Dependent personality disorder

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Classification according to ICD-10
F60.7 Dependent personality disorder
ICD-10 online (WHO version 2019)

The dependent personality disorder is characterized by excessive separation fears , clinging behavior, low self-esteem and a depressive mood . Additionally typical for this personality disorder are a lack of assertiveness and little initiative. The incidence in the population is estimated to be less than 1% percent. Other names for the disorder are also dependent or asthenic personality disorder.

Affected people feel weak, helpless and incompetent, which is why they often let others decide for them. They appear passive, submissive and clingy to others. For fear of being abandoned, they often do not express your own opinion. In contrast to people with anxious- avoidant personality disorder, however , the focus is on the need to be cared for .

description

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A basic problem of the dependent personality (DP) is that there is hardly any tolerance for ambiguity . DP have very little relation to themselves; thus there is a lack of willpower. DPs often copy the will of others and place them where their own will is required. The DP is not concerned with the social, emotional bond with a person or with certain groups of people, but basically it is about objects, it is about a means of finding an opinion. An emotional bond often does not extend beyond that of a child.

This clearly indicates a shock in childhood, in which the subject had to adapt to a situation to which it was cognitively unable to cope (e.g. sexual, physical or emotional abuse, assumption of adult roles, etc.). One form of the so-called self defense mechanisms is the separation from oneself in certain moments and situations. Often it is a form of persistent humiliation that the person concerned tries to avoid or, better, to endure by splitting off as a form of defense against the ego. DP often describe a state of "drifting away."

DP is often a secondary diagnosis of people with what is known as a borderline personality . Relationships are often intense but unstable. This is because the DP leads a completely different aspect of the relationship to the partner than the other way around. The DP is more or less indifferent to who the partner is, because he is not perceived as a subject, but becomes an object and guarantor of security (similar to how a shipwrecked person does not care which beach he is washed up on). Initiative is constantly required from the partner where there definitely cannot and will not be any initiative. All behaviors that result from this are symptomatic of a "higher rank" personality disorder. These relationships very soon become unstable because there is no real interest in the subject and there is therefore hardly any sensitivity to the interests and sensitivities of the other person.

A distinction is made between two different interaction patterns within the dependent personality disorder:

  • active-dependent interaction pattern. The variant, more closely linked to effort, is above all lively, socially adapted and charming. There is a tendency towards dramatic emphasis on emotions.
  • passive-dependent interaction pattern. This variant is characterized by submissiveness, a need for tenderness and little adaptation.

Classification and diagnosis

Diagnostic procedures

Clinical interviews such as the Structured Clinical Interview for DSM-Axis II (SKID-II) and the International Personality Disorder Examination (IPDE) are suitable for establishing a diagnosis .

People with a dependent personality disorder often have no insight into the disease at the beginning and often do not seek psychological help of their own free will. Instead, they usually follow urging from loved ones. For this reason and because of the symptomatic fear of rejection, an external assessment (e.g. by a partner or family members) should also be included in the diagnosis.

In the ICD-10

Green Belt: Research Criteria

The following diagnostic criteria for dependent (asthenic) personality disorder were developed in the ICD-10 (F 60.7) (FN02):

A. The general criteria for personality disorder (F60) must be met. At least four of the following characteristics or behaviors must be present:

  1. Encouraging or allowing others to make the most important decisions in life
  2. Subordination of own needs to those of other people on whom there is a dependency and disproportionate indulgence to their wishes
  3. Unwillingness to express reasonable claims against people on whom one depends
  4. Feeling uncomfortable when they are alone, due to an exaggerated fear of not being able to take care of themselves.
  5. Frequent preoccupation with the fear of being abandoned and of being dependent on oneself
  6. Impaired ability to make day-to-day decisions without much advice and confirmation from others.

Blue ribbon: Clinical diagnostic guidelines

Dependent (asthenic) personality disorder (F60.7) is a personality disorder with the following characteristics:

  1. Leaving responsibility for important areas of one's life to others.
  2. Subordination of own needs to those of others who are dependent on them and disproportionate indulgence to the wishes of others.
  3. Unwillingness to express reasonable claims against persons on whom there is a dependency.
  4. Perceiving oneself as helpless, incompetent and weak.
  5. Frequent fears of abandonment and constant need to make sure of the opposite; very uncomfortable feelings when alone.
  6. Experience of inner destruction and helplessness in ending a close relationship.
  7. In the event of mishap, these people tend to pass the responsibility on to others.

In the DSM-5

The following diagnostic criteria for dependent personality disorder were developed in the DSM-5 :

A deep and overpowering need to be cared for that leads to submissive, clingy behavior and separation fears. It starts in early adulthood, and the pattern shows up in different situations.

At least five of the following criteria must be met:

  1. Has difficulty making day-to-day decisions without extensive advice and approval from others.
  2. Needs others to take responsibility for his / her most important areas of life.
  3. Has difficulty disagreeing with other people for fear of losing support and approval. (Note: realistic fears of punishment are not considered here.)
  4. Has difficulty starting activities himself or doing things independently (more due to a lack of confidence in his or her own judgment or abilities than a lack of motivation or energy),
  5. Does everything imaginable to receive the care and attention of others up to and including voluntarily taking on unpleasant activities.
  6. Feeling uncomfortable alone or helpless from an exaggerated fear of not being able to take care of yourself.
  7. Urgently seek another relationship as a source of care and support when a close relationship ends.
  8. Is filled with fears of being abandoned and having to take care of yourself in an unrealistic way.

literature

  • Christopher Trouw: Depression and Dependent Personality Disorder. Process analysis of the therapeutic relationship in the context of inpatient group psychotherapy . Cuvillier, Göttingen 1998, ISBN 3-89712-081-X .

Individual evidence

  1. ↑ a b Peter Falkai, Hans-Ulrich Wittchen (ed.): Diagnostic and statistical manual of mental disorders DSM-5 . Hogrefe, Göttingen 2015, ISBN 978-3-8017-2599-0 , pp. 926-931 .
  2. ↑ a b Peter Fiedler: Personality disorders . In: Hans-Ulrich Wittchen & Jürgen Hoyer (Eds.): Clinical Psychology & Psychotherapy . 2nd revised and expanded edition. Springer, Berlin Heidelberg 2011, p. 1101-1121 .
  3. ↑ DocCheck Medical Services GmbH: Asthenic Personality Disorder - DocCheck Flexikon. Retrieved August 9, 2017 .