The Development of African American Culture

Running head: DEPENDENT PERSONALITY DISORDER Dependent Personality DisordeR Roxana Tejera Institutional

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Affiliation 1 DEPEDENT PERSONALITTY DISORDER 2 Abstract Dependent personality disorder is a condition where an individual has an excessive need for approval and guidance. The history of the disorder dates back to 1945. There are two primary categories of causal factors for DPD: (1) genetic factors; and (2) social and cultural factors. The principal symptoms for DPD include difficulty making decisions, inability to initiate things on your own, and need to be with and around people among others. DPD has five sub-types namely accommodative dependent disorder, selfless dependent disorder, disquieted dependent disorder, immature dependent disorder, accommodating, and ineffectual dependent disorder. This disorder can be prevented by rewarding independence during childhood. Unfortunately, it is not possible to prevent hereditary causes. Treating DPD is mainly through psychotherapy interventions for both short-term and long-term goals. To overcome this disorder, there is need for the person to accept that he or she needs help as well as have a willingness to go through counseling. DEPEDENT PERSONALITTY DISORDER 3 Dependent Personality Disorder Definition Dependent personality disorder (DPD) refers to a situation where an individual has an excessive and persuasive need to have someone taking care of him or her. The primary characteristics of this disorder include clinging behavior, submissiveness, and excessive fears of being alone. Hence, a person suffering from DPD can be defined as one who finds it difficult to initiate and do things on the own so that they have to rely on the affirmation and direction of “significant and powerful” others. These people exude low levels of confidence in their abilities and intelligence. They tend to belittle their achievements as long as others have not approved them. They are also prone to self-doubting and being pessimistic. As a result of feeling unable to function without guidance from others, these people go to great extents to establish and maintain the dependent relationships. History of DPD The history of DPD dates back to Abraham’s and Freud’s descriptions of oral dependency in 1927 (Andrasik 2006). However, by that time, the dependency was yet to acquire the status of a disorder. Abraham and Freud described the dependency as an oral character. In 1945, the condition appeared for the first time as a disorder in a Ware Department Technical Bulletin. Seven years later, in 1952, the disorder featured in the first edition of the Diagnostic and Statistical Manual (Andrasik 2006). At this time, clinicians referred to it as a subtype of passive-aggressive personality disorder. DEPEDENT PERSONALITTY DISORDER 4 Causes The development of dependent disorder is a result of multiple factors. Genetic factors have been found as one of the contributors to DPD (Reichborn-Kjennerud 2010). In a research involving 2794 Norwegian twins, Gjerde et al. (2012) revealed that the probability of inheriting a dependent disorder is 0.66 as compared to 0.64 in the case of avoidant personality disorder. According to these findings, children of parents with DPD face a considerable risk of inheriting the disorder as compared to those whose parents do not have the condition. Over-involvement of primary caretakers is the other established factor responsible for the development of DPD. In childhood, caretakers may cultivate dependence in the child by rewarding loyalty and punishing any attempt the child makes towards attaining independence. A child who has never been rewarded for exercising independence may never attempt it even if it would be appreciated. Similarly, a child who grows up in a home where a significant other has a dependent disorder may develop the condition as well. Children learn through observation and imitation. As such, if a child notes that his or her mother, father, an elder sibling or another close relative heavily relies on the approval of others to do anything, he or she may grow up knowing that is the way things are done. Sociological and psychological theories agree that children are born as blank slates. At the point of birth, children do not know what to do, when, or how. Society informs them everything about behavior. In other words, the behaviors people carry through life, including extreme dependence, is passed over to them by the society. The social learning theory expounds on how children learn. According to this theory, human beings, including children, learn from one another through observation, imitation, and DEPEDENT PERSONALITTY DISORDER 5 modeling. Framed differently, children like adults, pay attention to what the behavioral patterns of significant others. The second phase of behavior formation is trying to remember what one observed. The third stage involves reproducing the behavior. Thus, according to social learning theory, every behavior is learned from those close to the individual. Moreover, there are cultures that celebrate dependency. In most societies, asking for help is seen as being friendly and sociable. In tune with this view, people tend to keep asking for guidance and help. As these people grow and become members of a global culture, they are not able to let go the lessons inculcated in them. Unfortunately, there is no scientific formulae of knowing how the various contribute to the development of DPD. Symptoms According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), there are several ways of identifying DPD. One of the most pronounced symptoms of DPD is that these individuals have difficulties making common decisions (Hales et al. 2011). Typically, people suffering from this disorder need excessive reassurance before they settle on even simple decisions such as what time to eat or what clothing to wear. Another symptom very similar to this is that these people tend to transfer their responsibilities to others (Hales et al. 2011). As a functioning of feeling incapable of assuming autonomy, they allow others to handle things on their behalf. People with this disorder tend to depend on parents to decide on who to marry or spouse on where to live. At times, these people will also need excessive guidance on who to be friends with. Also, people with the dependent disorder are overly agreeable. They do whatever they can to avoid disagreements. To them, disagreeing is a far too risky involvement as it can destroy DEPEDENT PERSONALITTY DISORDER 6 dependent relationships. They are afraid of disagreements not because they are cowardly but because they do not want to lose a source of approval and guidance (Hales et al. 2011). In the same vein, these people are very quick to seek new relationships when an existing one ends. For example, in the case of divorce, these people will most likely get married again in the shortest time possible. They do all they can to be