Internet Mental Health

DEPENDENT PERSONALITY DISORDER


Diagnostic Features of Dependent Personality Disorder

SYMPTOM DEFINITION SELF-DESCRIPTION
EMOTIONAL DISTRESS (Impaired Stability)
Dependence Excessively relying on or being controlled by someone else. "I often seek advice or reassurance about everyday decisions."
Submissiveness Willing to give in to others; meekly obedient or passive "I find it hard to disagree with people if I depend on them a lot."
Generalized Anxiety Frequently feeling fearful or worried "I usually feel tense or nervous."
Separation Anxiety Having anxiety provoked by threats of separation or rejection from significant others "I worry about being left alone and having to care for myself."
Low Self-Esteem Having feelings of low self-worth or low self-confidence; feeling inferior "I feel awkward or out of place in social situations."

Core Features of Personality Disorders:

The general requirements for the diagnosis of a personality disorder are:

  • a pervasive pattern of maladaptive traits and behaviours

  • beginning in early adult life

    • it usually has its first manifestations in childhood and is clearly evident in adolescence

    • it is not diagnosed before early adult life because these maladaptive traits are very common in childhood and adolescence, but most individuals age-out of these traits before early adulthood

  • leading to substantial personal distress and/or social dysfunction, and disruption to others

  • is of long duration, typically lasting at least several years

Severity Rating Scale For Personality Disorders:

Severity rating scale for personality disorders in the International Classification of Diseases (ICD)-11:

  • Mild Personality Disorder: There are notable problems in many interpersonal relationships and the performance of expected occupational and social roles, but some relationships are maintained and/or some roles carried out. Mild personality disorder is typically not associated with substantial harm to self or others .

  • Moderate Personality Disorder: There are marked problems in most interpersonal relationships and in the performance of expected occupational and social roles across a wide range of situations that are sufficiently extensive that most are compromised to some degree. Moderate personality disorder often is associated with a past history and future expectation of harm to self or others, but not to a degree that causes long-term damage or has endangered life .

  • Severe Personality Disorder: There are severe problems in interpersonal functioning affecting all areas of life. The individual's general social dysfunction is profound and the ability and/or willingness to perform expected occupational and social roles is absent or severely compromised. Severe personality disorder usually is associated with a past history and future expectation of severe harm to self or others that has caused long-term damage or has endangered life .

Onset:

Dependent personality disorder occurs in 0.6% of the U.S. population. Typical features of dependent personality disorder are a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation.

For this diagnosis to be given, the individual must be at least in early adulthood. This disorder is only diagnosed when these behaviors become persistent and very disabling.

Treatment:

There is insufficient (randomized controlled trial) evidence to prove the effectiveness of any psychological intervention or medication for adults with this disorder. Lacking such evidence, it would be prudent to only offer crisis intervention or short-term psychotherapy, rather than long-term psychotherapy.

Prognosis:

Dependent Personality Disorder may last years or a lifetime. Individuals with this disorder have an increased risk of depression, alcohol or drug abuse, and physical, emotional, or sexual abuse. Occupational functioning is impaired if independent initiative is required. These individuals avoid positions of responsibility and become anxious when faced with decisions. Social relations tend to be limited to those few people on whom they are dependent.

SAPAS Personality Screening Test

Individuals with this disorder would have a significant impairment in the behaviors that are displayed in red :

Most of the time and in most situations:

      In general, do you have difficulty making and keeping friends?
      Would you normally describe yourself as a loner?
      In general, do you trust other people?
      Do you normally lose your temper easily?
      Are you normally an impulsive sort of person?
      Are you normally a worrier?
      In general, do you depend on others a lot?
      In general, are you a perfectionist?

Answer "Yes" or "No" to each of these 8 questions.

7-Question Well-Being Screening Test (By P. W. Long MD, 2020

Individuals with this disorder would have a significant impairment in the behaviors that are displayed in red :

      Agreeableness: I was kind and honest.
      Conscientiousness: I was diligent and self-disciplined.
      Openness/Intellect: I showed good problem-solving and curiosity.
      Sociality: I was gregarious, enthusiastic, and assertive. (Instead was unassertive, submissive).
      Emotional Stability: I was emotionally stable and calm. (Instead had separation anxiety, dependency).
      Physical Health: I was physically healthy.
      Role Functioning: I functioned well socially and at school/work.

How often in the past week did you do each of these 7 behaviors:


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Diagnose Dependent Personality Disorder

Diagnose All Personality Disorders

Limitations of Self-Diagnosis

Self-diagnosis of this disorder is often inaccurate. Accurate diagnosis of this disorder requires assessment by a qualified practitioner trained in psychiatric diagnosis and evidence-based treatment.

However, if no such professional is available, our free computerized diagnosis is usually accurate when completed by an informant who knows the patient well. Computerized diagnosis is less accurate when done by patients (because they often lack insight).

Example Of Our Computer Generated Diagnostic Assessment

Dependent Personality Disorder 301.6

This diagnosis is based on the following findings:

  • Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others (still present)

  • Needs others to assume responsibility for most major areas of his or her life (still present)

  • Has difficulty expressing disagreement with others because of fear of loss of support or approval (still present)

  • Has difficulty initiating projects or doing things on his or her own (still present)

  • Goes to excessive lengths to obtain nurturance and support from others (still present)

  • Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to cope (still present)

  • Urgently seeks another relationship as a source of care and support when a close relationship ends (still present)

  • Is unrealistically preoccupied with fears of being left to take care of himself or herself (still present)

Treatment Goals:

  • Goal: be more independent in making decisions.
    If this problem persists: She will continue to have great difficulty making everyday decisions without an excessive amount of advice and reassurance from others. She will be overly reliant on family help. She will depend on a parent or spouse to decide where to live, what kind of job to have, and which people to befriend.

  • Goal: don't rely on others to make all the important decisions.
    If this problem persists: She will continue to be passive and allow other people to take the initiative and to assume responsibility for most major areas of her life. She will avoid personal responsibility by being passive and allowing other people to assume responsibility. Her need for others to assume responsibility will go beyond appropriate requests for assistance from others.

  • Goal: be able to express disagreement.
    If this problem persists: Because she fears losing support or approval, she will continue to have difficulty expressing disagreement with others. She will submit to what others want, even if the demands are unreasonable.

  • Goal: have enough confidence to start projects or do things alone.
    If this problem persists: She will continue to have difficulty initiating projects or doing things independently. She will present as being inept and requiring constant assistance.

  • Goal: do not go to excessive lengths to obtain support from others.
    If this problem persists: She will continue to be devastated by separation and loss and will go to great lengths, even suffering abuse, to stay in a relationship. Thus she will make extraordinary self-sacrifices or tolerate verbal, physical, or sexual abuse.

  • Goal: do not fear being alone.
    If this problem persists: She will continue to feel helpless when alone, because of an exaggerated fear of being unable to cope. She will "tag along" with important others just to avoid being alone.

  • Goal: do not urgently and indiscriminately seek another supportive relationship when a close relationship ends.
    If this problem persists: If a relationship does end, she will continue to urgently seek another relationship to provide care and support. This search may become so urgent that she quickly and indiscriminately attaches to another person.

