How Do You Treat Dependent Personality Disorder?
Dependent personality disorder (DPD) is a mental health condition characterized by an excessive and pervasive need to be cared for. DPD can lead to an overreliance on others, and submissive or clingy behavior in order to satisfy one’s own emotional and physical needs. People who suffer from DPD often fear being abandoned and have significant difficulty making everyday decisions without approval from someone else. This can lead them to avoid age-appropriate responsibilities. DPD can be difficult to manage, but improvement in decision-making and daily function can occur with treatment.
It is not clear what causes dependent personality disorder (DPD), but the condition is believed to appear during childhood.
Children who suffered chronic illness, separation anxiety, or were exposed to parenting styles that were authoritarian or overprotective tend to be more at risk for developing behaviors associated with DPD than children who did not have those experiences.
Genetics, temperament, developmental, and psychological factors can also play a role in the development of dependent personality disorder.
Signs of Dependent Personality Disorder
The Diagnostic and Statistical Manual of Mental Health (DSM-5) lists specific criteria to obtain a DPD diagnosis. A person must experience an excessive and persistent need to be taken care of, which results in submissive and clingy behavior illustrated by five or more of the following symptoms:
- Significant difficulty making everyday decisions without excessive reassurances and advice from other people
- An extreme need to have other people take responsibility for important aspects of his or her life
- Difficulty expressing disagreement with other people for fear he or she will lose support or approval
- Difficulty self-initiating projects due to lack of self confidence in judgement and/or abilities, not because of a lack of energy or motivation
- Willingness to go to great lengths, including volunteering for unpleasant tasks, to gain support and nurturance from others
- Feeling helpless or uncomfortable when alone due to a fear of being unable to care for oneself
- An urgent need to begin a relationship with someone new who will provide support and care when a close relationship ends
- An unrealistic preoccupation with the fear of being left to care for oneself
People who have DPD usually display submissive and dependent behaviors to trigger caregiving from others. Support and caregiving tends to relieve symptoms of dependent personality disorder that can be rooted in self-perceptions of inadequacy and inability to function without help from other people.
Treatment for DPD
Dependent personality disorder is generally treated with residential treatment, psychotherapy and, if necessary, medication.
The most common types of psychotherapy, or talk therapy, used to treat DPD are psychodynamic psychotherapy and cognitive behavioral therapy (CBT). Both focus on exploring fears associated with independence and difficulty being assertive, as well as learning how to build self-confidence and healthy relationships.
Psychodynamic psychotherapy is an intense form of talk therapy designed to examine the full range of emotions as well as the relationship between an individual and their external world. Studies have shown that psychodynamic psychotherapy can be a very effective treatment option. With the help of a therapist and a deep examination of past and present behaviors, thoughts, and emotions, people living with dependent personality disorder can learn to change behavior and develop more balanced, satisfying relationships.
Psychodynamic therapy encourages people living with dependent personality disorder to talk about anything on their mind. This includes fears, desires, hopes, dreams, and any issues they are currently dealing with. Therapists help uncover and explore how repressed emotions from past events and experiences affect current behavior, relationships, and decision-making.
This type of therapy also acknowledges that people often engage in behaviors they may not realize to avoid negative thoughts, feelings, and situations that can cause distress. Avoidance behaviors that become extreme can interfere with everyday function. The aim of psychodynamic therapy is to help people living with DPD identify patterns that create avoidance behaviors, then learn how to better manage, and thus reduce, those behaviors.
The goal of psychodynamic therapy is to recognize, acknowledge, understand, express, and overcome negative thoughts and emotions that are disruptive. As symptoms of DPD are reduced, self-confidence, decisiveness, independence, and interpersonal relationship can be improved.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a a form of talk therapy that focuses on how a person thinks and behaves. The goal is to identify negative, unhelpful ways of thinking and patterns of behavior and replace them with positive, helpful ways of thinking and behaving. People in CBT treatment learn skills to better manage thoughts and emotions, and thereby better cope with situations and interpersonal relationships. Therapists often conduct exercises in the session as well as assign “homework” to be completed on one’s own. Homework assignments generally center on applying skills that have been learned to daily life.
