The Evolutionary Neurodevelopmental Perspective

There are many perspectives on personality; the view of personality as holistic must integrate diverse concepts into a single composite. Along with the histrionic, narcissistic, and antisocial, the dependent is one of four interpersonally imbalanced personality styles. In the evolutionary theory (Millon, 1990; Millon & Davis, 1996), the dependent personality is formulated as the passive-dependent pattern. Recall from Chapter 2 that passivity in an evolutionary context refers to a tendency to accommodate to your surrounds, that is, to make the most of whatever the environment offers. Whereas the narcissist and antisocial seek the fulfillment of their own selfish concerns and wishes, dependent personalities rely on others to make life meaningful, deliberately undermining their own self-sufficiency to avoid independence from those on whom they rely. They arrange their lives to ensure a constant supply of nurturance and guidance from their environment, searching 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 in a hostile world. This strategy is opposite that of the active personalities, particularly antisocials, who seek to alter the environment to suit their own needs, albeit in an impulsive and destructive form.

The characteristics of the dependent personality reviewed in each of the preceding perspectives support its passive nature. Such individuals avoid instrumental competencies that might allow them to adapt their surroundings to their own needs in any significant way. Seeing themselves as inept, they seek instrumental surrogates—stronger, more experienced figures to go forth into an unfriendly world. To bond their caretakers close to them, they maintain a disposition of sweetness and naïveté. Their world is kept simple and unsophisticated, their growth suspended at the edge of childhood. The dependent personality is summarized in terms of the eight domains of personality in Table 8.1. We consider its contrast with other theory-derived constructs in the next section.

Despite the paucity of concrete data and the unquestioned influence of learning, common sense tells us that an individual's inherited biological machinery may incline him or her to perceive and react to experiences in ways that result in his or her learning a passive and dependent style of behavior. Dependency per se is never inherited, but certain types of genetic endowments have high probabilities of evolving, under "normal" life experiences, into dependent personality patterns.

All infants are helpless and entirely dependent on their caretakers for protection and nurturance. During the first few months of life, children acquire a vague notion of which objects surrounding them are associated with increments in comfort and gratification; they become "attached" to these objects because they provide positive reinforcements. All of this is natural. Difficulties arise, however, if the attachments they learn are too narrowly restricted or so deeply rooted as to deter the growth of competencies by which they can obtain reinforcements on their own.

It seems plausible that infants who receive an adequate amount of reinforcing stimulation but obtain that stimulation almost exclusively from one source, usually the mother, will be disposed to develop dependent traits. They experience neither stimulus

TABLE 8.1 The Dependent Personality: Functional and Structural Domains

Functional Domains

Structural Domains

Expressive Behavior

Incompetent

Self-Image

Inept

Withdraws from adult responsibilities by acting helpless and seeking nurturance from others. Is docile and passive, lacks functional competencies, and avoids self-assertion.

Views self as weak, fragile, and inadequate. Exhibits lack of self-confidence by belittling own attitudes and competencies; hence, feels incapable of doing things independently.

Interpersonal Conduct

Representations

Immature

Needs excessive advice and reassurance, as well as subordinated self to stronger, nurturing figure without whom may feel anxiously alone and helpless.

Internalized representations are composed of infantile impressions of others, unsophisticated ideas, incomplete recollections, rudimentary drives, and childlike impulses, as well as minimal competencies to manage and resolve stressors.

Cognitive Style

Naïve

Morphologic Organization

Inchoate

Rarely disagrees with others and is easily persuaded. Unsuspicious and gullible. Reveals a Pollyanna attitude toward interpersonal difficulties, watering down objective problems and smoothing over troubling events.

Entrusting others with the responsibility to fulfill needs and cope with adult tasks, there is both a deficient morphologic structure and a lack of diversity in internal regulatory controls, leaving multiple undeveloped and undifferentiated adaptive abilities, as well as an elementary system for functioning independently.

Regulatory Mechanism

Introjection

Mood/ Temperament

Pacific

Is firmly devoted to another to strengthen the belief that an inseparable bond exists between them; jettisons independent views in favor of those of others to preclude conflicts and threats to relationships.

Is characteristically warm, tender, and noncompetitive. Works diligently to avoid social tensions and interpersonal conflicts.

Note: Shaded domains are the most salient for this personality prototype.

Note: Shaded domains are the most salient for this personality prototype.

impoverishment nor enrichment but are provided with stimuli from an unusually narrow sphere of objects. Because of this lack of variety, the infant forms a singular attachment, a fixation, on one object source to the exclusion of others.