  • Goal: overcome excessive fear of abandonment.
    If this problem persists: She will continue to be so dependent on the advice and help of another person that she will worry about being abandoned by that person when there are no grounds to justify such fears.


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Diagnostic Features

"Dependent personality disorder is characterized by pervasive passive reliance on other people to make one's major and minor life decisions, great fear of abandonment, feelings of helplessness and incompetence, passive compliance with the wishes of elders and others, and a weak response to the demands of daily life. Lack of vigour may show itself in the intellectual or emotional spheres; there is often a tendency to transfer responsibility to others" (ICD10). It is "a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts" (DSM-5).

In terms of the "Big-6" Dimensions of Mental Health this disorder is characterized by emotional distress (dependence, submissiveness, generalized anxiety, separation anxiety, low self-esteem). This leads to substantial personal distress and/or social dysfunction, and disruption to others. This is not diagnosed before early adult life because these maladaptive traits are very common in childhood and adolescence, but most individuals age-out of these traits before early adulthood. This disorder is of long duration, typically lasting at least several years.

The diagnosis of Dependent Personality Disorder requires 5 (or more) of the following:

  • Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.

  • Needs others to assume responsibility for most major areas of his or her life.

  • Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)

  • Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).

  • Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.

  • Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.

  • Urgently seeks another relationship as a source of care and support when a close relationship ends.

  • Is unrealistically preoccupied with fears of being left to take care of himself or herself.

Like all personality disorders, Avoidant Personality Disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.

This diagnosis should be used with great caution, if at all, in children and adolescents, for whom dependent behavior may be developmentally appropriate.

Dependency and separation anxiety are developmentally appropriate in children and adolescents. However, in some, the dependency and separation anxiety becomes excessive. Most adolescents grow out of their dependency and separation anxiety; however, for some it increases.

By early adulthood, if this dependency and separation anxiety becomes very pervasive and persistent; it is diagnosed as being Dependent Personality Disorder. Individuals with this disorder fear rejection/separation, are submissive, and are unable to handle conflict. These individuals do not trust their own ability to makedecisions. They go to great lengths, even suffering abuse, to stay in a relationship. They usually have feelings of inadequacy, hypersensitivity to criticism, and an excessive need for reassurance.

Course

Dependent Personality Disorder usually begins by early adulthood, and has a chronic course. Dependent behavior is very common in childhood, but most adolescents grow out of this behavior. Unfortunately, for some, this dependent behavior persists and intensifies into adulthood; thus they become diagnosed with this disorder. Chronic physical illness or Separation Anxiety Disorder in childhood or adolescence may predispose the individual to develop this disorder.

Complications

Dependent personality disorder has an increased risk of depression, alcohol or drug abuse, and physical, emotional, or sexual abuse. Occupational functioning is impaired if independent initiative is required. The individual avoids positions of responsibility and becomes anxious when faced with decisions. Social relations tend to be limited to those few people on whom the individual is dependent.

Comorbidity

Some other disorders frequently occur with this disorder:

    Non-Personality Disorders

            Depressive Disorders:
      • Persistent Depressive Disorder (Dysthymia)
            Anxiety Disorders:
      • Separation Anxiety Disorder, Panic Disorder, Agoraphobia

    Personality Disorders

            Avoidant Personality Disorder

            Borderline Personality Disorder
        Note: Avoidant, Dependent and Borderline Personality Disorders are closely related since they all share the same core feature of anxiety. If an individual has one of these personality disorders, they are very likely to have one of the others.

Associated Laboratory Findings

No laboratory test has been found to be diagnostic of this disorder.

Prevalence

Dependent personality disorder is more frequent in females, and is present in about 0.6% of the general population.

Controlled Clinical Trials Of Therapy

Click here for a list of all the controlled clinical trials of therapy for this disorder.

Psychotherapy

There is insufficient randomized controlled trial evidence to prove the effectiveness of any psychological intervention or medication for adults with this disorder. Lacking such evidence, it would be prudent to only offer crisis intervention or short-term psychotherapy, rather than long-term psychotherapy. The goal of therapy is to assist the client in becoming more independent - and to not become dependent upon the therapist.

Pharmacotherapy

There are currently no medications approved by the FDA to treat this disorder. Vitamins and dietary supplements are ineffective for all Personality Disorders.

Trustworthy Research (PubMed.gov)


A Dangerous Cult: Videos


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Videos


Stories

Rating Scales

SWAP-200 DPD - measures the severity of Dependent Personality Disorder

Lack Of Social Skills In Personality Disorders

There are social skills that are essential for healthy social functioning. Individuals with Dependent Personality Disorder lack the essential social skills of independence, assertiveness, and peacemaking.

Social Skills That Are Lacking In Dependent Personality Disorder

SOCIAL SKILL DEPENDENT PERSONALITY NORMAL
Independence Dependence on others Freedom from the control, influence, or support of others; not fearing separation from others
Assertiveness Submissiveness Being confident and direct in claiming one's rights or putting forward one's views
Peacemaking Inability to handle conflict Skillfully preventing (or handling) conflict within a group or family

Emotional Stability vs. Emotional Distress

EMOTIONAL STABILITY EMOTIONAL DISTRESS
Emotional Stability Emotional Instability
Having a stable and predictable mood Over-reacting to events with rapidly changing, intense, unpredictable emotions
Sense of Purpose No Sense of Purpose
Feeling that one’s life has a sense of purpose, direction or meaning; knowing one’s passion Wandering aimlessly through life without purpose, direction, meaning or a passion
Social Stability Social Instability
Having a stable and peaceful social life Unstable and stormy social life; frequently going from one social crisis to another
Self-Appreciation Self-Depreciation
Having a good opinion of oneself; feeling capable and of worth; good self-esteem Having a poor opinion of oneself; feeling worthless or useless; low self-esteem
Optimism Pessimism
Having a positive outlook on life; expecting a good outcome; hopeful; not giving up too easily Having a negative outlook on life; expecting the worst outcome; giving up too easily
Social Support Lack of Social Support
Having friends to turn to in times of need or crisis; having supportive companionship Feeling there is nobody to talk to, or to turn to in times of need or crisis; lacking companionship
Independence Separation Anxiety
Not fearing rejection, being alone, or being temporarily separated from loved ones Fear of abandonment; fear of rejection by, or separation from, significant others
Assertiveness Submissiveness
Being confident to think or express your own ideas or opinions Humble obedience and unassertiveness; frequently seeks advice and reassurance
Peacemaking Difficulty Handling Conflict
Skillfully preventing (or handling) conflict within a group or family Difficulty handling conflict with others

Avoidant, borderline, and dependent personality disorders are closely related and can be thought of as forming an "emotional distress cluster" of personality disorders. On personality testing, these three disorders all have low Emotional Stability scores.

Social Skills That Are Lacking In The "Emotional Distress Cluster" Of Personality Disorders

PERSONALITY DISORDER LACKING LACKING LACKING
Avoidant Personality Self-Confidence (instead has feeling inferior or shy) Optimism (instead has pessimism or expecting the worst) Belonging (instead has fearing rejection by others )
Dependent Personality Independence (instead has dependence on others ) Assertiveness (instead has submissiveness) Peacemaking (instead has inability to handle conflict)
Borderline Personality Emotional Stability (instead has emotional instability) Stable Self-Image (instead has unstable self-image ) Stable Relationships (instead has intense, chaotic relationships)

A Emotionally Stable Life (Emotional Stability)

How does one live a Emotionally Stable life?

