Dependent Personality Disorder.pdf

3/27/24, 9:41 PM Print Preview Chapter 12: Personality Disorders: 12-4b Dependent Personality Disorder Book Title: Psychopathology: An Integrative Approach to Mental Disorders Printed By: Wefae Ali ([email protected]) © 2023 Cengage Learning, Inc., Cengage Learning, Inc. 12-4b Dependent Personality...

3/27/24, 9:41 PM Print Preview Chapter 12: Personality Disorders: 12-4b Dependent Personality Disorder Book Title: Psychopathology: An Integrative Approach to Mental Disorders Printed By: Wefae Ali ([email protected]) © 2023 Cengage Learning, Inc., Cengage Learning, Inc. 12-4b Dependent Personality Disorder We all know what it means to be dependent on another person. People with dependent personality disorder (Cluster C (anxious or fearful) personality disorder characterized by a person’s pervasive and excessive need to be taken care of, a condition that leads to submissive and clinging behavior and fears of separation.) , however, rely on others to make ordinary decisions as well as important ones, which results in an unreasonable fear of abandonment. Consider the case of Karen. DSM 5 Table 12.9 Diagnostic Criteria for Avoidant Personality Disorder A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection. 2. Is unwilling to get involved with people unless certain of being liked. 3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed. 4. Is preoccupied with being criticized or rejected in social situations. 5. Is inhibited in new interpersonal situations because of feelings of inadequacy. 6. Views self as socially inept, personally unappealing, or inferior to others. 7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing. From American Psychiatric Association, (2022), Diagnostic and statistical manual of mental disorders (5th ed., Text Revision). Karen… https://ng.cengage.com/static/nb/ui/evo/index.html?deploymentId=607607251305910651374883797&eISBN=9780357657881&id=1993194890&nbId… 1/4 3/27/24, 9:41 PM Print Preview Whatever You Say Karen was a 45-year-old married woman who was referred for treatment by her physician for problems with panic attacks. During the evaluation, she appeared to be worried, sensitive, and naive. She was easily overcome with emotion and cried on and off throughout the session. She was self-critical at every opportunity throughout the evaluation. For example, when asked how she got along with other people, she reported that “others think I’m dumb and inadequate,” although she could give no evidence as to what made her think that. She reported that she didn’t like school because “I was dumb” and that she always felt that she was not good enough. Karen described staying in her first marriage for 10 years, even though “it was hell.” Her husband had affairs with many other women and was verbally abusive. She tried to leave him many times but gave in to his repeated requests to return. She was finally able to divorce him, and shortly afterward she met and married her current husband, whom she described as kind, sensitive, and supportive. Karen stated that she preferred to have others make important decisions and agreed with other people to avoid conflict. She worried about being left alone without anyone to take care of her and reported feeling lost without other people’s reassurance. She also reported that her feelings were easily hurt, so she worked hard not to do anything that might lead to criticism. Source: Case and excerpt reprinted, with permission, from A. T. Beck & A. Freeman, 1990, Cognitive therapy of personality disorders, Guilford Press. © 1990 by Guilford Press. Clinical Description Individuals with dependent personality disorder sometimes agree with other people when their own opinion differs so as not to be rejected (Bornstein, 2012). Their desire to obtain and maintain supportive and nurturing relationships may lead to their other behavioral characteristics, including submissiveness, timidity, and passivity. People with this disorder are similar to those with avoidant personality disorder in their feelings of inadequacy, sensitivity to criticism, and need for reassurance. However, people with avoidant personality disorder respond to these feelings by avoiding relationships, whereas those with dependent personality disorder respond by clinging to relationships (Bornstein, 2012; Disney, 2013). It is important to note that in certain cultures (such as East Asian Confucianism) dependence and submission may be viewed as a desired interpersonal state (Chen, Nettles, & Chen, 2009). Causes and Treatment We are all born dependent on other people for food, physical protection, and nurturance. Part of the socialization process in most cultures involves helping us live independently (Bornstein, 1992). It was thought that such disruptions as the early death of a parent or https://ng.cengage.com/static/nb/ui/evo/index.html?deploymentId=607607251305910651374883797&eISBN=9780357657881&id=1993194890&nbId… 2/4 3/27/24, 9:41 PM Print Preview neglect or rejection by caregivers could cause people to grow up fearing abandonment (Stone, 1993). It also is clear, however, that genetic influences are important in the development of this disorder (for example, Gjerde et al., 2012). What is not yet understood are the physiological factors underlying this genetic influence and the ways they interact with environmental influences (Sanislow et al., 2012). The treatment literature for this disorder is mostly descriptive; little research exists to show whether a particular treatment is effective (Borge et al., 2010; Paris, 2008). On the surface, because of their attentiveness and eagerness to give responsibility for their problems to the therapist, people with dependent personality disorder can appear to be ideal patients. That very submissiveness, however, negates one of the major goals of therapy, which is to make the person more independent and personally responsible (Leahy & McGinn, 2012). Therapy therefore progresses gradually as the patient develops confidence in his ability to make decisions independently (Maccaferri et al., 2020). There is a particular need for care that the patient does not become overly dependent on the therapist. DSM 5 Table 12.10 Diagnostic Criteria for Dependent Personality Disorder A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others. 2. Needs others to assume responsibility for most major areas of his or her life. 3. Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.) 4. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy). 5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant. 6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care of himself or herself. 7. Urgently seeks another relationship as a source of care and support when a close relationship ends. https://ng.cengage.com/static/nb/ui/evo/index.html?deploymentId=607607251305910651374883797&eISBN=9780357657881&id=1993194890&nbId… 3/4 3/27/24, 9:41 PM Print Preview 8. Is unrealistically preoccupied with fears of being left to take care of himself or herself. From American Psychiatric Association, (2022), Diagnostic and statistical manual of mental disorders (5th ed., Text Revision). Chapter 12: Personality Disorders: 12-4b Dependent Personality Disorder Book Title: Psychopathology: An Integrative Approach to Mental Disorders Printed By: Wefae Ali ([email protected]) © 2023 Cengage Learning, Inc., Cengage Learning, Inc. © 2024 Cengage Learning Inc. All rights reserved. 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