Any number of factors may give rise to this exclusive attachment. Unusual illnesses or prolonged physical complications in the child's health may prompt a normal mother to tend to her infant more frequently than is common at this age. On the other hand, an excessively worrisome and anxious mother may be overalert to real and fantasied needs she sees in her normal child, resulting in undue attention, cuddling, and so on. Occasionally, special circumstances surrounding family life may throw the infant and mother together into a symbiotic dependency.

Many youngsters who were not especially attached to their mothers in the earliest stages of life also develop the dependent pattern; experiences conducive to the acquisition of dependency behaviors can arise independently of an initial phase of exclusive maternal attachment.

Not uncommon are children's own deficit talents and temperamental disposition, such as their physical inadequacies, fearfulness of new challenges, anguish when left to themselves, and so on. Some children, by virtue of constitutional temperament or earlier learning, elicit protective behaviors from others; their parents may have unwillingly acceded to overprotective habits because the child "forced" them to do so. Similarly, children who have suffered prolonged periods of illness may be prevented from exercising their maturing capacities either because of realistic physical limitations or the actions of justifiably concerned parents.

Barring the operation of constitutional dispositions and physical deficits, the average youngster in this stage asserts his or her growing capacities and strives to do more and more things for himself or herself. This normal progression toward self-competence and environmental mastery may be interfered with by excessive parental anxieties or other harmful behaviors; for example, some parents may discourage their children's independence for fear of losing "their baby"; they place innumerable barriers and diverting attractions to keep their children from gaining greater autonomy. These parents limit their children's ventures outside the home, express anxiety lest they strain or hurt themselves, make no demands for self-responsibility, and provide them with every comfort and reward so long as they listen to mother. Rather than let them stumble and fumble with their new skills, the parents do things for them, make things easier, carry them well beyond the walking stage, spoon-feed them until they are 3, tie their shoelaces until they are 10, and so on. Time and time again, they are discouraged from their impulse to "go it alone."

Ultimately, because of the ease with which children can obtain gratifications simply by leaning on their parents, they forego their feeble efforts at independence, they never learn the wherewithal to act on their own to secure the rewards of life, and they need not acquire any self-activated instrumental behaviors to obtain reinforcements; all they need do is sit back passively and "leave it to mother."

Similar difficulties conducive to dependency may be generated in experiences with an individual's peer group. Feelings of unattractiveness and competitive inadequacy, especially during adolescence, may result in social humiliation and self-doubt. These youngsters, however, are more fortunate than the avoidant adolescent because they usually can retreat to their home where they will find both love and acceptance; in contrast, avoidant youngsters receive little solace or support from their families. Although the immediate rewards of affection and refuge at home are not to be demeaned, they may, in the long run, prove a disservice to these children because ultimately they must learn to stand on their own. It is implicit in parental overprotection that children cannot take care of themselves. Pampered children are apt to view themselves as their parents do—as people who need special care and supervision because they are incompetent, prone to illness, oversensitive, and so on. Their self-image mirrors this parental image of weakness and inferiority.

When they are forced to venture into the outside world, they find that their sense of inferiority is confirmed and they objectively are less competent and mature than others of their age. Unsure of their identity and viewing themselves to be weak and inadequate, they have little recourse but to perpetuate their early pattern by turning to others again to arrange their life and provide for them.

Contrast with Related Personalities

The dependent shares a variety of traits with other personality disorders, most notably the histrionic, avoidant, masochistic, and borderline personalities.

Histrionic and dependent personalities are usually easy to distinguish, but they do share certain characteristics. Both dependents and histrionics possess an intense need for social approval and affection. Both seek to please those to whom they are attached, and their search for love leads both to deny their own thoughts and feelings, especially when these might displeasure their partner. Both avoid putting forward an identity of their own, which might give others something concrete to find objectionable. Finally, both are often exceedingly sensitive to disapproval and are likely to experience any form of disinterest or criticism as devastating.

The crucial difference between the dependent and histrionic personalities lies in their interpersonal strategy for making others the center of their lives. Dependents passively lean on others for protection, nurturance, safety, and guidance. By their attitude of helplessness, they encourage others to be active to intercede for them to arrange and manage their life. In contrast, histrionics are active. Rather than sit on the sidelines, they take the initiative to modify their life circumstances to ensure, first and foremost, that the attention and approval they need from others is forthcoming. They do not sit passively, waiting for the competencies and skills of others to give shape to their lives. Moreover, they do not cling or seek nurturance, as does the dependent personality. Instead, histrionics reassure themselves that their relationships are solid by doing things that make attention pour in. As long as others do not become bored or disinterested, histrionics know their attachments are solid. The dependent evokes attention, but the histrionic provokes it. Thus, dependents are submissive, self-effacing, and docile, whereas the histrionic is gregarious, charming, and seductive. If attention is not forthcoming, the histrionic may sulk and become angry, whereas the dependent is afraid to express anger at caretakers.

