Dependent Personality Disorder DSM-5 301.6 (F60.7)
DSM-5 Category: Personality Disorder
Introduction
Dependent Personality Disorder is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), diagnosis assigned to individuals who are excessively needy and dependent on others.
Dependent Personality Disorder is classified as a Cluster C personality disorder (Fearful/anxious presentation). Throughout the developmental span, there are varying degrees of dependence on others which are normal and socially accepted and expected (Out of The Fog, 2014). Infants are helpless and totally reliant on their caregivers for survival needs. Toddlers have a bit more autonomy, but are not able to care for themselves. Children and adolescents are expected to develop increasing degrees of autonomy and adults are expected to be self reliant, unless they have a physical or psychological disability, or are in a short term impaired conditioned, e.g, an injury which impairs mobility. Elderly people may require varying degrees of care, depending on their health, and toward end of life, some will again be completely reliant on caregivers for survival. However, when an able-bodied adult or older adolescent does not have age appropriate ability to operate autonomously, the diagnostic criteria for Dependent Personality Disorder may be met.
Symptoms of Dependent Personality Disorder
According to the DSM-5, there is one criteria with eight features for Dependent Personality Disorder:
A. An excessive and pervasive need to be taken care of , submissive, clinging, needy behavior due to fear of abandonment. This may be expressed by:
- Difficulty making routine decisions without input, reassurance, and advice from others.
- Requires others to assume responsibilities which they should be attending to.
- Fear of disagreeing with others and risking disapproval.
- Difficulty starting projects without support from others.
- Excessive need to obtain nurturance and support from others, even allowing other to impose themselves rather than risk rejection or disapproval.
- Feels vulnerable and helpless when alone.
- Desperately seeks another relationship when one ends.
- Unrealistic preoccupation with being left alone and unable to care for themselves. (American Psychiatric Association, 2013).
Onset
The DSM-5 notes that Dependent Personality Disorder becomes apparent in young adulthood, although it is mentioned that it can appear in adolescence as well. In an adolescent, there will typically be increasing autonomy, and resistance to parental efforts at regulation of their behavior, or curtailing their freedom. In an adolescent who remains dependent on their parents for age appropriate decisions- e.g., what clothes to wear to school , and is having functional/adaptive deficits as a result- e.g., unable to perform chores such as making their own bed, or washing dishes, Dependent Personality Disorder may be unfolding (American Psychiatric Association, 2013).
Prevalence
According to the DSM-5, the prevalence of Dependent Personality Disorder was found to be 0.49% in the early 2000's, and is diagnosed much more frequently in females than males (American Psychiatric Association, 2013).
Risk Factors
The DSM-5 does not specify risk factors for Dependent Personality Disorder. One risk factor that can be inferred is being female, as the disorder is more frequently seen in women than men (American Psychiatric Association, 2013). One possible risk factor for the development of Dependent personality disorder is very strict authoritarian parenting where decisions are made for children and teenagers inappropriately, fostering dependence and an inability to make decisions (Cleveland Clinic, 2014)
Comorbidity
The DSM-5 does not indicates specific disorders that Dependent Personality Disorder is comorbid with (American Psychiatric Association, 2013). Alcohol, drug, and tobacco use disorders are all noted to have comorbidity with the personality disorders, as well as increased stress, less social support, suicidality, involvement with the criminal justice system, and interpersonal problems (Trull, Jahng, & Sher, 2010).
Treatment for Dependent Personality Disorder
The DSM-5 does not specify treatment options for Dependent Personality Disorder (American Psychiatric Association, 2013). Personality disorders are typically very treatment resistant, as personality can be defined as a relatively stable set of traits, values, attitudes, and beliefs about self, others and the world. A personality disorder is a maladaptive and dysfunctional version of the aforementioned description, The individual with a personality disorder will typically view others as the problem, and discount their own contribution. This makes them less likely to seek out psychotherapy, and they will hold a self- defeating view that the world must change for them, rather than seeing the value of conforming their behavior to societal expectations, at least to the degree necessary to function in life. CBT (Cognitive Behavioral Therapy) has been identified as an ideal treatment for personality Disorders. Individuals with Dependent Personality will feel incapable of carrying out adult tasks on their own. It will be important for the clinician not to be drawn into their expressions of dependence and helplessness, and treat them as though they are fragile. This type of validation of an unhealthy self image will perpetuate the disorder.
