Dependent personality disorder

Dependent personality disorder (DPD) is <noinclude>a personality disorder </noinclude>characterized by a pervasive dependence on other people and subsequent submissiveness in which people depend on others to meet their emotional and physical needs. Individuals with DPD often struggle to make independent decisions and seek constant reassurance from others. This dependence can result in a tendency to prioritize the needs and opinions of others over their own. There was a diagnostic category for DPD in the previous revision of the International classification of Diseases, ICD-10; but the ICD-11 no longer has distinct diagnoses for personality disorders.

Signs and symptoms

People with DPD depend excessively on others for advice, decision-making and the fulfillment of other needs, as they lack confidence in their abilities, competence and judgment. They may thus act passively and avoid responsibilities, delegating them to others. but has been associated with various genetic and environmental factors. A study in 2012 estimated that between 55% and 72% of the risk of the condition is inherited from one's parents.

Dependent traits in children tended to increase with parenting behaviours and attitudes characterized by overprotectiveness and authoritarianism. Thus the likelihood of developing dependent personality disorder increased, since these parenting traits can limit them from developing a sense of autonomy, rather teaching them that others are powerful and competent. Individuals with a history of neglect or an abusive upbringing may have an increased risk of developing DPD, particularly those who have experienced long-term abusive relationships.

The difference between a "dependent personality" and a "dependent personality disorder" is somewhat subjective, which makes diagnosis sensitive to cultural influences such as gender role expectations. There is a higher frequency of the disorder seen in women than men; hence, expectations relating to gender role may contribute to some extent. Traumatic or adverse experiences early in an individual's life, such as neglect and abuse or serious illness, can increase the likelihood of developing personality disorders, including dependent personality disorder, later in life. This is especially prevalent for those individuals who also experience high interpersonal stress and poor social support. There is also a hybrid model, called the Alternative DSM-5 model for personality disorders (AMPD), which defines personality disorder diagnoses through combinations of pathological traits and areas of overall impairment. This categorical system, retained from the DSM-IV, was found to be problematic due to reasons such as excessive diagnostic comorbidity, inadequate coverage, arbitrary boundaries with normal psychological functioning, and heterogeneity among individuals within the same categorial diagnosis. As a result of deficits of this system for personality disorders, the AMPD was developed for the DSM-5. The AMPD does not list dependent personality disorder as its own diagnostic entity. However, it is stated in the AMPD that what is conceptualized as DPD can instead be diagnosed as personality disorder – trait specified, which is a dimensional diagnosis that is constructed from the individual expression of personalty disorder, as manifested in both a general impairment in personality functioning along with at least one pathological personality trait.

The World Health Organization's ICD-11 has replaced the categorical classification of personality disorders in the ICD-10 – in which DPD is a distinct diagnostic category () – with a dimensional model containing a unified personality disorder () with severity specifiers, along with specifiers for prominent personality traits or patterns (). Severity is assessed based on the pervasiveness of impairment in several areas of functioning, as well as on the level of distress and harm caused by the disorder, while trait and pattern specifiers are used for recording the manner in which the disturbance is manifested. Dependent personality disorder shows a consistent association with the ICD-11 trait domain Negative Affectivity (), reflecting features such as low self-confidence and reliance on others. It is also frequently linked to Disinhibition (), possibly due to ICD-11's inclusion of irresponsibility within that domain. Moreover, while someone with DPD reacts to abandonment by appeasement and endeavor to obtain nurturance from someone else, people with borderline personality disorder react with "feelings of emotional emptiness, rage, and demands". In contrast to the social withdrawal seen in avoidant personality disorder in conjunction with their negative self-perception, in the case of DPD, interpersonal relationships are actively pursued. Characterized by "self-effacing and docile behavior", DPD can furthermore be differentiated from histrionic personality disorder, which entails "gregarious flamboyance with active demands for attention." The main goal of this therapy is to make the individual more independent and help them form healthy relationships with the people around them. This is done by improving their self-esteem and confidence.

Traits related to DPD, like most personality disorders, emerge in childhood or early adulthood. Findings from the NESArC study found that 18 to 29 year olds have a greater chance of developing DPD. DPD is more common among women compared to men as 0.6% of women have DPD compared to 0.4% of men.

Millon's subtypes

Psychologist Theodore Millon identified five adult subtypes of dependent personality disorder. Any individual dependent may exhibit none or one or more of the following:

{| class="wikitable"

!Subtype

!Features

!Traits

| Disquieted dependent

|Including avoidant features

| Restlessly perturbed; disconcerted and fretful; feels dread and foreboding; apprehensively vulnerable to abandonment; lonely unless near supportive figures.

| Selfless dependent

|Including masochistic features

| Merges with and immersed into another; is engulfed, enshrouded, absorbed, incorporated, willingly giving up own identity; becomes one with or an extension of another.

| Immature dependent

|Variant of "pure" pattern

| Unsophisticated, half-grown, unversed, childlike; undeveloped, inexperienced, gullible, and unformed; incapable of assuming adult responsibilities.

| Accommodating dependent

|Including histrionic features

| Gracious, neighborly, eager, benevolent, compliant, obliging, agreeable; denies disturbing feelings; adopts submissive and inferior role well.

| Ineffectual dependent

|Including schizoid features

| Unproductive, gainless, incompetent, meritless; seeks untroubled life; refuses to deal with difficulties; untroubled by shortcomings.

History

The conceptualization of dependency, within classical psychoanalytic theory, is directly related to Sigmund Freud's oral psychosexual stage of development. Frustration or over-gratification was said to result in an oral fixation and in an oral type of character, characterized by feeling dependent on others for nurturing and by behaviors representative of the oral stage. Later psychoanalytic theories shifted the focus from a drive-based approach of dependency to the recognition of the importance of early relationships and establishing separation from these early caregivers, in which the exchanges between the caregiver and the child become internalized, and the nature of these interactions becomes part of the concepts of the self and of others.