One approach to answering this question is to study the behavior of individuals who live anxious, emotionally unstable lives. Could the opposite of their maladaptive behavior define how to live a Emotionally Stable life?

Research has shown that anxiety and emotional instability highly correlates with low scores on the emotional stability personality dimension. The personality disorders that have the lowest scores on the emotional stability personality dimension are the Avoidant, Dependent, and Borderline Personality Disorders.

Could the opposite of the personality traits seen in the Avoidant, Dependent, and Borderline Personality Disorders be a clue as to how to live a Emotionally Stable life? If so, the right side of the following table would define a calm, emotionally stable life. (This table uses DSM-5 diagnostic criteria.)

Avoidant Personality Disorder The Opposite Of Avoidant Personality Disorder
Avoidance: Sociality:
Avoids occupational activities that involve significant interpersonal contact, because of her fear of criticism, disapproval, or rejection Doesn't avoid occupational activities that involve significant interpersonal contact, because of any fear of criticism, disapproval, or rejection
Is unwilling to get involved with people unless she is certain of being liked Is willing to get involved with people even if she is uncertain of being liked
Shows restraint within intimate relationships because of her fear of being shamed or ridiculed Is not reluctant in intimate relationships because of any fear of being shamed or ridiculed
Is preoccupied with being criticized or rejected in social situations Doesn't worry excessively about being criticized or rejected in social situations
Social Anxiety: Self-Confidence:
Is inhibited in new interpersonal situations because of her feelings of inadequacy Is not inhibited in new interpersonal situations because of any feelings of inadequacy
Views herself as socially inept, personally unappealing, or inferior to others Does not view herself as socially inept, personally unappealing, or inferior to others
Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing Is not reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
Dependent Personality Disorder The Opposite Of Dependent Personality Disorder
Dependency: Independence:
Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others Can make everyday decisions without an excessive amount of advice and reassurance from others
Needs others to assume responsibility for most major areas of her life Assumes responsibility for most major areas of her life
Has difficulty expressing disagreement with others because of her fear of loss of support or approval Can express disagreement with others
Has difficulty initiating projects or doing things on her own No difficulty initiating projects or doing things on her own
Goes to excessive lengths to obtain nurturance and support from others Does not go to excessive lengths to obtain nurturance and support from others
Feels uncomfortable or helpless when alone because of her exaggerated fears of being unable to cope Feels comfortable when alone
Urgently seeks another relationship as a source of care and support when a close relationship ends Does not urgently seek another relationship as a source of care and support when a close relationship ends
Is unrealistically preoccupied with fears of being left to take care of herself Is not preoccupied with fears of being left to take care of herself
Borderline (Emotionally Unstable) Personality Disorder The Opposite Of Borderline (Emotionally Unstable) Personality Disorder
Emotional Instability: Emotional Stability:
Rapidly shifting emotions Stable emotions
Inappropriate, intense anger or difficulty controlling anger Good anger control
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior No suicidal behavior, gestures, or threats, or self-mutilating behavior
Chronic feelings of emptiness Has meaning and purpose to her life
Impulsivity: Caution:
Potentially self-damaging impulsivity (e.g., spending, sex, substance abuse, reckless driving, binge eating) No potentially self-damaging impulsivity
Unstable, Intense, Chaotic Relationships: Stable Relationships:
Unstable and intense 'love-hate' relationships Stable, close, long-lasting interpersonal relationships
Frantic efforts to avoid real or imagined abandonment Can calmly cope with real or imagined abandonment
Markedly and persistently unstable self-image or sense of self Stable self-image; positive sense of herself

An Emotionally Distressed Life

How does one live an anxious, emotionally unstable life?

The following table summarizes the personality traits of individuals with Avoidant, Dependent and Borderline Personality Disorder. Individuals with these emotional distress personality disorders have marked anxiety or emotional instability. (This table uses ICD-10 diagnostic criteria.)

Avoidant Personality Traits:
Persistent and pervasive feelings of tension and apprehension. "I usually feel tense or nervous."
Belief that oneself is socially inept, personally unappealing, or inferior to others. "I feel awkward or out of place in social situations."
Excessive preoccupation about being criticized or rejected in social situations. "I worry a lot that people may not like me."
Unwillingness to get involved with people unless certain of being liked. "I won't get involved with people until I'm certain they like me."
Restrictions in lifestyle because of need of security. "A lot of things seem dangerous to me that don't bother most people."
Avoidance of social or occupational activities that involve significant interpersonal contact, because of fear of criticism, disapproval or rejection. "I keep to myself even when there are other people around."
Dependent Personality Traits:
Encouraging or allowing others to make most of one's important life decisions. "I let others make my big decisions for me."
Subordination of one's own needs to those of others on whom one is dependent, and undue compliance with their wishes. "I find it hard to disagree with people if I depend on them a lot."
Unwillingness to make even reasonable demands on the people one depends on. "I don't ask favors from people that I depend on a lot."
Feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself. "I usually feel uncomfortable or helpless when I'm alone."
Preoccupation with fears of being left to take care of oneself. "I worry about being left alone and having to care for myself."
Limited capacity to make everyday decisions without an excessive amount of advice and reassurance from others. "I often seek advice or reassurance about everyday decisions."
Borderline Personality Traits:
A marked tendency to quarrelsome behavior and to conflicts with others, especially when impulsive acts are thwarted or criticized "I argue or fight when people try to stop me from doing what I want."
A marked tendency to act unexpectedly and without consideration of the consequences "I take chances and do reckless things."
Liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions "Sometimes I get so angry I break or smash things."
Difficulty in maintaining any course of action that offers no immediate reward "I don't stick with a plan if I don't get results right away."
Unstable and capricious mood "I'm very moody."
Disturbances in and uncertainty about self-image, aims and internal preferences (including sexual) "I can't decide what kind of person I want to be."
Liability to become involved in intense and unstable relationships, often leading to emotional crises "I get into very intense relationships that don't last."
Excessive efforts to avoid abandonment "I go to extremes to try to keep people from leaving me."
Recurrent threats or acts of self-harm "A number of times, I've threatened suicide or injured myself on purpose."
Chronic feelings of emptiness "I often feel empty inside."

Parental Behaviors Which Increase The Risk Of Developing A Personality Disorder

Research has shown that genetic, environmental, and prenatal factors all play important roles in the development of personality disorder. Research has also shown that low parental affection and harsh parenting increase the risk of a child later developing a personality disorder.

"Low affection" was defined as: low parental affection, low parental time spent with the child, poor parental communication with the child, poor home maintenance, low educational aspirations for the child, poor parental supervision, low paternal assistance to the child's mother, and poor paternal role fulfillment. "Harsh parenting" was defined as: harsh punishment, inconsistent maternal enforcement of rules, frequent loud arguments between the parents, difficulty controlling anger toward the child, possessiveness, use of guilt to control the child, and verbal abuse.


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(USE SLIDER ON RIGHT SIDE OF THE ABOVE PAGE TO SEE FULL CHECKLIST)



This disorder is characterized by pathological personality traits in the following domain:

  • Emotional Distress , characterized by:

    • Dependence:
      Constantly looking to others for support and guidance.

