Dependent Personality Disorder and Psychopathology
Some dependent people, called Dependent Personality Disorder, are so disabled and restricted that they can hardly function alone. For others the disability is less severe, e.g. there are people addicts who must be with someone almost all the time--for some only one person will do (e.g. a parent, spouse, friend, or child), for others anyone will do. In other cases, there is a compulsive "dependency" of sorts but it isn't considered a disorder, such as a highly effective workaholic or a teenager constantly listening to music. People can become addicted to or, at least, dependent on many other specific activities, such as sports or exercise, sex, religion, social activities, hobbies, TV, reading, music, cleaning, dressing, and so on. If you feel insecure and inadequate, then you are more likely to depend on someone or repeat some activity over and over that you are sure you can do. Feeling so inadequate that you feel you can't handle your life must be a miserable existence.
Masserman (1943) proposed that psychological problems, e.g. hypochondria, were a panic reaction to being powerless or feeling unable to cope. He believed almost any neurotic reaction, such as anxiety, social withdrawal, depression, etc., no matter how ineffective, was more comfortable than doing nothing about the real stresses we face. So, being tense or sad is better than being weak and dependent. It is interesting to note that feeling helpless or inadequate has been involved in every emotion we have discussed thus far-stress, depression, anger, and, now, dependency.
The Diagnostic and Statistical Manual of Mental Disorders-IV-R describes a diagnosable disorder called "dependent personality." The characteristics are:
- Passively allows others to assume responsibility for major areas of life because of fears or inability to function independently (e.g., lets spouse decide what kind of job he/she should have).
- Subordinates his/her own needs to those of persons on whom he or she depends. This is to avoid conflicts and to avoid having to rely on self (e.g., a dependent or codependent person might even tolerate an abusive spouse).
- Lacks self-confidence (e.g., sees self as helpless, stupid).
Research spanning 30 years (Greenberg & Bornstein, 1988) suggests that a dependent personality is at risk of depression, alcoholism, obesity, tobacco addiction, and a variety of physical and psychosomatic disorders (note all the "oral" activities). In spite of having many psychological problems, dependent people show a strong tendency to believe that their problems are somatic and, consequently, they seek professional help for physical problems or see their depression as a "chemical imbalance." When under stress, dependent people generally seek out others, rather than withdraw. For unknown reasons, if a girl is dependent as a child, there is a tendency for her to remain consistently dependent from early childhood throughout adulthood. On the other hand, passivity and dependency in boys and men are not nearly so stable or predictable. Possibly, we are just more accepting of passivity in women and make fewer efforts to change them.
What are the more common dynamics of dependency? You might see yourself or your friends in some of these speculations:
- A person may become almost totally helpless, which, as noted in chapter 6, is a basis for feeling depressed. Therapists have observed that a dependent personality often precedes a depressive reaction.
- Dependent people manipulate others. Getting people into doing things for us may be a self-deceptive way to deny our helplessness or a way to prove our charm or cleverness and/or others' gullibility or weakness. Correspondingly, many people love to have someone depend on them and look up to them; thus, they are easily manipulated: "I just have to be nice and flatter Mom or cuddle up to Daddy and they'll do anything for me." The last example is harmless enough, but the manipulation can involve "playing hard ball." For instance, an effective way to get care and attention from our parents or loved ones is to make bad decisions, be indecisive or irresponsible, and get in trouble. Dependent people learn that weakness and passive defiance are very powerful and difficult to deal with: "I'm powerful, I can drive them up a wall" or "They don't have any choice but to take care of me!" Like an attention-starved child, some dependent people act as though it is better to get in trouble than to be neglected. Sometimes, governmental systems encourage dependency: "It is better to have a baby and go on welfare than to stay in school and have to look for a job." If anyone cares about you, being "down and out" and helpless are powerful ways of getting help. Certainly, being compassionate is commendable, but compassion must strengthen the weak, not further weaken them.
