People with dependent personality disorder suffer from an excessive belief that they are unable to function without help from others and that they need to be taken care of. This causes submissive behavior and fears of separation. The behavior begins by early adulthood.

 

The DSM-IV diagnostic criteria state that dependent personality disorder can be diagnosed in the presence of five or more of the following:

The ICD-10 diagnostic criteria differ in some matters of detail, but define essentially the same disorder.

 

The person with dependent personality disorder may be:

It should be remembered that dependency is not necessary maladaptive - it can be associated with a variety of healthy, adaptive traits and behaviors.

 

A full psychological and psychiatric history should be obtained, looking in particular at:

The patient's behavior and demeanor during the interview should be assessed.

It is important to bear in mind the patient's cultural norms before making a diagnosis of dependent personality disorder, and the diagnosis should be made only when the degree of dependence is obviously either unrealistic or in excess of these norms.

Psychological testing can suggest clustering of personality traits and may be useful in helping to make the diagnosis.

 

Patients with dependent personality disorder often seek treatment because of comorbid diagnoses or problems, and these conditions are often assumed to be complications of the personality disorder. However, according to epidemiological studies, their incidence is no higher than in the overall population.

Common among these comorbid problems are:

People with dependent personality disorder often avoid positions of responsibility and irritate superiors and work colleagues by seeking excessive guidance, being unable to make important decisions and displaying an inability to complete projects without help.

People with dependent personality disorder often form strong attachments, usually to one person and may have few relationships beyond that with this one main person.

Their relationships are often imbalanced and they may tolerate exploitation and abuse.

Financial problems are not uncommon because of the likelihood of financial exploitation in personal and business relationships.

 

Some dependency traits are normal at extremes of age, during times of illness and in certain cultures.

Dependency is part of many axis I psychiatric conditions, especially chronic major depression, panic disorder with agoraphobia, mental retardation, and schizophrenia.

It is important to rule out a personality change due to a medical condition or substance dependency and other personality disorders (e.g. borderline personality disorder, histrionic personality disorder and avoidant personality disorder).

 

The prognosis varies, but in many cases, dependency decreases with maturity.

Treatment is often successful in reducing symptomatic behaviors.

The aims of treatment are:

 

Obsessive compulsive personality disorder is not generally responsive to medications, which are at best adjunctive to non-pharmacological therapies and do not address the underlying disorder. However, an aggressive pharmacological approach to comorbid psychopathology can reduce dependency.

Antidepressant medications are helpful when depressive symptoms are present and can induce a non-specific increase in stress tolerance, a decreased hypersensitivity to rejection and decreased anxiety levels.

Selective serotonin reuptake inhibitors (e.g. paroxetine, sertraline) are particularly well tolerated, and tricyclic antidepressants (e.g. imipramine) have been demonstrated to be effective.

Drugs such as paroxetine and sedating antidepressants (e.g. imipramine, trazodone) are effective.

Benzodiazepines (e.g. clonazepam) can be used on a short-term crisis basis to control anxiety and prevent undesirable behaviors. However, avoid long-term use because of the risk of habituation in patients with dependent personality disorder.

Antidepressants such as trazodone or imipramine in low doses are helpful and can be given without risk of dependence. For infrequent problems with insomnia, a drugs such as zolpidem or zopiclone can be used.

 

Standard dosages are:

The main side effects of paroxetine and sertraline include:

The main side effects of imipramine include:

The main side effects of trazodone include:

The main side effects of clonazepam include:

The main side effects of zolpidem include:

The main side effects of zopiclone include:

 

Non-pharmacological treatments are usually the mainstay of therapy in dependent personality disorder. Treatments include:

Hospitalization is relatively contraindicated in patients with dependent personality disorder because of its tendency to promote regression.

It is worth remembering that patients with dependent personality disorder are often very adept at getting others to feel responsible for them. They can become very dependent on and demanding of their treating clinician. These behaviors should be addressed as part of treatment. It is necessary to resist the urge to reject a patient because of excessive demands but also to avoid becoming yet another caregiver.

 

It is important that the clinician should establish supportive role and be reliable and consistent.

Rules should be laid down for appropriate availability while allowing for a reasonable degree of dependence; so, for example, the clinician might be available for true crises but set limits on frequent, trivial telephone calls. Such rules can be explained at the start of the therapy.

It is useful for the patient to set personal goals for treatment.

Brief therapies typically take 3-5 months; long-term therapies can take several years. Reassess the degree to which goals are being accomplished at regular intervals and revise these goals or set new goals if necessary.

Treatment sessions should be tapered towards the end of treatment; at termination, it may be necessary to allow the patient the option of as-necessary sessions over the longer term.

The precise etiology of dependent personality disorder is not known. Psychosocial factors almost certainly play a role. The importance of cultural factors should always be borne in mind, since certain cultures encourage certain members of society, particularly women, to take on dependent roles.

 

Dependent personality disorder is one of the most commonly seen of the personality disorders in psychiatric settings. The prevalence in the general population has been reported to be 2-4% ; in outpatient psychiatric settings it is as high as 23% .

The prevalence is higher in females; in clinic populations, the proportion of males and females tends to be equal.