in a relationship that will provide the same support the previous one provided. Equally important, these people feel helpless when alone. Because of the feeling that they are not able to care for themselves, they tend to suffer from high degrees of anxiety when left alone (Hales et al. 2011). In response, these people prefer being around people, even if they have little interest in them. Lastly but not least, people with DPD have difficulty with starting anything. They see themselves as inept to accomplish any task. Even worse, they are not able to sustain tasks. Thus, if you assign them to do something, they need you to provide support all through. In the end, you prefer doing the task rather than assigning it to them. Different Types There are five main types of dependent personality disorder (DPD) namely disquieted, selfless, immature, accommodating, and ineffectual. The section below discusses each of these subtypes in brief. The Ineffectual Dependent Disorder People suffering from this type show a combination of schizoid and dependent patterns. The major symptoms of this disorder are that the person is not interested social relationships (Cavaiola & Lavender 2000). They tend to prefer solitary activities. However, in stark contrast, DEPEDENT PERSONALITTY DISORDER 7 people with this disorder understand and empathize with the emotions of others. Another distinguishing feature of this type is that the individuals have no drive to act on their own. The Disquieted Dependent Disorder People with this disorder are highly vulnerable to separation anxiety. At the same time, they are very cautious not to lose support. A notable distinguishing characteristic of people with this disorder is that they at times express their fear of losing supportive relationships (Cavaiola & Lavender 2000). They tend to have outbursts of anger when their needs for safety and security are not met. The Selfless Dependent Disorder For this disorder, total identification and idealization are the principal themes. These people tend to forfeit their own self-identities as they merge with others. Ironically, their loss of self-identity seems fulfilling. Besides the loss of self-identity, people with the selfless dependent disorder are highly prone to experience depression when their relationship face difficulties (Cavaiola & Lavender 2000). The Immature Dependent Disorder As the term suggests, people with this disorder are overly attached to childlike activities and children. They have zero interest in spending with adults and assuming adult responsibilities. Instead, they prefer engaging in childhood activities and derive satisfaction from relating with children (Cavaiola & Lavender 2000). The Accommodating Dependent Disorder DEPEDENT PERSONALITTY DISORDER 8 This disorder shares most symptoms with the histrionic personality disorder. People with this type are very agreeable, submissive, benevolent, and neighborly (Cavaiola & Lavender 2000). Also, these people seek to become the centers of attention. As such, they tend to exhibit self-dramatizing behaviors. Prevention To understand how to prevent DPD, it is important to divide the causal factors into two: (1) genetic factors: and (2) social and cultural factors. For the genetic factors, preventing DPD is virtually impossible. Hence, the only way of preventing the development of DPD is by addressing social and cultural factors. In this tune, one way of preventing DPD is by teaching caretakers on how to help children learn independence. At times, caretakers are too protective. They do not provide space for children to experiment and explore on their own. Essentially, caretakers should encourage children to be independent. They should reward any effort towards attaining independence. Another way of preventing DPD is by living independently. As mentioned elsewhere, children learn through imitation. Hence, significant others must ensure that they provide a good example of an independent life to children. In this light, parents and elder siblings should show children that they can decide on their own, and feel confident about their decisions even if nobody approves them. Treatment Plans for Short-Term and Long-Term Goals For both short-term and long-term goals, psychotherapy is the primary method of treating DPD. However, depending on the nature of the goals, short-term or long-term, different types of psychotherapy are used. For short-term goals, assertiveness training and cognitive-behavioral DEPEDENT PERSONALITTY DISORDER 9 therapy (CBT) are the most common treatments. Training in assertiveness helps build selfconfidence. CBT helps develop new perspectives and attitudes concerning others. For long-term goals, psychodynamic psychotherapy is the best intervention. Suggestions on How to Overcome the Disorder The first and probably the most important suggestion for people seeking to overcome the disorder is to accept that they need help. Unfortunately, most people suffering from DPD never seek help, they only seek help when symptoms become unmanageable. While this also helps, it is at times too late. That said, it is very important to accept that you need help. Denial never helps. Secondly, one needs to seek professional help. While it is good to seek help from friends and relatives, it is much better to approach professionals in psychotherapy. The importance of seeking professional help cannot be overstated. Thirdly, success from psychotherapy requires commitment and discipline on the part of the patient. Therefore, anyone willing to overcome DPD must have a positive attitude and mindset. One must not approach psychotherapy like it is punishment. There is need for willingness on the part of the patient. Parenting Skills to Help the Individuals One skill that parents need to help children with DPD is praising them for efforts. In the case of children with DPD, one of the greatest issues to deal with is to help them improve their confidence levels. Praising children helps boost their confidence levels. On top of verbal commendation, parents can also have a journal where they write the good things their children do. They can then allow the children to read through the journals occasionally. This will also DEPEDENT PERSONALITTY DISORDER 10 help people prone or already suffering from DPD to appreciate themselves and develop positive self-esteem. Setting rules and being strict on them is another skill parents to help individuals with DPD. It is not true that being passive results in better behavior. Inability to set and enforce rules makes it possible for dependent individuals to keep asking for support and direction, even in handling simple things. Parents need to define what areas their children can seek help. Most importantly, these rules should be revised over time as the child advances in age. Adults relying on their parents to decide on who to marry or where to live evidence that these parents encouraged that kind of excessive dependency. Parents must ensure that their children learn how to assume