Dependent personality disorder
Dependent personality disorder is a mental health issue where sufferers exhibit an excessive need to be taken care of, resulting in needy and submissive behaviour.
We recognise that the system of personality disorder diagnosis can be considered controversial. It is completely your choice which term, if any, you want to use, knowing that your doctor or care team may use another.
The terms used on Counselling Directory are those that are generally used in the UK, currently. We refer to these terms throughout, with the hope of reaching and supporting as many people as possible.
What is dependent personality disorder?
Dependent personality disorder is categorised as a Cluster C personality disorder, which also houses avoidant personality disorder and obsessive-compulsive disorder. Cluster C personality disorders all exhibit heightened levels of anxiety; in the case of someone with dependent personality disorder, feeling alone and helpless are the main sources.
People with dependent personality disorder tend to start experiencing changes in their behaviour during early adulthood. They will develop a pessimistic attitude towards most situations and doubt their own skills and abilities when completing tasks. Many sufferers even refer to themselves as ‘stupid’ after expressing an opinion.
Living with dependent personality disorder
Living with dependent personality disorder can be difficult for the individual and their close family and friends. People who have dependent personality disorder are likely to demonstrate a distinct fear of separation (from a partner or caregiver) to the extent that if a relationship ends, they almost instantly try to find another one to fill the void. They prefer to be with anyone rather than alone.
Furthermore, everyday decisions like choosing what to wear can seem daunting, and sufferers constantly seek reassurance from others rather than making decisions on their own. This indecisiveness could be underpinned by low self-confidence. Although a person who has dependent personality disorder might be ambitious, they rarely initiate creative projects and tasks because of their low self-confidence and self-belief.
Adults with this disorder usually depend on a spouse or parent to make the key decisions in their career, where they live, what car they drive and so on. Children and teenagers that display dependent personality disorder symptoms typically rely on their parents to make decisions on what friends they keep in touch with, what they wear, what college or school they should attend and how they should spend their time.
These individuals find it very hard to disagree with those they are dependent on and the people they converse with. Usually, they go along with decisions even if they think that they are wrong because they fear losing the close relationship that they depend on.
Unfortunately, people with dependent personality disorder are usually attracted to unpleasant tasks if their actions result in care and nurturing from others. In order to receive a diagnosis, understanding the dependent personality disorder symptoms can help.
Dependent personality disorder traits
Most individuals display different subsets of dependent behaviour. This means that even when a few of these traits are exhibited by a person, it does not necessarily mean they have the disorder. With this in mind, here are a number of traits that people with dependent personality disorder show:
- Blaming: Isolating the source of the problem (usually a person), rather than finding a way of solving the problem.
- Dependency: A reliance on another individual for their decision-making, subsistence and emotional health.
- Emotional blackmail: Attempting to control someone’s behaviours by using threats and punishments.
- Fear of abandonment: An unfounded belief that there is an immediate danger of being rejected and replaced.
- Low self-esteem: A low evaluation of self-worth.
- Mirroring: Imitating others’ behaviours, characteristics or traits.
- Projection: Attributing feelings to someone else, believing that they have those same feelings.
- Self-loathing: Hating oneself, one's actions, demographic or ethnic background.
- Stalking: Pursuing an individual that is perceived to be unwelcoming and pervasive.
- Testing: Forcing individuals to repeatedly display their commitment and love in a relationship.
- Theft: Taking something from a family member, spouse or partner without telling them.
Dependent personality disorder causes
The main cause of this personality disorder is still unknown but researchers have suggested that it could be a complex mix of genetic, social, biological and psychological factors. This theory is referred to as a biopsychosocial model of causation.
- Genetic and biological factors: There may be an increased possibility of the disorder being passed down to the next generation.
- Social factors: How the individual interacts with people around them during the early stages of development.
- Psychological factors: How the person learns to deal with stress, their temperament and personality development and the influence of the environment they grow up in.
Dependent personality disorder symptoms and diagnosis
Dependent personality disorder is listed in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) as a Cluster C personality disorder. Its symptoms revolve around the mindset that individuals need to depend on others to get through daily life. People with dependent personality disorder tend to:
- Find it tough to make decisions without other people’s input and guidance.
- Rarely express disagreement even if they think the point is wrong.
- Want others to make important life choices for them.
