Dependent personality disorder
Dependent personality disorder (DPD) is characterized in the DSM-5 by an excessive and pervasive need to be taken care of, leading to submissive and clinging behavior and fear of separation. Criteria include difficulty making everyday decisions without excessive advice and reassurance, need for others to assume responsibility for major areas of one's life, difficulty expressing disagreement due to fear of loss of support, difficulty initiating projects independently due to lack of confidence, excessive efforts to obtain support from others, discomfort when alone due to exaggerated fear of being unable to care for oneself, urgent seeking of a new relationship when one ends, and preoccupation with being left to take care of oneself.
From the perspective of attachment theory, DPD can be understood as an extreme manifestation of an anxious-preoccupied attachment style. The dependent individual has internalized a model of the self as incapable and incompetent, and a model of others as necessary for emotional survival. Bowlby described how early experiences with inconsistent caregivers — present but not reliably responsive — can generate hyperactivation of the attachment system, resulting in constant seeking of proximity and reassurance. Comorbidity in DPD is high: major depression (up to 50%), anxiety disorders, social phobia, and other personality disorders (especially avoidant and borderline) frequently coexist.
Treatment of DPD requires a delicate balance: the therapeutic relationship itself can reproduce the dependent pattern if the therapist is not vigilant. Cognitive-behavioral therapy works to identify and challenge core beliefs of incompetence and helplessness, gradually increase autonomous decision-making, and develop assertiveness skills. Psychodynamic psychotherapy explores the roots of the pattern in early attachment experiences, working toward a progressive internalization of the capacity for self-care. Group therapy can be especially useful for practicing assertiveness and experiencing that relationships can survive disagreement and independence.