Dependence Personality Disorder

Diagnostic criteria: Excessive need for care and submission.

The central feature of this disorder is a pervasive and excessive need to be cared for, leading to submissive, clingy behavior and intense fears of separation.

For diagnosis, this pattern must be chronic and manifest in a variety of contexts.

The person has remarkable difficulty making day-to-day decisions without an excessive amount of advice and reassurance from others; they cannot decide what to wear or what menu to choose without validation from a third party.

They need others to take responsibility for major areas of their life, delegating decisions about housing, employment or friendships.

They have immense difficulty expressing disagreement with others for fear of losing their support or approval, going so far as to agree with things they know are wrong just to avoid being rejected.

They have difficulty initiating projects or doing things on their own because of a lack of confidence in their own judgment, not because of a lack of energy.

They may volunteer for unpleasant tasks in order to get care and support, and feel uncomfortable or helpless when they are alone because of an exaggerated fear of being unable to care for themselves.

Relationship dynamics and vulnerability to abuse

The relational dynamics of these individuals are marked by urgency and submission.

When a close relationship ends, they urgently seek another relationship as a source of care and support, often without filtering the suitability of the new partner, just to alleviate the anxiety of loneliness.

This desperate need for bonding makes them extremely vulnerable to falling into unbalanced or abusive relationships.

Due to their tendency to submission and idealization of the attachment figure, they may tolerate mistreatment, excessive control or manipulation, especially if they are paired with Cluster B profiles such as narcissists or antisocials, who may exploit their need to please and their fear of abandonment.

They may put up with situations of domination or humiliation in order not to confront autonomy, under the mistaken belief that they cannot survive alone.

Promoting autonomy in therapy

The primary goal of treatment is not simply to solve the patient's immediate problems, but to foster his or her autonomy and self-efficacy.

The therapist must be careful not to fall into the trap of becoming the "savior" or the new dependency figure, constantly delegating responsibility for decisions to the patient.

Techniques such as problem-solving training are used so that the individual learns to trust his or her ability to face challenges.

Cognitive therapy questions the core beliefs about one's own incompetence ("I am weak", "I need others") and promotes an active role in his or her life.

Assertiveness training is vital for them to l