threatening physical illness in childhood
Treatment and therapeutic outcomes
Treatment for DPD is similar to that for all personality disorders, with psychotherapy as the gold standard.[18] Both individual and group psychotherapy have been proven effective in treating personality disorders such as DPD.
The 3 types of treatments below have shown to be the most effective for DPD:
Psychodynamic psychotherapy
Pharmacotherapy (MAOIs & SSRIs)
Treatment for DPD aims to:
Reduce subjective distress
Enable patients to understand that their problems are internal to themselves
Decrease significantly maladaptive and socially undesirable behaviors
Modify problematic personality traits
CBT and psychodynamic psychotherapy sessions that focus on evaluating fears of independence and difficulties with assertiveness are particularly useful for individuals with DPD.[19] Due to the nature of DPD, clinics must be careful not to promote dependence in the therapeutic relationship.
Although personality disorders are typically not very responsive to drugs, some medications, such as antidepressants, can effectively target specific symptoms of depression and anxiety associated with one’s personality disorder. Since DPD patients are at a heightened risk of drug dependence, benzodiazepines are usually not prescribed to treat symptoms.[20]
Because other disorders (e.g., depression, anxiety, substance abuse, and eating disorders) often coexist with DPD, treatment can be challenging.[21]
With treatment from a mental health provider, individuals with DPD can live an emotionally healthy life. If left untreated, those with DPD are at an increased risk for depression and anxiety as well as developing a substance abuse issue such as drug addiction or alcoholism. Further, without treatment, people with DPD are more likely to remain in abusive or unhealthy relationships.[22]
If you or someone you know are exhibiting signs of DPD, please reach out to a mental health professional for assistance.
Contributed by: Nicole Izquierdo
Editor: Jennifer (Ghahari) Smith, Ph.D.
References
1 American Psychiatric Association. (2013). In Diagnostic and statistical manual of mental disorders (5th ed.).
2 Zimmerman, M. (2021). Merck Manual. Dependent Personality Disorder. https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/dependent-personality-disorder-dpd
3 Ibid.
4 Ibid.
5 Ibid.
6 Disney, K. L. (2013). Dependent personality disorder: A critical review. Clinical Psychology Review, 33(8), 1184–1196. https://doi.org/10.1016/j.cpr.2013.10.001
7 Ibid.
8 Ibid.
9 American Psychiatric Association. (2013).
10 Ibid.
11 Ibid.
12 Zimmerman, M. (2021).
13 Ibid.
14 Ibid.
15 Zimmerman, M. (2021).
16 Sheppard Pratt. (2022). Dependent Personality Disorder. https://www.sheppardpratt.org/knowledge-center/condition/dependent-personality-disorder/
17 Cleveland Clinic. (2020). Dependent Personality Disorder. https://my.clevelandclinic.org/health/diseases/9783-dependent-personality-disorder
18 Ibid.
19 Faith, C. (2009). Dependent Personality Disorder: A Review of Etiology and Treatment. Graduate Journal of Counseling Psychology: 1(2), Article 7.
20 Zimmerman, M. (2021).
21 Bornstein, R. F. (1995). Comorbidity of dependent personality disorder and other psychological disorders: An integrative review. Journal of Personality Disorders, 9(4), 286-303. doi:https://doi.org/10.1521/pedi.1995.9.4.286
22 Zimmerman, M. (2021).