responsibilities. Another equally important skill for parents with individuals having DPD is how to argue and solve conflicts. From time to time, these parents need to pick moderate conflicts with these individuals. By so doing, these people will learn that disagreeing is normal in life and it does not mean the relationship is over. Evidence-based Therapies for DPD Cognitive-behavioral therapy (CBT) the most recognized and effective evidence-based interventions for DPD. Ideally, CBT seeks to address self-defeating thought processes and patterns. This kind of therapy helps deconstruct inflexible patterns hindering the person from embracing healthier behavior. Matusiewicz and colleagues conducted research on the available empirical support for CBT as an intervention for DPD in the years between 1980 and 2009 (Matusiewicz et al. 2010). This investigation observed that CBT is the most effective evidencebased intervention for DPD. DEPEDENT PERSONALITTY DISORDER 11 Psychodynamic therapy is the other most popular evidence-based intervention for DPD. Psychodynamic therapy also referred to as insight-oriented therapy aims at unconscious processes in the mind. This approach is based on the assertion that thought patterns, both conscious and unconscious, shape behavior. What people go through in life define their behavior patterns. What a child experiences during his or her early years shows up later in life. Studies investigating the effect of psychodynamic therapy on personality disorders including DPD have pointed that the approach has positive results. Research conducted by McMain and Alberta maintains this position (McMain & Alberta 2007). DEPEDENT PERSONALITTY DISORDER 12 Conclusion While every person needs people, excessive dependence on others is a disorder. As such, it is important to know the boundaries. For those who have found themselves in the situation that they cannot care for themselves and are always in constant need for support should not lose hope. DPD can be treated. For parents, it is important to note that children learn through imitation. Thus, it is important to provide to them good examples, which in this case is independence. During childhood, caretakers should reward independence without discouraging dependence. Most importantly, there parental skills that can be helpful for people living with individuals suffering from DPD. Some of these skills include praising the individual for effort, showing them that conflict is normal in life, and setting boundaries on areas the person is allowed to seek guidance or not. While these skills can help prevent the development of DHD, they may be of little importance if the person has lived with the condition for a long time. For this reason, it is advisable to seek professional help. In treating DPD, cognitive behavioral therapy and psychodynamic therapy are some of the most effective evidence-based interventions. The government should develop programs to help prevent the development of DPD. For example, the government can design programs to teach every parent on how children learn. With this understanding on how children learn, parents would know what skills to employ and how to conduct themselves in the presence of children. DPD is not just a social problem. It is also an economic problem. People with DPD have difficulties initiating anything meaning that their innovation and creativity levels are very low. DEPEDENT PERSONALITTY DISORDER 13 References Andrasik, F. (2006). Comprehensive Handbook of Personality and Psychopathology Volume 2. Hoboken: John Wiley & Sons. Cavaiola, A. A., & Lavender, N. J. (2000). Toxic coworkers: How to deal with dysfunctional people on the job. Oakland, Calif: New Harbinger Publications. Gjerde, L. C., Czajkowski, N., Røysamb, E., Ørstavik, R. E., Knudsen, G. P., Østby, K., Torgersen, S., Myers, J., Kendler, K. S., & Reichborn-Kjennerud, T. (2012). The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire. Acta Psychiatrica Scandinavica, 126(6), 448–457. http://doi.org/10.1111/j.1600-0447.2012.01862.x Hales, R. E., Yudofsky, S. C., Gabbard, G. O., & American Psychiatric Publishing. (2011). Essentials of psychiatry. Arlington, VA: American Psychiatric Pub. Matusiewicz, A. K., Hopwood, C. J., Banducci, A. N., & Lejuez, C. W. (2010). The Effectiveness of Cognitive Behavioral Therapy for Personality Disorders. The Psychiatric Clinics of North America, 33(3), 657–685. http://doi.org/10.1016/j.psc.2010.04.007 McMain, S., & Alberta, E. (2007). Advances in psychotherapy of personality disorders: A research update. Current Psychiatry Reports, 9 (1), 46-52. Reichborn-Kjennerud, T. (2010). The genetic epidemiology of personality disorders. Dialogues in Clinical Neuroscience, 12(1), 103–114. Running head: DEPENDENT PERSONALITY DISORDER Dependent Personality DisordeR Roxana Tejera Institutional Affiliation 1 DEPEDENT PERSONALITTY DISORDER 2 Abstract Dependent personality disorder is a condition where an individual has an excessive need for approval and guidance. The history of the disorder dates back to 1945. There are two primary categories of causal factors for DPD: (1) genetic factors; and (2) social and cultural factors. The principal symptoms for DPD include difficulty making decisions, inability to initiate things on your own, and need to be with and around people among others. DPD has five sub-types namely accommodative dependent disorder, selfless dependent disorder, disquieted dependent disorder, immature dependent disorder, accommodating, and ineffectual dependent disorder. This disorder can be prevented by rewarding independence during childhood. Unfortunately, it is not possible to prevent hereditary causes. Treating DPD is mainly through psychotherapy interventions for both short-term and long-term goals. To overcome this disorder, there is need for the person to accept that he or she needs help as well as have a willingness to go through counseling. DEPEDENT PERSONALITTY DISORDER 3 Dependent Personality Disorder Definition Dependent personality disorder (DPD) refers to a situation where an individual has an excessive and persuasive need to have someone taking care of him or her. The primary characteristics of this disorder include clinging behavior, submissiveness, and excessive fears of being alone. Hence, a person suffering from DPD can be defined as one who finds it difficult to initiate and do things on the own so that they have to rely on the affirmation and direction of “significant and powerful” others. These people exude low levels of confidence in their abilities and intelligence. They tend to belittle their achievements as long as others have not approved them. They are also prone to self-doubting and being pessimistic. As a result of feeling unable to function without guidance from others, these people go to great extents to establish and maintain the dependent relationships. History of DPD The history of DPD dates back to Abraham’s and Freud’s descriptions of oral dependency in 1927 (Andrasik 2006). However, by that