Other mental disorders and medical conditions. Dependent personality disorder must be distinguished from dependency arising as a consequence of other mental disorders (e.g., depressive disorders, panic disorder, agoraphobia) and as a result of other medical conditions.
Other personality disorders and personality traits. Other personality disorders may be confused with dependent personality disorder because they have certain features in com- mon. It is therefore important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet cri- teria for one or more personality disorders in addition to dependent personality disorder, all can be diagnosed. Although many personality disorders are characterized by dependent features, dependent personality disorder can be distinguished by its predominantly submis- sive, reactive, and clinging behavior. Both dependent personality disorder and borderline personality disorder are characterized by fear of abandonment; however, the individual with borderline personality disorder reacts to abandonment with feelings of emotional emp- tiness, rage, and demands, whereas the individual with dependent personality disorder re- acts with increasing appeasement and submissiveness and urgently seeks a replacement relationship to provide caregiving and support. Borderline personality disorder can further be distinguished from dependent personality disorder by a typical pattern of unstable and intense relationships. Individuals with histrionic personality disorder, like those with de- pendent personality disorder, have a strong need for reassurance and approval and may ap- pear childlike and clinging. However, unlike dependent personality disorder, which is characterized by self-effacing and docile behavior, histrionic personality disorder is charac- terized by gregarious ﬂamboyance with active demands for attention. Both dependent personality disorder and avoidant personality disorder are characterized by feelings of in- adequacy, hypersensitivity to criticism, and a need for reassurance; however, individuals with avoidant personality disorder have such a strong fear of humiliation and rejection that they withdraw until they are certain they will be accepted. In contrast, individuals with de- pendent personality disorder have a pattern of seeking and maintaining connections to im- portant others, rather than avoiding and withdrawing from relationships.
Many individuals display dependent personality traits. Only when these traits are in- ﬂexible, maladaptive, and persisting and cause significant functional impairment or sub— jective distress do they constitute dependent personality disorder.
Personality change due to another medical condition. Dependent personality disor- der must be distinguished from personality change due to another medical condition, in which the traits that emerge are attributable to the effects of another medical condition on the central nervous system.
Substance use disorders. Dependent personality disorder must also be distinguished from symptoms that may develop in association with persistent substance use.
Diagnostic Criteria 301.4 (F60.5)
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and in- terpersonal control. at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts. as indicated by four (or more) of the following: 1. Is preoccupied with details. rules. lists, order, organization, or schedules to the extent that the major point of the activity is lost.
2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.
6. Is reluctant tb delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
8. Shows rigidity and stubbornness.