Dependent Personality Disorder

What is dependent personality disorder?

Dependent personality disorder (DPD) is a mental health condition that involves an excessive need to be taken care of by others. A person with DPD relies on people close to them for their emotional or physical needs. Others may describe them as needy or clingy.

People with DPD believe they can’t take care of themselves. They may have trouble making everyday decisions, like what to wear or what food to eat, without others’ reassurance. They usually don’t realize that their thoughts and behaviors are problematic.

DPD is one of a group of conditions called “Cluster C” personality disorders. They involve feelings of anxiety and fear. Personality disorders are lasting patterns of behavior that are out of touch with cultural norms (how we’re expected to act). They start before adulthood — in childhood or adolescence. Personality disorders cause distress for the person with the condition and/or those around them.

Less than 1% of adults in the U.S. meet the criteria for DPD.

What is the difference between DPD and BPD?

Dependent personality disorder (DPD) and borderline personality disorder (BPD) both involve interpersonal difficulties and fear of abandonment, but they’re different personality disorders.

BPD involves extreme mood fluctuations, instability in relationships and impulsivity. People with BPD have an intense fear of abandonment and have trouble regulating their emotions, especially anger.

DPD doesn’t typically involve mood fluctuations and impulsivity. People with DPD are typically passive and submissive because they don’t want to cause conflict in their relationships.

What are the symptoms of dependent personality disorder?

Someone with dependent personality disorder may have several behavioral symptoms, including:

• Trouble making everyday decisions, like what to wear, without constant reassurance and advice from others.
• Difficulty starting tasks on their own.
• Intense fear of not being able to take care of themselves.
• Doing or volunteering for uncomfortable tasks to get support or nurturance from others.
• Needing others to take responsibility for various aspects of their life.
• Avoiding expressing disagreement or creating conflict in relationships for fear of losing the relationship.
• Feeling uncomfortable when alone.
• Having a fear of abandonment and a sense of helplessness when relationships end.

People with DPD tend to interact only with the few people they depend on. They’re also more likely to tolerate physical, sexual or emotional abuse because they don’t want to lose the relationship.

What causes dependent personality disorder?

Personality disorders, including DPD, are among the least understood mental health conditions. But researchers think DPD develops due to several factors, including:

• Experiencing abuse: People who have a history of abusive relationships have a higher risk of a DPD diagnosis.
• Childhood trauma: Children who have experienced child abuse (including verbal abuse) or neglect may develop DPD. It may also affect people who experienced a life-threatening illness during childhood.
• Genetics: Someone with a biological family member who has DPD or another anxiety disorder may be more likely to have a DPD diagnosis.
• Certain cultural, religious or family behaviors: Some people may develop DPD due to cultural or religious practices that emphasize reliance on authority.

How is dependent personality disorder diagnosed?

Personality continues to evolve throughout child and adolescent development. Because of this, healthcare providers don’t typically diagnose someone with dependent personality disorder until after the age of 18. Providers need evidence that these patterns of behavior are long-lasting and haven’t really changed with time.

Personality disorders, including DPD, can be difficult to diagnose. This is because most people with one don’t think there’s a problem with their behavior or way of thinking.

When they do seek help, it’s often due to conditions such as anxiety or depression from the problems created by their personality disorder, like relationship or work difficulties.

When a mental health professional, such as a psychologist or psychiatrist, suspects someone might have dependent personality disorder, they often ask broad, general questions that will shed light on:

• Past history.
• Relationships.
• Previous work history.
• Reality testing.

A person suspected of having DPD may lack insight into their behaviors and thought patterns. So, mental health professionals often work with the person’s family and friends to collect more information into their behaviors and history.

DSM-5 diagnostic criteria for dependent personality disorder

Mental health providers base a diagnosis of dependent personality disorder on the criteria for the condition in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Diagnostic criteria for dependent personality disorder involve a persistent pattern of at least five of the following behaviors:

• Difficulty making daily decisions without an excessive amount of advice and reassurance from others.
• Needing others to be responsible for the most important aspects of their life.
• Difficulty disagreeing with others because they fear the loss of support or approval.
• Issues starting projects on their own because they’re not confident in their judgment and abilities.
• Willingness to go to great lengths (like doing unpleasant tasks) to get support from others.
• Feeling uncomfortable or helpless when they’re alone because they fear they can’t take care of themselves.
• Urgently needing to form a new relationship with someone who will provide care and support when a close relationship ends.
• Unrealistic worry of being left to take care of themselves.

What is the treatment for dependent personality disorder?

Treating personality disorders is difficult because people with these conditions have deep-rooted patterns of thinking and behavior that have existed for many years.

Treatment for people with DPD is most effective with the involvement and support of loved ones. It usually involves psychotherapy and, potentially, medication.

Psychotherapy for DPD

Psychotherapy (talk therapy) is the treatment of choice for personality disorders. The goal of treatment is to help you uncover the motivations and fears associated with your thoughts and behavior. In addition, you can learn to relate to others more positively.

Two specific types of psychotherapy that can help people with DPD include:

• Psychodynamic therapy: This type of therapy focuses on the psychological roots of emotional suffering. Through self-reflection, you look into problematic relationships and behavior patterns in your life. This helps you better understand yourself. It can help you change how you relate to other people and your environment.
• Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. A therapist or psychologist helps you take a close look at your thoughts and emotions. You’ll come to understand how your thoughts affect your actions. Through CBT, you can unlearn negative thoughts and behaviors. You’ll learn to adopt healthier thinking patterns and habits. Therapy for DPD may especially focus on examining your fears of independence and difficulties with assertiveness.

Medication for DPD

There’s currently no medication that can treat personality disorders. But there’s medication for depression and anxiety, which people with dependent personality disorder may also have. Treating these conditions can make it easier to treat DPD.

For the best results, however, you should take medication in combination with psychotherapy.

Can dependent personality disorder be prevented?

You can’t prevent dependent personality disorder. But treatment can help lessen the issues it causes. Seeking help as soon as symptoms appear can help decrease the disruption to the person’s life, family and friendships.

What’s the prognosis for dependent personality disorder?

The prognosis (outlook) for dependent personality disorder depends on if it’s treated or not.

Left untreated, DPD may result in:

• Additional mental health conditions, like depression and substance use disorder.
• Relationship difficulties.
• Increased likelihood of experiencing physical, emotional or sexual abuse.

People with DPD also experience higher rates of suicidal ideation and suicide attempts. If you or a loved one are thinking about suicide, dial 988 on your phone to reach the Suicide and Crisis Lifeline. Someone is available to help you 24/7.