This paper explores the examination, symptoms, causes, complications and prognosis of dependent personality disorder. The paper provides characteristic features and the development time of the disease, explores consequences of sudden change of circumstances, and the essence of inner world of people with dependent personality disorder. The list of common symptoms of the disorder is given. The comparison between studied disorder and other personality disorders is provided. The paper explores the causes, complications and prognosis of the disease, which is definitely good as long as patient has enough motivation and seeks for professional help. The treatment of the disease which varies from drug treatment to therapy treatment is discussed. The selection of the therapy depends on specific case of the disease.
Dependent personality disorder is characterized by insecurity and low self-esteem. Dependent persons shift the responsibility for most decisions on others and consider the needs of the leader above their own needs. Dependent individuals do not have enough self-confidence and they feel unable to take care of themselves. At the same time, they often do not agree with the fact that they cannot decide on their own and do not know how to act. Due to fear of offending people they need, they are reluctant to express their opinions, even if they want to do it. Depending features may also be observed in people suffering from other personality disorders, but they usually hide behind other, more severe manifestations. Sometimes traits of dependent personality develop in the adult person with severe physical illness.
People with dependent personality disorder are characterized by passivity, subjugation and suggestibility. They try to pass the adoption of any more or less responsible decisions to others. In everyday life, they are inactive and fatigue; they lack initiative, independence, and the ability to resist the wishes of someone else in dealing with people (Lenzenweger & Clarkin, 2005).
For the first time, dependent personality disorder can be detected in the early school years, initially manifesting itself with the help of such asthenic features as sharp fatigue by the end of training, reduced performance, as well as increased timidity, indecisiveness, shyness, feelings of worthlessness. Most frequently, formation of dependent psychopathy occurs at puberty. General nervous weakness, excessive sensitivity and sensibility, a tendency to introspection are common to dependent personalities. These qualities are identified primarily in unusual, extreme situations (Derksen, 1999).
Inner world of people with this type of personality anomalies is determined by a complex set of experiences, which are dominated by the consciousness of worthlessness, helplessness, feeling depending on others, fear of impending difficulties, and vicissitudes of life. Fearing the responsibility and the need to take the initiative, they usually are content with minor roles, exhibit passive subjugation, obediently performing their assigned tasks. In the family, they are on the position of “adult children”, for which parents or spouse solve all major issues. They try not to contradict colleagues and relatives for fear of being rejected, meekly bearing all grievances and humiliations. They are always ready to serve everyone (Lenzenweger & Clarkin, 2005).
In a sudden change of circumstances associated with the need to make independent decisions, there may be a short-term anxiety states with a sense of helplessness and own inadequacy. In more severe cases (break with a spouse, disease of relative), there may be an “escape from reality” reaction (rejection reaction), occurring with anxious apathetic depression with the fear of loneliness and the desire to get away from the ills of life (Derksen, 1999).
Individuals with dependent personality disorder are characterized not only by abnormal temperament, but also by vulnerability, which is significantly greater than that in healthy people, and increased sensitivity to the effects of both internal – biological (age crises, menstrual cycle, pregnancy, childbirth, etc.) and external stress and somatogenic factors (Beck, Freeman & Davis, 2004).
As in the case of other personality disorders, dependent personality disorder is not diagnosed earlier than 18 years. Intensity of symptoms generally decreases with age. Even extreme manifestations are significantly smoothed to 40-50-year age.
Person is emotionally dependent on other people and spends a lot of effort trying to please others. Dependent personality manifests itself in need, passive, showing “clingy” behavior, and experiencing a strong fear of being alone.
Dependent and borderline personality disorders. Dependent personality disorder should be distinguished from the borderline, as they have common characteristics. Borderline personality disorder is also characterized by the fear of being abandoned, but borderline personality reacts to rejection with anger and a sense of emptiness. Dependent personality responds to a fear of rejection with resignation, and immediately searches for replacement in order to maintain dependence.
Dependent and histrionic personality disorder. People with hysterical disorder also have a strong need for acceptance and attention, but they are very active and demanding to get their way. On the contrary, dependent personality realizes its needs through obedient and self-deprecating behavior.
Dependent and avoidant personality disorders. Both disorders are characterized by a sense of inferiority and hypersensitivity to criticism. However, people with avoidant disorder have so intense fear of rejection that they tend to move away from the communication. Dependent personality, by contrast, is looking for contacts with other people needing their approval (Beck, Freeman & Davis, 2004).
