Dependent personality disorder is a disorder consisting of an excessive feeling of inadequacy, ignorance and lack of vitality in the absence of support from others, the need for which is felt the lion's share of the time. Previously, this deviation was called asthenic psychopathy. Subjects suffering from dependent personality disorder have low self-esteem and play a dependent role in relationships, which often determines their exploitation by others. At the same time, the number of social contacts is limited. Such individuals often become participants in toxic relationships. Moreover, after breaking a destructive relationship, they often plunge into depression. This disorder is diagnosed based on conversations with patients and anamnesis.
General information
Asthenic psychopathy is an outdated name for dependent personality disorder, which is characterized by an increased sense of helplessness.
People with the asthenic type of psychopathy are prone to passive consent, constantly feel incompetent and unviable, especially if there is no support from loved ones and relatives, and they often need it like air. They are characterized by a desire to survive at the expense of others, as well as a persistent excessive need for care and fear of abandonment. The International Classification of Diseases, Tenth Revision (ICD-10) assigned the code F60.7 and the name “Dependent Personality Disorder.” It is defined as a psychological disorder, expressed in the form of fear of loneliness, deep passive consent and submission to everyone around, especially if you need to make decisions and determine life goals. Patients are characterized by low activity - intellectual and emotional, a tendency to shift responsibility to others, and a weak response to the demands and standards of everyday life. There are dependent personality disorder, in addition to asthenic - inadequate, passive and self-suppressive.
It was previously believed that dependent personality disorder affects approximately 2% of the population and is more common among women. Classic examples are the wives of tyrants and alcoholics, but in the modern world it has become clear that both sexes are equally susceptible to this disease.
Description
Dependence and attachment are considered universal and perhaps the defining behaviors of mammals (Frances, 1988). Relying on others to a certain extent is certainly an adaptive behavior, but excessive dependence can create significant problems, and extreme forms of dependence are defined in the DSM-III as dependent personality disorder (DPD) (APA, 1980). When treating SPD, the therapist faces an interesting dilemma. At the beginning of psychotherapy, these patients may seem easily treatable. They are so attentive and receptive to the therapist's efforts that the therapist can finally breathe a sigh of relief after working with many other patients who clearly do not listen to the therapist or do not respect his words. Such patients are easy to involve in the treatment process, and they are so cooperative at the beginning of psychotherapy that there is hope for very rapid progress. But such expectations may increase therapist frustration later in treatment, when these patients appear to cling to treatment, resisting the therapist's efforts to encourage greater autonomy.
Hill (1970) identifies some of the difficulties of working with these patients when describing the initial improvement of an addicted patient: “The patient feels enlivened by the fact that some new person is taking an interest in her, satisfying her need for dependence and offering her a more worthwhile life... But the state of any patient invariably returns to its original state when she understands that psychotherapy is not a passive experience” (p. 39). Helping the patient to act independently of the therapist and promoting autonomy from the therapist and significant others is the most challenging task when working with SPD.
Pathogenesis
To be somewhat dependent on family and friends is part of not only human existence, but also that of many other living beings. Every day we need to make decisions, trust and confide, take into account the opinions of not only friends, but also strangers, so it is logical that addiction has become an everyday aspect of social interaction, but when it goes beyond the bounds of reason, clinical psychology identifies such a condition as dependent mental disorder . Previously, it was considered as an inability to respond effectively when receiving emotional, social, intellectual and physical stimuli against the background of maladaptation, incompetence, indiscretion, social instability, most often in people with insufficient physical and emotional endurance.
The first signs of a mental disorder may appear at a young age. Such boys and girls are sensitive and impressionable, feel an excessive need for care from family and friends, and are prone to dependency and inefficiency. This stimulates their development of excessive submissiveness and a tendency to become attached due to the risk of losing material support, separation, or the fear of abandonment. The attachment pattern develops on the basis of anxiety and dependence, especially manifested in conditions of the threat of being abandoned and becoming indifferent to a significant, supportive and closest person, for example, a parent, spouse, friend, etc.
In addition to dependence on others, rejection of a submissive person leads to a loss of trust and a decrease in self-esteem, which exacerbates the feeling of helplessness and inability to autonomy, stimulates the development of phobias and panic attacks . The main solution to problems is to find a loved one who will take care and take responsibility for all decisions, but this only worsens the situation, since the patient does not receive the skills and experience for independence and is even more afraid of losing an important person.
Treatment
Psychotherapy is used for treatment purposes. Drug treatment is used to correct complications.
