Dependent - Co-Dependent Personality Disorder

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

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 his or her life.

Has difficulty expressing disagreement with others because of fear of loss of support or approval.

Has difficulty initiating projects or doing things on his or her 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 himself or herself.

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 himself or herself.

Associated Features:

Differential Diagnosis:

Some disorders have similar or even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which he needs to rule out to establish a precise diagnosis.

Cause:

The cause of this disorder is not known. The disorder usually appears in early adulthood. This disorder is common but not well studied; however, more women than men have been found to have dependent personality disorder.

Treatment:

There is no specific treatment for this disorder. Psychotherapy may be useful in gradually helping people to make choices that affect their own life. Medication may also be helpful. Improvements are usually seen only with long-term therapy or treatment.

As with all personality disorders, psychotherapy is the treatment of choice. Treatment is likely to be sought by individuals suffering from this disorder when stress or other complications within their life have led to decreased efficiency in life functioning. As with all other personality disorders as well, they may present with a clear Axis I diagnosis and the personality disorder may only become apparent after a few sessions of therapy.

The most effective psychotherapeutic approach is one which is focuses on solutions to specific life problems the patient is presently experiencing. Long-term therapy, while ideal for many personality disorders, is contra-indicated in this instance since it reinforces a dependent relationship upon the therapist. While some form of dependency will exist no matter the length of therapy, the shorter the better in this case. Termination issues will likely be of extreme importance and will virtually be a litmus test of how effective the therapy has been. If the individual cannot end therapy successfully and move on to become more self-reliant, it should not be seen as a therapeutic failure. Rather, the individual was not likely seeking life-changing therapy in the first instance but instead solution-focused therapy.

As with all personality disorders, medications should only be prescribed for specific problems suffered by the individual. Sedative drug abuse and overdose is common in this population and should be prescribed with additional caution. Anti-anxiety agents and antidepressants should be prescribed only when there is a clear Axis I diagnosis in conjunction with the personality disorder. Physicians should resist the temptation to overprescribe to someone with this disorder, because they often present with multiple physical complaints or anxiety. The anxiety in this instance is clearly situationally-related and medication may actually interfere with effective psychotherapeutic treatment.