dependent personality disorder
Jump to navigation
Jump to search
Etiology
- psychoanalytic theory
- drawn to others to satisfy instinctual drive of dependency
- social psychologic theory
- dependency is a learned behavior
- dependency displayed in the mother-child relationship is generalized to other interpersonal relationships
- etiologic theory
- dependency is a form of attachment (emotional bond)
- a wish to be close to & in contact with dependent object
Pathology
- primary symptoms are predominantly submissive, reactive & clinging behavior
Clinical manifestations
- unable to make everyday decisions without excessive amount of advice & reassurance from others
- needs others to assume responsibility for most major areas of his or her life
- difficulty expressing disagreement with others because of fear or loss of support or approval
- difficulty initiating projects or doing things because of a lack of self-confidence rather than a lack of motivation
- excessive effort to obtain nurturance & support from others, to the point of volunteering to do things that are unpleasant
- feelings of uneasiness or helplessness when alone due to exaggerated fears of be unable to care for self
- urgently seeks another relationship as a source of care & support when a close relationship ends
- unrealistic preoccupation with fears of being left to care for self
- do not typically display distress when they receive additional care[2]
- more likely to become distressed when asked to perform more self-care[2]
- do not tend to be verbally abusive or threatening toward caregivers[2]
Differential diagnosis
- borderline personality disorder
- common symptom of fear of abandonment
- borderline personality
- dependant personality
- reacts with increasing appeasement & submissiveness
- urgently seeks replacement relationship
- histrionic personality disorder
- common symptoms
- appears child-like & clinging
- has strong need for reassurance & approval
- differences
- characteristics of histrionic personality
- flamboyant
- actively demands attention
- gregarious & charming behavior
- characteristics of dependent personality
- self-effacing
- docile
- characteristics of histrionic personality
- common symptoms
- avoidant personality disorder
- common symptoms
- feelings of inadequacy
- hypersensitivity to criticism
- need for reassurance
- differences
- characteristics of avoidant personality
- strong fear of humiliation & rejection
- withdrawal unless acceptance is certain
- characteristics of dependent personality
- seeking & maintaining connections to others rather than withdrawing from relationships
- characteristics of avoidant personality
- common symptoms
- dependency as a consequence of axis 1 disorders
- dependency also present in:
- distinguishing features of dependent personality
- early onset, chronic course
- dependency that is inflexible, maladaptive & cause significant functional impairment or subjective distress
Management
- individual psychodynamic therapy
- develop trusting relationship with the patient & allow the patient to transfer dependent wishes onto the therapist
- encourage expression of real feelings & wishes, endurance of anxiety of making decisions, acceptance of pleasurable experiences
- allow the patient to make own decisions
- conceptualize goals & encourage commitment to attaining these goals
- limit sessions & self-empower the patient
- cognitive behavior therapy
- form techniques to foster accurate self appraisal & independent decision making behavior
- define goals & set agendas for sessions
- challenge dichotomous thinking of the patient
- encourage in vivo exposure to anxiety-provoking situations
- develop positive behavior schemas & constructive substitute behaviors to replace old dependency habits
- pharmacotherapy
- treatment of concurrent axis 1 disorders
- follow-up
- long-term treatment of 3-5 years
- tapering number of sessions, but still making them available