Running head: DEPENDENT PERSONALITY DISORDER
Dependent Personality DisordeR
Roxana Tejera
Institutional Affiliation
1
DEPEDENT PERSONALITTY DISORDER
2
Abstract
Dependent personality disorder is a condition where an individual has an excessive need for
approval and guidance. The history of the disorder dates back to 1945. There are two primary
categories of causal factors for DPD: (1) genetic factors; and (2) social and cultural factors. The
principal symptoms for DPD include difficulty making decisions, inability to initiate things on
your own, and need to be with and around people among others. DPD has five sub-types namely
accommodative dependent disorder, selfless dependent disorder, disquieted dependent disorder,
immature dependent disorder, accommodating, and ineffectual dependent disorder. This disorder
can be prevented by rewarding independence during childhood. Unfortunately, it is not possible
to prevent hereditary causes. Treating DPD is mainly through psychotherapy interventions for
both short-term and long-term goals. To overcome this disorder, there is need for the person to
accept that he or she needs help as well as have a willingness to go through counseling.
DEPEDENT PERSONALITTY DISORDER
3
Dependent Personality Disorder
Definition
Dependent personality disorder (DPD) refers to a situation where an individual has an
excessive and persuasive need to have someone taking care of him or her. The primary
characteristics of this disorder include clinging behavior, submissiveness, and excessive fears of
being alone. Hence, a person suffering from DPD can be defined as one who finds it difficult to
initiate and do things on the own so that they have to rely on the affirmation and direction of
“significant and powerful” others. These people exude low levels of confidence in their abilities
and intelligence. They tend to belittle their achievements as long as others have not approved
them. They are also prone to self-doubting and being pessimistic. As a result of feeling unable to
function without guidance from others, these people go to great extents to establish and maintain
the dependent relationships.
History of DPD
The history of DPD dates back to Abraham’s and Freud’s descriptions of oral
dependency in 1927 (Andrasik 2006). However, by that time, the dependency was yet to acquire
the status of a disorder. Abraham and Freud described the dependency as an oral character. In
1945, the condition appeared for the first time as a disorder in a Ware Department Technical
Bulletin. Seven years later, in 1952, the disorder featured in the first edition of the Diagnostic
and Statistical Manual (Andrasik 2006). At this time, clinicians referred to it as a subtype of
passive-aggressive personality disorder.
DEPEDENT PERSONALITTY DISORDER
4
Causes
The development of dependent disorder is a result of multiple factors. Genetic factors
have been found as one of the contributors to DPD (Reichborn-Kjennerud 2010). In a research
involving 2794 Norwegian twins, Gjerde et al. (2012) revealed that the probability of inheriting a
dependent disorder is 0.66 as compared to 0.64 in the case of avoidant personality disorder.
According to these findings, children of parents with DPD face a considerable risk of inheriting
the disorder as compared to those whose parents do not have the condition.
Over-involvement of primary caretakers is the other established factor responsible for the
development of DPD. In childhood, caretakers may cultivate dependence in the child by
rewarding loyalty and punishing any attempt the child makes towards attaining independence. A
child who has never been rewarded for exercising independence may never attempt it even if it
would be appreciated.
Similarly, a child who grows up in a home where a significant other has a dependent
disorder may develop the condition as well. Children learn through observation and imitation. As
such, if a child notes that his or her mother, father, an elder sibling or another close relative
heavily relies on the approval of others to do anything, he or she may grow up knowing that is
the way things are done. Sociological and psychological theories agree that children are born as
blank slates. At the point of birth, children do not know what to do, when, or how. Society
informs them everything about behavior. In other words, the behaviors people carry through life,
including extreme dependence, is passed over to them by the society.
The social learning theory expounds on how children learn. According to this theory,
human beings, including children, learn from one another through observation, imitation, and
DEPEDENT PERSONALITTY DISORDER
5
modeling. Framed differently, children like adults, pay attention to what the behavioral patterns
of significant others. The second phase of behavior formation is trying to remember what one
observed. The third stage involves reproducing the behavior. Thus, according to social learning
theory, every behavior is learned from those close to the individual.
Moreover, there are cultures that celebrate dependency. In most societies, asking for help
is seen as being friendly and sociable. In tune with this view, people tend to keep asking for
guidance and help. As these people grow and become members of a global culture, they are not
able to let go the lessons inculcated in them. Unfortunately, there is no scientific formulae of
knowing how the various contribute to the development of DPD.
Symptoms
According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), there
are several ways of identifying DPD. One of the most pronounced symptoms of DPD is that
these individuals have difficulties making common decisions (Hales et al. 2011). Typically,
people suffering from this disorder need excessive reassurance before they settle on even simple
decisions such as what time to eat or what clothing to wear. Another symptom very similar to
this is that these people tend to transfer their responsibilities to others (Hales et al. 2011). As a
functioning of feeling incapable of assuming autonomy, they allow others to handle things on
their behalf. People with this disorder tend to depend on parents to decide on who to marry or
spouse on where to live. At times, these people will also need excessive guidance on who to be
friends with.
Also, people with the dependent disorder are overly agreeable. They do whatever they
can to avoid disagreements. To them, disagreeing is a far too risky involvement as it can destroy
DEPEDENT PERSONALITTY DISORDER
6
dependent relationships. They are afraid of disagreements not because they are cowardly but
because they do not want to lose a source of approval and guidance (Hales et al. 2011). In the
same vein, these people are very quick to seek new relationships when an existing one ends. For
example, in the case of divorce, these people will most likely get married again in the shortest
time possible. They do all they can to be in a relationship that will provide the same support the
previous one provided.
Equally important, these people feel helpless when alone. Because of the feeling that they
are not able to care for themselves, they tend to suffer from high degrees of anxiety when left
alone (Hales et al. 2011). In response, these people prefer being around people, even if they have
little interest in them.
