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most comfortable in relationships with people who take the initiative—and
take responsibility. Not surprisingly, then, they often choose overprotective
and dominating people to be their friends and part-
ners, becoming passive in those relationships. Gener-
ally, people who have dependent personality disorder
have a limited social circle, consisting of only a few
people on whom they depend, as is true of Matthew
in Case 13.10. Once they have established a relation-
ship, people with dependent personality disorder are
hesitant to disagree with the other person for fear
that he or she will withdraw emotional support. In
fact, an individual with this personality disorder may
go to great lengths to maintain the extensive support
that the other person provides, even tolerating men-
tal or physical abuse (American Psychiatric Associa-
tion, 2000).
It is important to note that even if an individual
possesses enough of the characteristics to meet the
diagnostic criteria in Table 13.23, he or she will not
be diagnosed with dependent personality disorder
unless these characteristics signifi cantly impair func-
tioning in major areas of life. Table 13.24 provides
additional information about this disorder.CASE 13.10 • FROM THE OUTSIDE: Dependent Personality Disorder
Matthew is a 34-year-old single man who lives with his mother and works as an accountant.
He is seeking treatment because he is very unhappy after having just broken up with his girl-
friend. His mother had disapproved of his marriage plans, ostensibly because the woman was
of a different religion. Matthew felt trapped and forced to choose between his mother and his
girlfriend, and because “blood is thicker than water,” he had decided not to go against his
mother’s wishes.... Matthew is afraid of disagreeing with his mother for fear that she will not
be supportive of him and he will then have to fend for himself. He criticizes himself for being
weak, but also admires his mother and respects her judgment.... He feels that his own judg-
ment is poor.
Matthew works at a job several grades below what his education and talent would permit.
On several occasions he has turned down promotions because he didn’t want the responsibil-
ity of having to supervise other people or make independent decisions.... He has two very
close friends whom he has had since early childhood. He has lunch with one of them every
single workday and feels lost if his friend is sick and misses a day.
Matthew is the youngest of four children and the only boy.... He had considerable separa-
tion anxiety as a child—he had diffi culty falling asleep unless his mother stayed in the room,
mild school refusal, and unbearable homesickness when he occasionally tried “sleepovers.”... He has lived at home his whole life except for 1 year of college, from which he returned
because of homesickness.
(Spitzer, Gibbon, et al., 2002, pp. 179–180)
Distinguishing Between Dependent Personality
Disorder and Other Disorders
Avoidant and dependent personality disorders share the characteristics of desire for
reassurance, feelings of inadequacy, and submissive behaviors (Leising, Sporberg, &
Rehbein, 2006). However, with avoidant personality disorder, these characteristics
focus on feeling socially inept, whereas with dependent personality disorder, they
focus on feeling incapable of taking care of oneself (Skodol, 2005), as Matthew in
Case 13.10 felt.Prevalence- The prevalence of dependent personality disorder in the general population is less
than 1% (Grant, Hasin, et al., 2004).
Comorbidity - Common Axis I disorders are mood disorders and anxiety disorders.
- Common comorbid personality disorders are avoidant, borderline, and histrionic
personality disorders.
Onset - As required by the diagnostic criteria, symptoms must emerge by young adulthood.
Course - Symptoms may improve over time, to the point where the individual no longer
meets the criteria for the disorder (Markowitz et al., 2005).
Gender Differences - In the general population, women tend to be diagnosed with dependent personality
disorder more often than men (Torgersen, 2005); in a clinical setting, however, men
and women may have similar prevalence rates (American Psychiatric Association,
2000).
Source: Unless otherwise noted, citations are to American Psychiatric Association, 2000.
Table 13.24 • Dependent Personality Disorder
Facts at a Glance