Dependent Personality Disorder Introduction

Clinical interest in dependent personality disorder has existed since Abraham first described the oral character. As a disorder, the personality type first appeared in a War Department Technical Bulletin in 1945 and later in the first edition of the Diagnostic and Statistical Manual in 1952 (American Psychiatric Association 1952) as a subtype of passive-aggressive personality disorder. Since then, a surprising number of studies have upheld the descriptive validity of dependent personality traits, viewed as submissiveness, oral character traits, oral dependence, or passive dependence, or as a constellation of both pathological and adaptive traits under the rubric dependency.

DSM-IV (American Psychiatric Association 1994) emphasizes two sets of traits (

Table 88-1): 1) dependency (criteria 1-5) and 2) insecure attachment (criteria 6-8). The description overlaps that of asthenic personality disorder in the International Classification of Diseases, Ninth Revision, which emphasizes compliance and a weak response to the demands of daily life.

The treatment literature is limited largely to case descriptions and uncontrolled studies, although several controlled treatment trials with admixtures of personality disorders address issues relevant to dependent personality disorder. Nonetheless, there is an apparent consensus in the clinical literature that the treatment of dependent personality disorder is often successful. This is indirectly supported by the relative lack of articles that report failures or focus on difficulties in treatment, in contrast to the plethora of such reports for other personality disorders.

Dependency is a universal personality trait; however, this review is limited to reports that are relevant to the treatment of the personality disorder only. Although dependent personality is common in the general population - the Midtown Manhattan Study found that it was present in 2.5% of the entire sample - it often occurs with other personality disorders, especially borderline, histrionic, and avoidant personality disorders, and less consistently with self-defeating, passive-aggressive, compulsive, schizotypal, and paranoid types; treatment should be modified accordingly. Patterns of comorbidity vary widely depending on sample source, reason for selection (e.g., major depression), and assessment method. This review does not include a discussion of managing the dependency that often accompanies chronic major psychiatric syndromes such as schizophrenia or unremitting depression. However, in noting that Axis I disorders such as depression often increase dependency, Skodol et al. (1996) suggested that if maladaptive dependency does not improve after the treated symptomatic disorder improves, then it might become the focus of treatment in its own right.

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