      Question: "Do you often seek advice or reassurance about everyday decisions?"
      • "Encouraging or allowing others to make most of one's important life decisions. " (ICD-10)

      • "Needs others to assume responsibility for most major areas of his or her life." (DSM-5)

      • "Limited capacity to make everyday decisions without an excessive amount of advice and reassurance from others." (ICD-10)

      • "Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others." (DSM-5)

      • "Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy)." (DSM-5)

      • "Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant." (DSM-5)


    • Submissiveness:
      Willing to give in to others; meekly obedient or unassertive.

      Question: "Do you find it hard to disagree with people if you depend on them a lot?"
      • "Subordination of one's own needs to those of others on whom one is dependent, and undue compliance with their wishes." (ICD-10)

      • "Unwillingness to make even reasonable demands on the people one depends on." (ICD-10)

      • "Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)" (DSM-5)


    • Separation Anxiety:
      Feeling uncomfortable or helpless when alone or when separated from caretakers.

      Question: "Do you worry about being left alone and having to care for yourself?"
      • "Feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself." (ICD-10)

      • "Preoccupation with fears of being left to take care of oneself." (ICD-10)

      • "Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself." (DSM-5)

      • "Urgently seeks another relationship as a source of care and support when a close relationship ends." (DSM-5)

      • "Is unrealistically preoccupied with fears of being left to take care of himself or herself." (DSM-5)




(Note: Recovery = symptomatic remission + full-time gainful employment + weekly contact with friends)


Dependent Personality Disorder F60.7 - ICD10 Description, World Health Organization

Dependent personality disorder is characterized by pervasive passive reliance on other people to make one's major and minor life decisions, great fear of abandonment, feelings of helplessness and incompetence, passive compliance with the wishes of elders and others, and a weak response to the demands of daily life. Lack of vigour may show itself in the intellectual or emotional spheres; there is often a tendency to transfer responsibility to others.

ICD-10 International Personality Disorder Examination Screening Questions

  • I let others make my big decisions for me.

  • I find it hard to disagree with people if I depend on them a lot.

  • I usually feel uncomfortable or helpless when I am alone.

  • I worry about being left alone and having to take care for myself.

  • I don't ask favors from people I depend on a lot.

  • I often seek advice or reassurance about everyday decisions.

ICD-10 Diagnostic Criteria (For Research)

    A. The general criteria of personality disorder must be met:

    • Evidence that the individual's characteristic and enduring patterns of inner experience and behavior deviate markedly as a whole from the culturally expected and accepted range (or 'norm').

    • The deviation must manifest itself pervasively as behavior that is inflexible, maladaptive, or otherwise dysfunctional across a broad range of personal and social situations (i.e. not being limited to one specific 'triggering' stimulus or situation).

    • There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behavior.

    • There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence.

    • The deviation cannot be explained as a manifestation or consequence of other adult mental disorders.

    • Organic brain disease, injury, or dysfunction must be excluded as possible cause of the deviation.

    B. At least four of the following must be present:

    • Encouraging or allowing others to make most of one's important life decisions.
        (E.g., "I let others make my big decisions for me.")

    • Subordination of one's own needs to those of others on whom one is dependent, and undue compliance with their wishes.
        (E.g., "I find it hard to disagree with people if I depend on them a lot.")

    • Unwillingness to make even reasonable demands on the people one depends on.
        (E.g., "I don't ask favors from people that I depend on a lot.")

    • Feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself.
        (E.g., "I usually feel uncomfortable or helpless when I'm alone.")

    • Preoccupation with fears of being left to take care of oneself.
        (E.g., "I worry about being left alone and having to care for myself.")

    • Limited capacity to make everyday decisions without an excessive amount of advice and reassurance from others.
        (E.g., "I often seek advice or reassurance about everyday decisions.")

Dependent Personality Disorder - Diagnostic Criteria, American Psychiatric Association

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following:

  • Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.

  • Needs others to assume responsibility for most major areas of his or her life.

  • Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)

  • Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).

  • Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.

  • Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.

  • Urgently seeks another relationship as a source of care and support when a close relationship ends.

  • Is unrealistically preoccupied with fears of being left to take care of himself or herself.

  • This enduring pattern of inner experience and behavior must deviate markedly from the expectations of the individual's culture.

  • This enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

  • This enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  • Dependency and separation anxiety are developmentally appropriate in children and adolescents. Most adolescents grow out of their dependency and separation anxiety; however, for some it increases. By early adulthood, if this dependency and separation anxiety becomes very pervasive and persistent; it is diagnosed as being Dependent Personality Disorder.

    Separation Anxiety Disorder - Diagnostic Criteria, American Psychiatric Association

    An individual diagnosed with separation anxiety disorder needs to meet all of the following criteria:

    • Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

      • Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.

      • Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.

      • Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.

      • Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.

      • Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.

      • Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.

      • Repeated nightmares involving the theme of separation.

      • Repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated.

    • The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.

    • The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.

    • The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder.

    Empirically Derived Taxonomy for Personality Diagnosis: Dependent Personality Disorder

    (This section uses an alternative classification system to that of the American Psychiatric Association)

    These individuals:
    • Are needy and dependent, fear being alone, and fear rejection or abandonment.

    • Are ingratiating or submissive, often consenting to things they find objectionable in an effort to maintain support or approval.

    • Are passive and unassertive and feel helpless and powerless.

    • Are indecisive, suggestible or easily influenced, and naive or innocent, seeming to know less about the ways of the world than would be expected.

    • Become attached to people who are emotionally unavailable, and create relationships in which they are in the role of caring for or rescuing the other person.

    • Get drawn into or remain in relationships in which they are emotionally or physically abused, or needlessly put themselves in dangerous situations (e.g., walking alone or agreeing to meet strangers in unsafe places).

    • Are insufficiently concerned with meeting their own needs and tend to feel unworthy or undeserving.

    • Have trouble acknowledging or expressing anger and instead become depressed, self-critical, or self-punitive.

    • Express anger in passive and indirect ways (e.g., making mistakes, procrastinating, forgetting) that may provoke or trigger anger or mistreatment from others.


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    Treatment Guidelines

    Setting Goals In Therapy

      Questions To Ask When Setting Goals

      In The Past Week:
      • WHO: was your problem?

      • EVENT: what did he/she do?

      • RESPONSE: how did you respond to that event?

      • OUTCOME: did your response help?

      • TRIGGER: what did you do that could have triggered this problem?

      • GOAL: what life skill(s) do you have to work on? (from checklist)

      Example Of Setting Goals In Interviewing A Person With Dependent Personality Disorder

      In The Past Week:
      • WHO: was your problem?
        "My boyfriend."

      • EVENT: what did he/she do?
        "I just found out he's sleeping with my best girlfriend."

      • RESPONSE: how did you respond to that event?
        "I felt so angry at both of them. I couldn't stand for this, but I couldn't walk out on my boyfriend. So I don't know what to do."

      • OUTCOME: did your response help?
        "No, I'm paralyzed - I don't want to lose either my girlfriend or my boyfriend. But my doing nothing about this is making me sick."

      • TRIGGER: what did you do that could have triggered this problem?
        "This isn't the first time that my boyfriend has cheated on me, but I never do anything about it."

