Dependent Personality Disorder

What Causes Dependent Personality Disorder?

The exact cause of DPD has not been discovered. Several factors, however, seem to put an individual at increased risk of DPD.

• Family history and genetics. People with DPD often have a family history of the same disorder or other anxiety disorders. Scientists suspect a genetic component to DPD, but no definite association with any gene or group of genes has been discovered.
• Childhood trauma. People who experience traumatic situations in childhood, such as abuse, neglect, or a serious illness, may be at a higher risk for DPD.
• Personality traits. People who have certain personality traits, such as a tendency to be anxious, are at an increased risk for DPD.
• Relationship history. Adults who have a history of being involved in abusive relationships are more likely to have DPD.
• Cultural factors. People who live in cultures or practice religions that prioritize subservience, obedience, or deference to authority are more at risk of DPD.

Is Dependent Personality Disorder Hereditary?

Scientists have not yet been able to identify a specific genetic component that increases the risk of DPD. Inherited genes may likely increase an individual’s susceptibility to DPD, but the disorder’s actual development may result from external triggering circumstances.

How Is Dependent Personality Disorder Detected?

DPD, like all personality disorders, involves a pattern of symptomatic behavior that remains consistent for a long time. By definition, DPD symptoms must begin in childhood or early adulthood, and the disorder is often diagnosed in children.

Possible indicators of DPD risk include:

• Anxiety
• Negative self-image
• Avoidance of making others angry
• Sensitivity to criticism
• Problems working independently
• Need for assurance
• Excessive need for advice when making decisions

How Is Dependent Personality Disorder Diagnosed?

Diagnosis of DPD begins with determining that the patient has a cluster of symptoms that meet the diagnostic criteria for the disorder. A doctor will start with a physical exam to rule out biological problems that may be causing symptoms. After these exams, if the doctor suspects that DPD or another personality disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment to solidify the diagnosis further.

Diagnostic steps may include:

• A physical exam. This exam will rule out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

The results of the psychological assessments will be compared to the diagnostic criteria for dependent personality disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM criteria for DPD include:

• A persistent need to be taken care of that manifests as submissiveness or clingy behavior.
• At least five symptoms are present.
• The symptoms begin by early adulthood.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Dependent Personality Disorder Treated?

There is no cure for DPD, and no medications are commonly used to treat the core disorder itself. Instead, the most common treatment course involves psychotherapy, with drugs sometimes used to treat other co-existing mental illnesses.

Therapies

Several different types of psychotherapy have proven to be effective at managing the effects of DPD, and the general course of treatment is the same as that for other personality disorders. Various therapy types may be effective for different individuals, and the most effective treatment may change over time, even in individual cases.

Commonly used therapeutic approaches include:

• Cognitive-behavioral therapy (CBT). This type of treatment focuses on teaching the patient to recognize inaccurate perceptions about themselves and others and develop strategies for dealing with these misperceptions when they occur.
• Psychodynamic therapy. This type of therapy helps the patient to identify their patterns of behavior. The therapist is likely to encourage examining the patient’s emotions, beliefs, and early childhood experiences.

Medications

There is no clear evidence that medications are effective at treating DPD itself. However, medicines may be used to treat symptoms such as depression or anxiety, which often co-exist with DPD. The drugs used to treat these symptoms include selective serotonin reuptake inhibitors (SSRIs) or sedatives such as alprazolam. Medicines are rarely used on their own, and the most effective treatments combine medications with psychotherapy.

How Does Dependent Personality Disorder Progress?

Treatment may help some people with DPD learn how to be more independent and have more healthy relationships. Left untreated, DPD can have significant adverse effects on a person’s life, including:

• Lack of success at work or school
• Unemployment or financial difficulties
• Depression
• Anxiety
• Abusive relationships
• Substance abuse

How Is Dependent Personality Disorder Prevented?

There is likely no way to prevent DPD from developing, but parents and caregivers who provide a nurturing and supportive environment for their children may be able to remove some of the disorder’s risk factors.

When signs of DPD emerge, early intervention can sometimes successfully prevent the condition from producing its most destructive complications.

Dependent Personality Disorder Caregiver Tips

Many people with dependent personality disorder also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with DPD:

• Many people with DPD also suffer from depression.
• Other anxiety disorders, such as panic disorder, generalized anxiety disorder (GAD), or post-traumatic stress disorder (PTSD), are often associated with DPD.
• Some people with DPD also have other personality disorders, such as borderline personality disorder.
• l Alcoholism and substance abuse are common consequences of DPD.

Dependent Personality Disorder Brain Science

Because personality disorders such as DPD are often associated with past traumatic experiences, some scientists believe these disorders may have something in common with post-traumatic stress disorder (PTSD). In PTSD, trauma causes lasting changes in brain circuitry, resulting in abnormal reactions to perceived stress later in life. Something similar might be going on in the case of personality disorders.

Traumatic stress affects three different areas of the brain:

• The amygdala is the brain region that experiences emotions and recognizes them in other people. The amygdala is also responsible for identifying threats and priming the body to react to them.
• The hippocampus is the center of memory, emotions, and motivation. In a stressful situation, its job is to compare the threat to past experiences and calm the amygdala’s fear response when it’s not necessary.
• The prefrontal cortex is responsible for rational thought and decision-making. In times of stress, it can overrule the amygdala’s fear response by recognizing the appropriate way to respond to a perceived threat.