time, the dependency was yet to acquire the status of a disorder. Abraham and Freud described the dependency as an oral character. In 1945, the condition appeared for the first time as a disorder in a Ware Department Technical Bulletin. Seven years later, in 1952, the disorder featured in the first edition of the Diagnostic and Statistical Manual (Andrasik 2006). At this time, clinicians referred to it as a subtype of passive-aggressive personality disorder. DEPEDENT PERSONALITTY DISORDER 4 Causes The development of dependent disorder is a result of multiple factors. Genetic factors have been found as one of the contributors to DPD (Reichborn-Kjennerud 2010). In a research involving 2794 Norwegian twins, Gjerde et al. (2012) revealed that the probability of inheriting a dependent disorder is 0.66 as compared to 0.64 in the case of avoidant personality disorder. According to these findings, children of parents with DPD face a considerable risk of inheriting the disorder as compared to those whose parents do not have the condition. Over-involvement of primary caretakers is the other established factor responsible for the development of DPD. In childhood, caretakers may cultivate dependence in the child by rewarding loyalty and punishing any attempt the child makes towards attaining independence. A child who has never been rewarded for exercising independence may never attempt it even if it would be appreciated. Similarly, a child who grows up in a home where a significant other has a dependent disorder may develop the condition as well. Children learn through observation and imitation. As such, if a child notes that his or her mother, father, an elder sibling or another close relative heavily relies on the approval of others to do anything, he or she may grow up knowing that is the way things are done. Sociological and psychological theories agree that children are born as blank slates. At the point of birth, children do not know what to do, when, or how. Society informs them everything about behavior. In other words, the behaviors people carry through life, including extreme dependence, is passed over to them by the society. The social learning theory expounds on how children learn. According to this theory, human beings, including children, learn from one another through observation, imitation, and DEPEDENT PERSONALITTY DISORDER 5 modeling. Framed differently, children like adults, pay attention to what the behavioral patterns of significant others. The second phase of behavior formation is trying to remember what one observed. The third stage involves reproducing the behavior. Thus, according to social learning theory, every behavior is learned from those close to the individual. Moreover, there are cultures that celebrate dependency. In most societies, asking for help is seen as being friendly and sociable. In tune with this view, people tend to keep asking for guidance and help. As these people grow and become members of a global culture, they are not able to let go the lessons inculcated in them. Unfortunately, there is no scientific formulae of knowing how the various contribute to the development of DPD. Symptoms According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), there are several ways of identifying DPD. One of the most pronounced symptoms of DPD is that these individuals have difficulties making common decisions (Hales et al. 2011). Typically, people suffering from this disorder need excessive reassurance before they settle on even simple decisions such as what time to eat or what clothing to wear. Another symptom very similar to this is that these people tend to transfer their responsibilities to others (Hales et al. 2011). As a functioning of feeling incapable of assuming autonomy, they allow others to handle things on their behalf. People with this disorder tend to depend on parents to decide on who to marry or spouse on where to live. At times, these people will also need excessive guidance on who to be friends with. Also, people with the dependent disorder are overly agreeable. They do whatever they can to avoid disagreements. To them, disagreeing is a far too risky involvement as it can destroy DEPEDENT PERSONALITTY DISORDER 6 dependent relationships. They are afraid of disagreements not because they are cowardly but because they do not want to lose a source of approval and guidance (Hales et al. 2011). In the same vein, these people are very quick to seek new relationships when an existing one ends. For example, in the case of divorce, these people will most likely get married again in the shortest time possible. They do all they can to be in a relationship that will provide the same support the previous one provided. Equally important, these people feel helpless when alone. Because of the feeling that they are not able to care for themselves, they tend to suffer from high degrees of anxiety when left alone (Hales et al. 2011). In response, these people prefer being around people, even if they have little interest in them. Lastly but not least, people with DPD have difficulty with starting anything. They see themselves as inept to accomplish any task. Even worse, they are not able to sustain tasks. Thus, if you assign them to do something, they need you to provide support all through. In the end, you prefer doing the task rather than assigning it to them. Different Types There are five main types of dependent personality disorder (DPD) namely disquieted, selfless, immature, accommodating, and ineffectual. The section below discusses each of these subtypes in brief. The Ineffectual Dependent Disorder People suffering from this type show a combination of schizoid and dependent patterns. The major symptoms of this disorder are that the person is not interested social relationships (Cavaiola & Lavender 2000). They tend to prefer solitary activities. However, in stark contrast, DEPEDENT PERSONALITTY DISORDER 7 people with this disorder understand and empathize with the emotions of others. Another distinguishing feature of this type is that the individuals have no drive to act on their own. The Disquieted Dependent Disorder People with this disorder are highly vulnerable to separation anxiety. At the same time, they are very cautious not to lose support. A notable distinguishing characteristic of people with this disorder is that they at times express their fear of losing supportive relationships (Cavaiola & Lavender 2000). They tend to have outbursts of anger when their needs for safety and security are not met. The Selfless Dependent Disorder For this disorder, total identification and idealization are the principal themes. These people tend to forfeit their own self-identities as they merge with others. Ironically, their loss of self-identity seems fulfilling. Besides the loss of self-identity, people with the selfless dependent disorder are highly prone to experience depression when their relationship face difficulties (Cavaiola & Lavender 2000). The Immature Dependent Disorder As the term