Dependent personality disorder (DPD) is a rare condition characterized by intense neediness. It’s diagnosed in 0.5-0.6% of the general population, according to the American Psychiatric Association. While some studies say that it is diagnosed more often in women, other studies indicate a similar prevalence of DPD among men and women.

What is dependent personality disorder?

Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, leading to a dependence on others to meet one’s emotional and physical needs. Individuals with DPD tend to display needy or clingy behavior and have a fear of separation. DPD also leads to difficulties in decision-making; sometimes, individuals with DPD struggle making choices as seemingly simple as ‘what to wear today’ without the advice and reassurance of others.

DPD presents an array of complications that can disrupt an individual’s day-to-day life. At work, it can impair one’s performance, prevent one from assuming positions of power and responsibility, and/or cause extreme anxiety. At home, the condition can not only strain one’s relationships, but also leave one vulnerable to abuse and exploitation because of one’s willingness to do anything to maintain a relationship with caregivers.

Besides disrupting the life of the individual experiencing it, DPD can also distress their families, partners, or others close to them, who may find themselves assuming caretaker roles. “He couldn’t be alone. He needed constant reassurance. He couldn’t make his own decisions or deal with even the smallest criticisms. I was no longer his partner, but his caretaker,” describes Catherine, whose partner was eventually diagnosed with DPD.

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What are the symptoms of dependent personality disorder?

The fifth Diagnostic and Statistical Manual, or DSM-5, lists one broad symptom of DPD, with several ways of manifesting:

Symptom: An pattern of pervasive and excessive psychological dependence on other people — i.e., needing to be taken care of and relying on someone else to meet one’s own emotional and physical needs — fear of separation, and passive, clinging, and submissive behavior.

Manifestations: The symptom presents in a variety of contexts, and is usually indicated by five or more of the following behaviors:

1. Difficulty in making everyday decisions without lots of advice and reassurance from others;
2. Difficulty in disagreeing with others because of fear of confrontation, loss of approval, or abandonment;
3. Difficulty taking the initiative or acting alone due to lack of self-confidence, rather than a lack of motivation or energy;
4. Holding others responsible for most major areas of one’s life;
5. Going to excessive lengths to obtain care and support from others, to the point of volunteering to do things that are unpleasant so as not to disappoint another and risk losing their care and support;
6. Feeling uncomfortable or helpless when left alone due deep fears of being unable to care for one’s self;
7. Urgently seeking new relationships when one close relationship ends in order to maintain consistent sources of care and support; and
8. Being unrealistically preoccupied with fears of being left to take care of one’s self.

What causes dependent personality disorder?

The exact cause of DPD remains unknown to scientists. But, experts have hypothesized contributing factors in the upbringing of people affected by DPD. Inconsistent parenting, or abuse, neglect, or other trauma, can prevent an individual from developing a stable sense of self, which may contribute to DPD. Conversely, overprotective parenting can prevent children from practicing emotional and behavioral independence, or even self-reliance, which may also contribute to DPD.

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“One possibility is that dependent personality begins with a gentle and easily frightened temperament that evokes protective feelings [from others]. Over-anxious parents who discourage independence, or a bullying brother or sister, reinforce the tendency. Constantly sheltered, the submissive child becomes still more passive, and others develop expectations that make the behavior and attitudes difficult to change,” an article on Harvard Health Publishing explains, adding that a child, who is has either been “rewarded for making excessive demands for care” or “never been rewarded for independent action” may also be prone to developing DPD.

Enduring a chronic physical illness, or separation anxiety during childhood, especially if one’s upbringing discourages independence, are considered risk factors. Similarly, family history of generalized anxiety disorders or phobias also puts one at a higher risk of developing DPD.

Can dependent personality disorder be treated?

Psychotherapy is generally recommended for DPD with the goal of helping the person become more active and independent. While DPD cannot be cured, therapy can help people with DPD experience improvements in symptoms. Research suggests therapy that combines social skills training with cognitive-behavioral therapy is best able to help people with DPD restructure their perceptions about themselves “as weak and ineffectual.”

Further, schema therapy, a form of psychotherapy that attempts to treat maladaptive or unhealthy coping and strengthen healthy coping methods has been found to be effective for DPD. It involves limited reparenting by the therapist. But, some experts suggest that for a person with DPD, psychotherapy should be short-term exercise only, since long-term therapy could put the person at risk of growing dependent on their therapist.

People with DPD are also prone to developing depression or anxiety, and medication may be used to treat these — but it doesn’t remedy DPD itself. Similarly, research suggests that borderline personality disorder, avoidant personality disorder, and histrionic personality disorder, often co-exist with DPD. If these conditions are left untreated, they can evolve into phobias and substance abuse, making substance abuse treatment and phobia treatment helpful in some DPD cases, though such treatment will not remedy DPD.

“…with treatment I feel hopeful about my future. I moved out of my parents’ house two months ago and have been single and comfortable living alone and not being in a relationship. Sometimes I still slip up, and I try to get my parents to make decisions for me, but then I remember what I learned in treatment and what I’m capable of, that I can trust myself to be independent,” shares an anonymous individual who underwent therapy for DPD.