Dependent Personality Disorder
Cluster C. Anxious / Fearful · Table 6.2 [1]
Pervasive and excessive need to be taken care of, leading to submissive, clinging behavior and fears of separation.
Characteristics (Table 6.2) [1]
| Triggering Event(s) | Expectations of self-reliance and/or being alone |
|---|---|
| Behavioral Style |
|
| Interpersonal Style |
|
| Cognitive Style | Suggestible and pollyannaish |
| Affective Style | Pleasant and anxious, timid, or sad when stressed |
| Temperament | Low energy level; fearful, sad or withdrawn, melancholic |
| Attachment Style | Preoccupied |
| Parental Injunction | Grew up with the message that they were incapable of managing on their own. |
| Self-View | Sees the self as likable but incapable or fragile. |
| World-View | Assumes other people exist to look after them because they cannot manage alone. |
| Maladaptive Schemas |
|
| Optimal Diagnostic Criterion | Relies on others to take charge of most of the important areas of their life. |
DSM diagnostic criteria
A far-reaching, outsized need to be cared for that drives submissive, clinging behavior and fear of separation, present from early adulthood.
- Struggles to make routine decisions without a great deal of advice and reassurance.
- Depends on others to shoulder responsibility for most major parts of their life.
- Finds it hard to voice disagreement, fearing the loss of support or approval.
- Has trouble starting projects or acting independently, from a lack of confidence rather than of drive.
- Goes to great lengths to secure care and support, even taking on disagreeable tasks to get it.
- Feels uneasy or helpless when alone, doubting their ability to look after themselves.
- Rushes to replace a lost close relationship with a new source of care.
- Is gripped by unrealistic fears of being left to fend for themselves.
- Borderline PD (dependency with abandonment rage and instability)
- Histrionic PD (dependency expressed through dramatic attention-seeking)
- Avoidant PD (avoids relationships vs. clings to them)
- Agoraphobia / depression with dependency
Treatment
- Build autonomy, assertiveness, and self-efficacy
- Tolerate being alone and making independent decisions
- Reduce reassurance-seeking and self-abasement
Foster autonomy without recreating the very dependency that brings the patient to therapy. Resist the pull to give advice and make decisions; instead, scaffold independent problem-solving and reinforce small acts of self-direction. Watch for transference of caretaking onto the therapist.
- Cognitive-behavioral therapy + assertiveness training
- Schema therapy (dependence, self-sacrifice)
- Group therapy
- Graded independent decision-making and problem-solving tasks.
- Assertiveness training and behavioral rehearsal of disagreement.
- Cognitive work on the 'I can't cope alone' belief.
- Plan for tolerating aloneness and managing relationship endings.
- Dependency transferred onto the therapist; reassurance-seeking in session
- Premature termination once a supportive relationship is secured elsewhere
- Therapist drawn into directing the patient's life
Good; dependent patients are often engaged and compliant, and respond well when autonomy is built gradually.
Practise this presentation
For training only. Diagnostic criteria are summarised, consult the full sources [1,2] for the complete text; see References. Not a substitute for supervised clinical assessment.