DSMIV Diagnostic Criteria

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A pervasive and excessive need to be cared for. This need leads to submissive, clinging behavior, and fears of separation beginning by early adulthood and indicated by at least five of the following: 1. Difficulty making everyday decisions without excessive advice and reassurance

2. Needs others to assume responsibility for major areas of his life

3. Difficulty expressing disagreement with others and unrealistically fears loss of support or approval if he disagrees.

4. Difficulty initiating projects or doing things on his or her own, due to a lack of self-confidence in judgment or abilities.

5. Goes to excessive lengths to obtain nurturance and support, to the point of volunteering to do things that are unpleasant.

6. Uncomfortable or helpless when alone due to exaggerated fears of being unable to care for himself.

7. Urgently seeks another source of care and support when a close relationship ends.

8. Unrealistically preoccupied with fears of being left to take care of himself.

II. Clinical Features of Dependent Personality Disorders

A. Patients will endure great discomfort in order to perpetuate the care taking relationship.

B. Social interaction is usually limited to the caretaker network.

C. These patients may function at work if no initiative is required.

III. Epidemiology of Dependent Personality Disorders

A. Women are affected slightly more than men.

B. Childhood illness or separation anxiety disorder of childhood may be a premorbid condition.

IV.Differential Diagnosis of Dependent Personality Disorders

A. Avoidant Personality Disorder: Avoidant patients are more focused on avoiding shame and rejection rather than getting needs met. Some may meet criteria for both disorders.

B. Borderline Personality Disorder: Borderline patients react with rage and emptiness when feeling abandoned. Dependent patients react with more submissive behavior when feeling abandoned. Self-destructive behavior and unstable relationships are unique to Borderline patients.

C. Histrionic Personality Disorder

1. These patients are also needy and clinging, and they have a strong desire for approval, but these patients actively pursue almost any kind of attention.

2. They tend to be very flamboyant, unlike dependent patients.

D. Personality Change Due to a General Medical Condition and Substance-Related Disorder: Acute symptoms are temporally related to a medication, drugs or a medical condition. The long standing patterns of behavior required for a personality disorder are not present.

V. Treatment of Dependent Personality Disorders

A. Insight-oriented psychotherapy, group, and behavioral therapies such as assertiveness and social skills training have all been used with success. Family therapy may also be helpful in supporting new needs of the dependent patient in treatment.

B. Dependent patients are at increased risk for mood disorders and anxiety disorders. Appropriate pharmacological interventions may be used if the patient has these disorders.

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