Lastly but not least, people with DPD have difficulty with starting anything. They see
themselves as inept to accomplish any task. Even worse, they are not able to sustain tasks. Thus,
if you assign them to do something, they need you to provide support all through. In the end, you
prefer doing the task rather than assigning it to them.
Different Types
There are five main types of dependent personality disorder (DPD) namely disquieted,
selfless, immature, accommodating, and ineffectual. The section below discusses each of these
subtypes in brief.
The Ineffectual Dependent Disorder
People suffering from this type show a combination of schizoid and dependent patterns.
The major symptoms of this disorder are that the person is not interested social relationships
(Cavaiola & Lavender 2000). They tend to prefer solitary activities. However, in stark contrast,
DEPEDENT PERSONALITTY DISORDER
7
people with this disorder understand and empathize with the emotions of others. Another
distinguishing feature of this type is that the individuals have no drive to act on their own.
The Disquieted Dependent Disorder
People with this disorder are highly vulnerable to separation anxiety. At the same time,
they are very cautious not to lose support. A notable distinguishing characteristic of people with
this disorder is that they at times express their fear of losing supportive relationships (Cavaiola &
Lavender 2000). They tend to have outbursts of anger when their needs for safety and security
are not met.
The Selfless Dependent Disorder
For this disorder, total identification and idealization are the principal themes. These
people tend to forfeit their own self-identities as they merge with others. Ironically, their loss of
self-identity seems fulfilling. Besides the loss of self-identity, people with the selfless dependent
disorder are highly prone to experience depression when their relationship face difficulties
(Cavaiola & Lavender 2000).
The Immature Dependent Disorder
As the term suggests, people with this disorder are overly attached to childlike activities
and children. They have zero interest in spending with adults and assuming adult responsibilities.
Instead, they prefer engaging in childhood activities and derive satisfaction from relating with
children (Cavaiola & Lavender 2000).
The Accommodating Dependent Disorder
DEPEDENT PERSONALITTY DISORDER
8
This disorder shares most symptoms with the histrionic personality disorder. People with
this type are very agreeable, submissive, benevolent, and neighborly (Cavaiola & Lavender
2000). Also, these people seek to become the centers of attention. As such, they tend to exhibit
self-dramatizing behaviors.
Prevention
To understand how to prevent DPD, it is important to divide the causal factors into two:
(1) genetic factors: and (2) social and cultural factors. For the genetic factors, preventing DPD is
virtually impossible. Hence, the only way of preventing the development of DPD is by
addressing social and cultural factors.
In this tune, one way of preventing DPD is by teaching caretakers on how to help
children learn independence. At times, caretakers are too protective. They do not provide space
for children to experiment and explore on their own. Essentially, caretakers should encourage
children to be independent. They should reward any effort towards attaining independence.
Another way of preventing DPD is by living independently. As mentioned elsewhere,
children learn through imitation. Hence, significant others must ensure that they provide a good
example of an independent life to children. In this light, parents and elder siblings should show
children that they can decide on their own, and feel confident about their decisions even if
nobody approves them.
Treatment Plans for Short-Term and Long-Term Goals
For both short-term and long-term goals, psychotherapy is the primary method of treating
DPD. However, depending on the nature of the goals, short-term or long-term, different types of
psychotherapy are used. For short-term goals, assertiveness training and cognitive-behavioral
DEPEDENT PERSONALITTY DISORDER
9
therapy (CBT) are the most common treatments. Training in assertiveness helps build selfconfidence. CBT helps develop new perspectives and attitudes concerning others. For long-term
goals, psychodynamic psychotherapy is the best intervention.
Suggestions on How to Overcome the Disorder
The first and probably the most important suggestion for people seeking to overcome the
disorder is to accept that they need help. Unfortunately, most people suffering from DPD never
seek help, they only seek help when symptoms become unmanageable. While this also helps, it is
at times too late. That said, it is very important to accept that you need help. Denial never helps.
Secondly, one needs to seek professional help. While it is good to seek help from friends
and relatives, it is much better to approach professionals in psychotherapy. The importance of
seeking professional help cannot be overstated.
Thirdly, success from psychotherapy requires commitment and discipline on the part of
the patient. Therefore, anyone willing to overcome DPD must have a positive attitude and
mindset. One must not approach psychotherapy like it is punishment. There is need for
willingness on the part of the patient.
Parenting Skills to Help the Individuals
One skill that parents need to help children with DPD is praising them for efforts. In the
case of children with DPD, one of the greatest issues to deal with is to help them improve their
confidence levels. Praising children helps boost their confidence levels. On top of verbal
commendation, parents can also have a journal where they write the good things their children
do. They can then allow the children to read through the journals occasionally. This will also
DEPEDENT PERSONALITTY DISORDER
10
help people prone or already suffering from DPD to appreciate themselves and develop positive
self-esteem.
Setting rules and being strict on them is another skill parents to help individuals with
DPD. It is not true that being passive results in better behavior. Inability to set and enforce rules
makes it possible for dependent individuals to keep asking for support and direction, even in
handling simple things. Parents need to define what areas their children can seek help. Most
importantly, these rules should be revised over time as the child advances in age. Adults relying
on their parents to decide on who to marry or where to live evidence that these parents
encouraged that kind of excessive dependency. Parents must ensure that their children learn how
to assume responsibilities.
Another equally important skill for parents with individuals having DPD is how to argue
and solve conflicts. From time to time, these parents need to pick moderate conflicts with these
individuals. By so doing, these people will learn that disagreeing is normal in life and it does not
mean the relationship is over.
