Dependent Personality Disorder
Personality disorder is a matter of false judgments of value. Listed below are the false value judgments that are at the root of Dependent Personality Disorder.
|for others to make everyday decisions for them; advice and reassurance from others
||having to make everyday decisions; having to rely solely on their own judgment
||has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
|for others to assume responsibiluty for major areas of their lives
||having to be responsible for themselves
||needs others to assume responsibility for most major areas of their lives
|support and approval from others
||losing the support or approval of others
||has difficulty expressing disagreement with others because of fear of loss of support or approval
|to follow the lead of others
||initiating projects or doing things on their own
||has difficulty initiating projects or doing things on their own
|nurturance and support
||being without nurturance and support
||goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant
|for a significant other
||being alone; not being taken care of
||feels uncomfortable or helpless when alone because of exaggerated fear of being unable to care for themselves
|relationships: care and support
||not having a relationship with a significant other
||urgently seeks another relationship as a source of care and support when a close relationship ends||
|to be taken care of: advice, reassurance, and support
||being left to care for themselves
||is unrealistically preoccupied with fears of being left to take care of themselves||
|praise and approval
||criticism and disapproval, especially from significant others
||is easily hurt by criticism or disapproval||
The Disease Perspective
Proposed Revision | APA DSM-5
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994, pp. 668-669) describes Dependent Personality Disorder as a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior 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.
The Dimensional Perspective
Here is a hypothetical profile, in terms of the five-factor model of personality, for Dependent Personality Disorder (speculatively constructed from McCrae, 1994, pg. 306):
- High Neuroticism
- Chronic negative affects, including anxiety, fearfulness, tension, irritability, anger, dejection, hopelessness, guilt, shame; difficulty in inhibiting impulses: for example, to eat, drink, or spend money; irrational beliefs: for example, unrealistic expectations, perfectionistic demands on self, unwarranted pessimism; unfounded somatic concerns; helplessness and dependence on others for emotional support and decision making.
- Low Extraversion
- Social isolation, interpersonal detachment, and lack of support networks; flattened affect; lack of joy and zest for life; reluctance to assert self or assume leadership roles, even when qualified; social inhibition and shyness.
- Low Openness
- Difficulty adapting to social or personal change; low tolerance or understanding of different points of view or lifestyles; emotional blandness and inability to understand and verbalize own feelings; alexythymia; constricted range of interests; insensitivity to art and beauty; excessive conformity to authority.
- High Agreeableness
- Gullibility: indiscriminate trust of others; excessive candor and generosity, to detriment of self-interest; inability to stand up to others and fight back; easily taken advantage of.
- High Conscientiousness
- Overachievement: workaholic absorption in job or cause to the exclusion of family, social, and personal interests; compulsiveness, including excessive cleanliness, tidiness, and attention to detail; rigid self-discipline and an inability to set tasks aside and relax; lack of spontaneity; overscrupulousness in moral behavior.
Performance anxiety, fear of abandonment, fear of negative evaluation (Bornstein, pg. 162).
Character Weaknesses and Vices*
- constant approval-seeking
- fear of abandonment
- hypersensitivity to criticism
- constant need for reassurance
- intolerance of being alone
- rejection sensitivity*
- excessive agreeableness
- inability to take initiative
* Derived from Michael Stone's (pg. 23) list of the "personality traits" of DSM-III-R Dependent Personality Disorder. Descriptors marked with an asterisk, he says, are not true personality traits.
The Behavior Perspective
Desire to obtain and maintain nurturant, supportive relationships (Bornstein, pg.162).
Want to minimize the fear of life while at the same time minimizing the fear of death (Maddi, 57).
Suggestibility, yielding, help-seeking, compliance (Bornstein, pg. 162).
Excessive emotional reliance on others, avoidance of situations requiring independent decisions, submissiveness and lack of self-assertion (Perry, pp. 2764, 2769).
Separation Anxiety Disorder, chronic physical illness, Adjustment Disorder, Anxiety Disorders, Mood disorders (American Psychiatric Association, pg. 667).
