Dependent Personality Disorder
A person with dependent personality disorder relies excessively on other people and lacks confidence in their own judgement, often needing help even with simple day-to-day decisions. They tend to present as lacking in ambition and compliant with the wishes of others, and describe themselves in self-effacing, humble terms that underplay their own abilities, sometimes finding themselves taken advantage of, or even bullied, in social or work settings because of this passivity.
This has traditionally been distinguished from a superficially similar pattern that can develop temporarily during bereavement or a depressive episode, which resolves as the person recovers and should not be equated with a true, lifelong personality disorder.
Recognition features
- Excessive emotional reliance on others and difficulty making even simple decisions without help or reassurance
- A passive demeanour, visible in posture, tone of voice, and manner, alongside a lack of ambition and ready compliance with others' wishes
- A self-effacing, humble self-presentation that tends to underplay the person's own abilities
- A tendency to be taken advantage of, or bullied, in social or employment settings
- Feelings of loneliness, often stemming from difficulty forming long-term relationships because of the emotional demands the person places on others, though some instead form seemingly happy relationships with very assertive partners
- Distress easily provoked by ordinary day-to-day problems, owing to limited confidence in problem-solving and decision-making
Eliciting it at interview
- Ask directly about how the person makes everyday decisions, including how much reassurance or involvement from others they feel they need
- Explore the person's account of their own abilities, listening for a pattern of habitual self-effacement or underplaying of competence
- Ask about experiences of being taken advantage of or bullied, in both social and work contexts
- Establish the timing and duration of the pattern carefully, since a similar picture arising only around bereavement or during a depressive episode should be expected to resolve rather than reflect true personality disorder
Distinguishing features
- Differs from a temporary, situational pattern of dependency following bereavement or during a depressive episode, which resolves over time and should not be equated with personality disorder
- Differs from anxious (avoidant) personality disorder, in which the central difficulty is a wish for relationships frustrated by shyness and poor social skills, rather than an established relationship maintained through excessive reliance on the other person
Common misconceptions
- That dependent personality disorder is simply a matter of low self-esteem; low confidence is part of the picture, but the defining feature is a pervasive reliance on others for decisions and support across day-to-day life
- That a period of increased dependency following bereavement or during depression indicates this personality disorder; such patterns are expected to resolve with time and should not be labelled as personality disorder
Related phenomena
Narcissistic Personality Disorder
Related defences
Practice this
A 33-year-old man says he cannot decide what to order at a restaurant without his wife choosing for him first, has never lived alone, and describes feeling "lost" and anxious whenever she is away for more than a day, going to great lengths to keep her from leaving even briefly. He is quiet and self-effacing, and describes himself as needing someone else to take charge of most areas of his life. What is this most consistent with? · A 29-year-old woman's partner ended their relationship two weeks ago. She describes feeling unable to function, has already begun urgently seeking a new relationship "so someone can look after things again," and says she has always let partners make even minor decisions for her because she "doesn't trust her own judgement." Before revealing the answer: does this fit dependent personality disorder, or would you want to know more first? · Two patients both seem to organise their lives around other people's attention and approval. Before revealing the answer, decide what distinguishes dependent personality disorder from histrionic personality disorder. · Two patients each seem to organise much of their life around securing other people's attention and care, but in very different styles — one dramatic and demanding centre stage, the other quiet and compliant. Before revealing the answer, decide which is histrionic and which is dependent personality disorder, and what tells them apart. · You are assessing a patient you suspect may have dependent personality disorder. Before revealing the answer, decide how you would explore this during the interview. · Explain why dependent personality disorder is considered a disorder of personality, rather than simply a description of someone who is unusually reliant on their partner.
Illustration
A 39-year-old woman telephones her mother each morning to help her decide what to wear for work, describes herself as 'not clever enough to really matter' despite a strong performance record, and stays in a relationship where her partner makes every significant decision on her behalf, saying she would feel lost having to manage alone.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 10, 'Personality Disorders'.