Knowledge of what causes excessive dependency to develop and continue into adulthood should inform the selection of treatment. The studies described here offer some hypotheses and findings to this end.

Kagan and Moss found a high correlation between passive and dependent behaviors at ages 6-10 years and their continuation into young adulthood. This was true across a broad array of dependent behaviors for women, whereas it was more limited for men: dependent behavior around childhood tasks correlated with a dependent vocational choice in adulthood. The authors suggested that these sex differences were cultural because American society punishes dependent behavior in males but rewards it in females.

Whitman et al. suggested that an individual may become passive whenever dependent needs are stimulated if the person finds these needs unacceptable in the situation because of either a neurotic sense of guilt or external frustration. As a secondary effect of frustration, the individual may become demanding in minor ways.

Millon suggested that dependent individuals have had their independence stifled by oversolicitous, controlling parents who discourage seeking rewards outside the family. Because dependent individuals have had a relatively good relationship with at least one parent, anxiety experienced in situations requiring independent action is counterbalanced by the expectation that someone will step in to help. The expectation of criticism for making independent decisions, taking action, or venturing into new activities further stifles independence. Instead of channeling hostile feelings into assertive behavior, dependent individuals often smooth over troubles by acting in an especially friendly, helpful, and concerned manner. In a study of the family environment, Head et al. found some support for Millon’s hypotheses in that the individuals with dependent personality disorder reported that their families were low in expressiveness and high in control. Baker et al. found that individuals with dependent personality disorder reported early family environments that were lower in encouraging independence and higher in control over the subject than in family environments of nondependent control subjects and lower in achievement and intellectual-cultural orientation than were the environments of individuals with histrionic personality disorder.

B. K. Alexander and Dibb studied addicted persons still living with their families of origin. Compared with control subjects, both the addicted persons and their parents perceived the addicted persons as passive, dependent, and incapable of autonomy and success. Neither the addicted person nor the overindulgent parent encouraged self-reliance.

Perry and Vaillant noted that dependent individuals often act in a submissive, compliant way in order to earn others’ gratitude. This ingratiating behavior entitles them in fantasy to maintain their important attachments and protects them from abandonment and the development of separation anxiety. Conversely, they can be quite aggressive toward others when they think doing so will ingratiate themselves with authority figures or secure care or help.

Epstein compared the social consequences of assertive, aggressive, passive-aggressive, and submissive behaviors. Submissive behavior, such as making a request accompanied by an indication that one will capitulate easily, consistently elicited high intentions to comply, low anger, and high sympathy from observers, generally equal to the levels obtained by assertive behavior. Thus, submissive behavior may have positive social consequences, depending on the characteristics of those with whom the submissive person interacts.

In a study of passive adolescents, Rosenheim and Gaoni postulated that the failure to make decisions, to enter into personal commitments, and to take independent action results from a fear of having to mourn childhood fantasies about the future. The refusal to take an active stance in working toward any plan thereby avoids having to set aside cherished, if overvalued or unrealistic, hopes for the future and avoids the sadness of mourning.

Andrews et al. suggested a biological hypothesis for dependency based on finding high levels of anxiety proneness, emotionality, and easy fatiguability in individuals with asthenic personality. A constitutional predisposition to develop high anxiety levels under stress may underlie the inability to cope.

A. T. Beck et al. proposed a cognitive conceptualization that dependent individuals believe two key internal assumptions. First, they believe themselves to be inadequate and helpless and the world to be cold, lonely, and dangerous. Second, they assume that the best thing is to find someone who is capable of dealing with the world and protecting them. Submissiveness and relinquishing independent decision making are considered acceptable trade-offs for maintaining the relationship.