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Dependent Personality Disorder

Dependent Personality Disorder (DPD) is a personality disorder characterized by an excessive need to be taken care of by others

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What is Dependent Personality Disorder (Zimmerman, 2022)?

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  • Dependent Personality Disorder (DPD) is a personality disorder characterized by an excessive need to be taken care of by others

    • This excessive need to be taken care of often leads to diminished independence and interests

  • Those with DPD experience extreme anxiety revolving around their wellbeing leading to dependent and submissive behaviors

  • Research shows that approximately 1% of the population suffers from DPD

    • Though DPD is diagnosed more often in women, studies show that the prevalence of DPD is equal amongst men and women

  • Comorbidities are common in DPD. Those with DPD often also suffer from a depressive disorder, anxiety disorder, substance use disorder, or other personality disorder

 

 

Symptoms of Dependent Personality Disorder (Zimmerman, 2022)?

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  • Those with DPD believe they are incapable of taking care of themselves so instead, submissiveness is used to try to get others to care for them

  • Symptoms of DPD often begin to show in early adulthood

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  • Common symptoms of DPD include:

    • Requiring much reassurance or advice when making simple and ordinary decisions

    • Often leaning on one specific person to take responsibility for majority of the aspects in their life

      • E.g., Having a significant other decide what they wear, where they work, etc.

    • Belittling their abilities

      • Those with DPD will often take criticism or disapproval as it validates their perceived incompetency

    • Inability to express disagreement due to the fear of losing support

      • E.g., Will agree to something that goes against their morals due to the simple fact that they do not want to lose help/support

    • Difficulty starting a task or working independently

    • Avoiding tasks that require taking responsibility

    • Presenting themselves as incompetent

    • Functioning efficiently when they are reassured that a competent individual is supporting and approving of them

      • They may avoid trying to appear too competent as they may lose their support

    • Refusing to learn skills required for independent living

    • Going to great lengths to receive support and approval

      • E.g., tolerating abuse, agreeing to unreasonable demands, etc.

    • Socially interacting with only those that support/care for them

    • Feeling extreme discomfort or fear when alone

    • When a caretaker relationship ends, immediately seeking any replacement

 

 

Causes and Risk Factors (Mayo Clinic, 2023)

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  • Research so far has shown that there are no direct or specific causes of this disorder, though, there are some factors and conditions that can increase the likelihood of an individual to develop DPD such as:​

    • Childhood trauma

    • War

    • Family history of personality disorders, depression, or anxiety

    • Stifling, withdrawn, or punishing parenting

    • Experiencing a chronic physical illness during childhood

 

 

Ruling Out Other Diagnosis (Zimmerman, 2020)

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  • There are other personality disorders that consist of hypersensitivity to rejection, though, the following diagnoses can be distinguished from DPD based on certain characteristics:

    • Borderline personality disorder – individuals with this disorder are too frightened to submit to the level of control as those with DPD

      • Unlike DPD, those with borderline personality disorder will alternate between submissiveness and rage

    • Avoidant personality disorder – individuals with this disorder are also too frightened to submit to the level as control as those with DPD

      • Those with DPD actively seek out and attempt to maintain relationships with others while those with avoidant personality disorder tend to withdraw until they feel that they can be accepted without criticism

    • Histrionic personality disorder – individuals with this disorder seek attention rather than reassurance, similar to DPD, though those with histrionic personality disorder tend to be more disinhibited, flamboyant and actively seeking attention

      • Those with DPD tend to be more self-effacing and shy

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  • The diagnosis of DPD should be determined based on the dependency that is present in other psychiatric disorders such as depressive disorders, panic disorder, agoraphobia, etc.

  • Clinicians should also be cautious about creating dependency within the therapeutic relationship

 

 

Treatment Options (Mayo Clinic, 2023)

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  • The treatment of DPD is similar to that of other personality disorders

  • Though DPD is difficult to treat, there are treatment options that can assist with symptoms associated with DPD

    • Psychodynamic psychotherapy and cognitive behavioral therapy can assist in focusing on fears of independence

    • Medication management is often used to alleviate some associated symptoms

      • Research on medication management and DPD is sparse though there is evidence that monoamine oxidase inhibitors (MAOIs) can be just as effective as selective serotonin reuptake inhibitors (SSRIs)

        • Benzodiazepines should not be used in the treatment of DPD as those with dependent personality disorder have an increased risk of drug dependency (Zimmerman, 2022)

 

 

 

Patient Story: How I Recovered from Dependent Personality Disorder: The Treatment That Gave Me My Freedom

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I have always struggled to be independent. I love to have other people take care of me, and I doubt every decision I make on my own. I was recently diagnosed with dependent personality disorder. I didn’t believe it until I delved into therapy during treatment.

 

I learned that my patterns of negative thoughts about myself were damaging but that I could change them. I learned to trust myself, to be more confident in my abilities, and to have healthier relationships with my family, friends, and romantic partners.

 

Dependent personality disorder, or DPD, is one of several types of personality disorders. A personality disorder is a mental illness characterized by stubborn, abnormal, and unhealthy thoughts and behaviors. These negatively impact functioning in relationships, in social situations, at work or school, and in other situations.

