When we think of individuals who display ‘dependence’, we typically think of more obvious examples like young children or elderly people who are physically incapable of taking care of themselves. In these circumstances, it is ‘socially acceptable’ that these groups of people would depend on others for everything, even for more basic needs like dressing, feeding, and much more. But now think about your own life. On one hand, you may be a very independent person who doesn’t need input from anyone or anything about how to live your life. Or, like many of us, you may find that you display a level of dependence on others. Maybe not for your basic needs, but you may look to others to get insight on their opinions and ideas about how you should make this decision or that. And this is completely normal. It is in human nature to want to be accepted and approved of by others in our lives!
With that being said, sometimes too much dependence on others can be detrimental to our lives, and such is the case for individuals with dependent personality disorder. As a disorder that is only diagnosed to 0.5-0.6% of the population, not many people understand or are even aware of the level of chronic dependence that those who struggle with the disorder actually face.
What is a personality disorder?
When we think about personality, we usually think about someone’s traits, how they act around people, or how they may approach certain situations. For example, to describe your friend’s personality to a stranger, you may say that they are “charming and likable”.
A personality disorder is defined as a mental disorder in which an individual has an unhealthy, inflexible pattern of thinking and feeling about oneself or others that lead to significant and adverse effects in many aspects of their life. People who struggle with personality disorders are unable to perceive or relate to situations or the people around them in a socially acceptable way, and around 10% of adults struggle with this type of disorder. In the DSM-5, personality disorders are classified into three distinct categories: Cluster A, Cluster B, and Cluster C. Cluster A disorders are odd, eccentric, “weird” behaviors. Cluster B disorders include dramatic, overly emotional, “wild” behaviors. Lastly, Cluster C disorders are characterized by anxious, fearful, “worried” behaviors. All in all, the DSM includes 10 specific types of personality disorders listed. They are:
Some of these personality disorders are more recognizable and widely discussed in the public and on social media, but many may still be unfamiliar to a lot of us. Dependent personality disorder (DPD) is one of the least commonly diagnosed personality disorders on the list, but is not of any lesser importance. It is defined as a Cluster C disorder, and we will go through some of its signs and symptoms to look out for.
Dependent Personality Disorder
Paraphrasing from the APA definition, DPD is a personality disorder that causes individuals to be passive and submissive, essentially allowing others to make decisions for them and take control over major areas of their lives. Additionally, those with DPD subordinate their personal needs to the needs of others because of depleted self-confidence and self-dependence. Essentially, these individuals display an extreme level of ‘clinginess’, are unable to make decisions on their own, and have a serious fear of being abandoned or separated from those that they depend on.
Some studies show that DPD is more commonly diagnosed in women, but overall this disorder usually manifests in equal amounts in both men and women. It commonly starts during childhood or by the age of 29, and can sometimes fizzle out during middle adulthood. The origins of this disorder are not completely understood, but it may arise as a result of abusive relationships, a family history of other personality disorders/anxiety disorders, childhood trauma (including verbal abuse or life-threatening illness), cultural factors, or religious factors.
People who struggle with DPD become dependent on several people who are close to them, but usually become extremely dependent on one or two specific people. They become very submissive and overly passive to whatever this person may want from them, and this list demonstrates that those with DPD may have symptoms such as:
- Inability to make everyday decisions on their own
- A need for reassurance or advice whenever making any type of decision
- Inability to choose what clothes to wear without input
- Inability to do basic tasks on their own
- Extreme anxiety or sadness when a loved one leaves them
- Passivity toward abuse or mistreatment (in order to keep the person they are dependent on near to them)
- Engagement in behavior or activities that are wrong or illegal to please their valued person
- Preferring that their valued person makes big personal decisions for them
- Difficulty disagreeing with people because they fear disapproval
- Lack of opinions
- Fear of having to care for themselves without the input of someone else
- Extreme clinginess
- Consider themselves to be inferior to others
- Interpret criticism or disapproval as proof of their inadequacy
- Do not get angry even if it is warranted in fear of being left alone
- Being alone makes them feel extremely afraid and uncomfortable
- Limit their interactions to those that they are dependent on
As the name suggests, individuals with DPD are extremely dependent on other people to the point that they are unable to make decisions or function normally on their own. They feel as though they are not competent enough to fend for themselves, hate being alone, and the thought of having to do something on their own is crippling and leads them to go to great lengths just to make the people they depend on happy and close to them. People with DPD need lots of assurance and advice about every task or situation in their lives, that they would prefer someone that they are dependent on to just do it for them. This may stem from their lack of confidence in their own judgements and capabilities.
