Understanding the Causes of Dependent Personality Disorder and Your Role in Your Loved One’s Treatment

Michael had never been a confident person, but that didn’t bother Catherine. “When we first met in grad school, I thought he was sweet and sensitive,” she says. “He wanted to be around me all the time, valued my opinions, and seemed utterly devoted to me—that seemed very romantic to me as a young woman.” And at first, it was romantic. The pair quickly bonded and became each other’s constant companions. “It was a wonderful time in my life,” Catherine remembers.

But while Michael was spurred in part by love, it wasn’t love alone that drove his extreme devotion. “In that honeymoon part of a relationship, that intense togetherness can be wonderful. It can be hard to step outside yourself in the midst of that kind of flurry of romance and see what is really happening,” Catherine explains. “But over time, I realized things weren’t right.” As the years passed, the traits that Catherine had first seen as signs of love took on a different quality. “He couldn’t be alone. He needed constant reassurance. He couldn’t make his own decisions or deal with even the smallest criticisms. I was no longer his partner, but his caretaker.” While some would have decided such a relationship dynamic was too much for them, Catherine didn’t. Instead, she encouraged Michael to speak to a professional, who quickly recognized his symptoms as signs of a dependent personality disorder.

Dependent personality disorder (DPD) can deeply disrupt a person’s ability to function in a healthy way. Because the disorder inherently manifests within relationships, the families and partners of people with DPD often find themselves pushed into caretaker roles, taking on an inordinate amount of responsibility for your loved one’s emotions and behaviors. As a result, the disorder often creates overwhelming distress for everyone involved. However, understanding the causes of dependent personality disorder and the role you can play in treatment can help you gain greater insight into your and your loved one’s experiences and create a plan for how to move forward.

As humans, we depend on others in order to live in healthy and meaningful ways every day. Our lives inherently intertwine with others, allowing us to have fulfilling relationships, care and be cared for, and benefit from the love, support, and guidance of others. However, in people with DPD, this dependency is intensified to an extraordinary degree, leading to extreme clinginess, interfering with autonomous function, and compromising the ability the engage in balanced, healthy relationships. Dr. Henning Saß explains:

The dependent personality disorders is characterized by an overpowering feeling of not being able to conduct one’s own life. With a weak self-image and helplessness, patients will seek support from others in all situations, especially from their partners. They have difficulties doing things on their own or making everyday decisions without advice from others, and fear that expressing disagreement might result in a loss of support or approval.

Driven by fear of rejection and abandonment coupled with a lack of confidence in their own abilities and judgment, people with DPD are typically highly submissive and conflict-avoidant. As a result, they may volunteer for burdensome and unpleasant tasks and even stay in abusive relationships. Indeed, research shows that people with DPD are a significantly high risker of intimate partner violence than the general population, a risk that is likely due in part to the fact that being alone is a more frightening prospect than mistreatment. Additionally, people with DPD often struggle to initiate projects, tasks, or life changes due to an enduring sense of anxiety, helplessness, and distrust in themselves.

When your loved one is struggling with a mental health disorder, one of the most common questions to have is, “Why?” Why did this happen? What went wrong? Unfortunately, there are often no easy answers; there is no single cause of dependent personality disorder that can be easily identified and resolved. Rather, DPD is believed to arise from complex interactions between biology and environment.

Researchers have long recognized that genetics impact the development of DPD, with some older studies suggesting genes explain “about one-third of the individual differences” in DPD traits. In recent years, however, evidence has emerged that genetics play a more significant role than previously realized. According to a methodologically rigorous twin study from the Norwegian Institute of Public Health, “two-thirds of variation in dependent personality disorder traits could be explained by genes.” The researchers are quick to note, however, that while this helps elucidate the causes of DPD on a population level, it does not necessarily translate to the individual. As Line C. Gjerde, lead author of the study, explains, “Whether or not a genetic vulnerability leads to the expression of a certain trait or disorder depends on a complex interplay of both genetic and environmental factors.”

Indeed, environmental factors, particularly dysfunctional relationships that interfere with healthy development, are believed to have a profound impact on the development of dependent personality disorder. These include:

• Attachment disruption: Lack of secure attachment in childhood due to inconsistent parenting, abuse, neglect, or other trauma may compromise one’s ability to form a stable sense of self, an internal sense of safety, secure attachments to other people, and “a healthy balance between independence and closeness to others.” The symptoms of DPD could then reflect the effects of attachment injury and be a manifestation of disordered attachment approaches.
• Authoritative or overprotective parenting: Authoritative or overprotective parenting may deprive one of opportunities to practice emotional and behavioral independence and self-reliance. Even rooted in good intentions, these parenting styles can cause children to develop a high level of anxiety, an unhealthy dependence on others to make decisions for them, and an inability to trust their own thoughts, feelings, and abilities, leading to profound feelings of helplessness. Families in which disobedience leads to the withholding of love, affection, or care may also serve as triggering environments for DPD.
• Inappropriate or absent rewards: Behavioral and social learning theory holds that our personalities are formed via conditioning and reinforcement. In other words, we learn how to be in the world through our interactions with other people and by observing how our own behaviors are received by others. Some researchers believe that both children who are rewarded for demanding high levels of care and those who are never rewarded for autonomy may be vulnerable to developing DPD.

Recognizing these causes can help you to better understand the roots of your loved one’s dependent personality disorder and look for treatment options that will address them.

While dependent personality disorder can be an overwhelming and disruptive condition, it is also a treatable one. By engaging in a variety of evidence-based psychotherapeutic modalities, your loved one can gain the skills and insight necessary to understand their disorder and replace disordered patterns of thought and behavior with healthier alternatives. Often, a residential treatment program offers the best environment to engage in these therapies due to the intensity of care made possible by the residential milieu. By participating in a broad, personalized spectrum of therapies in a safe and supportive environment, your loved one can deeply explore their lived experiences, address painful memories, integrate new learning, and practice healthy social interactions with the guidance of highly trained clinicians who understand the challenges of DPD treatment. As a result, they can move toward greater confidence, assertiveness, and independence.

However, treatment isn’t just about your partner or family member. While virtually all mental health disorders touch the lives of loved ones, the nature of DPD means that the illness has likely been a particularly significant part of your relationship. As such, your loved one’s healing process will likely have a profound impact on your relationship and your participation in the treatment process can be a critical part of recovery for both of you. Therefore, when selecting a treatment program, it is essential to choose one that will give you opportunities for healthy involvement that will promote better treatment outcomes.

The residential treatment program you choose should recognize the unique dynamics that evolve between people with DPD and their loved ones and offers appropriate support services to help both of you move forward. This includes structuring your involvement in a way that allows for healthy separation and increased independence on the part of your loved one while also giving you opportunities to work on your shared recovery. Family and couples therapy is typically an essential part of this process, giving you a safe space in which to process your experiences and explore how to move toward healthier relationship dynamics and boundaries as your loved one heals. While this is extraordinarily helpful for your loved one, you may also be surprised to find that it is essential for your own wellbeing as well; even if you deeply wish for a resolution to your loved one’s symptoms, the changes that creates in your relationship can be emotionally difficult. Having the support and guidance of compassionate clinicians can help you cope with these changes and embrace your new role in your loved one’s life while also developing long-term strategies to avoid falling back into destructive patterns.

Together—and individually—you and your loved one can break free from the limits of DPD and discover who you truly are when your experiences are not shaped by mental illness.

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Bridges to Recovery offers comprehensive residential treatment for people struggling with mental health disorders as well as co-occurring substance use disorders. Contact us to learn more about our renowned Los Angeles programs and how we can help you or your loved one start the journey toward healing.