DSM-II

In DSM-II, this disorder is called Asthenic personality

This behavior pattern is characterized by easy fatigability, low energy level, lack of enthusiasm, marked incapacity for enjoyment, and oversensitivity to physical and emotional stress. This disorder must be differentiated from Neurasthenic neurosis.

DSM-III

Diagnostic Criteria

The following are characteristic of the individual's current and long-term functioning, are not limited to episodes of illness, and cause either significant impairment in social or occupational functioning or subjective distress.

A. Passively allows others to assume responsibility for major areas of life because of inability to function independently (e.g., lets spouse decide what kind of job he or she should have).

B. Subordinates own needs to those of persons on whom he or she depends in order to avoid any possibility of having to rely on self, e.g., tolerates abusive spouse.

C. Lacks self-confidence, e.g., sees self as helpless, stupid.

Differential Diagnosis

Agoraphobia

In Agoraphobia, dependent behavior is common, but the individual is more likely to actively insist that others assume responsibility, whereas in Dependent Personality Disorder, the individual passively maintains a dependent relationship.

DSM-IV

Diagnostic Criteria

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
  2. needs others to assume responsibility for most major areas of his or her life
  3. has difficulty expressing disagreement with others because of fear of loss of support or approval. Note: Do not include realistic fears of retribution.
  4. has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy)
  5. goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant
  6. feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself
  7. urgently seeks another relationship as a source of care and support when a close relationship ends
  8. is unrealistically preoccupied with fears of being left to take care of himself or herself

Differential Diagnosis

Other mental disorders and general medical conditions

Dependent Personality Disorder must be distinguished from dependency arising as a consequence of other mental disorders (e.g., Mood Disorders, Panic Disorder, and Agoraphobia) and as a result of general medical conditions. Dependent Personality Disorder has an early onset, chronic course, and a pattern of behavior that does not occur exclusively during another disorder.

Other Personality Disorders

Other Personality Disorders may be confused with Dependent Personality Diosrder because they have certain features in common. 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 criteria 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 submissive reactive, and clinging behavior.

Borderline Personality Disorder

Both Dependent Personality Disorder and Borderline Personality Disorder are characterized by fear of abandonment; however, the individual with emptiness, rage, and demands, whereas the individual with Dependent Personality Disorder reacts 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.

Histrionic Personality Disorder

Individuals with Histrionic Personality Disorder, like those with Dependent Personality Disorder, have a strong need for reassurance and approval and may appear childlike and clinging. However, unlike Dependent Personality Disorder, which is characterized by self-effacing and docile behavior, Histrionic Personality Disorder is characterized by gregarious flamboyance with active demands for attention.

Avoidant Personality Disorder

Both Dependent Personality Disorder and Avoidant Personality Disorder are characterized by feelings of inadequacy, 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 Dependent Personality Disorder have a pattern of seeking and maintaining connections to important others, rathe than avoiding and withdrawing from relationships.

Personality Change Due to a General Medical Condition and symptoms related to substance use

Dependent Personality Disorder must be distinguished from Personality Change Due to a General Medical Condition, in which the traits emerge due to the direct effects of a general medical condition on the central nervous system. It must also be distinguished from symptoms that may develop in association with chronic substance use (e.g., Cocaine-Related Disorder Not Otherwise Specified).

Normal personality traits

Many individuals display dependent personality traits. Only when these traits are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress do they constitute Dependent Personality Disorder.

 DSM-5

Diagnostic Criteria

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
  2. Needs others to assume responsibility for most major areas of his or her life.
  3. Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)
  4. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgement or abilities rather than a lack of motivation or energy).
  5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
  6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
  7. Urgently seeks another relationship as a source of care and support when a close relationship ends.
  8. Is unrealistically preoccupied with fears of being left to take care of himself or herself.

Differential Diagnosis

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

Other personality disorders may be confused with dependent personality disorder because they have certain features in common. 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 criteria 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 submissive, reactive, and clinging behavior.

Borderline personality disorder

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 emptiness, rage, and demands, whereas the individual with dependent personality disorder reacts 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.

Histrionic personality disorder

Individuals with histrionic personality disorder, like those with dependent personality disorder, have a strong need for reassurance and approval and may appear childlike and clinging. However, unlike dependent personality disorder, which is characterized by self-effacing and docile behavior, histrionic personality disorder is characterized by gregarious flamboyance with active demands for attention.

Avoidant personality disorder

Both dependent personality disorder and avoidant personality disorder are characterized by feelings of inadequacy, 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 dependent personality disorder have a pattern of seeking and maintaining connections to important others, rather than avoiding and withdrawal from relationships.

Other personality traits

Many individuals display dependent personality traits. Only when these traits are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress do they constitute dependent personality disorder.

Personality change due to another medical condition

Dependent personality disorder 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.

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