suggests, people with this disorder are overly attached to childlike activities and children. They have zero interest in spending with adults and assuming adult responsibilities. Instead, they prefer engaging in childhood activities and derive satisfaction from relating with children (Cavaiola & Lavender 2000). The Accommodating Dependent Disorder DEPEDENT PERSONALITTY DISORDER 8 This disorder shares most symptoms with the histrionic personality disorder. People with this type are very agreeable, submissive, benevolent, and neighborly (Cavaiola & Lavender 2000). Also, these people seek to become the centers of attention. As such, they tend to exhibit self-dramatizing behaviors. Prevention To understand how to prevent DPD, it is important to divide the causal factors into two: (1) genetic factors: and (2) social and cultural factors. For the genetic factors, preventing DPD is virtually impossible. Hence, the only way of preventing the development of DPD is by addressing social and cultural factors. In this tune, one way of preventing DPD is by teaching caretakers on how to help children learn independence. At times, caretakers are too protective. They do not provide space for children to experiment and explore on their own. Essentially, caretakers should encourage children to be independent. They should reward any effort towards attaining independence. Another way of preventing DPD is by living independently. As mentioned elsewhere, children learn through imitation. Hence, significant others must ensure that they provide a good example of an independent life to children. In this light, parents and elder siblings should show children that they can decide on their own, and feel confident about their decisions even if nobody approves them. Treatment Plans for Short-Term and Long-Term Goals For both short-term and long-term goals, psychotherapy is the primary method of treating DPD. However, depending on the nature of the goals, short-term or long-term, different types of psychotherapy are used. For short-term goals, assertiveness training and cognitive-behavioral DEPEDENT PERSONALITTY DISORDER 9 therapy (CBT) are the most common treatments. Training in assertiveness helps build selfconfidence. CBT helps develop new perspectives and attitudes concerning others. For long-term goals, psychodynamic psychotherapy is the best intervention. Suggestions on How to Overcome the Disorder The first and probably the most important suggestion for people seeking to overcome the disorder is to accept that they need help. Unfortunately, most people suffering from DPD never seek help, they only seek help when symptoms become unmanageable. While this also helps, it is at times too late. That said, it is very important to accept that you need help. Denial never helps. Secondly, one needs to seek professional help. While it is good to seek help from friends and relatives, it is much better to approach professionals in psychotherapy. The importance of seeking professional help cannot be overstated. Thirdly, success from psychotherapy requires commitment and discipline on the part of the patient. Therefore, anyone willing to overcome DPD must have a positive attitude and mindset. One must not approach psychotherapy like it is punishment. There is need for willingness on the part of the patient. Parenting Skills to Help the Individuals One skill that parents need to help children with DPD is praising them for efforts. In the case of children with DPD, one of the greatest issues to deal with is to help them improve their confidence levels. Praising children helps boost their confidence levels. On top of verbal commendation, parents can also have a journal where they write the good things their children do. They can then allow the children to read through the journals occasionally. This will also DEPEDENT PERSONALITTY DISORDER 10 help people prone or already suffering from DPD to appreciate themselves and develop positive self-esteem. Setting rules and being strict on them is another skill parents to help individuals with DPD. It is not true that being passive results in better behavior. Inability to set and enforce rules makes it possible for dependent individuals to keep asking for support and direction, even in handling simple things. Parents need to define what areas their children can seek help. Most importantly, these rules should be revised over time as the child advances in age. Adults relying on their parents to decide on who to marry or where to live evidence that these parents encouraged that kind of excessive dependency. Parents must ensure that their children learn how to assume responsibilities. Another equally important skill for parents with individuals having DPD is how to argue and solve conflicts. From time to time, these parents need to pick moderate conflicts with these individuals. By so doing, these people will learn that disagreeing is normal in life and it does not mean the relationship is over. Evidence-based Therapies for DPD Cognitive-behavioral therapy (CBT) the most recognized and effective evidence-based interventions for DPD. Ideally, CBT seeks to address self-defeating thought processes and patterns. This kind of therapy helps deconstruct inflexible patterns hindering the person from embracing healthier behavior. Matusiewicz and colleagues conducted research on the available empirical support for CBT as an intervention for DPD in the years between 1980 and 2009 (Matusiewicz et al. 2010). This investigation observed that CBT is the most effective evidencebased intervention for DPD. DEPEDENT PERSONALITTY DISORDER 11 Psychodynamic therapy is the other most popular evidence-based intervention for DPD. Psychodynamic therapy also referred to as insight-oriented therapy aims at unconscious processes in the mind. This approach is based on the assertion that thought patterns, both conscious and unconscious, shape behavior. What people go through in life define their behavior patterns. What a child experiences during his or her early years shows up later in life. Studies investigating the effect of psychodynamic therapy on personality disorders including DPD have pointed that the approach has positive results. Research conducted by McMain and Alberta maintains this position (McMain & Alberta 2007). DEPEDENT PERSONALITTY DISORDER 12 Conclusion While every person needs people, excessive dependence on others is a disorder. As such, it is important to know the boundaries. For those who have found themselves in the situation that they cannot care for themselves and are always in constant need for support should not lose hope. DPD can be treated. For parents, it is important to note that children learn through imitation. Thus, it is important to provide to them good examples, which in this case is independence. During childhood, caretakers should reward independence without discouraging dependence. Most importantly, there parental skills that can be helpful for people living with individuals suffering from DPD. Some of these skills