Psychotherapy is aimed at correcting self-esteem, restoring self-confidence, restoring self-worth, and developing decision-making skills. During therapy, it is important to ensure that the client does not become dependent, therefore sessions should be held rarely, and if necessary, take long breaks. A mandatory element of therapy is support, which further increases the risk of a dependent relationship with the doctor. The best option is group psychotherapy.
Group classes allow participants with the same problems to support each other. They find themselves on equal terms, which also has a beneficial effect on the treatment process; participants learn to take responsibility, interact in relationships, and not obey.
Behavior correction has a positive effect on:
- assertive techniques (polite refusals, asserting independence);
- honing social skills in a group;
- playing out situations and learning to solve problems;
- goal setting training;
- development of self-confidence and self-efficacy.
To correct the behavior of an asthenic person, it is necessary to form in him an adequate perception of himself, self-love, and teach him to perceive loneliness as solitude. You need to change the attitude “to be happy, I need people” to realizing yourself as an integral and independent person who does not need additions.
Codependent relationships, in which asthenics usually find themselves, are a stumbling block for successful therapy. Separation from a dominant partner is the most painful part of rehabilitation. If there is a need to interrupt therapy sessions (the doctor is immersed in the role of a rescuer), then regression of the asthenic’s behavior is more often observed.
Causes
Psychological factors contribute to the development of dependent personality disorder - childhood trauma, genetic predisposition to anxiety disorders , upbringing errors and an environment that provides all material benefits and all-encompassing care. This applies to a greater extent to persons who have reached the age of majority and remain to live with their parents. The main causes of psychopathy are considered to be:
- excessive indulgence;
- development of phobias, for example, being abandoned, losing a job, etc.;
- psychological deprivation in childhood up to about one year of age (lack of opportunity to meet vital needs);
- strong narcissistic partner.
...but extremely problematic for the patient
Multiple personality disorder affects a person in such a way that he always feels that society is rejecting him. As a rule, the patient has an idealized idea of how he should be treated in society. As soon as reality diverges from this idea, a person runs away in fear, “closes himself in a shell,” withdraws into himself, fences himself off.
It is fear that is the leading factor in the formation of communicative behavior. Patients usually:
- constrained;
- unsure of themselves;
- modest beyond measure;
- unnatural;
- demonstrative in their avoidance of society;
- pleading to the point of humiliation.
This behavior is due to the fact that patients are sure in advance that society will reject them, and they try to take measures in advance so that it “doesn’t hurt so much.”
View gallery
Symptoms of Dependent Personality Disorder
Symptoms of asthenic psychopathy are primarily associated with a dependent position, the desire to shift responsibility to others, the fear of abandonment and a tendency to submit. They are expressed in the form of reactions such as:
- increased anxiety ;
- frequent panic attacks;
- diffidence;
- passivity and suggestibility;
- modesty and uncertainty;
- excessive obedience and excessive gullibility;
- tendency to alcoholism , smoking and abuse of other psychoactive substances, as a way to avoid problems and life difficulties;
- anxious-apathetic depressive mood;
- gluttony;
- avoidance – phobic avoidance of responsibility.
In addition, somatic symptoms can begin with conversion disorders and develop into hypochondria and somatization, for example, leading to benign tumors, hypertension or stomach ulcers . This may be a manifestation of a passive-dependent pattern in the form of an immature reaction to receive increased attention from doctors and family.
Tests and diagnostics
The diagnosis of asthenic psychopathy can be made by a psychoanalyst after a thorough study of the clinical picture and symptoms, medical history and daily observations of the patient’s reactions and behavior. To determine the dependent type of personality disorder in a patient, it is necessary to identify compliance with general and specific diagnostic criteria (3 or more) of the WHO, which are defined as:
- the need to dissolve in someone, to shift responsibility for making important decisions to someone else;
- tendency to submission, excessive obedience and neglect of one’s own needs in comparison with the desires of others, manifestation of high compliance to submission;
- complexity or lack of claims and requirements for persons on whom the patient depends;
- Depressive thoughts, discomfort, ineffectiveness and helplessness - usually caused by the fear of being alone and not coping with independent adult life;
- the constant experience of being abandoned by people with whom close ties have been established, because in such a situation you will have to be left only to yourself;
- the need for encouragement and advice when making decisions, even in everyday life;
- in addition, there may be a constant presence of feelings of helplessness, incompetence, and weak vitality.
