Dependent Personality Disorder Signs And Symptoms

Dependent Personality Disorder (DPD) is typified by a widespread and pervasive need to be taken care of, potentially leading to submissive, dependent behavior and fears of separation from loved ones. It often begins in childhood or early adulthood and is typically present in social and personal contexts. The dependent and submissive behaviors often arise from a self-perception of the inability to function adequately without the help of others. 

While approximately 10% of adults have been diagnosed with a personality disorder in the US, fewer than 1% are diagnosed with DPD. The disorder is marked by a poorly developed identity, poor self-esteem, poor self-appraisal, unusually high levels of intimacy with caregivers, anxiousness, and separation insecurity.

Potential causes of DPD

Experts have been unable to pinpoint a specific cause of DPD, but it most likely comes from a mix of environment, genetics, and developmental influences. For example, people with DPD may have a family with DPD (or another disorder with similar symptoms), a history of childhood trauma, or a history of abusive relationships.

Diagnostic criteria

The DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) provides a set of criteria for all personality disorders. For a diagnosis of PDP, the individual must present five (or more) of the following criteria:

• Difficulty making everyday decisions without excessive involvement and reassurance from others (usually a caregiver or loved one). These decisions can be anything from what to eat and what to wear to when to sleep. This happens not because they are physically or mentally disabled but because they often believe that they can’t care for themselves appropriately.
• The individual has an intense need for others to take responsibility for significant issues in their life. Examples include an adult who depends on parents, partner, or friends to pick out where they should live, or a high school graduate who allows their parents to decide if they are going to college or not, what they should apply for in college, how they should act in school and so on. This must happen continuously in several areas of life for it to be taken as a symptom.
• Trouble disagreeing with people due to a baseless fear of losing appreciation or approval. Some people with DPD may go out of their way to avoid conflict to please those they depend on. Out of fear that their caregivers might leave them, they’ll often agree or comply with their wishes, even if it’s harmful or undesirable. 
• They have trouble creating or initiating something by themselves because of perceived inadequacy in judgment and capability. People with DPD may have difficulty starting or maintaining a task or project on their own. They might believe they are not good or smart enough, so they wait for others to initiate projects. They are sometimes able to do well with what they consider “adequate supervision.”
• The individual displays excessive effort to obtain nurturance and appreciation from other people, often to their detriment. People with DPD sometimes go to great lengths to seek care from the people around them. They might agree to do unpleasant tasks or tolerate abusive behaviors to obtain that care. 
• Feelings of helplessness or discomfort when left alone. People with DPD may feel very helpless when left alone, with heightened fears that they may be unable to care for themselves. 
• An urgent need for new relationships when a relationship ends. When a relationship with a caregiver ends, a person with DPD will sometimes immediately seek another caregiver or someone they can “depend” on. They quickly seek to fill the space left by the previous caregiver. For example, someone with PDP may immediately seek a partner to fill the role of a former partner or family they once depended on to control their life. 
• Excessive fear of responsibility to care for themselves. Individuals with Dependent Personality Disorder may worry continuously that they will one day be left alone to care for themselves. Even if they are being cared for in a safe environment, they may experience fear due to the unrealistic worry that their present caregiver will leave them alone.

Other characteristics of DPD

People with DPD may sometimes display other behaviors and characteristics that aren’t necessarily criteria for diagnosis. Some include:

• Pessimism and self-doubt to the point where people with DPD may belittle their own abilities and assets. They may refer to themselves as “stupid” or make other disparaging remarks.
• People with DPD tend to take criticism and disapproval poorly, using it as “proof” that they are worthy, and they consequently may lose faith in their abilities. 
• People with this disorder sometimes find it difficult to work where they are not dependent on a superior. They may require their superior to tell them what to do and may be unable to work where independence is the norm.
• They may avoid responsibility and may pass over promotions to positions where responsibility is required to the extent that it’s detrimental to their growth in the workplace.
• Social relations are often limited to the few people on whom they are dependent and perhaps these people’s group of friends.

Comorbidity and similarities to other personality disorders

There are several disorders that are common comorbidities with DPD. For instance, depressive disorders such as persistent or major depressive disorder often accompany DPD. Anxiety disorders or alcohol use disorders are also sometimes associated with DPD. Some phobias are present as a comorbid disorder along with DPD as well. Social phobia is common, and agoraphobia is sometimes associated with Dependent Personality Disorder. 

Although DPD has some similar symptoms to these disorders, it doesn’t necessarily indicate an official comorbidity. It’s important to obtain an official diagnosis from a mental health professional.

Other personality disorders

Other personality disorders may be confused with DPD because they have certain features in common.

Dependent Personality Disorder and Borderline Personality Disorder are commonly characterized by the fear of abandonment. However, people with Borderline Personality Disorder tend to react to abandonment with feelings of emotional emptiness, rage, and demands. Individuals with DPD usually react with increasing appeasement and submissiveness and urgently seek replacement relationships to provide caregiving and support.

Dependent Personality Disorder and Histrionic Personality Disorder are often characterized by a strong need for reassurance and approval. People with Histrionic Personality Disorder may flirt excessively with multiple people to get the attention they need or desire. At the same time, those with Dependent Personality Disorder usually focus on a few caregivers with whom they are self-effacing and docile.

Dependent Personality Disorder and Avoidant Personality Disorder are characterized by feelings of inadequacy, hypersensitivity to criticism, and a need for reassurance. People with Avoidant personality disorder tend to avoid and withdraw from relationships until they are certain they will be accepted. In contrast, people with Dependent Personality Disorder usually have a pattern of seeking and maintaining connections with others whom they deem important.

Treatment options for BPD