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Dependent PD. Mnemonic NEEDS PUSH Needy Expression of disagreement is limited Excessive need for nurturance Decision making is difficult Self-Motivation.

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Presentation on theme: "Dependent PD. Mnemonic NEEDS PUSH Needy Expression of disagreement is limited Excessive need for nurturance Decision making is difficult Self-Motivation."— Presentation transcript:

1 Dependent PD

2 Mnemonic NEEDS PUSH Needy Expression of disagreement is limited Excessive need for nurturance Decision making is difficult Self-Motivation is lacking Preooccupied with being left alone Urgently seeks a relationship when one ends Self-confidence is lacking Helpless when alone

3 History Freud (1923) – oral stage arrest Abraham (1924) – oral-receptive characters WW II (1940s) – immature war reactions Fenichel (1945) – looks for “nursing mother” Horney (1950s) – compliant type Millon (1969) – passive-dependent Bowlby (1969) – clinging attachment

4 DSM History DSM-I (1952) considered a subtype of passive aggressive DSM-II (1968) inadequate personality DSM-III (1980) 3 criteria DSM-III-R (1987) 9 criteria

5 DSM Definition “a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation" (APA, 1994, p. 665). 5/8 criteria for diagnosis

6 DSM Definition NSF: Non-sufficient Funds Need to be taken care of Submissive and clingy Fears separation

7 Factor Analytic View Livesley, Schroeder, and Jackson (1990) two orthogonal factors attachment and dependence attachment was defined as needing someone, where as dependence was defined as the excessive need for advice, encouragement, etc.

8 Co-morbidity DPD ANX* PDs MOOD BDL, HPD Eating* Somatization* = significant co-morbidity Bornstein (1995) Major Dep Dysthymia Phobias Agoraphobia Substance

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10 Media Examples What about Bob? Bob Wiley (Bill Murray) Rocky Adrian (Talia Shire) Forrest Gump Forrest, Forrest Gump (Tom Hanks) All in the Family Edith (Jean Stapleton)

11 Interview Considerations appear to be deceptively simple to treat cooperative and easy to please “gains” in therapy may not generalize Turkat (1990) depression tension

12 Interview Considerations take whatever appointment times are offered become model patients, need to please rarely canceling appointments or arriving late therapists are treated with admiration mistakes of therapist overlooked

13 Interview Considerations self-doubt, tends to belittle self low self-confidence, faith in others high need for reassurance neediness, rarely lives alone work below level of ability continually seek advice seek protection and dominance from others avoid positions of responsibility

14 Interview Considerations at risk for substance abuse, overmedication and abusive relationships may have a "somatic orientation“ Exploration of issues viewed as criticism Confrontation does not work

15 Epidemiology more common among females (controversial issue) Estimates vary 2.5 to 3.0% of the general population? DEP tends to be more common after the age of 40

16 Cause - Biological dependency may be the result of high levels of anxiety-proneness No Audio

17 Cause - Analytic Freud and Abraham described their oral-character as due to overindulgence or deprivation in the oral or sucking stage of development others argue that DPD is the result of faulty attachment

18 Ego Defenses Idealization Reaction Formation Projective Identification Induces guilt in others

19 Psychodynamics Oral fixation Oral eroticism = gratification of oral libidinal needs Oral dependent = early fixation Oral sadism = later fixation when teeth appear Oral character = adult version of earlier fixation

20 Oral Characters oral dependent (early fixation, dependent) Everything should come to you excessive eating, drinking, or cigar smoking good listener or being a gullible person oral sadistic (late fixation, independent) Can’t count on anyone cynical, pessimistic and bitingly sarcastic Nail biting

21 Cause - Cognitive-behavioral Beliefs are key Sees self as needy, weak, helpless and incompetent Sees others as nurturant, supportive and competent find shelter in the context of a relationship protect them and assume responsibility

22 Cause - Interpersonal Family of origin probably has a lot to do disorder a dominant mother/father may force dependency in children Children are overprotected and discouraged from being assertive Independent actions can be criticized, particularly when the choice is a poor one Child fears making a choice because of criticism

23 Testing No Audio

24 Testing using the Family Environment Scale, found that individuals with DEP display a unique dysfunctional family backgroundFamily Environment Scale low expressiveness high control

25 Reich (1996) associated with lower socioeconomic status, and poorer functioning in the family/home sphere relatives of individuals with DEP are more likely to have generalized anxiety disorder

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27 Testing MMPI-2, there may be a 2-7 profile (depression/psychasthenia) another possibility is a high scale 3 (hysteria) and a mildly elevated K

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