According to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fifth revision (DSM-5), the diagnosis of asthenic psychopathy is confirmed if it is possible to find compliance with the 3 points listed below:
- there are difficulties with making everyday decisions, especially if you have not received a lot of advice and approval;
- the patient gives preference to an environment that can and will take responsibility for his life;
- there is a fear of expressing protest and disagreement due to fear of losing material support and approval;
- lack of initiative and difficulties in performing independent activities;
- the desire to receive care and support from other people and even the willingness to perform unpleasant, unethical and irrational actions for this;
- exaggerated fear of performing independent actions and fear of abandonment;
- during a breakup, patients experience an urgent need to find new connections that can provide support and help make decisions;
- a large number of phobias and anxiety about criticism and disapproval.
Diagnostic indicators (DSM-IV-TR)
The American Psychiatric Association's DSM-IV-TR, which is widely used to diagnose mental disorders, defines avoidant personality disorder as “a persistent tendency toward social withdrawal, feelings of inferiority, hypersensitivity to negative evaluations, and beginning between the ages of 18 and 24, presenting in a variety of forms.” , and manifested by four (or more) of the following symptoms:
- Avoidance of professional activities associated with frequent interpersonal contacts for fear of criticism, condemnation or rejection
- reluctance to deal with people without confidence that they like you
- showing reticence to enter into new intimate relationships out of fear of shame, rejection, or ridicule due to low self-esteem
- concern about possible criticism or rejection during communication
- reticence when making new acquaintances due to feelings of inferiority
- opinion of oneself as a person who does not know how to communicate with an unpleasant personality or as “second-class” in relation to others
- frequent reluctance to take risks or engage in new activities because it may lead to an awkward situation.
Avoidant personality disorder is often confused with antisocial personality disorder; clinically, the term “antisocial” means disrespect for the norms and rules of society, not social withdrawal. Unlike schizoid personality disorder, people with avoidant disorder crave social relationships but feel unable to obtain them.
In children
The first signs of a predisposition to psychopathy in school-age children are the development of asthenic traits:
- sudden fatigue at the end of lessons;
- excessive timidity, indecision and shyness;
- expressed feelings of inferiority.
Attention! To avoid problems in the future, it is recommended to show a child with similar problems to a psychologist who will help to understand the root causes of dependent orientation.
General prevention
Unfortunately, there is no specific standard for the prevention of various personality disorders, since each person is individual. However, it is still possible to prevent the development of mental disorders in a child. For this purpose, many mental health programs have been developed today to help parents and children solve family problems.
These types of programs are mainly educational in nature - they involve lectures and discussions aimed at understanding developmental psychology.
Adults suffering from a personality disorder should not neglect the services of a psychiatrist. If you are unable to control your emotions and reactions, it is advisable to consult with a competent specialist who will prescribe appropriate therapy.
Despite the fact that this kind of personality disorder is not a mental illness, during the period of decompensation a person is not able to independently overcome painful symptoms. Therefore, to avoid undesirable consequences, you should definitely seek medical help.
Diet for dependent personality disorder
Vitamin-protein diet
- Efficiency: 5 kg in 7-10 days
- Terms: up to 14 days
- Cost of products: 1700-1800 rubles. in Week
The main task of a dependent person in choosing a diet is to independently develop a menu, taking into account individual needs and preferences - one should not give up favorite foods or, on the contrary, pass them on to please loved ones. You can try any balanced, rational diet and, for example, sign up for Pilates or swimming, depending on what you feel like. It is important to understand that the human body is an autonomous, unique unit with its own preferences and characteristics. Every day you need healthy sleep, physical activity, as well as a complete diet, including not only proteins and carbohydrates, but also healthy fats and vitamins. For this, it is best to give preference to such products as:
- fresh colorful fruits and vegetables, which just by their appearance already lift your spirits, there is a wide variety of them and everyone can find their favorites;
- herbs and spices, stimulating appetite and tonic;
- “healthy” food processing - stewing with unrefined oils, baking, boiling and steaming;
- cereals and legumes are the basis of a healthy diet, capable of providing the body with microelements, vegetable proteins and complex carbohydrates;
- dietary meats;
- healthy drinks - natural teas, herbal infusions, compotes and freshly squeezed juices;
- nuts, seeds, seafood containing large amounts of healthy fats.
It is best to give up white sugar and flour, which, like simple carbohydrates and empty calories, are very easily digested and cause addiction. Excessive caffeine can also increase irritability and nervousness.
