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Dependent Personality Disorder

Rosanne Zandvliet

DSM IV TR - Diagnostic Criteria

Dependent Personality Disorder (DPD)

dependency is normal in childhood and adolescence, NOT in adulthood.

First time listed as own disorder in DSM III (1980)

In DSM IV TR: Axis II, Cluster C - Anxious and fearful

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 for himself or herself

(7) urgently seeks another relationship as a source of care and support when a close relationship ends

(8) is unrealistically preoccupied with fears of being left to take care of himself or herself

DSM IV TR - Things to consider

DPD dependence has been described as similar to that of an animal in need of care.

Cultural factors must be considered. African American and Hispanic cultures are more community focused and their members depend on one another more than their White counterparts.

The elderly do need actual care, must not be disregarded as DPD

Statistics

DPD occurs in 0.6% of the general population.

more common in females

onset in "early adulthood"

chronic

Improvements

Millon's Subtypes

Theodore Million proposed 5 subtypes for adults: may have none or one of the following

Need higher correlations among DPD criteria, low correlation with other PD criteria.

-criteria 1-4 are too close to Avoidant PD, 6-8 are too close to Borderline PD

Weakly operationalized - most problems with criteria 3 and 5.

Trull et. al. (1987) studied validity in DSM III, criteria changes need new review.

-overlap with avoidant, borderline and histrionic

-unique dependency characteristics must be retained

DSM V Suggested Changes

revamping of personality disorders due to high comorbidity.

dependent personality disorder is suggested to be excluded from DSM 5.

- due to diagnostic criteria and many PD's

-70-90% found in in-patients, only 25% in non-treatment seeking samples

-comorbidity is due to treatment seeking

Would result in those who are now patients being undiagnosed

-personality disorder trait specified.

Blashfield and Breen, 1989

R.K. Blashfield, M.J. Breen

Face validity of the DSM-III-R personality disorders

The American Journal of Psychiatry, 146 (12) (1989), pp. 1575–1579

Five Factor Model ultimately not approved.

Dependent personality disorder: a critical review.

Krystle L KL Disney

Clinical psychology review , 2013, Vol.33(8), p.1184-1196

S. Karterud, G. Pedersen, S. Friis, O. Urnes, T. Irion, J. Braband, et al.

The Norwegian network of psychotherapeutic day hospitals

Ther Communities, 19 (1998), pp. 15–28

Trull et al., 1987

T.J. Trull, T.A. Widiger, A. Frances

Covariation of criteria sets for avoidant, schizoid, and dependent personality disorders

The American Journal of Psychiatry, 144 (6) (1987), pp. 767–771

Empirical Evidence

Huprich and Fine, 1996

S.K. Huprich, M.A. Fine

Self-defeating personality disorder: Diagnostic distinguishability and overlap with dependent personality disorder

Journal of Personality Disorders, 10 (1996), pp. 229–246

Self as helpless and inept, others as strong and competent.

Heterogeneity:

Gude, Karterud, Pederson, Falkum (2006) in Norway

-there is no "core" way of presenting with DPD

-questions construct validity of DPD

T. Millon, R.D. Davis

Disorders of personality: DSM-IV and beyond

(2nd ed.)J. Wiley, New York (1996)

Validity:

Blashfield and Breen (1989)

-Clinicians identified DPD correctly 73% of the time

Huprich and Fine (1996)

-Identified correctly 93% of the time

External Validity

Criteria 2 and 7 never tested

Criteria 3 and 4 contradict

Only 4 of 8 criteria empirically supported

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