Depression, Agoraphobia, phobias, alcoholism, smoking, eating disorders (Bornstein, pp. 91-120).
The Life Story Perspective
Overprotective, authoritarian parenting; sex role socialization. (Bornstein, pp. 38-53)
What is the link between parental overprotectiveness and authoritarianism and the development of dependent personality traits in children? Parental overprotectiveness and authoritarianism serve simultaneously to (1) reinforce dependent behaviors in children of both sexes and (2) prevent the child from developing independent, autonomous behaviors (since the parents do not permit the child to engage in the kinds of trial-and-error learning that are involved in developing a sense of independence and mastery during childhood). Thus, when parental overprotectiveness or parental authoritarianism is characteristic of the family unit, this will tend to produce high levels of dependency in children (since both parenting styles foster and encourage dependent behavior). When both parental overprotectiveness and parental authoritarianism are present within the family unit, dependency in children is particularly likely to result. (Bornstein, pg. 41)
Basic Belief: I am helpless. [Strategy]: Attachment (Beck, Freeman & associates, pg. 26).
Representation of self as powerless and ineffectual; belief that others are powerful and in control (Bornstein, pg. 162).
The "idealized self is made up of beliefs about how we should feel, think, or act" (Tamney, pg. 32).
In Cognitive Therapy of Personality Disorders, Aaron T. Beck, Arthur Freeman, and associates (1990) list typical beliefs associated with each specific personality disorder. According to my view, the beliefs and attitudes rationalize and reinforce the idealized image and the compulsive attachments and aversions. They are analogous to Karen Horney's "shoulds" and "neurotic claims." Here are the typical beliefs that they have listed (pg. 360) for Dependent Personality Disorder:
- I am needy and weak.
- I need somebody around available at all times to help me carry out
what I need to do or in case something bad happens.
- My helper can be nurturant, supportive, and confident if he or she
wants to be.
- I am helpless when I am left on my own.
- I am basically alone unless I can attach myself to a stronger
- The worst possible thing would be to be abandoned.
- I must do nothing to offend my supporter or helper.
- I must be subservient in order to maintain his or her good will.
- I need others to help me make decisions or tell me what to do.
- I must maintain access to him or her at all times.
- I should cultivate as intimate a relationship as possible.
- I can't make decisions on my own.
- I can't cope as other people can.
- I need others to help me make decisions or tell me what to do.
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th ed. Washington: Author.
Beck, Aaron T. and Freeman, Arthur M. and Associates (1990). Cognitive Therapy of Personality Disorders. New York : Guilford Press.
Beck, Aaron T. and Freeman, Arthur M. and Associates (2003). Cognitive Therapy of Personality Disorders, 2nd ed. New York : Guilford Press.
Bornstein, Robert F. (1993). The Dependent Personality. New York : Guilford Press.
Cooper, Terry D. (2003). Sin, Pride, and Self-Acceptance: The Problem of Identity in Theology and Psychology. Downers Grove, IL: InterVarsity Press.
Maddi, Salvatore R. (1968). Conflict model: intrapsychic version; Rank's position. Personality theories: a comparative analysis. Homewood, IL: Dorsey.
McCrae, Robert R. (1994). "A Reformulation of Axis II: Personality and Personality-Related Problems." Costa, Paul T., Jr., Widiger, Thomas A., editors. Personality Disorders and the Five-Factor Model of Personality. Washington, D.C.: The American Psychological Association.
Perry, J. Christopher (1989). Personality Disorders: Dependent Personality Disorder. Treatments of Psychiatric Disorders, Vol. 3.
American Psychiatric Association. Task Force on Treatments of Psychiatric Disorders. Washington, DC : American Psychiatric Association.
Stone, Michael H. (1993). Abnormalities of personality: within and beyond the realm of treatment. New York: W.W. Norton.
Tamney, Joseph B. (2002). The Resilience of Conservative Religion. New York: Cambridge UP.