Evidence-based Therapies for DPD
Cognitive-behavioral therapy (CBT) the most recognized and effective evidence-based
interventions for DPD. Ideally, CBT seeks to address self-defeating thought processes and
patterns. This kind of therapy helps deconstruct inflexible patterns hindering the person from
embracing healthier behavior. Matusiewicz and colleagues conducted research on the available
empirical support for CBT as an intervention for DPD in the years between 1980 and 2009
(Matusiewicz et al. 2010). This investigation observed that CBT is the most effective evidencebased intervention for DPD.
DEPEDENT PERSONALITTY DISORDER
11
Psychodynamic therapy is the other most popular evidence-based intervention for DPD.
Psychodynamic therapy also referred to as insight-oriented therapy aims at unconscious
processes in the mind. This approach is based on the assertion that thought patterns, both
conscious and unconscious, shape behavior. What people go through in life define their behavior
patterns. What a child experiences during his or her early years shows up later in life. Studies
investigating the effect of psychodynamic therapy on personality disorders including DPD have
pointed that the approach has positive results. Research conducted by McMain and Alberta
maintains this position (McMain & Alberta 2007).
DEPEDENT PERSONALITTY DISORDER
12
Conclusion
While every person needs people, excessive dependence on others is a disorder. As such,
it is important to know the boundaries. For those who have found themselves in the situation that
they cannot care for themselves and are always in constant need for support should not lose
hope. DPD can be treated. For parents, it is important to note that children learn through
imitation. Thus, it is important to provide to them good examples, which in this case is
independence. During childhood, caretakers should reward independence without discouraging
dependence. Most importantly, there parental skills that can be helpful for people living with
individuals suffering from DPD. Some of these skills include praising the individual for effort,
showing them that conflict is normal in life, and setting boundaries on areas the person is
allowed to seek guidance or not. While these skills can help prevent the development of DHD,
they may be of little importance if the person has lived with the condition for a long time. For
this reason, it is advisable to seek professional help. In treating DPD, cognitive behavioral
therapy and psychodynamic therapy are some of the most effective evidence-based interventions.
The government should develop programs to help prevent the development of DPD. For
example, the government can design programs to teach every parent on how children learn. With
this understanding on how children learn, parents would know what skills to employ and how to
conduct themselves in the presence of children. DPD is not just a social problem. It is also an
economic problem. People with DPD have difficulties initiating anything meaning that their
innovation and creativity levels are very low.
DEPEDENT PERSONALITTY DISORDER
13
References
Andrasik, F. (2006). Comprehensive Handbook of Personality and Psychopathology Volume 2.
Hoboken: John Wiley & Sons.
Cavaiola, A. A., & Lavender, N. J. (2000). Toxic coworkers: How to deal with dysfunctional
people on the job. Oakland, Calif: New Harbinger Publications.
Gjerde, L. C., Czajkowski, N., Røysamb, E., Ørstavik, R. E., Knudsen, G. P., Østby, K.,
Torgersen, S., Myers, J., Kendler, K. S., & Reichborn-Kjennerud, T. (2012). The
heritability of avoidant and dependent personality disorder assessed by personal interview
and questionnaire. Acta Psychiatrica Scandinavica, 126(6), 448–457.
http://doi.org/10.1111/j.1600-0447.2012.01862.x
Hales, R. E., Yudofsky, S. C., Gabbard, G. O., & American Psychiatric Publishing. (2011).
Essentials of psychiatry. Arlington, VA: American Psychiatric Pub.
Matusiewicz, A. K., Hopwood, C. J., Banducci, A. N., & Lejuez, C. W. (2010). The
Effectiveness of Cognitive Behavioral Therapy for Personality Disorders. The Psychiatric
Clinics of North America, 33(3), 657–685. http://doi.org/10.1016/j.psc.2010.04.007
McMain, S., & Alberta, E. (2007). Advances in psychotherapy of personality disorders: A
research update. Current Psychiatry Reports, 9 (1), 46-52.
Reichborn-Kjennerud, T. (2010). The genetic epidemiology of personality disorders. Dialogues
in Clinical Neuroscience, 12(1), 103–114.
Running head: DEPENDENT PERSONALITY DISORDER
Dependent Personality DisordeR
Roxana Tejera
Institutional Affiliation
1
DEPEDENT PERSONALITTY DISORDER
2
Abstract
Dependent personality disorder is a condition where an individual has an excessive need for
approval and guidance. The history of the disorder dates back to 1945. There are two primary
categories of causal factors for DPD: (1) genetic factors; and (2) social and cultural factors. The
principal symptoms for DPD include difficulty making decisions, inability to initiate things on
your own, and need to be with and around people among others. DPD has five sub-types namely
accommodative dependent disorder, selfless dependent disorder, disquieted dependent disorder,
immature dependent disorder, accommodating, and ineffectual dependent disorder. This disorder
can be prevented by rewarding independence during childhood. Unfortunately, it is not possible
to prevent hereditary causes. Treating DPD is mainly through psychotherapy interventions for
both short-term and long-term goals. To overcome this disorder, there is need for the person to
accept that he or she needs help as well as have a willingness to go through counseling.
DEPEDENT PERSONALITTY DISORDER
3
Dependent Personality Disorder
Definition
Dependent personality disorder (DPD) refers to a situation where an individual has an
excessive and persuasive need to have someone taking care of him or her. The primary
characteristics of this disorder include clinging behavior, submissiveness, and excessive fears of
being alone. Hence, a person suffering from DPD can be defined as one who finds it difficult to
initiate and do things on the own so that they have to rely on the affirmation and direction of
“significant and powerful” others. These people exude low levels of confidence in their abilities
and intelligence. They tend to belittle their achievements as long as others have not approved
them. They are also prone to self-doubting and being pessimistic. As a result of feeling unable to
function without guidance from others, these people go to great extents to establish and maintain
the dependent relationships.