 

One of the most damaging aspects of personality disorders is that when you’re experiencing one, it is extremely difficult to see that there is anything wrong with the way you think or behave. This is why it took me so long to get treatment for DPD. What my family saw in me that eventually led to a diagnosis was:

 

  • Neediness

  • An inability to make decisions without their input

  • Difficulty spending any time alone

  • Avoiding responsibility for even the most basic things

  • Difficulty functioning independently

  • A need to please everyone around me

  • A deep fear of being abandoned by them

  • Poor self-esteem and low self-confidence

  • Complete devastation after the end of a relationship with a boyfriend

  • Allowing a boyfriend to be emotionally abusive

 

It was this last sign of DPD that broke my parents and finally pushed them to push me to get help. I have always felt as if I need the validation and support of other people in order to do anything. I thought if I didn’t have a relationship I would be lost. So when my last boyfriend got really mean, and even hit me a couple of times, I let him.

 

I received a diagnosis of DPD because my patterns were clear: I thought I needed other people to meet my emotional needs; I feared being alone or doing anything without someone else’s help; I had no confidence in myself at all; and I let others walk all over me

It was the end of my last relationship that convinced me to get help. While my parents had been pushing me for a long time before that, I didn’t see what they saw. When my boyfriend left me, I sank into a serious depression for a couple weeks. I found I couldn’t function alone and had to go home to stay with my parents.

 

Realizing that I could not live alone and that I had allowed by boyfriend to treat me badly finally pushed me to follow my parents’ advice and see someone for a diagnosis. Even then, I didn’t really think there was anything wrong with me. It’s only after treatment that I see more clearly how damaging my relationships and choices were. I recommend anyone in a similar situation listen very carefully to what their loved ones say. They see your harmful behaviors better than you do.

 

My parents were so supportive, and it was natural for me to rely on them to find a solution to my problem. After getting the diagnosis of DPD, they gave me options for treatment but insisted I make the final choice. I went with residential treatment. To be honest, it was because I knew it would mean being surrounded by caregivers.

 

My motives and reasoning weren’t perfect, but residential treatment turned out to be the best decision I could make. I really benefited from several aspects of this kind of care, including being able to leave all other responsibilities at home and focus on my own well-being in a safe place.

It was also really useful to be around other people struggling with similar issues. I learned in treatment that my approach to relationships was highly flawed. Being in a supportive, social environment in treatment really helped me practice building better relationships and social skills.

 

One of the aspects of treatment that really helped motivate me to make positive changes was coming to a better understanding of what may have contributed to my personality disorder. My therapist helped me connect some of the natural aspects of my temperament and how I was as a child with the DPD that I later developed.

 

As a kid, I struggled with anxiety disorder, and so did my mom. I was afraid of new things and very cautious. I tried to avoid what scared me, like going to school, making new friends, trying a new sport, or being without my parents. My dad tended to push me to try new things, but my mom, cautious like me, often gave in and let me stay home a lot. Now I can see how she sheltered me and was overly protective. No one really knows what causes DPD, but these kinds of personality traits I had, the relationship with my mother, and my anxiety probably contributed.

 

I learned in residential care that there is no cure for a personality disorder and no medication for it. I also learned that the best way to manage DPD and change my negative thought and behavior patterns was to work through all my issues with a good therapist. Immediately I was eager to please and wanted to let my therapist take care of me, but what she helped me realize was that I needed to do the work myself. She was simply my guide.

We worked mostly with cognitive behavioral therapy. My therapist helped me explore my past and how that contributed to DPD, but also how my choices as an adult made my symptoms worse. With this therapy I had concrete things I could do, steps to take to make real changes to the way I think about myself and relationships to others. From these changes I could then take action to do things differently and make better choices.

 

In treatment, I practiced being more assertive, making decisions on my own, including choices about my own care, and reacting in more productive ways to other people and developing positive new friendships.

 

I also benefited from taking charge of other aspects of my well-being. I learned how to cook and make healthy food choices. I learned how to meditate and do yoga to cope with anxiety. I even went on an adventure therapy session, something I would never have done before treatment. All of this helped build my self-confidence and prepared me to be more independent going back home.

 

DPD has been a difficult condition to live with and to manage. But with treatment I feel hopeful about my future. I moved out of my parents’ house two months ago and have been single and comfortable living alone and not being in a relationship. Sometimes I still slip up, and I try to get my parents to make decisions for me, but then I remember what I learned in treatment and what I’m capable of, that I can trust myself to be independent.

 

Retrieved from: https://www.bridgestorecovery.com/blog/how-i-recovered-from-dependent-personality-disorder-the-treatment-that-gave-me-my-freedom/#:~:text=I%20didn't%20believe%20it,%2C%20friends%2C%20and%20romantic%20partners.

 

 

Crisis Resources:

  • NAMI HelpLine

  • NAMI Crisis Text Line

    • Text NAMI to 741-741

  • COPE (Hennepin County)

    • Adult: 612-596-1223

    • Child: 612-348-2233

  • Ramsey County

    • Adult: 651-266-7900

    • Child: 651-266-7878

  • Text Connect (Crisis counseling via text)

    • Text “HOME” to 741741

 

 

References

 

 

Mayo Clinic. (2023). Personality disorders. https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463

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Zimmerman, M. (2022). Dependent Personality Disorder. Merck Manual – Professional Version. https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/dependent-personality-disorder-dpd

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