- Don’t initiate new activities because of their lack of self-confidence and self-belief.
- Go out of their way to gain support from others.
- Feel uncomfortable and helpless when alone.
- Start a new relationship soon after their earlier relationship ends.
- Have a continuous fear that they will end up alone.
- Can easily be hurt by criticism.
A diagnosis requires at least five out of eight criteria that are listed by the DSM to be present. Many people only exhibit a few symptoms, making it difficult to be diagnosed.
Diagnosing this cluster C personality disorder usually happens in early adulthood as most personality disorders exhibit enduring behavioural patterns over a number of years. Being diagnosed in childhood or during teenage years is rare because of the continuous behavioural and developmental changes young people go through. If it is diagnosed before the age of 18, symptoms have to be present for over a year.
Cultural factors and age also need to be considered when diagnosing dependent personality disorder. Certain cultural customs exhibit submissive or dependent behaviour towards opposite sexes or authority figures, which can be mistaken as symptoms of this disorder. So when the criteria are met, and the person is outside of their cultural norms, then a diagnosis can be made.
Dependent personality disorder does however share the characteristic of other personality disorders where symptoms will decrease in intensity with age.
When is it time to seek help for dependent personality disorder?
As mentioned before, early adulthood is when most cases of dependent personality disorder are diagnosed. But experts agree that, similarly to other personality disorders, seeking help early is the best way to treat it. If you have noticed signs of DPD but are unsure you qualify for a full diagnosis, you should still seek advice.
If left untreated certain complications can arise:
- The development of other anxiety disorders such as avoidant personality disorder, obsessive-compulsive disorder and panic disorder.
- Substance abuse.
Getting help for dependent personality disorder and receiving treatment early can prevent these complications from occurring. If you are concerned you may have dependent personality disorder, you may be feeling anxious about seeking help due to fear of harming your relationships if you talk about them with others. Try not to worry about this. Recognising that you might have a problem is the first step on the road to recovery. Talk to your GP about your concerns and they will help you find the right type of treatment for you.
Dependent personality disorder treatment
Counselling tends to be an effective form of dependent personality disorder treatment, and approaches used include cognitive behavioural therapy and interpersonal therapy - depending on what works best for the client. Although people who suffer from this cluster C personality disorder appear to be compliant with most suggestions for treatment, this compliance may be a symptom of the disorder itself. As a result, sufferers can be more difficult to treat than initially thought.
Below is a guide to some of the most commonly used counselling approaches to help treat dependent personality disorder.
Psychodynamic therapy is an approach that is established on the belief that adult behavioural patterns are connected to negative childhood experiences. These childhood experiences create a belief pattern that stays with the individual through their adult life. Individuals with dependent personality disorder can benefit from group and individual psychodynamic psychotherapy sessions.
Cognitive behavioural therapy aims to change the way we think (cognition) and our behaviour to treat personality disorders. A therapist will analyse and discuss negative thought patterns, and how they affect daily life and will try to change them for the better. For the behavioural approach, the therapist will examine the harmful behaviours and will help the sufferer understand why they happen, and most importantly give advice on how they can change them.
Interpersonal therapy focuses on how mental health issues can affect relationships. After an initial assessment in the early sessions, together with a therapist the interpersonal issues will be identified and ranked in order of importance. Then the aim will be to develop a set of adjustments, and how to implement them in daily life. This type of therapy is best suited to people that have been diagnosed with dependent personality disorder, as the therapy is very targeted and usually lasts between 12 and 16 sessions.
Group therapy can be helpful for socially remittent people who lack decision-making skills and have problems being assertive. The group dynamic may be more effective for highlighting and treating insecurities than a one-to-one session by encouraging people to talk about their issues with others in similar situations.
Family or couples counselling
Young adults with dependent personality disorder are usually brought to family therapy by their parents. The aim of this is to tend to the family relationship when all members are in the same room, as there can be resistance if not all of the family is present. This type of therapy encourages family members to empathise with and help each other. It presents the opportunity to build on family strengths and make positive changes in their lives and relationships.
Couples counselling on the other hand can help reduce anxiety in the relationship if either partner is displaying intense dependency on the other. Even though a lot of the counselling will be done in session, ‘homework’ will be set, which usually consists of a task or a discussion for when the couple gets home. This is then talked about in the next session to help build or repair the relationship.
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