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) DSM-II (1968) DSM-III (1980) DSM-III-R (1987)
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 PDs DPD Eating* MOOD ANX* = significant co-morbidity
Bornstein (1995)
Somatization*
PDs
DPD
BDL, HPD
Eating*
Major Dep
Dysthymia
MOOD
ANX*
Substance
Phobias
Agoraphobia

10. Media Examples What about Bob? Rocky Forrest Gump All in the Family
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 oral sadistic
(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 background
low expressiveness
high control
Head, Baker, and Williamson (1991)

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

26. N3 = Depression
N4 = Self-consciousness
N6 = Vulnerabilities

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