Persons affected by dependent personality disorder have a disproportionately low level of confidence in their own intelligence and abilities and have difficulty making decisions and undertaking projects on their own. Their pervasive reliance on others, even for minor tasks
or decisions, makes them exaggeratedly cooperative out of fear of alienating those whose help their need. They are reluctant to express disagreement with others and are often willing to go to abnormal lengths to win the approval of those on whom they rely. Another common feature of the disorder is an exaggerated fear of being left to fend for oneself. Adolescents with dependent personality disorder rely on their parents to make even minor decisions for them, such as what they should wear or how they should spend their free time, as well as major ones, such as what college they should attend or which career they should choose.
It is important to note that in other societies where cultural norms are different, dependent and/or passive traits may be valued, particularly in women. The criteria outlined here for dependent personality disorder is applicable to Americans only, and even then may not apply to all cultural groups within the United States.
Demographics
Dependent personality disorder occurs equally in males and females and usually begins by early adulthood. Overall prevalence is approximately one to two percent of the general population. Because children and adolescents are dependent on adults by necessity, dependent personality disorder is very rarely diagnosed in these age groups.
Causes and symptoms
In the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Text Revision (DSM-IV-TR), the American Psychiatric Association states that five of the following criteria should be present for a diagnosis of dependent personality disorder:
difficulty making decisions, even minor ones, without guidance and reassurance from others
requiring others to take responsibility for major decisions and responsibilities beyond what would be age-appropriate (e.g., letting a parent choose a college without offering any input on the decision)
difficulty disagreeing with others due to an unreasonable fear of alienation
unable to initiate or complete projects or tasks due to a belief that he or she is either inept or that the appearance of success would lead a support person(s) to abandon him or her
takes on unreasonably unpleasant tasks or sacrifices things in order to win the approval of others
unable to spend time alone due to a lack of self-reliance and an unreasonable fear of being unable to care for oneself
inability to remain independent of a close relationship as manifested by seeking a substitute support relationship immediately after one ends (e.g., a teenager who feels she must have a boyfriend constantly to validate her self-worth)
unrealistic preoccupation with the thought of being left to care for oneself
Dependent personality disorder is more common in those who have suffered from chronic illness in childhood. A child may also exhibit dependent behavior in response to a specific stressful life event (such as the death of a caregiver or a divorce). However, it should not be considered a potential symptom of dependent personality disorder unless the behavior becomes chronic and significantly interferes with day-to-day functioning and/or causes the child significant distress.
When to call the doctor
It is developmentally suitable for young children to go through "clingy" stages where overt dependent behavior on a parent or caregiver is commonplace. However, if dependency in a child or adolescent starts to interfere with school work, daily living, and the child's sense of self-esteem and well-being, parents should seek professional help from their child's doctor. If a child or teen indicates at any time that he/she has had recent thoughts of self-injury, suicide, or of inflicting harm on others, professional assistance from a mental health care provider or care facility should be sought immediately.
Diagnosis
Older teens or young adults who have demonstrated at least five of the DSM-IV-TR criteria (or symptoms) outlined above are eligible for a diagnosis of dependent personality disorder. In the DSM-IV-TR, the APA warns that a diagnosis of dependent personality disorder "should be used with great caution, if at all, in children and adolescents, for whom dependent behavior may be developmentally appropriate." Children are dependent on parents and other adults in their lives for support and physical and emotional safety by necessity; it is only when the behaviors are excessive and age inappropriate that a diagnosis of dependent personality disorder can be contemplated.
Treatment
The primary treatment for dependent personality disorder is psychotherapy, with an emphasis on learning to cope with anxiety, developing assertiveness, and improving decision-making skills. Group therapy can also be helpful. In cases where parents or other adult caregivers seem to be facilitating the behavior, therapy for them is also appropriate.
Prognosis
Dependent personality disorder frequently occurs in tandem with other personality-based mental illness, such as borderline, histrionic, and avoidant personality disorders. It is also believed that those diagnosed with dependent personality disorder are at an increased risk of mood and anxiety disorders.
Prevention
There is no known prevention strategy for dependent personality disorder. However, some tactics that can promote healthy socialization and positive self-esteem from an early age include encouraging healthy peer relationships, investing a child with increasing levels of age-appropriate responsibilities and independence, and offering choices to even the smallest children.
Parental concerns
Dependent personality disorder is an extremely rare diagnosis in children. Parents of children who have been diagnosed with dependent personality disorder may wish to seek a second opinion from a trained psychologist or psychiatrist specializing in pediatric care. Separation anxiety shares some common features with dependent personality disorder, and should be considered as a differential diagnosis.
KEY TERMS
Borderline personality disorder—A mental disorder characterized by mood swings, unstable interpersonal relationships, poor self-image, and self-destructive and impulsive behaviors.
Histrionic personality disorder—A mental disorder characterized by inappropriate attention-seeking behavior, rapid emotional shifts, and exaggerated expression of emotion.
Separation anxiety—Childhood fear of leaving parents for any reason.
BOOKS
Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR). Washington, DC: American Psychiatric Press, Inc., 2000.
PERIODICALS
Grant, BF et al. "Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions." Journal of Clinical Psychiatry. 65, no. 7 (July 2004): 948–58.
ORGANIZATIONS
The American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Ave., N.W., Washington, D.C. 20016–3007. (202) 966–7300. Web site: <www.aacap.org>.
National Institute of Mental Health. 6001 Executive Boulevard, Rm. 8184, MSC 9663, Bethesda, MD 20892–9663. (301) 443–4513.