      • GOAL: what life skill(s) do you have to work on? (from checklist)
        "I want to work on: (1) Independence ("not fearing rejection, being alone, or being temporarily separated from loved ones"), and (2) Extraversion ("being confident and direct in claiming one's rights or putting forward one's views")."

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    Self-Help Resources

    Monitoring Your Progress

    NOTE: When each of the following presentations finish; you must exit by manually closing its window in order to return to this webpage.

    The Healthy Social Behavior Scale lists social behaviors that research has found to be associated with healthy social relationships. You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



    The Mental Health Scale lists behaviors and symptoms that research has found to be associated with mental health (or disorder). You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



    The Life Satisfaction Scale lists the survey questions often used to measure overall satisfaction with life. You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



    Life Satisfaction Scale (5-Minute Video)

    The "Big 6" Dimensions of Mental Health

    Research has shown that there are 5 major dimensions (the "Big 5 Factors" or Five-Factor Model) of personality disorders and other mental disorders.

    This website uses these 5 major dimensions of human behavior (i.e., Agreeableness, Conscientiousness, Openness/Intellect, Extraversion/Sociability, and Emotional Stability) to describe all mental disorders. This website adds one more dimension, "Physical Health", to create the "Big 6" dimensions of mental health.

    The behaviors of the "Five Factor Model of Personality" represent five adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociability" ], (4) decide whether to proceed in a cautious or impulsive manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness/Intellect" ].



    Desiderata (5-Minute Video)



    The following "Morning Meditation" allows you to plan your day using these "Big 6" dimensions of mental health.



    The following "Evening Meditation" allows you to review your progress on these "Big 6" dimensions of mental health.




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      "In physical science a first essential step in the direction of learning any subject is to find principles of numerical reckoning and practicable methods for measuring some quality connected with it. I often say that when you can measure what you are speaking about and express it in numbers you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind: it may be the beginning of knowledge, but you have scarcely, in your thoughts, advanced to the stage of science, whatever the matter may be."

      Lord Kelvin (1824 – 1907)


    • The best summary on bad research is given by Laura Arnold in this TEDx lecture. If you read nothing else about research, you owe it to yourself to watch this short video - it is excellent!

    • Economist in grim battle against deceptive scholarship

    • List of Predatory Journals and Publishers

    • The power of asking "what if?"

    • The active placebo effect: 2300 years ago, the Greek Stoic philosophers taught that it is not the objective event, but our subjective judgment about the event, that determines our behavior. The active placebo effect bears witness to this ancient wisdom.

    • Criteria For High Quality Research Studies

    • It is troubling that a recent study found that two-thirds of important psychological research studies couldn't be replicated. High quality research must meet the following criteria:

      • Randomized Controlled Trial:
        Ask: Was the trial randomized? Was the randomization procedure described and was it appropriate? The best research design is to have research subjects randomly assigned to an experimental or control group. It is essential that confounding factors be controlled for by having a control group or comparator condition (no intervention, placebo, care as usual etc.).

      • Representative Sample:
        Ask: Do the research subjects represent a normal cross-section of the population being studied? Many psychological research studies using university students are flawed because their subjects are not representative of the normal population since they are all W.E.I.R.D. (White, Educated, Intelligent, Rich, and living in a Democracy).

      • Single Blind Trial:
        Ask: Was the treatment allocation concealed? It is essential that the research subjects are kept "blind" as to whether they are in the experimental or control group (in order to control for any placebo effects).

      • Double Blind Trial (Better Than Single Blind Trial):
        Ask: Were blind outcome assessments conducted? In a double blind study, neither the research subjects nor the outcome assessors know if the research subject is in the experimental or control group. This controls for both the placebo effect and assessor bias.

      • Baseline Comparability:
        Ask: Were groups similar at baseline on prognostic indicators? The experimental and control groups must be shown to be comparable at the beginning of the study.

      • Confounding Factors:
        Ask: Were there factors, that weren't controlled for, that could have seriously distorted the study's results? For example, research studies on the effectiveness of mindfulness cognitive therapy in preventing depressive relapse forgot to control for whether the research subjects were also simultaneously receiving antidepressant medication or other psychological treatments for depression.

      • Intervention Integrity:
        Ask: Was the research study protocal strictly followed? The research subjects must be shown to be compliant (e.g., taking their pills, attending therapy) and the therapists must be shown to be reliably delivering the intervention (e.g., staying on the research protocol).

      • Statistical analysis:
        Ask: Was a statistical power calculation described? The study should discuss its statistical power analysis; that is whether the study size is large enough to statistically detect a difference between the experimental and control group (should it occur) and usually this requires at least 50 research subjects in the study.

        Ask: Are the results both statistically significant and clinically significant? Many medical research findings are statistically significant (with a p-value <0.05), but they are not clinically significant because the difference between the experimental and control groups is too small to be clinically relevant.

        For example, the effect of a new drug may be found to be 2% better than placebo. Statistically (if the sample size was large enough) this 2% difference could be statistically significant (with a p-value <0.05). However, clinicians would say that this 2% difference is not clinically significant (i.e., that it was too small to really make any difference).

        Statistically, the best way to test for clinical significance is to test for effect size (i.e., the size of the difference between two groups rather than confounding this with statistical probability).

        When the outcome of interest is a dichotomous variable, the commonly used measures of effect size include the odds ratio (OR), the relative risk (RR), and the risk difference (RD).

        When the outcome is a continuous variable, then the effect size is commonly represented as either the mean difference (MD) or the standardised mean difference (SMD) .

        The MD is the difference in the means of the treatment group and the control group, while the SMD is the MD divided by the standard deviation (SD), derived from either or both of the groups. Depending on how this SD is calculated, the SMD has several versions such, as Cohen's d, Glass's Δ, and Hedges' g.

          Clinical Significance: With Standard Mean Difference, the general rule of thumb is that a score of 0 to 0.25 indicates small to no effect, 0.25-0.50 a mild benefit, 0.5-1 a moderate to large benefit, and above 1.0 a huge benefit. It is a convention that a SMD of 0.5 or larger is a standard threshold for clinically meaningful benefit.

        The statistical summary should report what percentage of the total variance of the dependent variable (e.g., outcome) can be explained by the independent variable (e.g., intervention).

        In clinical studies, the study should report the number needed to treat for an additional beneficial outcome (NNTB), and the number needed to treat for an additional harmful outcome (NNTH).

          Number Needed To Benefit (NNTB): This is defined as the number of patients that need to be treated for one of them to benefit compared with a control in a clinical trial. (It is defined as the inverse of the absolute risk reduction.) Note: Statistically, the NNTB depends on which control group is used for comparison - e.g., active treatment vs. placebo treatment, or active treatment vs. no treatment.

          Number Needed To Harm (NNTH): This is defined as the number of patients that need to be treated for one of them to be harmed compared with a control in a clinical trial. (It is defined as the inverse of the absolute increase in risk of harm.)

          Tomlinson found “an NNTB of 5 or less was probably associated with a meaningful health benefit,” while “an NNTB of 15 or more was quite certain to be associated with at most a small net health benefit.”

        Ask: Does the researcher accept full responsibility for the study's statistical analysis? The researcher should not just hand over the study's raw data to a corporation (that may have $1,000 million invested in the study) to do the statistical analysis.

