Personality Disorders 102: Dependent PD

Dependent Personality Disorder was first identified in a 1948 War Department Technical Manual. It was then included in the first DSM as a subtype of the now defunct Passive-Aggressive Personality Disorder, before becoming a condition of its own.

DPD is part of the Cluster C “Anxious” disorders, and it’s basic property is anxiety over independence and autonomy. A person with DPD will be compelled to rely excessively on either one person (such a significant other) or a multiple people (such as close group of friends) to help them navigate most or all aspects of life. This reliance is not out of laziness, nor a wish to delegate responsibility. Instead, it is to escape their fear.

A person with DPD will generally see the world as a cold, dangerous place, and will usually believe that they are deficient and unable to survive on their own. Therefore, they will seek out others who they view as stronger and more capable than them, to help them navigate through life. They will strongly fear losing that support or angering their support network, due to their belief that they cannot function alone.

The DSM-IV describes DPD as: a pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  • 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 his or her life
  • has difficulty expressing disagreement with others because of fear of loss of support or approval.
  • has difficulty initiating projects or doing things on his or her 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 himself or herself
  • 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 himself or herself

People with DPD are often fairly well-liked, as their tolerance, willingness to help others, and desire to accommodate others make them easy to get along with. They also make good employees for the same reasons. However, relationship difficulties will emerge if the other person gets annoyed or frustrated at the person with DPD’s perceived lack of initiative.

A person with DPD is very unlikely to get into trouble of their own accord, as they dislike conflict and dislike doing anything to hurt anyone else, but they may easily be drawn into the “wrong crowd” or taken advantage of due to their unwillingness to speak up about situations they disagree with. In extremes, a person with DPD may be unable to remove themselves from an abusive relationship.

The prevalence of DPD is estimated to be about 1.7% of the general population; lower than most other personality disorders. It’s not clear yet whether there are fewer people with DPD, or whether they are just less likely to come to the attention of mental health services.

Someone with DPD often seeks treatment due to their feelings about other people i.e. they may be upset with themselves for needing to rely on others, or may feel very alone after the end of a friendship/relationship.

The best recommended treatment is counselling in order to get the person with DPD to examine their beliefs about the world; however, that is complicated by the fact that the person with DPD may become stuck in the therapeutic relationship and become dependent on the therapist. For that reason, counselling arrangements are normally kept to a short time, and their emphasis is on the person discovering what they can do for themselves.

Psychological Criticisms of DPD

The first obvious flaw in the description of DPD is its relation to female stereotypes. In more female-negative media, they can be portrayed with this kind of dependent “clingy” behaviour. Also, males are supposed to be the opposite of this; autonomous, decisive and stubborn. This may logically affect how DPD is diagnosed across males and females, such as by making it harder to identify female sufferers as the disorder is not as immediately salient as with male sufferers.

A related factor is cross-cultural differences: in patriarchal societies, women are stereotyped as (or supposed to be) dependent on the male members of their family and are supposed to relinquish responsibility over the course of their life to others. In cultures like these, this disorder would be thought useless, as this would be the natural/desired behaviour of women rather than an abnormal behaviour pattern.

This also applies to the differences between collectivistic and individualistic societies: someone with DPD would not be noticed in a collectivist society in the same way as in an individualistic society. It could be argued that as schizoid PD is only noticeable due to western society putting so much emphasis on extraversion, dependent PD has only become noticeable due to autonomy and self-focus being the default in Western societies.

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