include praising the individual for effort, showing them that conflict is normal in life, and setting boundaries on areas the person is allowed to seek guidance or not. While these skills can help prevent the development of DHD, they may be of little importance if the person has lived with the condition for a long time. For this reason, it is advisable to seek professional help. In treating DPD, cognitive behavioral therapy and psychodynamic therapy are some of the most effective evidence-based interventions. The government should develop programs to help prevent the development of DPD. For example, the government can design programs to teach every parent on how children learn. With this understanding on how children learn, parents would know what skills to employ and how to conduct themselves in the presence of children. DPD is not just a social problem. It is also an economic problem. People with DPD have difficulties initiating anything meaning that their innovation and creativity levels are very low. DEPEDENT PERSONALITTY DISORDER 13 References Andrasik, F. (2006). Comprehensive Handbook of Personality and Psychopathology Volume 2. Hoboken: John Wiley & Sons. Cavaiola, A. A., & Lavender, N. J. (2000). Toxic coworkers: How to deal with dysfunctional people on the job. Oakland, Calif: New Harbinger Publications. Gjerde, L. C., Czajkowski, N., Røysamb, E., Ørstavik, R. E., Knudsen, G. P., Østby, K., Torgersen, S., Myers, J., Kendler, K. S., & Reichborn-Kjennerud, T. (2012). The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire. Acta Psychiatrica Scandinavica, 126(6), 448–457. http://doi.org/10.1111/j.1600-0447.2012.01862.x Hales, R. E., Yudofsky, S. C., Gabbard, G. O., & American Psychiatric Publishing. (2011). Essentials of psychiatry. Arlington, VA: American Psychiatric Pub. Matusiewicz, A. K., Hopwood, C. J., Banducci, A. N., & Lejuez, C. W. (2010). The Effectiveness of Cognitive Behavioral Therapy for Personality Disorders. The Psychiatric Clinics of North America, 33(3), 657–685. http://doi.org/10.1016/j.psc.2010.04.007 McMain, S., & Alberta, E. (2007). Advances in psychotherapy of personality disorders: A research update. Current Psychiatry Reports, 9 (1), 46-52. Reichborn-Kjennerud, T. (2010). The genetic epidemiology of personality disorders. Dialogues in Clinical Neuroscience, 12(1), 103–114. Running head: DEPENDENT PERSONALITY DISORDER Dependent Personality Disorder Name Institutional Affiliation 1 DEPEDENT PERSONALITTY DISORDER 2 Abstract Dependent personality disorder is a condition where an individual has an excessive need for approval and guidance. The history of the disorder dates back to 1945. There are two primary categories of causal factors for DPD: (1) genetic factors; and (2) social and cultural factors. The principal symptoms for DPD include difficulty making decisions, inability to initiate things on your own, and need to be with and around people among others. DPD has five sub-types namely accommodative dependent disorder, selfless dependent disorder, disquieted dependent disorder, immature dependent disorder, accommodating, and ineffectual dependent disorder. This disorder can be prevented by rewarding independence during childhood. Unfortunately, it is not possible to prevent hereditary causes. Treating DPD is mainly through psychotherapy interventions for both short-term and long-term goals. To overcome this disorder, there is need for the person to accept that he or she needs help as well as have a willingness to go through counseling. DEPEDENT PERSONALITTY DISORDER 3 Dependent Personality Disorder Definition Dependent personality disorder (DPD) refers to a situation where an individual has an excessive and persuasive need to have someone taking care of him or her. The primary characteristics of this disorder include clinging behavior, submissiveness, and excessive fears of being alone. Hence, a person suffering from DPD can be defined as one who finds it difficult to initiate and do things on the own so that they have to rely on the affirmation and direction of “significant and powerful” others. These people exude low levels of confidence in their abilities and intelligence. They tend to belittle their achievements as long as others have not approved them. They are also prone to self-doubting and being pessimistic. As a result of feeling unable to function without guidance from others, these people go to great extents to establish and maintain the dependent relationships. History of DPD The history of DPD dates back to Abraham’s and Freud’s descriptions of oral dependency in 1927 (Andrasik 2006). However, by that time, the dependency was yet to acquire the status of a disorder. Abraham and Freud described the dependency as an oral character. In 1945, the condition appeared for the first time as a disorder in a Ware Department Technical Bulletin. Seven years later, in 1952, the disorder featured in the first edition of the Diagnostic and Statistical Manual (Andrasik 2006). At this time, clinicians referred to it as a subtype of passive-aggressive personality disorder. DEPEDENT PERSONALITTY DISORDER 4 Causes The development of dependent disorder is a result of multiple factors. Genetic factors have been found as one of the contributors to DPD (Reichborn-Kjennerud 2010). In a research involving 2794 Norwegian twins, Gjerde et al. (2012) revealed that the probability of inheriting a dependent disorder is 0.66 as compared to 0.64 in the case of avoidant personality disorder. According to these findings, children of parents with DPD face a considerable risk of inheriting the disorder as compared to those whose parents do not have the condition. Over-involvement of primary caretakers is the other established factor responsible for the development of DPD. In childhood, caretakers may cultivate dependence in the child by rewarding loyalty and punishing any attempt the child makes towards attaining independence. A child who has never been rewarded for exercising independence may never attempt it even if it would be appreciated. Similarly, a child who grows up in a home where a significant other has a dependent disorder may develop the condition as well. Children learn through observation and imitation. As such, if a child notes that his or her mother, father, an elder sibling or another close relative heavily relies on the approval of others to do anything, he or she may grow up knowing that is the way things are done. Sociological and psychological theories agree that children are born as blank slates. At the point of birth, children do not know what to do, when, or how. Society informs them everything about behavior. In other words, the behaviors people carry through life, including extreme dependence, is passed over to them by the society. The social learning theory expounds on how children learn. According to this theory, human beings, including children, learn from one another through observation, imitation, and DEPEDENT PERSONALITTY DISORDER 5 modeling. Framed differently, children