In PTSD, the hippocampus may be damaged, so it cannot correctly record the memories that would defuse the amygdala’s fear response. In addition, communication between the prefrontal cortex and the amygdala may be impaired, so the rational response to stress doesn’t get through. The result is misidentification of threats and inappropriate fear responses. A similar mechanism may be at play in personality disorders, which could help explain the root of the disorders’ symptoms.

Dependent Personality Disorder Research

Title: Effectiveness of PTSD-treatment Compared to Integrated PTSD-PD-treatment in Adult Patients With Comorbid PTSD and CPD (PROSPER-C)

Stage: Recruiting

Principal investigator: Kathleen Thomaes, MD, PhD

Sinai Centre

Arkin, Netherlands 

Post-traumatic stress disorder (PTSD) is highly comorbid with personality disorders (PD), mainly borderline (BPD) and cluster C personality disorders (CPD). It is not clear yet what treatment is most effective for those who suffer both PTSD and PD. There is a growing preference in clinicians for evidence-based PTSD treatments, such as Eye Movement Desensitization and Reprocessing (EMDR) or Imagination and Rescripting (ImRs), because these treatments are relatively short, and there is some evidence that comorbid PD symptoms might resolve as well. However, at least 30-44% of PTSD patients do not sufficiently respond to PTSD treatments or are excluded because of suicidality or self-harm. PD treatments are more intensive than PTSD treatments, e.g., Dialectical Behavior Therapy (DBT) and Schema-Focused Therapy (SFT). There is some evidence that integrated PTSD-PD treatment is twice as effective as PD treatment alone. Still, integrated PTSD-PD treatment is not yet directly compared to PTSD treatment alone. This study will address this knowledge gap, including secondary outcome measures on functioning, quality of life, and cost-effectiveness.

For patients with comorbid PTSD and CPD, ImRs-only will be compared to integrated SFT-ImRs (PROSPER-C).

Psychological (cognitive, affective, and relational) and neurobiological candidate predictors and mediators of treatment outcome will be investigated through a machine-learning paradigm to develop a clinically useful and individual prediction instrument of treatment outcome. Example predictors and mediators are educational level, working memory, hyper- and hypo-arousal, therapeutic alliance and social support, resting-state fMRI, an emotional face task fMRI, cortisol levels from hair samples, and (epi)genetic markers.

For the neurobiological prediction, a subgroup of patients will undergo MRI scans, as will healthy controls as control subjects.

Title: Preventing Vulnerable Child Syndrome in the NICU With Cognitive Behavioral Therapy (PreVNT Trial) (PreVNT)

Stage: Recruiting

Principal investigator: Margaret K. Hoge, MD

UT Southwestern Medical Center

Dallas, TX 

The NICU is a stressful experience for parents. This stress naturally affects parents in different ways, ranging from feelings of depression, anxiety, or post-traumatic stress disorder (PTSD). While these feelings are very common in parents of NICU children, they can also impact the ways parents perceive their infants, which leads to alterations of parenting styles and exposure to developmental activities for growing infants. This phenomenon is well described in the literature as Vulnerable Child Syndrome (VCS) or Parent Perceived Child Vulnerability (PPCV) to illness. Traumatic events from earlier experiences in the NICU usually cause PPCV to occur. Examples of traumatic events include the feared death of the child, which leads to parent anxiety, depression, or emotional trauma. This altered perception of the child has been linked to worsened development outcomes for NICU children further into childhood and continued feelings of depression, anxiety, or fear in the parents and lack of confidence in their parenting abilities.

CBT sessions have been proven beneficial for NICU parents by decreasing depression, anxiety, and PTSD. However, there has not been research to see if CBT sessions are impactful for PPCV and the impacts it has on parent and child outcomes. Since literature suggests that depression, anxiety, and PTSD play an integral role in the development of PPCV and VCS, it could be assumed that CBT sessions should also be beneficial for PPCV and VCS. Therefore, this study will research if CBT sessions can improve parent-child interactions before and after discharge by helping parents better understand their child’s health and empowering them with confidence in parenting skills. It will also evaluate if the effects of the CBT sessions will remain present and beneficial for parents’ perceptions over time. With the results of this study, it will be evaluated if it is possible to improve the care for parents and children in the NICU and the long-term outcomes of parents and NICU children through CBT.

This will be a randomized control trial and will be conducted to assess the outcomes of infants and parents receiving either CBT sessions versus standard of care.

English and/or Spanish-speaking parents of infants born at 30.6 weeks gestational age (GA) or less who survive to 33 weeks GA will be eligible to participate in the study. Families will be approached at 33 weeks GA to participate in the study. Once enrolled, the mother (and father, if willing to participate) will be randomized into a control group (standard NICU and follow up care information) versus the intervention group (standard NICU and follow up care information plus a total of 5 CBT sessions split between the NICU and outpatient clinic visits post-discharge from NICU). The CBT sessions will address PPCV and VCS in parents and parenting skills to address preventing this. The CBT sessions will be standardized with a manual for study investigators to follow during sessions and made with Dr. Richard Shaw from Stanford University, who wrote the prior CBT manual for anxiety, depression, and PTSD for NICU parents. Study staff will be trained to give the standardized CBT sessions using the manual via pilot sessions. There will be 3 CBT sessions given in the Parkland NICU before discharge, and then 2 in the THRIVE follow-up clinic at Children’s Medical Center after discharge from the NICU.

Scales used for assessment will be distributed at enrollment to the study and upon completion of the CBT sessions.