Dependent Personality Disorder Treatment
According to the DSM-5, individuals with dependent personality disorder (DPD) have “a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation.” They have a hard time making everyday decisions without first seeking a lot of advice and reassurance from others. They need people to assume responsibility for most areas of their lives.
Individuals with DPD might be unable to express a differing opinion because they’re afraid of losing support or approval. They lack self-confidence in their judgment and abilities, so they have difficulty starting projects or doing anything on their own. They are hyper-sensitive to criticism. They feel uncomfortable or helpless when they’re alone. When a close relationship ends, they immediately seek another relationship to serve as a source of care and support.
DPD commonly co-occurs with depression and anxiety disorders, and has some overlap with avoidant personality disorder.
Even though it’s one of the most commonly diagnosed personality disorders and has been in the DSM for almost four decades, DPD hasn’t received much attention in the research literature. Also, Division 12 of the American Psychological Association, which identifies treatments with strong or moderate research support, doesn’t include a treatment for DPD.
However, psychotherapy is absolutely the mainstay of treatment, and people with DPD can learn to cultivate healthier relationships with others—and with themselves.
Research on psychotherapy for dependent personality disorder (DPD) is scarce, and there’s very little recent data. Earlier studies tended to combine DPD with other cluster C personality disorders (avoidant personality disorder and obsessive-compulsive personality disorder).
A 2009 meta-analysis on all three cluster C personality disorders found that social skills training, cognitive behavioral therapy, and psychodynamic interventions were effective.
For example, social skills training (SST) teaches individuals to understand verbal and non-verbal cues during interactions, carry on a conversation, and communicate in an assertive way. It might include techniques such as modeling, role playing, and receiving feedback. SST is typically added to other types of therapy.
Cognitive behavioral therapy (CBT) can help individuals with DPD shift how they think about themselves and their abilities, along with challenging and changing other damaging longstanding beliefs. It can help individuals become more independent and build their self-confidence.
A 2013 review article noted that DPD is often treated with cognitive therapy, which also emphasizes changing distorted, unhelpful thoughts: “CT may be particularly effective for DPD because it can focus on patients’ beliefs about themselves, as well as their fear of being judged.” It can “focus on restructuring cognitions of the self as weak and ineffectual.”
However, according to the same article, others have noted that integrated approaches might be more effective, because they “might be better able to capture the complexity of DPD, as they conceptualize the individual from multiple perspectives.”
In 2014, a large multi-site randomized controlled trial explored the effectiveness of schema therapy (ST), clarification-oriented psychotherapy, and treatment as usual for individuals with a broad range of personality disorders, including DPD. ST emerged as the most effective treatment, and had the lowest drop-out rate.
ST integrates cognitive, behavioral, experiential, and interpersonal techniques. It theorizes that individuals have various schemas (core themes or patterns that we repeat throughout our lives) and coping styles that can either be adaptive or maladaptive. ST aims to heal maladaptive schemas, weaken unhealthy coping types, and to strengthen healthy coping styles.
ST emphasizes limited re-parenting, where the therapist partly meets the client’s unmet childhood needs (within healthy therapy boundaries). For example, a therapist offers praise, provides a safe attachment, and sets limits. ST also includes psychoeducation about core needs and functional and dysfunctional behavior.
In addition, a mindfulness-based approach might be a promising intervention for DPD. In 2015, a preliminary randomized controlled study found that a 5-session mindfulness-based therapy was effective for maladaptive interpersonal dependency (MID).
MID is a personality syndrome that plays a significant role in DPD (and other disorders, such as depression, social anxiety, substance use, and borderline personality disorder). MID is characterized by the propensity to rely on others for guidance, support, and reassurance. Individuals see themselves as weak and helpless, and others as strong and powerful. They fear negative evaluation and being abandoned. They’re also passive and submissive.
The mindfulness-based approach incorporated techniques that helped dependent individuals to appreciate themselves and value their internal experiences. Specifically, they learned to become more mindful of their thoughts, emotions, and interpersonal interactions. For instance, mindfulness can help individuals realize that thoughts such as “I’m helpless” or “I’m weak” are just thoughts and not true-blue facts about who they are.
According to a 2018 report from SANE Australia, the goals of treating DPD in psychotherapy “may include promoting self-expression, assertiveness, decision-making and independence.”
Medication typically isn’t prescribed to treat dependent personality disorder (DPD), and no medication has been approved by the U.S. Food and Drug Administration. Medication is generally prescribed for co-occurring disorders, such as depression and anxiety disorders.
Therapy is the best treatment for dependent personality disorder (DPD). The below suggestions can complement therapy (or help while you’re waiting to see a therapist), depending on the severity of the disorder.
Engage in solo activities. Get used to enjoying your own company. Think about activities that you really enjoy doing, and participate in them on a regular basis. This might be anything from taking a restorative yoga class to meditating for 10 minutes to reading in a coffee shop during your lunchbreak.
Develop your own interests. Similarly, think about what hobbies you’d like to pursue. What would you like to learn about? What brought you joy as a child? What subjects did you gravitate toward in school? What sounds interesting?
Start supporting your independence. Think about small responsibilities you can start taking on. For example, begin by creating a list of things you currently don’t do but someone else does for you. Then identify one small task you can take on. Consider this as an opportunity to grow, learn, sharpen your skills, and build confidence.
Cultivate a healthy relationship with yourself. There are many ways to do this, but you might start with small gestures, such as: giving yourself a compliment (about anything); practicing a self-compassionate meditation; getting some rest; getting enough sleep; and naming one thing you like about yourself. (Here are 22 additional suggestions.)
Check out additional resources. It can help to find books and workbooks on navigating excessive dependency. For example, here’s a book to check out: Dependent Personality Disorder Cognitive Behavioral Therapy Self-Help Guide. Also, ask your therapist for recommendations.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Bamelis, L.L., Evers, S.M., Spinhoven, P., Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171, 3, 305-322. DOI: 10.1176/appi.ajp.2013.12040518.
Carrotte, E, and Blanchard, M. (2018, June). Understanding how best to respond to the needs of Australians living with personality disorder. Melbourne. Prepared by SANE Australia for the National Mental Health Commission. Retrieved from https://www.sane.org/images/NMHC_SANE_PD_Report.pdf.
Disney, K.L. (2013). Dependent personality disorder: A critical review. Clinical Psychology Review, 33, 8, 1184-1196. DOI: https://doi.org/10.1016/j.cpr.2013.10.001.
Dixon-Gordon, K.L., Turner, B.J., Chapman, A.L. (2011). Psychotherapy for personality disorders. International Review of Psychiatry, 23, 282-302. DOI: 10.3109/09540261.2011.586992.
McClintock, A.S., Anderson, T. (2015). The application of mindfulness for interpersonal dependency: Effects of a brief intervention. Mindfulness, 62, 2, 243-252. DOI: http://dx.doi.org/10.1007/s12671-013-0253-3.
McClintock, A.S., Anderson, T., Cranston, S. (2015). Mindfulness therapy for maladaptive interpersonal dependency: A preliminary randomized controlled trial. Behavior Therapy, 46, 856-868. DOI: 10.1016/j.beth.2015.08.002.
Simon, W. (2009). Follow-up psychotherapy outcome of patients with dependent, avoidant and obsessive–compulsive personality disorders: A meta-analytic review. International Journal of Psychiatry in Clinical Practice, 13, 2, 153–165. DOI: 10.1080/13651500802570972.
Tartakovsky, M. (2020). Dependent Personality Disorder Treatment. Psych Central. Retrieved on September 24, 2020, from https://psychcentral.com/disorders/dependent-personality-disorder/treatment/