like adults, pay attention to what the behavioral patterns of significant others. The second phase of behavior formation is trying to remember what one observed. The third stage involves reproducing the behavior. Thus, according to social learning theory, every behavior is learned from those close to the individual. Moreover, there are cultures that celebrate dependency. In most societies, asking for help is seen as being friendly and sociable. In tune with this view, people tend to keep asking for guidance and help. As these people grow and become members of a global culture, they are not able to let go the lessons inculcated in them. Unfortunately, there is no scientific formulae of knowing how the various contribute to the development of DPD. Symptoms According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), there are several ways of identifying DPD. One of the most pronounced symptoms of DPD is that these individuals have difficulties making common decisions (Hales et al. 2011). Typically, people suffering from this disorder need excessive reassurance before they settle on even simple decisions such as what time to eat or what clothing to wear. Another symptom very similar to this is that these people tend to transfer their responsibilities to others (Hales et al. 2011). As a functioning of feeling incapable of assuming autonomy, they allow others to handle things on their behalf. People with this disorder tend to depend on parents to decide on who to marry or spouse on where to live. At times, these people will also need excessive guidance on who to be friends with. Also, people with the dependent disorder are overly agreeable. They do whatever they can to avoid disagreements. To them, disagreeing is a far too risky involvement as it can destroy DEPEDENT PERSONALITTY DISORDER 6 dependent relationships. They are afraid of disagreements not because they are cowardly but because they do not want to lose a source of approval and guidance (Hales et al. 2011). In the same vein, these people are very quick to seek new relationships when an existing one ends. For example, in the case of divorce, these people will most likely get married again in the shortest time possible. They do all they can to be in a relationship that will provide the same support the previous one provided. Equally important, these people feel helpless when alone. Because of the feeling that they are not able to care for themselves, they tend to suffer from high degrees of anxiety when left alone (Hales et al. 2011). In response, these people prefer being around people, even if they have little interest in them. Lastly but not least, people with DPD have difficulty with starting anything. They see themselves as inept to accomplish any task. Even worse, they are not able to sustain tasks. Thus, if you assign them to do something, they need you to provide support all through. In the end, you prefer doing the task rather than assigning it to them. Different Types There are five main types of dependent personality disorder (DPD) namely disquieted, selfless, immature, accommodating, and ineffectual. The section below discusses each of these subtypes in brief. The Ineffectual Dependent Disorder People suffering from this type show a combination of schizoid and dependent patterns. The major symptoms of this disorder are that the person is not interested social relationships (Cavaiola & Lavender 2000). They tend to prefer solitary activities. However, in stark contrast, DEPEDENT PERSONALITTY DISORDER 7 people with this disorder understand and empathize with the emotions of others. Another distinguishing feature of this type is that the individuals have no drive to act on their own. The Disquieted Dependent Disorder People with this disorder are highly vulnerable to separation anxiety. At the same time, they are very cautious not to lose support. A notable distinguishing characteristic of people with this disorder is that they at times express their fear of losing supportive relationships (Cavaiola & Lavender 2000). They tend to have outbursts of anger when their needs for safety and security are not met. The Selfless Dependent Disorder For this disorder, total identification and idealization are the principal themes. These people tend to forfeit their own self-identities as they merge with others. Ironically, their loss of self-identity seems fulfilling. Besides the loss of self-identity, people with the selfless dependent disorder are highly prone to experience depression when their relationship face difficulties (Cavaiola & Lavender 2000). The Immature Dependent Disorder As the term suggests, people with this disorder are overly attached to childlike activities and children. They have zero interest in spending with adults and assuming adult responsibilities. Instead, they prefer engaging in childhood activities and derive satisfaction from relating with children (Cavaiola & Lavender 2000). The Accommodating Dependent Disorder DEPEDENT PERSONALITTY DISORDER 8 This disorder shares most symptoms with the histrionic personality disorder. People with this type are very agreeable, submissive, benevolent, and neighborly (Cavaiola & Lavender 2000). Also, these people seek to become the centers of attention. As such, they tend to exhibit self-dramatizing behaviors. Prevention To understand how to prevent DPD, it is important to divide the causal factors into two: (1) genetic factors: and (2) social and cultural factors. For the genetic factors, preventing DPD is virtually impossible. Hence, the only way of preventing the development of DPD is by addressing social and cultural factors. In this tune, one way of preventing DPD is by teaching caretakers on how to help children learn independence. At times, caretakers are too protective. They do not provide space for children to experiment and explore on their own. Essentially, caretakers should encourage children to be independent. They should reward any effort towards attaining independence. Another way of preventing DPD is by living independently. As mentioned elsewhere, children learn through imitation. Hence, significant others must ensure that they provide a good example of an independent life to children. In this light, parents and elder siblings should show children that they can decide on their own, and feel confident about their decisions even if nobody approves them. Treatment Plans for Short-Term and Long-Term Goals For both short-term and long-term goals, psychotherapy is the primary method of treating DPD. However, depending on the nature of the goals, short-term or long-term, different types of psychotherapy are used. For short-term goals, assertiveness training and cognitive-behavioral DEPEDENT PERSONALITTY DISORDER 9 therapy (CBT) are the most common treatments. Training in assertiveness helps build selfconfidence. CBT helps develop new perspectives and attitudes concerning others. For long-term goals, psychodynamic psychotherapy is the best intervention. Suggestions on How to Overcome the