Mental health articles

dependent personality disorder symptoms According to the DSM-IV-TR (American
Psychiatric Association, 2000, p. 721), dependent personality disorder (DPD),
one of the most prevalent disorders reported in mental health settings, is characterized
by “a pervasive and excessive need to be taken care of that leads to
submissive and clinging behaviors and fears of separation.” With these college
students, parents may decide what college to attend, what major to pursue,
and even what courses to select. But these students feel unprepared not only to
make these decisions, but also to decide where and with whom to eat and how
to spend their time. Lacking any confi dence in their decision-making skills,
these students look to others to take care of them and make their decisions.

Jodi, a sophomore who looks younger than her stated age, has come to
the counseling center feeling devastated because her boyfriend, Tom,
has broken up with her. Th ey met at orientation last year and did everything
together. She tried to please Tom by becoming involved in his
hobbies and interests, and always had him review her academic work
and approve of her decisions. When he broke up with her, Tom said that
Jodi was too needy and suff ocating and should go for help. Jodi wanted
to go home but her parents were opposed to the idea. Feeling stuck and
unsure, she predictably asks the therapist what she should do.

One temptation when working with these students is to take control, give
advice, and become the authority in response to the underlying message of “Help me, and I will do exactly what you say. I will please you” (Millon et al., 2000,
p. 231). Although therapy can helpfully become a safe haven for these students,
they also need to become more independent, maintain healthy relationships without
being submissive, and ultimately not depend on therapy. Th e therapist must
overtly state these goals in the beginning of treatment and explore the student’s
fears of abandonment.
Another temptation is to respond to their fear of rejection and abandonment
with reassuring statements. Far better is to explore these fears and their
connection to signifi cant interpersonal relations (Birtchnell & Borgherini,
1999). Having the student understand healthy dependence or the concept of
interdependence also can be useful.
Procedures about emergencies and extra contacts such as advice-seeking
phone calls or e-mails should be discussed early in treatment. More frequent
appointments may be necessary if the student presents too many crises. Since
many counseling centers cannot provide more than one weekly session, someone
like Jodi might need to be referred to an off -campus provider, taking care,
of course, to make a smooth transition.
Although no controlled outcome studies exist (Crits-Christoph & Barber,
2004), an interpersonal approach seems appropriate due to these students’
attachment and dependency issues. Th is approach helps students to understand
their interactive patterns, including underlying reinforcements, and
then to decide if change is desired; the therapist provides support and a feeling
of safety so that clients can manage their anxiety. One approach utilizes a time
limit, making clear the exact number of sessions at the outset, so students can form a quick therapeutic alliance, concentrate on a circumscribed focus, and not regress or act out (Luborsky, 1984).
If a student with DPD has only mild to moderate impairment, an ongoing
interpersonal therapy group might be indicated. With severe cases, assertiveness
training, decision-making training, or a supportive problem-solving or
social skills group might be helpful. Group therapy as an adjunct to individual
treatment helps students recognize that there are many people who can be
relied upon for support. Involvement in an ongoing group also may decrease
the chance of relapse following the termination of individual therapy. Th ere
are no pharmacological treatment studies for DPD per se, but medication can be used if panic attacks emerge.

Tags: disorder, Personality Disorder, symptom