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.
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.
Counseling
and Psychotherapy [ See
Therapy Section ]:
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.
Pharmacotherapy
[ See
Psychopharmacology Section ] :
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