Disorder The first and probably the most important suggestion for people seeking to overcome the disorder is to accept that they need help. Unfortunately, most people suffering from DPD never seek help, they only seek help when symptoms become unmanageable. While this also helps, it is at times too late. That said, it is very important to accept that you need help. Denial never helps. Secondly, one needs to seek professional help. While it is good to seek help from friends and relatives, it is much better to approach professionals in psychotherapy. The importance of seeking professional help cannot be overstated. Thirdly, success from psychotherapy requires commitment and discipline on the part of the patient. Therefore, anyone willing to overcome DPD must have a positive attitude and mindset. One must not approach psychotherapy like it is punishment. There is need for willingness on the part of the patient. Parenting Skills to Help the Individuals One skill that parents need to help children with DPD is praising them for efforts. In the case of children with DPD, one of the greatest issues to deal with is to help them improve their confidence levels. Praising children helps boost their confidence levels. On top of verbal commendation, parents can also have a journal where they write the good things their children do. They can then allow the children to read through the journals occasionally. This will also DEPEDENT PERSONALITTY DISORDER 10 help people prone or already suffering from DPD to appreciate themselves and develop positive self-esteem. Setting rules and being strict on them is another skill parents to help individuals with DPD. It is not true that being passive results in better behavior. Inability to set and enforce rules makes it possible for dependent individuals to keep asking for support and direction, even in handling simple things. Parents need to define what areas their children can seek help. Most importantly, these rules should be revised over time as the child advances in age. Adults relying on their parents to decide on who to marry or where to live evidence that these parents encouraged that kind of excessive dependency. Parents must ensure that their children learn how to assume responsibilities. Another equally important skill for parents with individuals having DPD is how to argue and solve conflicts. From time to time, these parents need to pick moderate conflicts with these individuals. By so doing, these people will learn that disagreeing is normal in life and it does not mean the relationship is over. Evidence-based Therapies for DPD Cognitive-behavioral therapy (CBT) the most recognized and effective evidence-based interventions for DPD. Ideally, CBT seeks to address self-defeating thought processes and patterns. This kind of therapy helps deconstruct inflexible patterns hindering the person from embracing healthier behavior. Matusiewicz and colleagues conducted research on the available empirical support for CBT as an intervention for DPD in the years between 1980 and 2009 (Matusiewicz et al. 2010). This investigation observed that CBT is the most effective evidencebased intervention for DPD. DEPEDENT PERSONALITTY DISORDER 11 Psychodynamic therapy is the other most popular evidence-based intervention for DPD. Psychodynamic therapy also referred to as insight-oriented therapy aims at unconscious processes in the mind. This approach is based on the assertion that thought patterns, both conscious and unconscious, shape behavior. What people go through in life define their behavior patterns. What a child experiences during his or her early years shows up later in life. Studies investigating the effect of psychodynamic therapy on personality disorders including DPD have pointed that the approach has positive results. Research conducted by McMain and Alberta maintains this position (McMain & Alberta 2007). DEPEDENT PERSONALITTY DISORDER 12 Conclusion While every person needs people, excessive dependence on others is a disorder. As such, it is important to know the boundaries. For those who have found themselves in the situation that they cannot care for themselves and are always in constant need for support should not lose hope. DPD can be treated. For parents, it is important to note that children learn through imitation. Thus, it is important to provide to them good examples, which in this case is independence. During childhood, caretakers should reward independence without discouraging dependence. Most importantly, there parental skills that can be helpful for people living with individuals suffering from DPD. Some of these skills include praising the individual for effort, showing them that conflict is normal in life, and setting boundaries on areas the person is allowed to seek guidance or not. While these skills can help prevent the development of DHD, they may be of little importance if the person has lived with the condition for a long time. For this reason, it is advisable to seek professional help. In treating DPD, cognitive behavioral therapy and psychodynamic therapy are some of the most effective evidence-based interventions. The government should develop programs to help prevent the development of DPD. For example, the government can design programs to teach every parent on how children learn. With this understanding on how children learn, parents would know what skills to employ and how to conduct themselves in the presence of children. DPD is not just a social problem. It is also an economic problem. People with DPD have difficulties initiating anything meaning that their innovation and creativity levels are very low. DEPEDENT PERSONALITTY DISORDER 13 References Andrasik, F. (2006). Comprehensive Handbook of Personality and Psychopathology Volume 2. Hoboken: John Wiley & Sons. Cavaiola, A. A., & Lavender, N. J. (2000). Toxic coworkers: How to deal with dysfunctional people on the job. Oakland, Calif: New Harbinger Publications. Gjerde, L. C., Czajkowski, N., Røysamb, E., Ørstavik, R. E., Knudsen, G. P., Østby, K., Torgersen, S., Myers, J., Kendler, K. S., & Reichborn-Kjennerud, T. (2012). The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire. Acta Psychiatrica Scandinavica, 126(6), 448–457. http://doi.org/10.1111/j.1600-0447.2012.01862.x Hales, R. E., Yudofsky, S. C., Gabbard, G. O., & American Psychiatric Publishing. (2011). Essentials of psychiatry. Arlington, VA: American Psychiatric Pub. Matusiewicz, A. K., Hopwood, C. J., Banducci, A. N., & Lejuez, C. W. (2010). The Effectiveness of Cognitive Behavioral Therapy for Personality Disorders. The Psychiatric Clinics of North America, 33(3), 657–685. http://doi.org/10.1016/j.psc.2010.04.007 McMain, S., & Alberta, E. (2007). Advances in psychotherapy of personality disorders: A research update. Current Psychiatry Reports, 9 (1), 46-52. Reichborn-Kjennerud, T. (2010). The genetic epidemiology of personality disorders. Dialogues in Clinical Neuroscience, 12(1), 103–114.
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