DPD involves a pervasive and excessive need to be taken care of that leads to submissiveness, clinging, and fears of separation. Its primary diagnostic criteria include extreme difficulty making decisions without others' input, need for others to assume responsibility for most aspects of daily life, extreme difficulty disagreeing with others, inability to initiate projects due to lack of self-confidence, and going to excessive lengths to obtain the approval of others.
An individual with DPD always seeks a relationship, in which he or she clings to this relationship in very dependent manner and goes to the utmost extent to keep both the ends meet. This disorder includes abnormally high levels of the neuroticism facets of anxiousness, self-consciousness, and vulnerability following dependent individuals desperately seeks another relationship as soon as one ends (i.e. dependent persons are high in extraversion).
Excessively dependent behavior may be seen in persons who have developed debilitating mental and physical conditions, such as agoraphobia, schizophrenia, severe injuries, or dementia. However, a diagnosis of DPD requires the presence of the dependent traits since late childhood or adolescence. One can diagnose the presence of a personality disorder at any age during a person's lifetime, but if (for example) a DPD diagnosis is given to a person at the age of 75, this presumes that the dependent behavior was evident since the age of approximately 18 (i.e., predates the onset of a co morbid mental or physical disorder).
Differences in personality due to differing cultural norms should not be confused with the presence of a personality disorder. Cultural groups differ greatly in the degree of importance attached to deferent behavior, politeness, and passivity. The diagnosis of DPD requires that the dependent behavior result in clinically significant functional impairment or distress.
Etiology and Pathology
Insecure interpersonal attachment is central to the etiology and pathology of DPD. Insecure attachment and helplessness may be generated through a parent-child relationship, perhaps by a clinging parent or a continued infantilization during a time in which individuation and separation normally occurs. However, the combination of an anxious and/or inhibited temperament with inconsistent or overprotective parenting may also generate or exacerbate dependent personality traits (Maddux, 2005, p. 219). Unable to generate feelings of security and confidence for themselves, dependent persons may rely on a parental figure or significant other for constant reassurance of their worth. Eventually, persons with DPD may come to believe that their self-worth is defined by their importance to another person.
Five-Factor Model Reformulation
DPD is characterized by maladaptively high levels of agreeableness and the neuroticism facets of anxiousness, self-consciousness, and vulnerability. Persons with DPD