Dependent Personality Disorder (DPD)

Dependent Personality Disorder (DPD)

Dependent Personality Disorder (DPD)

Much more so than most, patients with dependent PD (DPD) feel the need for someone else to take care of them. Because they desperately fear separation, their behavior becomes so submissive and clinging that it may result in others’ taking advantage of them or rejecting them. Anxiety blossoms if they are thrust into a position of leadership, and they feel helpless and uncomfortable when they are alone. Because they typically need much reassurance, they may have trouble making decisions. Such patients have trouble starting projects and sticking to a job on their own, though they may do well under the careful direction of someone else. They tend to belittle themselves and to agree with people who they know are wrong. They may also tolerate considerable abuse (even battering).

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Though it may occur commonly, this condition has not been well studied. Some writers believe that it is difficult to distinguish it from avoidant PD. It has been found more often among women than men. Bud Stanhope, a patient with the sleep terror type of non-rapid eye movement sleep arousal disorder, also had DPD; his history is given in an earlier chapter.

Essential Features of Dependent Personality Disorder

The need for supportive relationships draws these people into clinging, submissive behavior and fears of separation. Fear of disapproval makes it hard to disagree with others; to gain support, they will even take extraordinary steps, such as assuming unpleasant tasks. Low self-confidence prevents them from starting or carrying out projects independently; indeed, they want others to take responsibility for their own major life areas. If they do make even everyday decisions, they require lots of advice and reassurance. Exaggerated, unrealistic fears of abandonment and the notion that they cannot care for themselves will cause these people to feel helpless or uncomfortable when alone; they may desperately seek a replacement for a lost close personal relationship.

dependent personality disorder (dpd)

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The Fine Print

The D’s: • Duration (begins in teens or early 20s and endures) • Diffuse contexts • Differential diagnosis (physical and substance use disorders, mood and anxiety disorders, other PDs)

Janet Greenspan

A secretary in a large Silicon Valley company, Janet Greenspan was one of the best workers there. She was never sick or absent, and she could do anything—she’d even had some bookkeeping experience. Her supervisor noted that she was polite on the phone, typed like a demon, and would volunteer for anything. When the building maintenance crew went out on strike, Janet came in early every day for a week to clean the toilets and sinks. But still, somehow, she just wasn’t working out.

Her supervisor complained that Janet needed too much direction, even for simple things—such as what sort of paper to type form letters on. When she was asked what she thought the answer should be, her judgment was good, but she always wanted guidance anyway. Her constant need for reassurance took an inordinate amount of her supervisor’s time. That was why she had been referred to the company mental health consultant for an evaluation.

At 28, Janet was slender, attractive, and carefully dressed. Her chestnut hair already showed streaks of gray. She appeared at the doorway of the office and asked, “Where would you like me to sit?” Once she started talking, she spoke readily about her life and her work.

She had always felt timid and unsure of herself. She and her two sisters had grown up with a father who was affectionate but dictatorial; their mouse of a mother seemed to welcome his loving tyranny. At her mother’s knee, Janet had learned obedience well.

When Janet was 18, her father suddenly died; within a few months, her mother remarried and moved to another state. Janet felt bereft and panic-stricken. Instead of beginning college, she took a job as a teller in a bank; soon afterward, she married one of her customers. He was a 30-year-old bachelor, set in his ways, and he soon let it be known that he preferred to make all of the couple’s decisions himself. For the first time in a year, Janet relaxed.

But even security bred its own anxieties. “Sometimes at night I wake up, wondering what I’d do if I lost him,” Janet told the interviewer. “It makes my heart beat so fast I think it might stop from exhaustion. I just don’t think I could manage on my own.”

Evaluation of Janet Greenspan

Janet had the following symptoms of DPD: She needed considerable advice to make everyday decisions (criterion A1); she wanted her husband to make their decisions (A2); panic-stricken when her father died and her mother left town, she fled into an early marriage (A7); she feared being left to fend for herself, even though she had had no indication that this was likely (A8). She even volunteered to clean the office toilet, probably to secure the favor of the rest of the staff (A5). We have no evidence that she was reluctant to disagree with others, but otherwise the criteria fit like a rubber glove. Five are needed for diagnosis. Janet reported that she had been this way since childhood; from the history, her character traits would seem to have affected both work and social life. Fortunately, she married someone whose need to be in charge matched her dependency. Cognitive, affective, and interpersonal areas were involved (see the criteria for a general PD).

Dependent behavior is found in several mental disorders that Janet did not appear to have, including somatic symptom disorder and agoraphobia. The person with the secondary psychosis in what used to be called folie à deux (or shared psychotic disorder—now it is usually diagnosed as delusional disorder) often has a dependent personality. Major depressive disorder and dysthymia are important in the differential diagnosis; either of these may become prominent when patients lose those upon whom they depend. Even if Janet had all the required physiological symptoms for generalized anxiety disorder, she would not be given this diagnosis, because her worries were evidently limited to fears of abandonment.

Patients with DPD must be differentiated from those with histrionic PD, who are impressionable and easily influenced by others (but Janet did not seem to be especially attention-seeking). Other PDs usually included in the differential diagnosis are borderline and avoidant.

With a GAF score of 70, Janet’s diagnosis would be simple:

F60.7 [301.6] Dependent personality disorder

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