The Neglected Disorder


The DSM-5 has classified dependent personality disorder (DPD) as a pattern of submissive and clinging behavior related to an excessive need to be taken care of. This can lead to significant impairment in their interpersonal relationships and their ability to function in society. They are characterized as having difficulty making choices without assurance and their need for assistance goes beyond what is considered age and situation appropriate (American Psychiatric Association, 2013). They take criticism and disapproval as evidence of their unworthiness (Schoenleber, 2010). They are often afraid of losing the support of the others and will often have difficulties expressing their opinions or emotions to others and may perform unreasonable acts in order to keep them around (American Psychiatric Association, 2013).

The illness is prevalent in less than 1% of the general population (Bressert, 2016). There is little information regarding its distribution across cultures but has been argued to affect men and women equally. Those with DPD are believed by psychologists to be one of the easiest patients to handle. Although they are seen as needy and anxious, they are also viewed as compliant, insightful, and conscientious. This leads clinicians to perceive this illness as “low risk,” when, in actuality, DPD adults have been shown to have an increased risk of possessing physical illnesses and are also more likely to remain in an abusive relationship, engage in self-harm, and commit suicide than their non-DPD counterparts (Bornstein, 2012).

DPD is among the most under researched mental illnesses despite its presence in the past 32 years. The research conducted on DPD is often qualitative, methodologically flawed, anecdotal, and has received little attention. Much of the studies regarding DPD have been done based on the information provided in the DSM-3, but since the description of the disorder is still changing, this information is not completely valid. It has also been difficult to find a treatment option for those with DPD that will have a moderate or strong effect (Disney, 2013).

In 2009, reports of dissatisfaction regarding the criteria in the DSM-4 were made by the International Society for the Study of Personality Disorders (ISSPD). Members stated that the diagnostic model lacked proper general coverage and information and “poor discriminant validity.” The DSM-5 Personality and Personality Disorders Work Group worked to remove some of the personality disorders listed in the DSM-4 from its classification based on their level of clinical utility and quality of information regarding the disorders (Pull, 2013). This recommendation was also argued on the basis that deleting these personality disorders would reduce the level of comorbidity between them and other disorders. However, research was conducted at the Rhode Island Hospital on 2,150 psychiatric outpatients with more than 25% having a personality disorder included in the DSM-4. When removing the five disorders 59 patients could no longer be diagnosed, displaying the ineffectiveness of this recommendation (Zimmerman et al., 2011). It was decided that disorders that possessed modest clinical relevance and low levels of functional impairment would be deleted (Bornstein, 2012). Dependent personality disorder did not fit this criteria and was included in the DSM-5.

Psychologist Robert Bornstein had argued that DPD has adequate clinical purpose and its frequency warrants it a distinct personality disorder category in DSM-5. DPD has been also shown to help predict the risk of attempted suicide, child abuse, and compliance in children, adolescents, young adults and old adults. The rate of DPD diagnoses in inpatient and outpatient was also comparable to that of the majority of personality disorders that were proposed for retention (Bornstein, 2012).

Dependency is a part of the human experience and we have all developed it at some point in our lives. Once it begins to inhibit a person’s ability to function, it begins to pose as a risk. Greater focus and availability of information regarding other mental illnesses such as depression, borderline personality disorder, and obsessive compulsive disorder allows those who possess them to become more understood. However, those with dependent personality disorder will continue to be misunderstood as long as research and knowledge regarding the disorder is scarce.

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Bornstein RF. (2012) From dysfunction to adaptation: an interactionist model of dependency. Annu Rev Clin Psychol 2012; 8:291–316.

Bressert, S. (2016). Dependent Personality Disorder Symptoms | Psych Central. Retrieved September 23, 2016, from http://psychcentral.com/disorders/dependent-personality-disorder-symptoms/

Disney, K. L. (2013). Dependent personality disorder: A critical review. Clinical Psychology Review, 33(8), 1184-1196. doi:10.1016/j.cpr.2013.10.001

Pull, C. (2013). Too few or too many? Reactions to removing versus retaining specific personality disorders in DSM-5. Current Opinion In Psychiatry, 26(1), 73-78. doi:10.1097/YCO.0b013e32835b2cb5

Schoenleber, M., & Berenbaum, H. (2010). Shame aversion and shame-proneness in Cluster C personality disorders. Journal Of Abnormal Psychology, 119(1), 197-205. doi:10.1037/a0017982

Zimmerman, M., Chelminski, I., Young, D., Dalrymple, K., & Martinez, J. (2011). Does DSM-IV Already Capture the Dimensional Nature of Personality Disorders? The Journal of Clinical Psychiatry, 72(10), 1333-1339. doi:10.4088/jcp.11m06974


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