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At this point of time, it is unknown what exactly causes dependent personality disorder. There are many theories, but they all more or less inclined to the recognition of the possible impact of biological and genetic factors, as well as of those traces that education and experience leave (Sperry, 2003). If to speak about environmental factors, there are data concerning the effect of the authoritarian and hyper-caregiving style of family upbringing. Many dependent personalities have experienced humiliation in their lives. The concept of “learned helplessness” also explains the reason why some people make sure they are unable to manage their lives (Derksen, 1999).
People with dependent personality disorder are prone to depression, anxiety disorders, phobias, and the formation of substance dependence. They are also at risk of suffering from physical and sexual violence, because they are ready to do everything to keep the relationship with the dominant partner. Professional activities and relationships are the most problematic areas for dependent personality. Crisis often appears with difficulties in dealing with people at work and at home. The loss of a meaningful relationship can lead a person with dependent personality disorder to episodes of major depression, generalized anxiety or panic attacks. At work, problems arise when independent decision should be made without guidance from anyone (Beck, Freeman & Davis, 2004). Overall prognosis for individuals with dependent personality disorder is good, particularly if they seek professional help (Derksen, 1999).
People with personality disorders, in general, do not often seek treatment until their condition begins to significantly affect their lives. Thus, dependent personality often “brings” symptoms of anxiety and / or depression to the reception of the doctor, but not its own personal characteristics. It is important to say that the sooner psychotherapy is started the better and more successful treatment of dependent disorder will be if the patient has a great motivation for change. Medications may be used to treat people with dependent personality disorder to influence anxiety and depressive symptoms. Accuracy is very important in deciding on prescribing medicines, because people with dependent personality disorder have a high risk of drug dependence. Hospitalization is rarely necessary, except the cases of bereavement or emotional crisis (Beck, Freeman & Davis, 2004).
In selecting drugs, the more preferred are tranquilizers (diazepam, clonazepam, xanax, lorazepam, etc.), as well as antipsychotics with predominantly anxiolytic effect (eglonylum, chlorprothixenum, sonapax, theralenum). These drugs significantly reduce the propensity to painful doubts; they also reduce anxiety, fears and internal stress. Use of neuroleptics of elective action as well as tranquilizers is accompanied by a noticeable leveling of sensitive ideas of reference, reduction of suspiciousness and vulnerability, facilitating the contact with the surroundings (Lenzenweger & Clarkin, 2005).
Psychotherapy is the primary treatment for dependent disorders. The goal of therapy is to help the person with dependent personality disorder become more active and independent, learn to shape a healthier relationship. Short-term therapy with specific goals is more preferable.
Group therapy involves the use of mechanisms of group dynamics and the totality of relationships and interactions that occur between the group members as well as the therapist and the group as a whole. This type of psychotherapy is focused on correcting deviations and anomalous behavior of the patient through indirect disclosure, awareness and psychological processing of existing problems. As a result, group therapy eliminates inadequate settings and cognitive, emotional and behavioral patterns. Particularly important is the fact that the patient acquires real experience of constructive overcome of intra- and interpersonal conflicts in the course of this work. Treatment is recommended in small mixed groups, combining patients with personality, neurotic and other disorders of borderline psychiatry circle (Derksen, 1999).
Family psychotherapy is aimed at reorganizing the style of family relations. Particular attention is paid to the adequate distribution of responsibilities between the family members and the normalization of the distorted patterns of interpersonal relations. The significance of this method for personality disorders increases with the view of the fact that patient does not often consult the doctor, but the relative does, while the reason of this consult remains unclear for a patient. Furthermore, the patient sometimes considers itself a “victim” of a family conflict. It is important to help the patient understand that disturbed context of relations leads to interpersonal conflicts and confrontation between family members (Sperry, 2003).
It is necessary to determine the acceptable norms of behavior and appropriate forms of communication jointly with the patient. It is important to watch closely the nature of the actions toward patient, not to cause a reduction in the self-esteem. It is important for patient to be aware of the difficulties of this process and not yield to easily arising feeling of weariness, disappointment in the success of therapy and annoyance during the period of treatment.
The doctor should always respect the patient’s dependence sense, no matter how pathological it may be. It is also very important for doctor not to “stuck” in the role of the dominant person, providing sufficient conditions for the formation of the autonomous behavior of the patient.