      • Completeness of follow-up data:
        Ask: Was the number of withdrawals or dropouts in each group mentioned, and were reasons given for these withdrawals or dropouts? Less than 20% of the research subjects should drop out of the study. The intervention effect should persist over an adequate length of time.

      • Handling of missing data:
        Ask: Was the statistical analysis conducted on the intention-to-treat sample? There must be use of intention-to-treat analysis (as opposed to a completers-only analysis). In this way, all of the research subjects that started the study are included in the final statistical analysis. A completers-only analysis would disregard those research subjects that dropped out.

      • Replication of Findings:
        Ask: Can other researchers replicate this study's results? The research study's methodology should be clearly described so that the study can be easily replicated. The researcher's raw data should be available to other researchers to review (in order to detect errors or fraud).

      • Fraud:
        Ask: Is there a suspicion of fraud? In a research study, examine the independent and dependent variables that are always measured as a positive whole number (e.g., a variable measured on a 5-point Likert-type scale ranging from "1 = definitely false to 5 = definitely true" etc.). For each of these variables, look at their sample size ( n ), mean ( M ) and standard deviation ( SD ) before they undergo statistical analysis. There is a high suspicion of fraud in a study's statistics:

        • If the M is mathematically impossible (online calculator): This is one of the easiest ways to mathematically detect fraud. The mean ( M ) is defined as "the sum ( Sum ) of the values of each observation divided by the total number ( n ) of observations". So: M = Sum / n . Thus: ( Sum ) = ( M ) multiplied by ( n ). We know that, if a variable is always measured as a positive whole number, the sum of these observations always has to be a whole number. For these variables to test for fraud: calculate ( M ) multiplied by ( n ). This calculates the Sum which MUST be a positive whole number. If the calculated Sum isn't a positive whole number; the reported mean ( M ) is mathematically impossible - thus the researcher either cooked the data or made a mistake. A recent study of 260 research papers published in highly reputable psychological journals found that 1 in 2 of these research papers reported at least one impossible value , and 1 in 5 of these research papers reported multiple impossible values. When the authors of the 21 worst offending research papers were asked for their raw data (so that its reliability could be checked) - 57% angrily refused. Yet such release of raw data to other researchers is required by most scientific journals. (Here is an example of a research paper filled with mathematically impossible means.)

        • If the SD is mathematically impossible (online calculator): When researchers fraudulently "cook" their data, they may accidently give their data a mean and standard deviation that is mathematically impossible.

        • If the SD/M is very small (i.e., the variable's standard deviation is very small compared to the mean suggesting data smoothing).

        • If the SD's are almost identical (i.e., the variables have different means but almost identical standard deviations).

        • If the 4th digit of the values of the variables aren't uniformly distributed - since each should occur 10% of the time (Benford's Law).

        • If the researcher is legally prevented from publishing negative findings about a drug or therapy because that would violate the "nondisclosure of trade secrets" clause in the research contract (i.e., it is a "trade secret" that the drug or therapy is ineffective - hence this can not be "disclosed"). Approximately half of all registered clinical trials fail to publish their results.

        • If the researcher refuses to release his raw data to fellow researchers (so that they can check its validity). In order to be published in most scientific journals, a researcher must promise to share his raw data with fellow researchers. Thus a researcher's refusal to do so is almost a sure indicator of fraud.

        • If the research study's data contradicts the study's own conclusions - surprisingly, this often occurs.

    • Calling Bullshit In The Age of Big Data - "Bullshit is language, statistical figures, data graphics, and other forms of presentation intended to persuade by impressing and overwhelming a reader or listener, with a blatant disregard for truth and logical coherence." Reading the syllabus of this university course should be required reading for every student of mental health. This syllabus is absolutely fantastic!

    • Statistical Methods in Psychology Journals: Guidelines and Explanations - American Psychologist 1999

    • Not All Scientific Studies Are Created Equal - video

    • The efficacy of psychological, educational, and behavioral treatment

    • Estimating the reproducibility of psychological science

    • Psychologists grapple with validity of research

    • Industry sponsorship and research outcome (Review) - Cochrane Library

    • 'We've been deceived': Many clinical trial results are never published - (text and video)

    • Junk science misleading doctors and researchers

    • Junk science under spotlight after controversial firm buys Canadian journals

    • Medicine with a side of mysticism: Top hospitals promote unproven therapies - Are some doctors becoming modern witchdoctors?

    • When Evidence Says No, But Doctors Say Yes


    • Cochrane Reviews (the best evidence-based, standardized reviews available)

    Research Topics

    Dependent Personality Disorder - Core Clinical Journals

    Dependent Personality - All Journals

    Dependent Personality - Review Articles - Core Clinical Journals

    Dependent Personality - Review Articles - All Journals

    Dependent Personality Disorder - Treatment - Core Clinical Journals

    Dependent Personality Disorder - Treatment - All Journals

    Recommended Free Full Text Articles


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    Normal Distribution Of Human Attributes

    Regression to the Mean (Or Why Scientific Experiments Require A Control Group)

    The "Big 6" Dimensions of Mental Health

    Research has shown that there are 5 major dimensions (the "Big 5 Factors" or Five-Factor Model) of personality disorders and other mental disorders. There are two free online personality tests that assess your personality in terms of the "Five Factor Model of Personality". Although not computerized online, the Big Five Inventory (BFI) is a 44-item test often used in personality research.

    This website uses these 5 major dimensions of human behavior to describe all mental disorders. (This website adds one more dimension, "Physical Health", to create the "Big 6" dimensions of mental health.)

    The behaviors of the "Five Factor Model of Personality" represent five adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociability" ], (4) decide whether to proceed in a cautious or impulsive manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness/Intellect" ].

    Which "Big 6" Dimensions of Mental Health are Impaired in Dependent Personality Disorder?

    THE POSITIVE SIDE OF THE "BIG 6" DIMENSIONS OF MENTAL HEALTH THE NEGATIVE SIDE OF THE "BIG 6" DIMENSIONS OF MENTAL HEALTH THIS DISORDER
    Agreeableness
    Being kind and honest.
    Antagonism
    Being unkind or dishonest.
    Conscientiousness
    Being diligent and self-disciplined.
    Disinhibition
    Being distractible, impulsive, or undisciplined.
    Openness/Intellect
    Showing good creativity, problem-solving, and learning ability
    Impaired Intellect
    Showing decreased creativity, problem-solving, or learning ability.
    Extraversion
    Being gregarious, assertive and enthusiastic.
    Detachment
    Being detached, unassertive, or unenthusiastic.
    Emotional Stability
    Being emotionally stable and calm.
    Emotional Distress
    Being emotionally unstable/distressed.
          Emotional Distress
    Physical Health
    Being physically fit and healthy.
    Physical Symptoms
    Being physically unfit or ill.





    The Following Will Only Discuss The Dimensions of Mental Illness That Are Abnormal In This Disorder

    The problems that are characteristic of this disorder are highlighted with this pink background color.


