Dependent Personality Disorder

DEPENDENT PERSONALITY DISORDER

Clinical Picture

Dependent personality disorder is characterized by a per-vasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. These behaviors are designed to elicit caretaking from others. The disorder occurs in as much as 15% of the pop-ulation and is seen three times more often in women than in men. It runs in families and is most common in the youngest child. People with dependent personality disor-der often seek treatment for anxious, depressed, or somatic symptoms (APA, 2000).

Clients are frequently anxious and may be mildly uncomfortable. They are often pessimistic and self-critical; other people hurt their feelings easily. They commonly report feeling unhappy or depressed; this is associated most likely with the actual or threatened loss of support from another. They are preoccupied exces-sively with unrealistic fears of being left alone to care for themselves. They believe they would fail on their own, so keeping or finding a relationship occupies much of their time. They have tremendous difficulty making decisions, no matter how minor. They seek advice and repeated reassurances about all types of decisions, from what to wear to what type of job to pursue. Although they can make judgments and decisions, they lack the confidence to do so.

Clients perceive themselves as unable to function outside a relationship with someone who can tell them what to do. They are very uncomfortable and feel help-less when alone, even if the current relationship is intact. They have difficulty initiating projects or com-pleting simple daily tasks independently. They believe they need someone else to assume responsibility for them, a belief that far exceeds what is age or situation appropriate. They may even fear gaining competence because doing so would mean an eventual loss of sup-port from the person on whom they depend. They may do almost anything to sustain a relationship, even one of poor quality. This includes doing unpleasant tasks, going places they dislike, or, in extreme cases, tolerat-ing abuse. Clients are reluctant to express disagreement for fear of losing the other person’s support or approval; they may even consent to activities that are wrong or illegal to avoid that loss.

When these clients do experience the end of a relation-ship, they urgently and desperately seek another. The unspoken motto seems to be “Any relationship is better than none at all.”

Nursing Interventions

The nurse must help clients to express feelings of grief and loss over the end of a relationship while fostering auton-omy and self-reliance. Helping clients to identify their strengths and needs is more helpful than encouraging the overwhelming belief that “I can’t do anything alone!” Cog-nitive restructuring techniques such as reframing and decatastrophizing may be beneficial.

Clients may need assistance in daily functioning if they have little or no past success in this area. Included are such things as planning menus, doing the weekly shopping, budgeting money, balancing a checkbook, and paying bills. Careful assessment to determine areas of need is essential. Depending on the client’s abilities and limitations, referral to agencies for services or assistance may be indicated.

The nurse also may need to teach problem-solving and decision-making and help clients apply them to daily life. He or she must refrain from giving advice about problems or making decisions for clients even though clients may ask the nurse to do so. The nurse can help the client to explore problems, serve as a sounding board for discus-sion of alternatives, and provide support and positive feed-back for the client’s efforts in these areas.