Clinical criteria (DSM-5)
For a diagnosis of dependent personality disorder patients must have:
A persistent, excessive need to be taken care of, resulting in submissive and clinging behavior and fears of separation.
This persistent need is shown by the presence of 5 or more of the following:
- Difficulty making daily decisions without an inordinate amount of advice and reassurance from other people.
- A need to have others be responsible for most important aspects of their life.
- Difficulty expressing disagreement with others because they fear loss of support or approval.
- Difficulty starting projects on their own because they are not confident in their judgment and/or abilities (not because they lack motivation or energy).
- Willingness to go to great lengths (e.g., do unpleasant tasks) to obtain support from others.
- Feelings of discomfort or helplessness when they are alone because they fear they cannot take care of themselves.
- An urgent need to establish a new relationship with someone who will provide care and support when a close relationship ends.
- Unrealistic preoccupation with fears of being left to take care of themselves.
Also, symptoms must have begun by early adulthood.
Differential diagnosis
Several other personality disorders are characterized by hypersensitivity to rejection. However, they can be distinguished from dependent personality disorder based on characteristic features, as follows:
Borderline personality disorder: Patients with this disorder are too frightened to submit to the same degree of control as patients with dependent personality disorder. Patients with borderline personality disorder, unlike those with dependent personality disorder, vacillate between submissiveness and rageful hostility.
Avoidant personality disorder: Patients with this disorder are also too frightened to submit to the same degree of control as patients with dependent personality disorder. Patients with avoidant personality disorder withdraw until they are sure they will be accepted without criticism; in contrast, those with dependent personality disorder seek out and try to maintain relationships with others.
Histrionic personality disorder: Patients with this disorder seek attention rather than reassurance (as do those with dependent personality disorder), but they are more disinhibited. They are more flamboyant and actively seek attention; those with dependent personality disorder are self-effacing and shy.
Dependent personality disorder should be distinguished from the dependency that is present in other psychiatric disorders (e.g., depressive disorders, panic disorder, agoraphobia).