History of DPD
The history of DPD dates back to Abraham’s and Freud’s descriptions of oral
dependency in 1927 (Andrasik 2006). However, by that time, the dependency was yet to acquire
the status of a disorder. Abraham and Freud described the dependency as an oral character. In
1945, the condition appeared for the first time as a disorder in a Ware Department Technical
Bulletin. Seven years later, in 1952, the disorder featured in the first edition of the Diagnostic
and Statistical Manual (Andrasik 2006). At this time, clinicians referred to it as a subtype of
passive-aggressive personality disorder.
DEPEDENT PERSONALITTY DISORDER
4
Causes
The development of dependent disorder is a result of multiple factors. Genetic factors
have been found as one of the contributors to DPD (Reichborn-Kjennerud 2010). In a research
involving 2794 Norwegian twins, Gjerde et al. (2012) revealed that the probability of inheriting a
dependent disorder is 0.66 as compared to 0.64 in the case of avoidant personality disorder.
According to these findings, children of parents with DPD face a considerable risk of inheriting
the disorder as compared to those whose parents do not have the condition.
Over-involvement of primary caretakers is the other established factor responsible for the
development of DPD. In childhood, caretakers may cultivate dependence in the child by
rewarding loyalty and punishing any attempt the child makes towards attaining independence. A
child who has never been rewarded for exercising independence may never attempt it even if it
would be appreciated.
Similarly, a child who grows up in a home where a significant other has a dependent
disorder may develop the condition as well. Children learn through observation and imitation. As
such, if a child notes that his or her mother, father, an elder sibling or another close relative
heavily relies on the approval of others to do anything, he or she may grow up knowing that is
the way things are done. Sociological and psychological theories agree that children are born as
blank slates. At the point of birth, children do not know what to do, when, or how. Society
informs them everything about behavior. In other words, the behaviors people carry through life,
including extreme dependence, is passed over to them by the society.
The social learning theory expounds on how children learn. According to this theory,
human beings, including children, learn from one another through observation, imitation, and
DEPEDENT PERSONALITTY DISORDER
5
modeling. Framed differently, children like adults, pay attention to what the behavioral patterns
of significant others. The second phase of behavior formation is trying to remember what one
observed. The third stage involves reproducing the behavior. Thus, according to social learning
theory, every behavior is learned from those close to the individual.
Moreover, there are cultures that celebrate dependency. In most societies, asking for help
is seen as being friendly and sociable. In tune with this view, people tend to keep asking for
guidance and help. As these people grow and become members of a global culture, they are not
able to let go the lessons inculcated in them. Unfortunately, there is no scientific formulae of
knowing how the various contribute to the development of DPD.
Symptoms
According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), there
are several ways of identifying DPD. One of the most pronounced symptoms of DPD is that
these individuals have difficulties making common decisions (Hales et al. 2011). Typically,
people suffering from this disorder need excessive reassurance before they settle on even simple
decisions such as what time to eat or what clothing to wear. Another symptom very similar to
this is that these people tend to transfer their responsibilities to others (Hales et al. 2011). As a
functioning of feeling incapable of assuming autonomy, they allow others to handle things on
their behalf. People with this disorder tend to depend on parents to decide on who to marry or
spouse on where to live. At times, these people will also need excessive guidance on who to be
friends with.
Also, people with the dependent disorder are overly agreeable. They do whatever they
can to avoid disagreements. To them, disagreeing is a far too risky involvement as it can destroy
DEPEDENT PERSONALITTY DISORDER
6
dependent relationships. They are afraid of disagreements not because they are cowardly but
because they do not want to lose a source of approval and guidance (Hales et al. 2011). In the
same vein, these people are very quick to seek new relationships when an existing one ends. For
example, in the case of divorce, these people will most likely get married again in the shortest
time possible. They do all they can to be in a relationship that will provide the same support the
previous one provided.
Equally important, these people feel helpless when alone. Because of the feeling that they
are not able to care for themselves, they tend to suffer from high degrees of anxiety when left
alone (Hales et al. 2011). In response, these people prefer being around people, even if they have
little interest in them.
Lastly but not least, people with DPD have difficulty with starting anything. They see
themselves as inept to accomplish any task. Even worse, they are not able to sustain tasks. Thus,
if you assign them to do something, they need you to provide support all through. In the end, you
prefer doing the task rather than assigning it to them.
Different Types
There are five main types of dependent personality disorder (DPD) namely disquieted,
selfless, immature, accommodating, and ineffectual. The section below discusses each of these
subtypes in brief.
The Ineffectual Dependent Disorder
People suffering from this type show a combination of schizoid and dependent patterns.
The major symptoms of this disorder are that the person is not interested social relationships
(Cavaiola & Lavender 2000). They tend to prefer solitary activities. However, in stark contrast,
DEPEDENT PERSONALITTY DISORDER
7
people with this disorder understand and empathize with the emotions of others. Another
distinguishing feature of this type is that the individuals have no drive to act on their own.
The Disquieted Dependent Disorder
People with this disorder are highly vulnerable to separation anxiety. At the same time,
they are very cautious not to lose support. A notable distinguishing characteristic of people with
this disorder is that they at times express their fear of losing supportive relationships (Cavaiola &
Lavender 2000). They tend to have outbursts of anger when their needs for safety and security
are not met.
The Selfless Dependent Disorder
For this disorder, total identification and idealization are the principal themes. These
people tend to forfeit their own self-identities as they merge with others. Ironically, their loss of
self-identity seems fulfilling. Besides the loss of self-identity, people with the selfless dependent
disorder are highly prone to experience depression when their relationship face difficulties
(Cavaiola & Lavender 2000).
The Immature Dependent Disorder
As the term suggests, people with this disorder are overly attached to childlike activities
and children. They have zero interest in spending with adults and assuming adult responsibilities.
Instead, they prefer engaging in childhood activities and derive satisfaction from relating with
children (Cavaiola & Lavender 2000).