    EMOTIONAL STABILITY VS. EMOTIONAL DISTRESS

    EMOTIONAL STABILITY (Stability)
    Description: Emotional Stability is synonymous with stability and calm. The Emotional Stability dimension measures the behaviors that are central to the concept of COURAGE - having calm composure and endurance when confronting adversity. Individuals with high Emotional Stability are relatively tough, brave, and insensitive to physical pain, feel little worry even in stressful situations, and have little need to share their concerns with others. High Emotional Stability is associated with better: longevity, leadership, job [team] performance, and marital success. (This dimension appears to measure the behaviors that differentiate safety from danger.)
    Descriptors: Calm, rarely angry, rarely depressed or moody, rarely anxious or embarrassed.
    • From Between facets and domains: 10 aspects of the Big Five
      • Stability:
        • Rarely get irritated
        • Keep my emotions under control
        • Rarely lose my composure
        • Am not easily annoyed
      • Calm:
        • Relaxed, handle stress well
        • Feel comfortable with myself
        • Am not embarrassed easily
        • Seldom feel blue
        • Rarely feel depressed
    • From International Personality Item Pool:
      • Remain calm under pressure
      • Rarely get irritated
      • Feel comfortable with myself
      • Relaxed most of the time
      • Am not embarrassed easily
    Language Characteristics: Pleasure talk, agreement, compliment, low verbal productivity, few repetitions, neutral content, calm, few self-references, many short silent pauses, few long silent pauses, many tentative words, few aquiescence, little exaggeration, less frustration, low concreteness.
    "I am relaxed, and I handle stress well."
    "I am emotionally stable, and not easily upset."
    "I remain calm in tense situations."
    "I rarely get irritated."
    "I keep my emotions under control."
    "I rarely lose my composure."
    "I am not easily annoyed."
    "I seldom feel blue."
    "I feel comfortable with myself."
    "I rarely feel depressed."
    "I am not embarrassed easily."
    EMOTIONAL DISTRESS (Impaired Stability)
    Description: Emotional Distress is synonymous with emotional volatility and negative emotion. Individuals with high emotional volatility are easily upset or angered. They often are very moody and emotionally labile. Individuals that have high negative emotion exhibit over-sensitivity to threat or stress. They exhibit excessive fear, anxiety, depression, or irritability.
    ICD-11 Description: The core feature of the Emotional Distress (or Negative Affectivity) trait domain is the tendency to experience a broad range of negative emotions. Common manifestations of Emotional Distress include: experiencing a broad range of negative emotions with a frequency and intensity out of proportion to the situation; emotional lability and poor emotion regulation; negativistic attitudes; low self-esteem and self-confidence; and mistrustfulness.
    Descriptors: Easily upset, angry, depressed, moody, anxious, embarrassed.
    • From Between facets and domains: 10 aspects of the Big Five
      • Emotional Instability:
        • Get angry or upset easily
        • Change my mood a lot
        • Am a person whose moods go up and down easily
        • Get easily agitated
        • Can be stirred up easily
      • Negative Emotion:
        • Worry a lot
        • Get nervous easily
        • Am filled with doubts about things
        • Feel threatened easily
        • Am easily discouraged
        • Become overwhelmed by events
        • Am afraid of many things
    • From International Personality Item Pool:
      • Panic easily
      • Get angry easily
      • Often feel blue
      • Worry about things
      • Am easily intimidated
    Evolution: All animals have evolved a "fight or flight" response to threat to ensure their survival. Mammals went one step further and evolved a "fight, flight, or freeze" response to threat. In humans, this mammalian "freeze" response to threat involves inhibition of behavior in response to threat, punishment, and emotional distress. This threat response of "freezing", shutting down or passively avoiding is commonly seen in human anxiety or depression (e.g., freezing with fear or being immobilized by indecision, worry or depression).
    Language Characteristics: Problem talk, dissatisfaction, high verbal productivity, many repetitions, polarised content, stressed, many self-references, few short silent pauses, many long silent pauses, few tentative words, more aquiescence, many self references, exaggeration, frustration, high concreteness.
    Screening Questions:
    • "I worry about almost everything."
    • "I get emotional easily, often for very little reason."
    • "I fear being alone in life more than anything else."
    • "I get stuck on one way of doing things, even when it’s clear it won’t work."
    • "I get irritated easily by all sorts of things."
    Research: Lower scores on Emotional Stability are associated with unhappiness, dysfunctional relationships, and mental health problems. *MRI research found that Low Emotional Stability (= Emotional Distress or Neuroticism) was associated with increased volume of brain regions associated with threat, punishment, and emotional distress.
    * Anxiety:
    "I worry about almost everything."
    "I'm always fearful or on edge about bad things that might happen."
    "I always expect the worst to happen."
    "I am a very anxious person."
    "I get very nervous when I think about the future."
    "I often worry that something bad will happen due to mistakes I made in the past."
    "I am filled with doubts about things."
    "I feel threatened easily."
    "I am afraid of many things."
    * Separation Anxiety:
    "I fear being alone in life more than anything else."
    "I can't stand being left alone, even for a few hours."
    "I’d rather be in a bad relationship than be alone."
    "I'll do just about anything to keep someone from abandoning me."
    "I dread being without someone to love me."
    ("Emotional Stability vs. Emotional Distress" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five) [More Information]
    *MRI Research:
    Testing predictions from personality neuroscience. Brain structure and the big five.



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    The "Big 6" Dimensions of Mental Health

    Research has shown that there are 5 major dimensions (the "Big 5 Factors" or Five-Factor Model) of personality disorders and other mental disorders. There are two free online personality tests that assess your personality in terms of the "Five Factor Model of Personality". Although not computerized online, the Big Five Inventory (BFI) is a 44-item test often used in personality research.

    This website uses these 5 major dimensions of human behavior to describe all mental disorders. (This website adds one more dimension, "Physical Health", to create the "Big 6" dimensions of mental health.)

    The behaviors of the "Five Factor Model of Personality" represent five adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociability" ], (4) decide whether to proceed in a cautious or impulsive manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness/Intellect" ].

    The "Five Factor Model of Personality" as Shown In Dogs

    All animals have personalities - that is, consistent individual differences in behavior. Within virtually any population, some individuals are consistently more active, more aggressive, or are more willing to engage in risk-taking behavior. Thus the same "Big 5 Factors" of personality found in humans can be found in dogs.



    AGREEABLENESS VS. ANTAGONISM
    Agreeableness ("Friend")
    Dog is friendly towards unfamiliar people.
    Dog is friendly towards other dogs.
    When off leash, dog comes immediately when called.
    Dog willingly shares toys with other dogs.
    Dog leaves food or objects alone when told to do so.
    Antagonism ("Foe")
    Dog is dominant over other dogs.
    Dog is assertive with other dogs (e.g., if in a home with other dogs, when greeting).
    Dog behaves aggressively towards unfamiliar people.
    Dog shows aggression when nervous or fearful.
    Dog aggressively guards coveted items (e.g., stolen item, treats, food bowl).
    Dog is quick to sneak out through open doors, gates.

    CONSCIENTIOUSNESS VS. DISINHIBITION
    Conscientiousness ("Self-Controlled")
    Dog works at tasks (e.g., getting treats out of a dispenser, shredding toys) until entirely finished.
    Dog works hard all day herding or pulling a sleigh (if a "working dog" on the farm or in the snow). *
    Dog is curious.
    Disinhibition ("Disinhibited")
    Dog is boisterous.
    Dog seeks constant activity.
    Dog is very excitable around other dogs.

