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| Temperament | Low energy level; fearful, sad or withdrawn, melancholic |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 | “You can't do it by yourself.” |
| Self-View | “I'm nice, but inadequate (or fragile).” |
| World-View | “Others are here to take care of me, because I can't do it myself.” |
| Maladaptive Schemas |
|
| Optimal Diagnostic Criterion | Needs others to assume responsibility for most major areas of his or her life. |
DSM diagnostic criteria
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.
- Has difficulty making everyday decisions without excessive advice and reassurance.
- Needs others to assume responsibility for most major areas of their life.
- Has difficulty expressing disagreement for fear of loss of support or approval.
- Has difficulty initiating projects or doing things on their own (from lack of self-confidence, not motivation).
- Goes to excessive lengths to obtain nurturance and support, even volunteering for unpleasant tasks.
- Feels uncomfortable or helpless when alone, fearing inability to care for self.
- Urgently seeks another relationship as a source of care when a close one ends.
- Is unrealistically preoccupied with fears of being left to take care of 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.