The distinction between the avoidant and the dependent is often more difficult to make, at least on the basis of surface behavior. Both dependents and avoidants may seem shy, lacking in confidence, and fearful of criticism, and both have strong needs for protection and nurturance. Dependents, however, often play the shy, innocent role to encourage others to encroach upon them and take control. Their submission automatically pulls for dominance from others. Dependents could not adopt such a tactic without believing that others are fundamentally trustworthy. They withdraw so that others will seek, with the goal of finding an enlightened despot who will shepherd them through life while rewarding their loyalty with protection and kindness. The dependent, therefore, is fundamentally receptive to interpersonal overtures. In contrast, avoidants actively shrink from others because they fear rejection and humiliation. Instead of trusting others, they trust that others will put them under a microscope and scrutinize their every shortcoming for public review. Moreover, dependents are largely incapable of taking the initiative on their own behalf, whereas avoidants desperately wish to develop their potentials and can act autonomously when social judgment is not a possibility.

Likewise, both the dependent and the masochist are often self-effacing and submissive but for different reasons. Dependents seek to form good alliances that insulate them from the trials of life and ensure their continued protection. Their helplessness may appear as if it undoes their possibilities for success, but it serves the larger purpose of getting others to assume the instrumental role. In contrast, masochists readily work for their own benefit but then feel guilty or fearful of success and undermine their opportunities. Whereas dependents fail out of passivity, masochists actively work for it.

Finally, dependents and borderlines share certain traits, particularly a fear of abandonment. Borderlines also tend to blur the boundary between self and others and very often idealize their partners at the beginning of a relationship. Borderlines, however, readily express anger and rapidly shifting emotions and often intimidate others with their intensity, whereas dependents are rarely forceful. Likewise, borderlines may attempt to control their partners to avoid abandonment, but dependents wait passively to see what happens and trust that the outcome will be good. Moreover, dependents function well as long as their caretakers provide them with love and guidance. In contrast, the rapidly shifting emotions of the borderline reflect a greater degree of psychological decompensation. In periods of intense stress, borderlines may experience temporary loss of contact with reality, whereas dependents are more likely to develop panic attacks or other anxiety disorders.

Pathways to Symptom Expression

Dependents are naturally predisposed to develop a variety of clinical syndromes. Although different individuals vary in terms of their specific characteristics and thus develop different disorders, in each case, the logic that connects the personality disorder and the ensuing syndrome is easily seen. As you read the following paragraphs, try to identify the connection between personality and symptom. Because more is known about the connection between dependent traits and the development of other psychopatholo-gies, this topic is discussed in more detail here than in other chapters.

Anxiety

Dependents are extremely vulnerable to develop anxiety disorders, especially panic disorder and agoraphobia (Marshall, 1996; J. Reich, 1987; Starcevic, 1992). Those who develop generalized anxiety disorder are beset by persistent background worries. Most of their concerns are related to the possibility of being abandoned or being unable to cope or even to survive. Alternatively, their meager competencies may lead to intrusive worries about task performance, especially if they are under pressure to undertake more adult responsibilities. Such persons are likely to feel restless or tense, fatigue easily, and experience sleep difficulties. For example, they may lie awake for hours going over conversations with their significant other to ensure that nothing offensive has been said to jeopardize their relationship. A vicious circle may develop where anxiety feeds back and interferes with what problem-solving skills the dependent does possess (Turkat & Carlson, 1984). Where threats to their security are restricted in scope, dependents may develop specific phobias. These not only anchor anxieties to concrete threats but also inform others in a very objective way about the kind of stimuli the dependent wishes to avoid.

For many dependents, the anticipation of abandonment or helplessness may become so real that they suddenly find themselves overwhelmed by catastrophic thoughts, resulting in a full-scale panic attack. Some may use these attacks for manipulative purposes, first, as concrete proof that a disabling condition prevents them from undertaking any further responsibility and, second, as a means of evoking nurturance, sympathy, and support from others. For the dependent, then, the net effect of secondary gain, what the individual gets out of the disorder, is doubled. Not surprisingly, panic attacks in dependents are frequently accompanied by agoraphobia, a fear of being left alone or of being left without help in situations from which escape is nearly impossible. The higher the number of dependent traits, the more difficult recovery becomes (Hoffart & Hedley, 1997). In situations such as traveling away from home, waiting in line or in a crowd, or riding with strangers on a bus or train, the fear usually becomes tolerable when the dependent is accompanied by the reassuring presence of a companion. From a psychoanalytic perspective, the companion functions as a protecting mother figure who comforts the phobic anxiety aroused by infantile dependence (Kleiner & Marshall, 1985).