Unlike psychodynamic psychotherapy, CBT focuses more on current life difficulties rather than factors that may have led to those difficulties. The push is to move forward with new coping skills for dealing with stressors and situations.
New strategies and skills learned through CBT are designed to change negative, unhelpful thinking patterns. These skills can also help people living with dependent personality disorder develop new perceptions of self, relative to others. CBT strategies and skills can include:
- Identifying current life situations that are causing distress
- Recognizing distorted thinking
- Restructuring distorted thinking
- Identifying and facing fears rather than avoiding them
- Using relaxation techniques to calm mind and body
People living with dependent personality disorder can be predisposed to developing dependent relationships with those who can give them care and support. As a result, mental health professionals often work with individuals to ensure dependency is not promoted within the therapy relationship.
Generally, medications are prescribed in addition to psychotherapy to treat specific symptoms, rather than to treat DPD. People with dependent personality disorder frequently experience symptoms associated with depression and anxiety. Antidepressants are often prescribed to treat symptoms of depression, and anti-anxiety medications are prescribed to treat symptoms of anxiety. However, because people with DPD tend to have an increased risk for dependency, caution is used when prescribing benzodiazepines for anxiety.
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Caring for Someone With Dependent Personality Disorder
People with dependent personality disorder tend not to live on their own—the need to have someone else care for and support them tends to displace the ability to live independently. Though people with DPD may feel that living with someone who provides care is a preferential situation, it can be extremely challenging for the person in the caregiver role. Interpersonal relationships can be difficult under the best of circumstances, because no two people are alike. Varying wants and needs can cause discord and conflict in any close, platonic, familial or romantic relationship. But when the relationship becomes unbalanced or one-sided, as often happens in situations involving a person with DPD, significant stress can be placed on the person in the caregiver role. Additionally, the relationship can become co-dependent or even abusive.
People with DPD tend not to express what they are really thinking or feeling for fear of abandonment or rejection. The need to be taken care of can motivate them to go to extreme lengths to please the person providing care. As a result, it is possible for a person caring for someone with DPD to inadvertently take advantage by making all the decisions to their liking, and without the honest input of their partner, friend, or family member.
In some situations, it is possible for people in the role of caregiver to purposefully take advantage of, and even verbally, physically, or sexually abuse, someone living with dependent personality disorder.
People who suffer from DPD often view criticism as proof they are incompetent and unable to make their own decisions. A person caring for someone with dependent personality disorder who knows and purposefully exploits this fact could essentially control their partner through verbal abuse. Their partner with DPD would likely go to extremes trying to please the caregiver for fear of abandonment, even though the relationship is abusive. The same is often true for relationships involving physical and sexual abuse.
Codependency and DPD
Codependency is commonly described as an imbalanced relationship where one person engages in compulsive caretaking and the other person engages in dependent behavior. The caregiver derives pleasure from being needed, and the dependent derives gratification from being taken care of.
In codependent relationships, the caregiving/needy behavior cycle becomes destructive. Excessive caregiving provokes neediness and creates even more dependency and, thus, a greater need for care. Codependency can pose serious problems between people who are in close relationships. It is even more problematic when DPD is involved, as the need for dependency is already significant.
Treatment can be beneficial for people caring for someone with DPD. Treatment programs can help people who are providing care learn how their role as caregiver may affect them. It could also help caregivers learn skills to provide nurture and care without making all the decisions, to assist their partner or friend grow more independent, and to help prevent codependency and abuse.
Learning to manage DPD and develop healthier relationships can be achieved with dedication to therapy. Residential care especially can provide the tools necessary for treating and managing dependent personality disorder and creating an individualized treatment plan best suited for the individual and their loved ones.