They are extremely people pleasing to the close people in their lives, and will even put up with abuse (verbal, mental, sexual) to avoid abandonment even when there are other options available to them. If for some reason, the person they are dependent on leaves or breaks up with them, a person with DPD quickly replaces them with a new person who will fulfill their needs and support them (even if that person does not have their best interests in mind).
DPD vs. BPD
You may be wondering, what is the difference between DPD and borderline line personality disorder (BPD)? Both DPD and BPD are personality disorders, and both actually share very similar symptoms. As we have discussed in a previous blog post, BPD affects an individual’s ability to feel towards themselves and others, a common similarity among personality disorders. Moreso, BPD specifically impacts a person’s ability to regulate their emotions and is characterized by impulsivity, mood swings, and an extreme fear of abandonment or instability. Sound familiar?
Well, DPD and BPD do share nearly identical symptoms, but how a person reacts to these symptoms determines what personality disorder they are diagnosed with. For example, let’s say there are two patients (one with BPD and one with DPD) who are feeling anxious or unstable. Each patient may be feeling the same levels of emotional distress, but their reaction to their thoughts and feelings are different. The patient with DPD might react by becoming very submissive and withdrawing themselves out of discomfort and insecurity. Meanwhile, the patient with BPD might react with rage, reckless behavior, or aggression.
BPD and DPD are similar in the sense that those with these disorders are hypersensitive to abandonment or rejection, have deep feelings of loneliness, avoid responsibility, have a difficult time maintaining their relationships, and go out of their way to prevent abandonment by those they value. Research shows that there is a 20% comorbidity rate in subjects who have BPD and DPD, and this may be a result of their many shared symptoms.
Outcomes and Treatment
Those who struggle with DPD may run into several challenges as they navigate this disorder. DPD may:
- Put a strain on relationships. When an individual struggles with DPD, those that are close around them can become frustrated or overwhelmed by how much this individual depends on them. The more that they depend on their friends and family to make decisions and approve of everything they do, the more likely conflict is to arise. Loved ones may feel the need to retreat and pull away from this person, but in turn the individual may become even more clingy and desperate for their attention.
- Put individuals at risk of isolation or abusive relationships. When someone with DPD finds a person or a small group of people they depend on, they might restrict their social interactions to those people only. Instead of fostering a wider social circle, these individuals cling onto their people, and tight. Even if there is a chance to branch out and make new friends, people with DPD are uncomfortable with the unknown and would rather attach themselves more intensely to their valued person. This level of submissiveness and need for emotional support results in people with DPD tolerating any type of behavior from their support people, even abuse.
- Inability to accomplish goals. Because people with DPD depend too much on the opinions of others, they are unable to do or accomplish many things that they otherwise could. These people feel as though they are incompetent unless someone gives them permission or approval to do things. Without prior approval or encouragement, they cannot make decisions for themselves and may even choose to do unenjoyable tasks if they think it will make their support people happy.
Though there are many complications that accompany DPD, those who suffer from this disorder can still live meaningful, independent lives. Mental health providers suggest that those who may be experiencing symptoms of DPD speak with their providers, and together they can come up with a plan to help manage DPD. A lot of the times, those with DPD may not be willing to take this initiative, so if you know someone who may be struggling with this disorder, you can help them reach out.
Whether it be psychotherapy, cognitive behavioral therapy, or medication, individuals with DPD can learn new ways to handle difficult social situations and learn to live for themselves!