Depression

The link between depression and dependency is well researched. In fact, the two are often so frequently associated that some researchers have sought to determine whether they can be measured separately at all (Overholser, 1991). Cognitive theorists frequently emphasize feelings of hopelessness and helplessness as two key components in depression. The connection is obvious: Subjectively at least, hopeless persons have nothing to look forward to, and helpless persons have no means of putting their life on a better course. Both characteristics are closely related to the dependent personality. Because dependents have few competencies of their own, they may have only a few strained relationships and a sense of utter helplessness. Likewise, with no possibility of ever learning how to master the complexities of life on their own, they easily become mired in hopelessness. Real abandonment may prompt the dependent to plead for reassurance and support. Excessive guilt and self-condemnation are also common as means of evoking sympathy while preempting further expressions of criticism from former protectors.

Once an individual is depressed, dependency complicates the road to recovery. Bad things happen to everyone in the normal course of life, but adverse events are particularly devastating to depressed persons, whose coping resources and motivation are already compromised. Dealing with normal adversity is often a major issue in psychotherapy, for subjects who experience adverse life events are more prone to relapse. Moreover, if these events affect aspects of life that are highly valued, relapse becomes even more likely: Removing one of the few things a recovering depressive feels is most reinforcing or pleasurable in an already sad existence lays the foundation for disaster. However, by considering each individual's level of dependency, predictions of who will relapse and the number of weeks to relapse can be improved (Lam, Green, Power, & Checkley, 1996). Highly dependent recovering depressives relapse more quickly than those with lower levels of dependency, even if the level of adversity is the same for both. The association between dependency and relapse in major depression has even been found in subjects assessed six years after first being studied (Alneas & Torgersen, 1997).

Eating Disorders

There is also evidence that dependents suffer from higher than expected rates of eating disorders (Tisdale, Pendeliton, & Marler, 1990; Wonderlich, Swift, Slotnick, & Goodman, 1990). Bornstein (2001), in a meta-analysis of the relationship between interpersonal dependency and eating disorder symptoms, found that there is a positive association between the two in both anorexia and bulimia. However, there are symptoms of other personality disorders as well as dependency that are also implicated in eating disorders. Additionally, when eating disorder symptoms remit, dependency levels decrease as well. So, while there is a significant relationship, it is relatively modest and nonspecific.

Physical Symptoms

Because dependents cannot cope instrumentally by taking control of their lives and changing their circumstances directly, they must cope indirectly. Theoretically, they should develop syndromes that function both to relieve them of responsibility and to bond their protectors to them even more closely, thus doubling their secondary gains. Phobic disorders provide one route; physical disorders provide another. Functionally, they are probably almost equivalent, with one important exception: An anxiety disorder leaves the dependent open to blame and derision, either for being weak or for refusing to adjust to a level of adult maturity.

The connection between dependency and a physical disorder, however, is more obscure, more easily denied, and more readily elicits sympathy and allegiance from others, who may even complain that it's a cruel world in which someone as sweet and innocent as the dependent must be so afflicted. Such illnesses divert attention from the true source of dismay, the feeling that others might be losing interest and that the bonds of relationships are somehow strained or failing. Alternatively, for some dependents, feigned physical disorders may represent an attack on themselves for being so objectively helpless and incompetent, disguised in the form of bodily ailments and physical exhaustion. Most of the time, the relationship between dependency and physical disorder operates on an unconscious basis. However, it is possible that particularly severe cases may consciously fabricate physical symptoms in order to assume the sick role and thereby manipulate their physical status directly to ensure that appropriate levels of attention and solicitation are forthcoming.

Consider the case of Jack, who is now unemployed and, like Sharon, on the edge of divorce (see Case 8.2). Jack is obviously a dependent personality. He has never held down a real job, working instead in his father's bookkeeping business and even then only bringing coffee, cigarettes, and other items to the staff. With a naive and childlike demeanor, he finds it difficult to disagree with anyone. When asked about his chronic back pain, Jack consistently looks to his wife, Joan, to decide what to say. Indeed, she has always taken charge of the house and finances. Whereas another husband might be troubled by his inability to provide for the family, Jack is not troubled by his lack of achievement, but instead has enjoyed having others take care of him all his life. Joan is simply the latest in a long chain. Like many somaticizing subjects, Jack's problems seem a little too convenient. He is not nearly as troubled as you might expect for someone on the edge of being declared physically disabled. The fact that his pain developed suddenly on the day the divorce papers were to be served argues that his symptoms are more functional than real.

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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