The Accommodating Dependent Disorder
DEPEDENT PERSONALITTY DISORDER
8
This disorder shares most symptoms with the histrionic personality disorder. People with
this type are very agreeable, submissive, benevolent, and neighborly (Cavaiola & Lavender
2000). Also, these people seek to become the centers of attention. As such, they tend to exhibit
self-dramatizing behaviors.
Prevention
To understand how to prevent DPD, it is important to divide the causal factors into two:
(1) genetic factors: and (2) social and cultural factors. For the genetic factors, preventing DPD is
virtually impossible. Hence, the only way of preventing the development of DPD is by
addressing social and cultural factors.
In this tune, one way of preventing DPD is by teaching caretakers on how to help
children learn independence. At times, caretakers are too protective. They do not provide space
for children to experiment and explore on their own. Essentially, caretakers should encourage
children to be independent. They should reward any effort towards attaining independence.
Another way of preventing DPD is by living independently. As mentioned elsewhere,
children learn through imitation. Hence, significant others must ensure that they provide a good
example of an independent life to children. In this light, parents and elder siblings should show
children that they can decide on their own, and feel confident about their decisions even if
nobody approves them.
Treatment Plans for Short-Term and Long-Term Goals
For both short-term and long-term goals, psychotherapy is the primary method of treating
DPD. However, depending on the nature of the goals, short-term or long-term, different types of
psychotherapy are used. For short-term goals, assertiveness training and cognitive-behavioral
DEPEDENT PERSONALITTY DISORDER
9
therapy (CBT) are the most common treatments. Training in assertiveness helps build selfconfidence. CBT helps develop new perspectives and attitudes concerning others. For long-term
goals, psychodynamic psychotherapy is the best intervention.
Suggestions on How to Overcome the Disorder
The first and probably the most important suggestion for people seeking to overcome the
disorder is to accept that they need help. Unfortunately, most people suffering from DPD never
seek help, they only seek help when symptoms become unmanageable. While this also helps, it is
at times too late. That said, it is very important to accept that you need help. Denial never helps.
Secondly, one needs to seek professional help. While it is good to seek help from friends
and relatives, it is much better to approach professionals in psychotherapy. The importance of
seeking professional help cannot be overstated.
Thirdly, success from psychotherapy requires commitment and discipline on the part of
the patient. Therefore, anyone willing to overcome DPD must have a positive attitude and
mindset. One must not approach psychotherapy like it is punishment. There is need for
willingness on the part of the patient.
Parenting Skills to Help the Individuals
One skill that parents need to help children with DPD is praising them for efforts. In the
case of children with DPD, one of the greatest issues to deal with is to help them improve their
confidence levels. Praising children helps boost their confidence levels. On top of verbal
commendation, parents can also have a journal where they write the good things their children
do. They can then allow the children to read through the journals occasionally. This will also
DEPEDENT PERSONALITTY DISORDER
10
help people prone or already suffering from DPD to appreciate themselves and develop positive
self-esteem.
Setting rules and being strict on them is another skill parents to help individuals with
DPD. It is not true that being passive results in better behavior. Inability to set and enforce rules
makes it possible for dependent individuals to keep asking for support and direction, even in
handling simple things. Parents need to define what areas their children can seek help. Most
importantly, these rules should be revised over time as the child advances in age. Adults relying
on their parents to decide on who to marry or where to live evidence that these parents
encouraged that kind of excessive dependency. Parents must ensure that their children learn how
to assume responsibilities.
Another equally important skill for parents with individuals having DPD is how to argue
and solve conflicts. From time to time, these parents need to pick moderate conflicts with these
individuals. By so doing, these people will learn that disagreeing is normal in life and it does not
mean the relationship is over.
Evidence-based Therapies for DPD
Cognitive-behavioral therapy (CBT) the most recognized and effective evidence-based
interventions for DPD. Ideally, CBT seeks to address self-defeating thought processes and
patterns. This kind of therapy helps deconstruct inflexible patterns hindering the person from
embracing healthier behavior. Matusiewicz and colleagues conducted research on the available
empirical support for CBT as an intervention for DPD in the years between 1980 and 2009
(Matusiewicz et al. 2010). This investigation observed that CBT is the most effective evidencebased intervention for DPD.
DEPEDENT PERSONALITTY DISORDER
11
Psychodynamic therapy is the other most popular evidence-based intervention for DPD.
Psychodynamic therapy also referred to as insight-oriented therapy aims at unconscious
processes in the mind. This approach is based on the assertion that thought patterns, both
conscious and unconscious, shape behavior. What people go through in life define their behavior
patterns. What a child experiences during his or her early years shows up later in life. Studies
investigating the effect of psychodynamic therapy on personality disorders including DPD have
pointed that the approach has positive results. Research conducted by McMain and Alberta
maintains this position (McMain & Alberta 2007).
DEPEDENT PERSONALITTY DISORDER
12
Conclusion
While every person needs people, excessive dependence on others is a disorder. As such,
it is important to know the boundaries. For those who have found themselves in the situation that
they cannot care for themselves and are always in constant need for support should not lose
hope. DPD can be treated. For parents, it is important to note that children learn through
imitation. Thus, it is important to provide to them good examples, which in this case is
independence. During childhood, caretakers should reward independence without discouraging
dependence. Most importantly, there parental skills that can be helpful for people living with
individuals suffering from DPD. Some of these skills include praising the individual for effort,
showing them that conflict is normal in life, and setting boundaries on areas the person is
allowed to seek guidance or not. While these skills can help prevent the development of DHD,
they may be of little importance if the person has lived with the condition for a long time. For
this reason, it is advisable to seek professional help. In treating DPD, cognitive behavioral
therapy and psychodynamic therapy are some of the most effective evidence-based interventions.
