Individuals with dependent personality disorder may go to excessive lengths to obtain nurturance and support from others, even to the point of volunteering for unpleasant tasks if such behavior will bring the care they need (Criterion 5). They are willing to submit to what others want, even if the demands are unreasonable. Their need to maintain an im- portant bond will often result in imbalanced or distorted relationships. They may make ex- traordinary self—sacrifices or tolerate verbal, physical, or sexual abuse. (It should be noted that this behavior should be considered evidence of dependent personality disorder only when it can clearly be established that other options are available to the individual.) Indi- viduals with this disorder feel uncomfortable or helpless when alone, because of their ex— aggerated fears of being unable to care for themselves (Criterion 6). They will "tag along" with important others just to avoid being alone, even if they are not interested or involved in what is happening.
When a close relationship ends (e.g., a breakup with a lover; the death of a caregiver), in- dividuals with dependent personality disorder may urgently seek another relationship to provide the care and support they need (Criterion 7). Their belief that they are unable to function in the absence of a close relationship motivates these individuals to become quickly and indiscriminately attached to another individual. Individuals with this disorder are often preoccupied with fears of being left to care for themselves (Criterion 8). They see themselves as so totally dependent on the advice and help of an important other person that they worry about being abandoned by that person when there are no grounds to justify such fears. To be considered as evidence of this criterion, the fears must be excessive and unrealistic. For ex- ample, an elderly man with cancer who moves into his son’s household for care is exhibiting dependent behavior that is appropriate given this person’s life circumstances.
Individuals with dependent personality disorder are often characterized by pessimism and self—doubt, tend to belittle their abilities and assets, and may constantly refer to them- selves as “stupid.” They take criticism and disapproval as proof of their worthlessness and lose faith in themselves. They may seek overprotection and dominance from others. Oc— cupational functioning may be impaired if independent initiative is required. They may avoid positions of responsibility and become anxious when faced with decisions. Social re- lations tend to be limited to those few people on whom the individual is dependent. There may be an increased risk of depressive disorders, anxiety disorders, and adjustment dis- orders. Dependent personality disorder often co-occurs with other personality disorders, especially borderline, avoidant, and histrionic personality disorders. Chronic physical ill- ness or separation anxiety disorder in childhood or adolescence may predispose the indi- vidual to the development of this disorder.
Data from the 2001—2002 National Epidemiologic Survey on Alcohol and Related Condi- tions yielded an estimated prevalence of dependent personality disorder of 0.49%, and de- pendent personality was estimated, based on a probability subsample from Part II of the
National Comorbidity Survey Replication, to be 0.6%.
This diagnosis should be used with great caution, if at all, in children and adolescents, for whom dependent behavior may be developmentally appropriate.
The degree to which dependent behaviors are considered to be appropriate varies sub- stantially across different age and sociocultural groups. Age and cultural factors need to be considered in evaluating the diagnostic threshold of each criterion. Dependent behav— ior should be considered characteristic of the disorder only when it is clearly in excess of the individual’s cultural norms or reﬂects unrealistic concerns. An emphasis on passivity, politeness, and deferential treatment is characteristic of some societies and may be mis- interpreted as traits of dependent personality disorder. Similarly, societies may differen— tially foster and discourage dependent behavior in males and females.
In clinical settings, dependent personality disorder has been diagnosed more frequently in females, although some studies report similar prevalence rates among males and females.