Do you know someone, a friend, coworker, or relative, who you believe is in an unloving and unsupportive romantic relationship? Do you wonder why that individual would stay with someone who puts them down, takes no interest in his or her feelings, needs, and interests, and shows no compassion or respect? Have you wondered why that person doesn’t leave?

It could be he or she has dependent personality disorder (DPD). This is one of the most frequently diagnosed personality disorders, and while you would think it would be more common in women, it occurs just as frequently in men.

Those with DPD exhibit feelings of nervousness, fear, helplessness, submissiveness, and an intense need to be taken care of and reassured. They have difficulty making decisions and depend too much on others to meet their emotional and physical needs. Because those with DPD experience intense fear of separation and loss, they will go to great lengths, even suffering abuse (physical and emotional), to remain in or keep a relationship.

The cause of DPD is unknown; however, researchers believe it most likely involves both biological and developmental factors. Having an overprotective or authoritarian parent(s) can also contribute to the development of this disorder. DPD can appear as early as childhood; however, because childhood is a time when one must depend on others for their emotional and physical security and well-being, it is more difficult to make the diagnosis. As such, it is usually observed and diagnosed in early to middle adulthood.

According to the Diagnostic and Statistical Manual of Mental Disorders-IV-TR, a person is diagnosed with this disorder if he or she exhibits five out of these eight symptoms or characteristics:

• Difficulty making decisions without an excessive amount of advice and reassurance from others
• Needs others to assume responsibility for most major areas of his or her life
• Has difficulty expressing disagreement with others due to fear or loss of support or approval (this does not include realistic fears of retribution)
• Difficulty doing things independently due to lack of self-confidence
• Goes to excessive lengths to obtain nurturance and support from others
• Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself/herself
• Urgently seeks another relationship as a source of care and support when a close relationship ends
• Unrealistically preoccupied with fears of being left to take care of himself/herself

Psychotherapy (counseling) is the main method of treatment for DPD. The goal of therapy is to help the person with DPD become more active and independent, and to learn to form healthy relationships. Specific strategies might include assertiveness training to help the individual with DPD develop self-confidence or cognitive behavioral therapy to help the person examine faulty cognitions and related emotions.

When a person with DPD seeks out treatment, it is usually not due to the disorder itself but due to the thinking and behaviors associated with the disorder. Anxiety disorders (including panic attacks), depression, phobias, relationship difficulties, and/or coping with everyday stresses are typically the presenting problem. As such, it usually takes some time before a therapist can accurately diagnose this disorder. When the person’s symptoms of depression and/or anxiety are interfering with day-to-day functioning, the use of medication may be added to the treatment plan.

Because the main characteristic of someone with DPD is dependency on others, the therapist must be hyperalert to this dynamic and be sure not to be just another caregiver in the person’s life. When a person with DPD is faced with decisions, the goal of therapy is to help him or her explore all the possible options, weight the positives and negatives of each one, and empower him or her to make the best decisions and lifestyle choices. Decisions made independently by the individual with DPD should be highlighted and celebrated in the treatment. Over time, this will lead to more independence on the part of the person with DPD.

In addition, it is extremely vital for the therapist to help the person with DPD understand that the feelings of anxiety, panic, and depression that lead to the initiation of therapy is a direct result of his or her significant dependency needs. This connection of the feelings to the main factors associated with DPD is extremely therapeutic. Having awareness, insight, and knowledge about oneself is a strong ally on the road to change and healing.

Although prevention of DPD might not be possible, treatment can help an individual who is prone to this disorder learn more productive ways of dealing with situations. Therapy is a gradual process with the focus on increasing self-esteem and self-confidence, while empowering the person to make decisions that increase physical and psychological well-being.

When someone realizes that the choices and decisions he or she has made have led to positive outcomes, he or she will begin to feel more confident in the ability to care for him- or herself. This experience and insight can open the door to a future of healthy and loving relationships; not just with others, but also with oneself.