The government should develop programs to help prevent the development of DPD. For
example, the government can design programs to teach every parent on how children learn. With
this understanding on how children learn, parents would know what skills to employ and how to
conduct themselves in the presence of children. DPD is not just a social problem. It is also an
economic problem. People with DPD have difficulties initiating anything meaning that their
innovation and creativity levels are very low.
DEPEDENT PERSONALITTY DISORDER
13
References
Andrasik, F. (2006). Comprehensive Handbook of Personality and Psychopathology Volume 2.
Hoboken: John Wiley & Sons.
Cavaiola, A. A., & Lavender, N. J. (2000). Toxic coworkers: How to deal with dysfunctional
people on the job. Oakland, Calif: New Harbinger Publications.
Gjerde, L. C., Czajkowski, N., Røysamb, E., Ørstavik, R. E., Knudsen, G. P., Østby, K.,
Torgersen, S., Myers, J., Kendler, K. S., & Reichborn-Kjennerud, T. (2012). The
heritability of avoidant and dependent personality disorder assessed by personal interview
and questionnaire. Acta Psychiatrica Scandinavica, 126(6), 448–457.
http://doi.org/10.1111/j.1600-0447.2012.01862.x
Hales, R. E., Yudofsky, S. C., Gabbard, G. O., & American Psychiatric Publishing. (2011).
Essentials of psychiatry. Arlington, VA: American Psychiatric Pub.
Matusiewicz, A. K., Hopwood, C. J., Banducci, A. N., & Lejuez, C. W. (2010). The
Effectiveness of Cognitive Behavioral Therapy for Personality Disorders. The Psychiatric
Clinics of North America, 33(3), 657–685. http://doi.org/10.1016/j.psc.2010.04.007
McMain, S., & Alberta, E. (2007). Advances in psychotherapy of personality disorders: A
research update. Current Psychiatry Reports, 9 (1), 46-52.
Reichborn-Kjennerud, T. (2010). The genetic epidemiology of personality disorders. Dialogues
in Clinical Neuroscience, 12(1), 103–114.
Running head: DEPENDENT PERSONALITY DISORDER
Dependent Personality Disorder
Name
Institutional Affiliation
1
DEPEDENT PERSONALITTY DISORDER
2
Abstract
Dependent personality disorder is a condition where an individual has an excessive need for
approval and guidance. The history of the disorder dates back to 1945. There are two primary
categories of causal factors for DPD: (1) genetic factors; and (2) social and cultural factors. The
principal symptoms for DPD include difficulty making decisions, inability to initiate things on
your own, and need to be with and around people among others. DPD has five sub-types namely
accommodative dependent disorder, selfless dependent disorder, disquieted dependent disorder,
immature dependent disorder, accommodating, and ineffectual dependent disorder. This disorder
can be prevented by rewarding independence during childhood. Unfortunately, it is not possible
to prevent hereditary causes. Treating DPD is mainly through psychotherapy interventions for
both short-term and long-term goals. To overcome this disorder, there is need for the person to
accept that he or she needs help as well as have a willingness to go through counseling.
DEPEDENT PERSONALITTY DISORDER
3
Dependent Personality Disorder
Definition
Dependent personality disorder (DPD) refers to a situation where an individual has an
excessive and persuasive need to have someone taking care of him or her. The primary
characteristics of this disorder include clinging behavior, submissiveness, and excessive fears of
being alone. Hence, a person suffering from DPD can be defined as one who finds it difficult to
initiate and do things on the own so that they have to rely on the affirmation and direction of
“significant and powerful” others. These people exude low levels of confidence in their abilities
and intelligence. They tend to belittle their achievements as long as others have not approved
them. They are also prone to self-doubting and being pessimistic. As a result of feeling unable to
function without guidance from others, these people go to great extents to establish and maintain
the dependent relationships.
History of DPD
The history of DPD dates back to Abraham’s and Freud’s descriptions of oral
dependency in 1927 (Andrasik 2006). However, by that time, the dependency was yet to acquire
the status of a disorder. Abraham and Freud described the dependency as an oral character. In
1945, the condition appeared for the first time as a disorder in a Ware Department Technical
Bulletin. Seven years later, in 1952, the disorder featured in the first edition of the Diagnostic
and Statistical Manual (Andrasik 2006). At this time, clinicians referred to it as a subtype of
passive-aggressive personality disorder.
DEPEDENT PERSONALITTY DISORDER
4
Causes
The development of dependent disorder is a result of multiple factors. Genetic factors
have been found as one of the contributors to DPD (Reichborn-Kjennerud 2010). In a research
involving 2794 Norwegian twins, Gjerde et al. (2012) revealed that the probability of inheriting a
dependent disorder is 0.66 as compared to 0.64 in the case of avoidant personality disorder.
According to these findings, children of parents with DPD face a considerable risk of inheriting
the disorder as compared to those whose parents do not have the condition.
Over-involvement of primary caretakers is the other established factor responsible for the
development of DPD. In childhood, caretakers may cultivate dependence in the child by
rewarding loyalty and punishing any attempt the child makes towards attaining independence. A
child who has never been rewarded for exercising independence may never attempt it even if it
would be appreciated.
Similarly, a child who grows up in a home where a significant other has a dependent
disorder may develop the condition as well. Children learn through observation and imitation. As
such, if a child notes that his or her mother, father, an elder sibling or another close relative
heavily relies on the approval of others to do anything, he or she may grow up knowing that is
the way things are done. Sociological and psychological theories agree that children are born as
blank slates. At the point of birth, children do not know what to do, when, or how. Society
informs them everything about behavior. In other words, the behaviors people carry through life,
including extreme dependence, is passed over to them by the society.
The social learning theory expounds on how children learn. According to this theory,
human beings, including children, learn from one another through observation, imitation, and
DEPEDENT PERSONALITTY DISORDER
5
modeling. Framed differently, children like adults, pay attention to what the behavioral patterns
of significant others. The second phase of behavior formation is trying to remember what one
observed. The third stage involves reproducing the behavior. Thus, according to social learning
theory, every behavior is learned from those close to the individual.
