Dependents arrange their lives to ensure a constant supply of nurturance and guidance from their environment. They can be described as self-effacing, obsequious, docile, and ingratiating. Many search for an all-powerful magic hero, someone who will take care of them, save them from the competitive struggles of life, and protect them from any possibility of harm. Given a nurturing and understanding partner, dependents often function with ease, being sociable, warm, affectionate, and generous. One normal variant of the dependent is Oldham and Morris's (1995) devoted style, who is caring and puts the needs of others first. Another is Millon's (Millon et al., 1994) agreeing style, who is cooperative and amiable. A healthy dependent is capable of genuine empathy for others and has the capacity to give unconditional love. The more pathological variants fuse their identity with that of others and become inextricably enmeshed with others.
There exist several adult subtypes of the dependent personality. The adult subtypes include the disquieted dependent, who displays a mixture of avoidant and dependent personalities; the accommodating dependent, who has an insatiable need for affection and nurturance and often shares traits with the histrionic; the immature dependent, who never develops competencies and remains childlike; the ineffectual dependent, who reflects a combination of schizoid and dependent features; and the selfless dependent, who is known for idealization and total identification.
Psychodynamically, the dependent can be thought of as fixated at the oral stage of development. For the dependent, this fixation is thought to have occurred through indulgence at the oral stage rather than through frustration. They tend to rely on introjection and idealization, generally of partners, as defense mechanisms. They may also use denial to avoid feelings of anxiety that introjection does not abolish.
Interpersonally, dependents are often seen as generous and thoughtful, overly apologetic, or even obsequious. Beneath their warmth and friendliness, however, lies a solemn search for assurances of acceptance and approval. To achieve their interpersonal goals, dependent personalities attach themselves to others, submerge their own individuality, deny points of difference, and avoid expressions of power. Interpersonal formulations of the development of the dependent personality emphasize parental overprotection, over-concern, overnurturance, and active discouragement of autonomy as the major developmental pathways. Some parents never allow their children to develop independently. In effect, they remove any need to explore the world by bringing the world to the child. Other family members and peer group experiences can also contribute to the development of a dependent personality.
The cognitive perspective asserts that the helpless façade that dependents project eventually works its way into their self-concept. Accordingly, the self-schema of dependents includes both positive and negative qualities. On the positive side, dependents see themselves as considerate, thoughtful, and cooperative; on the negative side, they often tell themselves that they are helpless and completely alone in the world. To remedy these deficits, dependents often form conditional beliefs; for example, they can survive only if someone protects them, or if they are alone, they will die. Dependents are cognitively immature. They seldom look inward and possess only vague ideas about their self-identity and direction.
The evolutionary developmental perspective conceptualizes dependents as arranging their lives to ensure a constant supply of nurturance from the environment, but doing so in a passive way. They avoid developing competencies that would allow them to actively adapt to their surroundings.
The dependent personality disorder is related to several other personality disorders including the histrionic, avoidant, and masochistic. Dependents are extremely vulnerable to developing anxiety disorders such as generalized anxiety disorder, phobias, agoraphobia, and panic attacks. Additionally, dependents often develop depression, dissociative reactions, and display physical symptoms such as assuming the "sick role."
Psychotherapy can be effective in treating the dependent personality. Most dependents are highly motivated to remain in therapy, as the therapeutic relationship itself naturally supplies them with the very resources they feel are deficient in their everyday lives. The strength and authority of the therapist is comforting and reassuring and provides the idealized omnipotent figure that dependents seek to rescue them in time of need. Moreover, dependents are usually ready to trust and to talk with a therapist. Cognitive techniques can be used to challenge dependents' propensity toward black-and-white thinking with the goal of engaging dependents in a more active style of problem solving that discon-firms life as an existence of total helplessness and moves them toward a more competent self-image. Psychodynamic exploration may also be effective in helping dependents understand the developmental basis from which maladaptive patterns arose, though insight alone is unlikely to be sufficient in producing personality change.
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