What is Dependent Personality Disorder and What Are the Symptoms?

What is a personality disorder?

A personality disorder is a type of mental disorder characterized by a pattern of persistent behaviors, thoughts, and emotions that deviate from cultural and societal expectations, and cause significant problems in relationships, social and occupational functioning, and personal well-being.

A person with a personality disorder may have difficulty regulating their emotions, relating to others, and adapting to changes in their environment. They may also have a distorted sense of self, problems with identity, and a limited range of emotional expression.

What is Dependent Personality Disorder?

Dependent Personality Disorder (DPD) is one of ten personality disorders identified within the Diagnostic and Statistical Manual of Mental Disorders (5th Edition), otherwise known as the DSM-V.

The following description paints a picture of how someone diagnosed with dependent personality disorder may appear to others:

Dependent personalities are caring to a fault, allowing others’ well-being to come first no matter what the cost may be to themselves or their identity. Ever helping and giving, they are committed to their personal relationships, especially to their spouses and the institution of marriage. Essentially. they live their lives through others and for others, to whom they offer warmth, tenderness, and consideration. When people they care for are happy, they are happy. Not surprisingly, they tend to assume the more passive role in their relationships, deferring to the opinions and desires of those they love, whose pleasure and fulfillment they then enjoy vicariously. They prefer harmony in their relationships and tend to be apologetic even when others should take the greater part of responsibility for a disagreement.

‘Personality Disorders in Modern Life’ by Millon et al, 2012^[1]

What sets Dependent Personality Disorder apart from other personality disorders is that it is marked by a pervasive reliance on other individuals for emotional and physical needs.

DPD sits within a section of the DSM-V in which disorders are characterized by excessive fear and anxiety, typically emerging before early adulthood.

This disorder is a chronic condition in which individuals struggle to achieve normal levels of independence, with only a minority successfully doing so.

What are the signs of Dependent Personality Disorder?

Symptoms of DPD include extreme passivity, distress or helplessness when relationships end, avoidance of responsibilities, and significant submission.

DPD may also be identified in individuals with avoidance of decision-making, fear of abandonment, clingy behavior, low social boundaries, and oversensitivity to criticism.

Professionals^[2] look at four areas of functioning that are all impacted by dependent personality disorder. These are:

1. Cognitive: a perception of oneself as powerless and ineffectual, coupled with the belief that other people are comparatively powerful and potent
2. Motivational: a desire to obtain and maintain relationships with protectors and caregivers
3. Behavioral: a pattern of relationship-facilitating behavior designed to strengthen interpersonal ties and minimize the possibility of abandonment and rejection
4. Emotional: fear of abandonment, fear of rejection, and anxiety regarding evaluation by figures of authority

What are the five subtypes of dependent personality disorder?

Psychologist Theodore Millon identified five subtypes of Dependent Personality Disorder. Here are the five subtypes along with the personality traits exhibited by each subtype:

1. Disquieted dependent (Including avoidant features): Restlessly perturbed; disconcerted and fretful; feels dread and foreboding; apprehensively vulnerable to abandonment; lonely unless near supportive figures
2. 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
3. Immature dependent (Variant of “pure” pattern): Unsophisticated, half-grown, unversed, childlike; undeveloped, inexperienced, gullible, and unformed; incapable of assuming adult responsibilities
4. Accommodating dependent (Including histrionic features): Gracious, neighborly, eager, benevolent, compliant, obliging, agreeable; denies disturbing feelings; adopts submissive and inferior role well
5. Ineffectual dependent (Including schizoid features): Unproductive, gainless, incompetent, meritless; seeks untroubled life; refuses to deal with difficulties; untroubled by shortcomings

Are there any risk factors associated with Dependent Personality Disorder?

Women are more frequently diagnosed with Dependent Personality Disorder than men. However cultural expectations surrounding gender roles may contribute to this discrepancy.

A family history of anxiety disorder may contribute to the development of DPD, as a 2004 twin study^[4] discovered a heritability rate of 0.81 for personality disorders as a whole.

Children and adolescents with a history of anxiety disorders and physical illnesses are also more susceptible to developing DPD.

Those who were raised by overprotective or authoritarian parents are also more vulnerable to this disorder. Childhood traits associated with dependence tend to increase with overprotective and authoritarian parenting styles, which limit the child’s sense of autonomy and reinforce the belief that others are powerful and competent. These factors increase the likelihood of developing dependent personality disorder.

Traumatic experiences during childhood, such as neglect, abuse, or serious illness, can also increase the risk of developing personality disorders later in life. Individuals who have experienced neglect or abuse during their upbringing are at a higher risk of developing DPD, particularly if they are involved in long-term abusive relationships. Studies^[5] suggest that this risk is further heightened in those who also experience high levels of interpersonal stress and poor social support.

How is Dependent Personality Disorder diagnosed?

Personality disorders are typically diagnosed after a comprehensive evaluation by a mental health professional.

The criteria for diagnosis varies according to which diagnostic manual is used by mental health professionals. The main two are the DSM-V (published by the American Psychological Association) and the International Classification of Diseases (11th Revision), published by the World Health Organization.

