Dependency and co-dependency are psychological catch phrases that seem to come up a lot these days. It is common to hear these terms in every day conversations about relationships.
But what is the actual psychiatric definition of a person who is dependent to the point of disorder? When does dependency change from being within the bounds of normal or even necessary human feeling and experience to being a treatable problem?
A person who has a dependent personality disorder expresses dependency in ways that are excessive, uncontrolled and maladaptive. In fact, dependent personality disorder is defined as the pervasive, excessive need to be taken care of – leading to submissive, clinging behaviour and fears of separation.
These fears and behaviours typically begin by early adulthood and show up in at least five areas.
Some of the ways these traits present themselves include: having difficulty making any decisions without excessive advice and reassurance; needing others to take responsibility for most areas of life; having a hard time expressing disagreement with others for fear of disapproval; difficulty initiating projects or activities because of poor self-confidence; going to excessive lengths to obtain care and support from others; or feeling uncomfortable or helpless when alone.
Dependent individuals might also urgently seek new relationships for support when another close relationship ends. Similarly, the dependent individual might be excessively preoccupied with the fear of being left to take care of him or herself in the event of losing a close relationship.
Basically, individuals with a dependent personality disorder often disregard their own personal needs and even tolerate mistreatment or abuse because they are unable to be self-assertive. A primary goal throughout life is to avoid offending or angering others at any cost. As a result, a person with this disorder often loses individuality and becomes self-deprecating, submissive and excessively apologetic.
Even when content in a relationship, the dependent person harbours an unrealistic fear of losing that relationship and being left alone.
Sometimes, dependent people overuse the health care system because of the attention and care they receive when visiting a doctor for a medical illness. Generally, they tend to be over-zealous and compliant with treatment and have a higher than average risk for medication abuse or overdose.
Dependent individuals are often more likely to experience either positive or negative placebo responses to medications.
As with most personality disorders, dependent personality disorder is difficult to treat.
Typically, those with this disorder are unlikely to seek treatment for it. It is possible they will seek treatment for depression or loss when a significant relationship comes to an end or may seek explanations for their lack of success in social and work situations.
There is no medication specifically designed for treating this disorder. Sometimes antidepressant medications can help to treat co-existing depression or anxiety, but should be used carefully because of the risk for abuse or overdose.
Behaviour therapy is generally the most effective treatment for dependent personality disorder and can be quite successful. In particular, assertiveness training can help individuals adjust their reactions to domineering or abusive relationships.
Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.
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