Dependent personality disorder

Background
  • A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation

Clinical Features
  • Five (or more) of the following criteria, beginning by early adulthood and present in a variety of contexts:[1]
    • Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
    • Needs others to assume responsibility for most major areas of his or her life.
    • Has difficulty expressing disagreement with others because of fear of loss of support or approval.
    • Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).
    • Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
    • Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
    • Urgently seeks another relationship as a source of care and support when a close re­lationship ends.
    • Is unrealistically preoccupied with fears of being left to take care of himself or herself.

Differential Diagnosis
  • Other personality disorders
  • Personality change due to another medical condition
  • Substance use disorders

Evaluation
  • A clinical diagnosis; however if entertaining other organic causes may initiate workup below

General ED Psychiatric Workup

Management
  • May need lots of reassurance
  • Try a low-key, casual tone
  • Respond with empathy for emotions, but be firm and set boundaries regarding requests for excessive reassurances (e.g. emphasize what is already reassuring about presentation and that additional tests cannot be performed at this time)
  • Emphasize follow-up plan and that patient can always return if deteriorates or not getting better, so that patient does not feel abandoned
  • Referral for outpatient psychiatric treatment, as psychotherapy is the primary treatment.

Disposition
  • Discharge

See Also


References
  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
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