Description

Dependent personality disorder (DPD) is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation (1).

• Begins no later than adolescence or early adulthood
• Common behaviors and variations:
  • Can be very clingy to caregivers
  • May make dramatic and urgent demands for medical attention
  • Hypersensitive to negative evaluation
  • May be very agreeable or submissive with others (even when they do not agree) out of fear of losing support/approval
  • May experience significant distress when faced with decisions
  • May experience fear when alone
  • Lack of independence/fear of independence
  • Above behaviors are in excess of cultural norms.
• Exhibits an urgent need to start new relationships when one has ended
• Patients with this disorder typically display little insight into their behavior.

Geriatric Considerations
Illness (acute and chronic) may cause regression resulting in dependent behaviors. With DPD, illness and aging are likely to intensify fearfulness and helplessness.

Pediatric Considerations
Diagnosis is rarely made for children/adolescents and may not be appropriate due to the necessary dependency of children/adolescents. Other psychiatric disorders must be ruled out as well as behavior related to a general medical condition (GMC) or to the developmental cycle of the child. For diagnosis, baseline behaviors must be representative of DPD for at least 1 year.

Pregnancy Considerations
Physical and social changes may induce stress or increase fears, which may result in increased dependent behaviors. Distinguish this disorder from increased dependency due to pregnancy (e.g., when support system is inadequate).

Epidemiology

• Predominant age: onset no later than adolescence or early adulthood (may go undiagnosed for years)
• Predominant sex: female > male

Prevalence
Prevalence of DPD is ~0.6% (2).

Etiology and Pathophysiology

A combination of hereditary temperamental traits and environmental/developmental factors

Risk Factors

• Chronic or severe illness or disability in children
• Childhood/adolescent separation anxiety
• Parenting style that does not encourage age-appropriate independence

General Prevention

Children with chronic illness or handicap may be more susceptible to DPD. Foster appropriate independence in the face of disability.

Commonly Associated Conditions

• Co-occurring personality disorders are common, especially borderline, avoidant, and histrionic personality disorders.
• Increased risk with mood, anxiety, and adjustment disorders
• Increased risk for alcohol and drug abuse
• Patients may contribute to, or prolong, underlying illness to get attention.