For DPD diagnosis, the DSM-V^[6] requires patients to be experiencing at least five of the following factors:

• Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
• Needs others to assume responsibility for most major areas of their life
• Has difficulty expressing disagreement with others because of fear of loss of support or approval
• Has difficulty initiating projects or doing things on their own (because of a lack of self confidence in judgment or abilities rather than a lack of motivation or energy)
• Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant
• Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves
• Urgently seeks another relationship as a source of care and support when a close relationship ends
• Is unrealistically preoccupied with fears of being left to take care of themselves

Within the International Classification of Diseases (ICD-10), diagnosis of DPD is described as follows:

[A] personality disorder… characterized by pervasive passive reliance on other people to make one’s major and minor life decisions, great fear of abandonment, feelings of helplessness and incompetence, passive compliance with the wishes of elders and others, and a weak response to the demands of daily life. Lack of vigor may show itself in the intellectual or emotional spheres; there is often a tendency to transfer responsibility to others.

The ICD-10 requires patients to meet the criteria of general personality disorder, in addition to at least four of the following:

It is characterized by at least four of the following:

• Encouraging or allowing others to make most of one’s important life decisions
• Subordination of one’s own needs to those of others on whom one is dependent, and undue compliance with their wishes
• Unwillingness to make even reasonable demands on the people one depends on
• Feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself
• Preoccupation with fears of being abandoned by a person with whom one has a close relationship, and of being left to care for oneself
• Limited capacity to make everyday decisions without an excessive amount of advice and reassurance from others
• Associated features may include perceiving oneself as helpless, incompetent, and lacking stamina

The distinction between a “dependent personality” and a “dependent personality disorder” is somewhat subjective, making diagnosis sensitive to cultural influences such as gender role expectations

What disorders are similar to Dependent Personality Disorder?

Individuals with Dependent Personality Disorder and borderline personality disorder share a common fear of abandonment.

However, individuals with Dependent Personality Disorder do not exhibit the same mood swings and impulsivity that are characteristic of borderline personality disorder. Dependent personalities are often passive and submissive, for fear of jeopardising their relationships.

How common is Dependent Personality Disorder?

According to a recent survey of 43,093 Americans^[7], only 0.49% of adults meet the diagnostic criteria for DPD.

The study also found that young adults aged 18 to 29 are more likely to develop DPD.

DPD is more prevalent among women, with 0.6% of women having DPD compared to 0.4% of men.

How is Dependent Personality Disorder treated?

Some individuals with personality disorders may not seek treatment or may struggle to adhere to treatment due to their condition’s nature, making it a complex and challenging disorder to manage. However, Cluster C, which includes DPD, is considered the most treatable of the three clusters of personality disorders.

For those who do seek treatment for personality disorders, options may involve psychotherapy, medication, or a combination of both.

It is important to understand the specific triggers for symptoms and to motivate patients to engage in therapy. DPD is often treated with Cognitive Therapy, an approach believing people with DPD have distorted thinking patterns that maintain the disorder. Childhood experiences may contribute to this.

Cognitive Therapy can be helpful for DPD because it focuses on patients’ beliefs about themselves and their fear of being judged.

In therapy, it is important to address patients’ beliefs about themselves as weak and ineffectual. However, some researchers suggest that integrated approaches, such as combining Cognitive Behavioral Therapy (CBT) and Existential Therapy, may be more effective for DPD.

Social skills training, CBT, and Psychodynamic Therapy have all been shown to be effective treatments for Cluster C disorders.

Dependent men may have unique challenges in therapy, such as difficulty discussing their feelings and fear of judgment. Normalizing dependency needs and expanding support systems may be helpful for this population. Patients with DPD may also have difficulty ending therapy, so gradually tapering treatment may be necessary.

Treatment for Dependent Personality Disorder at The Center • A Place of HOPE

Treatment at The Center • A Place of HOPE is focused around Whole Person Care, a multidisciplinary treatment approach that cares for the whole person, instead of just the symptoms.

Pioneered by founder, Dr. Gregory Jantz in the early 1980s, Whole Person Care addresses the emotional, physical, intellectual, relational, and spiritual elements of life. The aim is that the entire “you” can emerge as a whole, healed human being and the result is a deeper, longer-lasting, and more complete recovery.

At The Center • A Place of HOPE, a team of world-class, licensed and board-certified professionals is assigned to each patient. Team members are highly specialized professionals who take the time to get to know patients personally in order to understand all of the life events that have contributed to the current situation.

Treatment programs are uniquely tailored, personalized to individual needs and life experiences, and built to return each patient to a place of lasting balance, health and happiness.

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[1] Millon, T., Millon, C. M., Meagher, S. E., Grossman, S. D., & Ramnath, R. (2012). Personality disorders in modern life. John Wiley & Sons.
[2] Beitz, Kendra; Bornstein, Robert F. (2006). Practitioner’s Guide to Evidence-Based Psychotherapy. Springer, Boston, MA. pp. 230–237.
[3] Gjerde, L. C.; Czajkowski, N.; Røysamb, E.; Ørstavik, R. E.; Knudsen, G. P.; Østby, K.; Torgersen, S.; Myers, J.; Kendler, K. S.; Reichborn-Kjennerud, T. (2012). “The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire”. Acta Psychiatrica Scandinavica. 126 (6): 448–457.
[4] Coolidge, F.L.; Thede, L.; Jang, K.L. (2 December 2013). Are personality disorders psychological manifestations of executive function deficits? Bivariate heritability evidence from a twin study. Behavior Genetics (2004), pp. 34, 75-84, cited in Nolan-Hoeksema, Abnormal Psychology (6th. ed.), pp. 273, McGraw Hill Education (2014). ISBN 978-0-07-803538-8.
[5] Simonelli, Alessandra; Parolin, Micol (2017). “Dependent Personality Disorder”. Encyclopedia of Personality and Individual Differences. Springer, Cham. pp. 1–11.
[6] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC
[7] National Epidemiologic Survey on Alcohol and Related Conditions; NESARC; Grant et al., 2004