Dependent Personality Disorder (F60.7) Diagnostic Criteria
Dependent personality disorder doesn’t have too much history, not showing up until 1980 in the DSM-III1 and significantly expanding in 1987 in the DSM-III-R2. However, there was a sentence in the DSM-I in 19523 regarding a subtype of passive-aggressive personality disorder called passive-dependent, described as, “helplessness, indecisiveness, and a tendency to cling to others as a dependent child to a supporting parent.” Since 1994 in the DSM-IV4, there have been no major changes in the DSM regarding dependent personality disorder. So let’s dive into the criteria for dependent personality disorder in the DSM-5-TR5.
| Note: Text in these boxes are the exact words from DSM-5-TR1 |
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Dependent Personality Disorder Criteria
| “A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following5:” (p. 769) |
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The main patterns involve being submissive, clinging, and avoiding separation from others because they need to be taken care of. The behaviors involved in those with dependent personalities strongly pull for caretaking from a stronger “other” because they feel they cannot make it on their own. They need someone else’s help. And these patterns don’t just show up one day; it is there by at least early adulthood and spans many settings, like work, school, home, etc. Then, there needs to be five out of the following eight criteria.
Indecisive: Dependent Personality Disorder (Criterion 1)
| “Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others5.” (p. 769) |
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This ventures past normal support. The dependent personality needs their strong, nurturing person to make decisions for them or to provide them with a developmentally inappropriate amount of reassurance. There is an inherent childlikeness to this dynamic. This could look like: “What shirt do I wear? Should I carry an umbrella? How do I set the table? Should I use the teaspoons or the tablespoons? …I don’t know how…I need your help.”
Submission: Dependent Personality Disorder (Criterion 2)
| “Needs others to assume responsibility for most major areas of his or her life5.” (p. 769) |
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They fear responsibility because they don’t think they can adequately take care of themselves, so they pull for their person to take responsibility for them. They don’t take the initiative. They depend on the other person to make the decisions on where to live, their job, who to be friends with, etc. This isn’t appropriate dependency as we might see in younger children or the elderly, it’s developmentally inappropriate.
Passivity: Dependent Personality Disorder (Criterion 3)
| “Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)5” (p. 769) |
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Because the dependent person feels they cannot live independently without their support person, they completely disregard their own opinions and anger. They feel so unable to function alone that they will agree with things that they feel are wrong rather than risk losing their caretaker. They often seek a person who exudes overprotection and dominance, and then they acquiesce, never standing up for themselves. However, this does not include situations where there is actual fear of retribution, such as blackmail, threat, or abuse.
Lack of Initiation: Dependent Personality Disorder (Criterion 4)
| “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)5.” (p. 769) |
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The dependent personality believes themselves to be totally inept, so how could they start a project? They feel they are incapable of doing it. It’s not procrastination or perfectionism or ADHD or depressive lack of motivation. They feel incapable or incompetent and need someone to help them. They believe others can perform better than them. However, with the right amount of reassurance that someone else is supervising and approving, they can complete the task. But this can turn into a cycle. They rely and depend on others, so they don’t learn independence. And they can fear being more independent and competent, thinking they will then lose their support. They doubt themselves, are pessimistic, and belittle their assets and abilities. Any disapproval or criticism will be taken as evidence that they are worthless, contributing to their lack of faith in themselves. Responsibility and decision making is anxiety provoking. This can even negatively impact their ability to find and keep a job if they can’t independently initiate tasks.
People-Pleasing: Dependent Personality Disorder (Criterion 5)
| “Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant5.” (p. 769) |
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Because they will do what they need to do to get the care they need, they can be unreasonably self-sacrificial, leading to and attracting imbalanced relationships because they need to maintain their connection with the other person. This can include tolerating abuse when there is ample opportunity to leave the situation.
Helplessness: Dependent Personality Disorder (Criterion 6)
| “Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself5.” (p. 769) |
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This is a good place to differentiate this from separation anxiety disorder in adults. Dependent personalities don’t want to be separated because they don’t want to feel helpless in their alone-ness, believing they can’t adequately take care of themselves. Those with separation anxiety disorder are anxious about their specific attachments and what could happen to them.
Clingy: Dependent Personality Disorder (Criterion 7)
| “Urgently seeks another relationship as a source of care and support when a close relationship ends5.” (p. 769) |
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They don’t believe they can function without a close attachment, so they need to connect quickly with someone else if they have a breakup or there’s a death. But it can be indiscriminate… It reminds me of a little puppy that hasn’t yet opened its eyes, searching around for nurturance without necessarily vetting where it’s coming from.
Dependence: Dependent Personality Disorder (Criterion 8)
| “Is unrealistically preoccupied with fears of being left to take care of himself or herself5.” (p. 769) |
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This was a theme throughout all the criteria, but it is because they believe they are so absolutely reliant on the other person, for advice, care, and help, that they couldn’t handle losing the support of the person. It happens when there’s no evidence to justify the fear. And the fear has to be unrealistic and excessive. For example, it’s not a realistic fear that your adult child might move states when you need care for your cancer. But it would be an excessive fear that your adult child will get married and “abandon” you when you don’t actually need care.
If you want to better understand and care for a dependent individual in your life, or if you are a dependent personality and want to explore it, feel free to reach out! If you’re in Virginia (or a PsyPact state), check out our private practice, Quest Psychological and Counseling Services for available services. If you’re a provider stuck on a case, we also offer consultations for mental health professionals!
References
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders: DSM-III (3rd ed.). https://doi.org/10.1176/appi.books.9780521315289.dsm-iii ↩︎ ↩︎
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders: DSM-III-R (3rd edition, revised.). https://doi.org/10.1176/appi.books.9780890420188.dsm-iii-r ↩︎
American Psychiatric Association. (1952). Diagnostic and statistical manual: Mental disorders (1st ed.). https://doi.org/10.1176/appi.books.9780890420331.dsm-i ↩︎
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders: DSM-IV (4th ed.). https://doi.org/10.1176/appi.books.9780890420614.dsm-iv ↩︎
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th edition, text revision.). https://doi.org/10.1176/appi.books.9780890425787 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