- Dependency may stem from an insatiable need for love or a need to prove one's importance: "Give me more proof you really love me" or "I want Mommy to love me more than she does anyone else in the world, even more than Dad" or "I want you to love me totally, like my Daddy did." We all have needs to be babied and cared for, of course. And, perhaps, we are all a little resentful that we aren't loved and nurtured enough (for our inner child). But it is only in extreme cases where we constantly demand proof of love.
- Some psychologists point out the similarity between the fear in dependency and the fear in agoraphobia, which is a fear of being away from home and in crowds or open spaces where we have no support. Both can be intense fears that debilitate us.
- Martyrdom and masochism may, in some cases, also be closely related. The subservient person who neglects him/herself while serving others "hand and foot" may feel taken advantage of and lead a life of suffering--that's a martyr. Shainness (1984), a female psychiatrist, has written a book, Sweet Suffering, describing the tendency of some women (and men) to fear authority and to put themselves down to such an extent that it becomes a form of masochism (an enjoyment of pain and degradation).
- A common reaction to dependency is anger. Others may respond hostilely to our dependency and we may resent the dependency we see in others. Wouldn't you hate to be weak and considered rather helpless all the time? As we saw in chapter 7, sometimes long-term subservience results in a sudden outburst of violence but more likely it will result in continuing passive-aggressiveness ("I won't do anything as long as you're bugging me"). A resentful child or a disgruntled employee or student will passively (quietly) resist, e.g. the child will procrastinate ("I'll do it as soon as this TV program is over" but forgets), the worker just doesn't pay much attention, and the student pretends to like the teacher but talks about him/her behind his/her back.
Naturally, having someone constantly expect you to take care of them, especially if you feel they could care for themselves, will become irritating (unless you are a needy codependent). It may not be as obvious, but the weak, dependent person is also likely to subtly resent someone who always has more or is more capable or better organized. Resentment is associated with dependency in all directions, including feeling like a victim as we discussed in chapter 7.
- Mutual unassertiveness or an unverbalized compromise may be the easiest but not the best arrangement. For example, students implicitly strike a bargain with teachers, such as "if you don't make me assume responsibility for planning and controlling my own learning, I'll tolerate your dull lectures over the textbook. Make it easy for me to get an A or B and I'll not criticize your teaching." A labor union and the management might compromise like this: "I'll let you have the money and status of being the boss if my workload is easy and if I don't have to learn about the business, make decisions, or take any other responsibility for running this business." Avoiding responsibility is almost always a form of dependency. If one person accepts responsibility (a boss or one spouse in child care or one sex in military combat) and another person avoids responsibility, it is hard to assume those two people are equals.
- Dependency seems to be related to alcoholism, perhaps both in the beginning of the process (dependent needs lead to drinking) and at the end of the process (the disabilities of alcoholism force us to be dependent). Dependency is also related to cigarette smoking; the reasons aren't known.
Dependent people as psychotherapy patients
The dependent person is prone to a variety of physical and psychological disorders. Given the same degree of poor health, dependent people are far more likely to seek treatment than independent people. And, they behave differently from non-dependent people in treatment, e.g. dependent personalities react more positively toward the doctor and comply more fully with doctors' orders; they are more perceptive of treatment procedures and other people; they request extra help and useful information about themselves; they stay in treatment longer (Bornstein, 1993).
The dependent person is in many ways an ideal patient: quick to come in, observant, cooperative, positive, eager to get treatment, eager to please, etc. The problem is that dependent people will resist terminating this nurturant relationship with a caring, giving authority figure. They often get worse or have a crisis near the end of therapy.
How will a dependent personality react to self-help? An interesting but unresearched question. Probably they would much prefer to interact with a supportive professional than with a self-help book. They may be drawn to a self-help group and become a perceptive, active, helpful group member. But, as in a relationship with a therapist, they are likely to resist making real changes in their lives and may be very reluctant to leave the group. Regardless of whether you are in therapy or doing self-help, you have to confront your dependency. Dependency has many payoffs; you must be willing to give them up before much self-improvement can be made.
Now we will turn to the self-treatment of passivity and dependency.