    OPEN-MINDEDNESS / INTELLECT VS. CLOSED-MINDEDNESS / IMPAIRED INTELLECT
    Intellect
    Dog is able to focus on a task in a distracting situation (e.g., loud or busy places, around other dogs).
    Impaired Intellect
    Dog is slow to respond to corrections.
    Dog ignores commands.
    Dog is slow to learn new tricks or tasks.

    EXTRAVERSION VS. DETACHMENT
    Sociality ("Approach")
    Dog is attention seeking (e.g., nuzzling, pawing or jumping up on family members looking for attention and physical contact).*
    Dog seeks companionship from people.
    Dog is affectionate.
    Detachment ("Avoidance")
    Dog is aloof.
    Dog gets bored in play quickly.
    Dog is lethargic.

    EMOTIONAL STABILITY VS. EMOTIONAL DISTRESS
    Emotional Stability ("Safety")
    Dog tends to be calm.
    Dog is relaxed when greeting people.
    Dog is confident.
    Dog adapts easily to new situations and environments.
    Emotional Distress ("Danger")
    Dog is anxious.
    Dog is shy.
    Dog behaves fearfully towards unfamiliar people.
    Dog exhibits fearful behaviors when restrained.
    Dog avoids other dogs.
    Dog behaves fearfully towards other dogs.
    Dog behaves submissively (e.g., rolls over, avoids eye contact, licks lips) when greeting other dogs.
    Modified from Jones, A. C. (2009). Development and validation of a dog personality questionnaire. Ph.D. Thesis. University of Texas, Austin.

    * New items added by Phillip W. Long MD

    The "Five Factor Model of Personality" In A Social Species

    The behaviors of the "Five Factor Model of Personality" serve adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociality" ], (4) decide whether to proceed in a self-controlled or disinhibited manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness to Experience" ].

    Spider Personalities

    All animals have personalities (defined as consistent behavioral differences among individuals). Animals can consistently differ on: (1) Antagonism (e.g., aggression), (2) Disinhibition (e.g., risk taking), (3) Intellect (e.g., inventiveness), (4) Extraversion (e.g., assertiveness), and (5) Emotional Stability (e.g., calmness).

    Some social spiders live in colonies of up to several hundred individuals, and exhibit cooperative behaviours such as prey capture and maternal care. Researchers have found that spider personalities differ in aggressiveness:
    • Aggressive spiders are more likely to attack their mirror image than are shy spiders who are more likely to run away.
    • In a spider colony, individual spiders differ in degree of boldness (aggression) vs. shyness (nonaggression). [Aggressive spiders show shorter latencies to attack prey and to resume movement after a disturbance.] Hunting prey for these social spiders is a collective effort. The presence of a bold spider causes the shy spiders to become bolder which increases the effectiveness of their collective hunting effort. A positive feedback loop is established whereby hunting success increases spider boldness which increases future collective hunting success. However, when researchers removed these bold "leader" spiders, the collective hunting by the remaining spiders became less successful. The bold "leader" spiders thus were shown to have a disproportionately large impact on the group, and so were named "keystone individuals". Because of their special personality characteristic (boldness) the "leader" spiders performed a vital function (making the shy spiders bolder) which fascilitated collective social action.

      This research made the very important finding that the spiders modified each other's personalities. The bold spiders became bolder because of their hunting success. However their hunting success was entirely dependent upon gaining the collective support of the shy spiders. Likewise, the shy spiders owed their hunting success to being made bolder by association with the bold spider. Thus for more successful collective action, the bold "leader" spider needed to have followers, and the shy "follower" spiders needed to have a "leader". To make their collective social action more successful, the different spider personalities had to bring out the "best" in each other.

    The "Five Factor Model of Personality" and Personality Disorders

    There are two free online personality tests that assess your personality in terms of the "Big 5" dimensions of personality. The following diagram shows the relationship between the "Big 5" dimensions of personality and personality disorders. This diagram is based on the research of Sam Gosling, Jason Rentfrow, and Bill Swann, Gerard Saucier, Colin G. DeYoung, and Douglas Samuel and Thomas Widiger.


    Enlarge Image

    3D Models of How the Personality Disorders Are Correlated



    The DSM-IV personality disorders in the National Comorbidity Survey Replication study determined how personality disorders statistically correlated with each other. The above 3D model was created (by P.W. Long MD) from this correlational data.

    This statistical model shows that all of the personality disorders are highly correlated - they are overlapping entities that blend into each other with no clear boundaries. This 3D model groups personality disorders into two highly interrelated large clusters (named "greed" and "fear" by PWL).

    The fact that these personality disorders are so highly interrelated suggests that it is common for individuals to have multiple personality disorders.



    Section III of the DSM-5 presents an alternative model for personality disorders. Based on research findings, this model drops four personality disorders: Schizoid, Paranoid, Dependent, and Histrionic.

    The above 3D model shows the statistical correlations between personality disorders in this alternative DSM-5 model.

      Note: Borderline Personality Disorder plays a central role in this model. It is correlated to all of the other major personality disorders (except Schizotypal Personality Disorder). It could be argued that Borderline Personality Disorder may not be a true personality disorder. Instead, it may more represent chaotic instability - an advanced stage in which a previous stable personality disorder becomes unstable and goes from order into chaos. This would explain why Borderline Personality Disorder is usually diagnosed in combination with another personality disorder.

      Thus, it is argued, instead of diagnosing someone as having both "Avoidant and Borderline Personality Disorders"; it would be more correct to diagnose "Avoidant Personality Disorder with Emotionally Unstable Traits".

      Chaos theory states that balanced systems under stress can be pushed into instability. Specifically, as stress on a stable system is increased, a "tipping point" is reached wherein the system quickly goes from stability to instability. The following animated graphs illustrate this mathematical principle. The vertical (y) axis represents the stress level. As the stress level increases, a tipping point is reached whereafter the system becomes more unstable. (These animations recycle.)

      Logistic map animation.gif
      By Snaily CC BY-SA 3.0, The "tipping point" between stability and instability



      According to chaos theory, these animations could represent what happens when a personality disorder is under increasing stress. Initially, the personality disorder remains stable; then under increasing stress a tipping point is reached wherein the previously stable personality disorder becomes chaotic. Any further stress makes the personality disorder even more unstable.

      Thus the emotional instability, chaotic social functioning, and self-harming behavior of Borderline Personality Disorder could represent a chaotic, unstable state of a previously stable personality disorder.

    Primate Evolution

    There appears to be three different ways in which primates have evolved socially:
    • The chimpanzees have evolved to be socially antagonistic, competitive, callous, and manipulative. Chimpanzees are the only primates (apart from humans) that wage organized war. Thus chimpanzee social behavior most closely mirrors the antagonistic behavior of the antisocial-paranoid-narcissistic-histrionic-borderline cluster of personality disorders.

    • In contrast, the bonobos have evolved to be socially anxious, peaceful, cooperative, and loving. Thus bonobo social behavior most closely mirrors the emotional distress (anxious) behavior of the avoidant-dependent cluster of personality disorders.

    • Another separate evolutionary path was followed by the orangutans. They evolved to become solitary hermits. Thus orangutan social behavior most closely mirrors the detached behavior of the schizoid-schizotypal cluster of personality disorders.


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