Impact on Functioning
Dependent Personality Disorder will typically have major impacts on most areas of functioning. As an adult, there are societal expectations for independence, decisiveness, confidence, and self reliance, particularly in American culture. An individual who does not meet these expectations will have difficulty functioning in occupational, academic, and interpersonal settings. Individuals with Dependent Personality Disorder may continue to reside with their parents past their twenties, may not learn how to drive a car, may be unemployed, and not continue or complete their education. It is noted in the DSM -5 that Individuals with Dependent Personality disorder will tolerate situations from which others would promptly withdraw, including verbal, physical and sexual abuse. (American Psychiatric Association, 2013). Women with Dependent Personality Disorder were found to be at risk for spousal abuse. Due to economic and emotional dependence of their abusive husbands (Loas, Cormier, & Perez-Diaz, 2011). Individuals with dependent personality disorder may be viewed with pity, disgust, anger, frustration, or contempt by others, and will try the patience of others, (Out of The Fog, 2014), including their clinicians. There may be a reciprocal causality for the abuse of persons with Dependent Personality Disorder. They tend to be naïve, have poor boundaries, and enter new relationships without forethought of potential risks (Cleveland Clinic, 2014) and may be prone to exploitation by predatory individuals. Their behavior may try the patience of individuals who are emotionally dyscontrolled and prone to violence, but the Dependent personality will tolerate the abuse due to their fear of abandonment and their belief that they are unable to function without support. In this way, a very unhealthy relationship dynamic will be established.
Differential Diagnosis
There are diagnostic rule-outs for Dependent Personality Disorder the clinician to consider, In the DSM -5, disorders such as Borderline Personality Disorder, and Histrionic Personality Disorder have overlapping features which the clinician must discriminate between to render an accurate diagnosis (American Psychiatric Association, 2013). There are also cultures where the expectation for people at certain ages, or in certain social contexts, is to defer to others. This is especially true in certain societies where women are regarded as second class citizens- e.g, Afghanistan under Taliban rule. Women were required to wear Burkas, a garment covering them from head to toe, could not work outside the home, pursue education, or even appear in public unless in the company of their husband or male relative (Trust in Education, n.d.) Individuals who are recently emigrated from such cultures may retain submissive behaviors, in which case this is a culture norm, rather than a disorder. It could be debated that in the context of a more autonomous society, such as the United States, such behavior could be classified as a disorder through social learning, as such an individual will have a difficult time operating independently and fulfilling adult expectations outside their original culture.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Edition). Washington, DC.
Cleveland Clinic. (2014). Dependent Personality Disorder. Cleveland Clinic. Retrieved March 22, 2014 from http://my.clevelandclinic.org/neurological_institute/center-for-behavorial-health/diseaseconditions/hic-dependent-personality-disorder.aspx
Loas, G, Cormier, J, and Perez-Diaz F (2011). Dependent personality disorder and physical abuse. Psychiatry Research.185 (2011) 167–170.
Out of The Fog (2014). Dependent Personality Disorder. Out of the Fog. Retrieved March 22, 2014 from http://outofthefog.net/Disorders/DPD.html
Trull,T.J., Jahng, S., Sher, K.J. (2010). Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. Journal of Personality Disorders. 24(4): 412–426. Retrieved March 19, 2014 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771514/1
Trust in Education. (n.d.) Life as An Afghan Woman. Trust In Education. Retrieved March 22, 2014 from http://www.trustineducation.org/resources/life-as-an-afghan-woman/
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