Moreover, there are cultures that celebrate dependency. In most societies, asking for help
is seen as being friendly and sociable. In tune with this view, people tend to keep asking for
guidance and help. As these people grow and become members of a global culture, they are not
able to let go the lessons inculcated in them. Unfortunately, there is no scientific formulae of
knowing how the various contribute to the development of DPD.
Symptoms
According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), there
are several ways of identifying DPD. One of the most pronounced symptoms of DPD is that
these individuals have difficulties making common decisions (Hales et al. 2011). Typically,
people suffering from this disorder need excessive reassurance before they settle on even simple
decisions such as what time to eat or what clothing to wear. Another symptom very similar to
this is that these people tend to transfer their responsibilities to others (Hales et al. 2011). As a
functioning of feeling incapable of assuming autonomy, they allow others to handle things on
their behalf. People with this disorder tend to depend on parents to decide on who to marry or
spouse on where to live. At times, these people will also need excessive guidance on who to be
friends with.
Also, people with the dependent disorder are overly agreeable. They do whatever they
can to avoid disagreements. To them, disagreeing is a far too risky involvement as it can destroy
DEPEDENT PERSONALITTY DISORDER
6
dependent relationships. They are afraid of disagreements not because they are cowardly but
because they do not want to lose a source of approval and guidance (Hales et al. 2011). In the
same vein, these people are very quick to seek new relationships when an existing one ends. For
example, in the case of divorce, these people will most likely get married again in the shortest
time possible. They do all they can to be in a relationship that will provide the same support the
previous one provided.
Equally important, these people feel helpless when alone. Because of the feeling that they
are not able to care for themselves, they tend to suffer from high degrees of anxiety when left
alone (Hales et al. 2011). In response, these people prefer being around people, even if they have
little interest in them.
Lastly but not least, people with DPD have difficulty with starting anything. They see
themselves as inept to accomplish any task. Even worse, they are not able to sustain tasks. Thus,
if you assign them to do something, they need you to provide support all through. In the end, you
prefer doing the task rather than assigning it to them.
Different Types
There are five main types of dependent personality disorder (DPD) namely disquieted,
selfless, immature, accommodating, and ineffectual. The section below discusses each of these
subtypes in brief.
The Ineffectual Dependent Disorder
People suffering from this type show a combination of schizoid and dependent patterns.
The major symptoms of this disorder are that the person is not interested social relationships
(Cavaiola & Lavender 2000). They tend to prefer solitary activities. However, in stark contrast,
DEPEDENT PERSONALITTY DISORDER
7
people with this disorder understand and empathize with the emotions of others. Another
distinguishing feature of this type is that the individuals have no drive to act on their own.
The Disquieted Dependent Disorder
People with this disorder are highly vulnerable to separation anxiety. At the same time,
they are very cautious not to lose support. A notable distinguishing characteristic of people with
this disorder is that they at times express their fear of losing supportive relationships (Cavaiola &
Lavender 2000). They tend to have outbursts of anger when their needs for safety and security
are not met.
The Selfless Dependent Disorder
For this disorder, total identification and idealization are the principal themes. These
people tend to forfeit their own self-identities as they merge with others. Ironically, their loss of
self-identity seems fulfilling. Besides the loss of self-identity, people with the selfless dependent
disorder are highly prone to experience depression when their relationship face difficulties
(Cavaiola & Lavender 2000).
The Immature Dependent Disorder
As the term suggests, people with this disorder are overly attached to childlike activities
and children. They have zero interest in spending with adults and assuming adult responsibilities.
Instead, they prefer engaging in childhood activities and derive satisfaction from relating with
children (Cavaiola & Lavender 2000).
The Accommodating Dependent Disorder
DEPEDENT PERSONALITTY DISORDER
8
This disorder shares most symptoms with the histrionic personality disorder. People with
this type are very agreeable, submissive, benevolent, and neighborly (Cavaiola & Lavender
2000). Also, these people seek to become the centers of attention. As such, they tend to exhibit
self-dramatizing behaviors.
Prevention
To understand how to prevent DPD, it is important to divide the causal factors into two:
(1) genetic factors: and (2) social and cultural factors. For the genetic factors, preventing DPD is
virtually impossible. Hence, the only way of preventing the development of DPD is by
addressing social and cultural factors.
In this tune, one way of preventing DPD is by teaching caretakers on how to help
children learn independence. At times, caretakers are too protective. They do not provide space
for children to experiment and explore on their own. Essentially, caretakers should encourage
children to be independent. They should reward any effort towards attaining independence.
Another way of preventing DPD is by living independently. As mentioned elsewhere,
children learn through imitation. Hence, significant others must ensure that they provide a good
example of an independent life to children. In this light, parents and elder siblings should show
children that they can decide on their own, and feel confident about their decisions even if
nobody approves them.
Treatment Plans for Short-Term and Long-Term Goals
For both short-term and long-term goals, psychotherapy is the primary method of treating
DPD. However, depending on the nature of the goals, short-term or long-term, different types of
psychotherapy are used. For short-term goals, assertiveness training and cognitive-behavioral
DEPEDENT PERSONALITTY DISORDER
9
therapy (CBT) are the most common treatments. Training in assertiveness helps build selfconfidence. CBT helps develop new perspectives and attitudes concerning others. For long-term
goals, psychodynamic psychotherapy is the best intervention.
Suggestions on How to Overcome the Disorder
The first and probably the most important suggestion for people seeking to overcome the
disorder is to accept that they need help. Unfortunately, most people suffering from DPD never
seek help, they only seek help when symptoms become unmanageable. While this also helps, it is
at times too late. That said, it is very important to accept that you need help. Denial never helps.
Secondly, one needs to seek professional help. While it is good to seek help from friends
and relatives, it is much better to approach professionals in psychotherapy. The importance of
seeking professional help cannot be overstated.
Thirdly, success from psychotherapy requires commitment and discipline on the part of
the patient. Therefore, anyone willing to overcome DPD must have a positive attitude and
mindset. One must not approach psychotherapy like it is punishment. There is need for
willingness on the part of the patient.
Parenting Skills to Help the Individuals
One skill that parents need to help children with DPD is praising them for efforts. In the
case of children with DPD, one of the greatest issues to deal with is to help them improve their
confidence levels. Praising children helps boost their confidence levels. On top of verbal
commendation, parents can also have a journal where they write the good things their children
do. They can then allow the children to read through the journals occasionally. This will also
DEPEDENT PERSONALITTY DISORDER
10
help people prone or already suffering from DPD to appreciate themselves and develop positive
self-esteem.
Setting rules and being strict on them is another skill parents to help individuals with
DPD. It is not true that being passive results in better behavior. Inability to set and enforce rules
makes it possible for dependent individuals to keep asking for support and direction, even in
handling simple things. Parents need to define what areas their children can seek help. Most
importantly, these rules should be revised over time as the child advances in age. Adults relying
on their parents to decide on who to marry or where to live evidence that these parents
encouraged that kind of excessive dependency. Parents must ensure that their children learn how
to assume responsibilities.
Another equally important skill for parents with individuals having DPD is how to argue
and solve conflicts. From time to time, these parents need to pick moderate conflicts with these
individuals. By so doing, these people will learn that disagreeing is normal in life and it does not
mean the relationship is over.
Evidence-based Therapies for DPD
Cognitive-behavioral therapy (CBT) the most recognized and effective evidence-based
interventions for DPD. Ideally, CBT seeks to address self-defeating thought processes and
patterns. This kind of therapy helps deconstruct inflexible patterns hindering the person from
embracing healthier behavior. Matusiewicz and colleagues conducted research on the available
empirical support for CBT as an intervention for DPD in the years between 1980 and 2009
(Matusiewicz et al. 2010). This investigation observed that CBT is the most effective evidencebased intervention for DPD.
DEPEDENT PERSONALITTY DISORDER
11
Psychodynamic therapy is the other most popular evidence-based intervention for DPD.
Psychodynamic therapy also referred to as insight-oriented therapy aims at unconscious
processes in the mind. This approach is based on the assertion that thought patterns, both
conscious and unconscious, shape behavior. What people go through in life define their behavior
patterns. What a child experiences during his or her early years shows up later in life. Studies
investigating the effect of psychodynamic therapy on personality disorders including DPD have
pointed that the approach has positive results. Research conducted by McMain and Alberta
maintains this position (McMain & Alberta 2007).
DEPEDENT PERSONALITTY DISORDER
12
Conclusion
While every person needs people, excessive dependence on others is a disorder. As such,
it is important to know the boundaries. For those who have found themselves in the situation that
they cannot care for themselves and are always in constant need for support should not lose
hope. DPD can be treated. For parents, it is important to note that children learn through
imitation. Thus, it is important to provide to them good examples, which in this case is
independence. During childhood, caretakers should reward independence without discouraging
dependence. Most importantly, there parental skills that can be helpful for people living with
individuals suffering from DPD. Some of these skills include praising the individual for effort,
showing them that conflict is normal in life, and setting boundaries on areas the person is
allowed to seek guidance or not. While these skills can help prevent the development of DHD,
they may be of little importance if the person has lived with the condition for a long time. For
this reason, it is advisable to seek professional help. In treating DPD, cognitive behavioral
therapy and psychodynamic therapy are some of the most effective evidence-based interventions.
The government should develop programs to help prevent the development of DPD. For
example, the government can design programs to teach every parent on how children learn. With
this understanding on how children learn, parents would know what skills to employ and how to
conduct themselves in the presence of children. DPD is not just a social problem. It is also an
economic problem. People with DPD have difficulties initiating anything meaning that their
innovation and creativity levels are very low.
DEPEDENT PERSONALITTY DISORDER
13
References
Andrasik, F. (2006). Comprehensive Handbook of Personality and Psychopathology Volume 2.
Hoboken: John Wiley & Sons.
Cavaiola, A. A., & Lavender, N. J. (2000). Toxic coworkers: How to deal with dysfunctional
people on the job. Oakland, Calif: New Harbinger Publications.
Gjerde, L. C., Czajkowski, N., Røysamb, E., Ørstavik, R. E., Knudsen, G. P., Østby, K.,
Torgersen, S., Myers, J., Kendler, K. S., & Reichborn-Kjennerud, T. (2012). The
heritability of avoidant and dependent personality disorder assessed by personal interview
and questionnaire. Acta Psychiatrica Scandinavica, 126(6), 448–457.
http://doi.org/10.1111/j.1600-0447.2012.01862.x
Hales, R. E., Yudofsky, S. C., Gabbard, G. O., & American Psychiatric Publishing. (2011).
Essentials of psychiatry. Arlington, VA: American Psychiatric Pub.
Matusiewicz, A. K., Hopwood, C. J., Banducci, A. N., & Lejuez, C. W. (2010). The
Effectiveness of Cognitive Behavioral Therapy for Personality Disorders. The Psychiatric
Clinics of North America, 33(3), 657–685. http://doi.org/10.1016/j.psc.2010.04.007
McMain, S., & Alberta, E. (2007). Advances in psychotherapy of personality disorders: A
research update. Current Psychiatry Reports, 9 (1), 46-52.
Reichborn-Kjennerud, T. (2010). The genetic epidemiology of personality disorders. Dialogues
in Clinical Neuroscience, 12(1), 103–114.
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