A CASE OF Dependent Personality Disorder
By: THEODORE MILLON
et al.
Notes:
(1) Numbers mark aspects of the case most consistent with DSM
criteria as follow, and
do not necessarily indicate that the
case “meets” diagnostic criteria in this respect.
(2) Patient's name has been changed in respect to
confidentiality, and names mentioned are not of a real existent person.
Case of Sharon
Sharon, a 32-year-old teacher’s aide, first sought therapy at the suggestion
of the school principal, someone she is particularly close to. The principal had “taken her under her wing.” Although Sharon has worked as an aide at the
same school for nine years, (1) she still requires the advice and encouragement
of other teachers before starting any new project for the students, sometimes
needing reassurance multiple times in the same day. (4)
Sharon is the younger of two sisters. She describes her childhood as
“traditional” and “perfect,” with her father being the strong figure on whom
the rest of the family relied. Her mom was old-fashioned and took good care of
everyone. From almost the day Sharon was born, everyone treated her like a
“precious porcelain doll.” All of her needs were met before she even knew there
was a void. In school, her sister Brandy became her guardian. If anything went wrong,
Sharon ran to Brandy to make it right, whether it was to protect her from
bullies or help her in her classes. (2) Sometimes, Brandy even did
Sharon’s homework herself. Although Sharon was only an average student, the
teachers liked her because she was “sweet and well-behaved.” As a teenager,
Sharon never learned to drive. Instead, Brandy always took her wherever she
wanted to go. (2)
The Saturday after graduating from high school, Sharon married Tom,
an appliance mechanic who reminded her of her father. And like her father, Tom
loved the idea of having a wife at home who didn’t work and didn’t mind
catering to him, having his meals ready when he got home. He even thought it
was “cute” that she was so helpless at many daily tasks. For the most part,
Sharon adored Tom and loved playing the role of the traditional wife although
she occasionally found it difficult to assert herself in the relationship,
fearing that Tim might become angry with her. (3)
Soon, however, Tom began to see Sharon as needy and suffocating. Without
her own circle of friends, she insisted they spend every free moment together. (6)
Tom eventually convinced Sharon to take a job as a teacher’s aide when they
were experiencing some financial difficulties, and he encouraged her to keep it
once the problems were settled. However, because Tom drops her off at work
every morning and picks her up again in the evening, he can never hang out with
guys after work or even stay late to earn extra money. Responding to her
neediness, Tom eventually decided that Sharon should have more of an identity
of her own and insisted that she enroll in junior college. She asked Tom to
pick out her classes and warned him that he would likely have to tutor her in
the evenings as well as drive her to and from classes. Sharon has reluctantly
agreed to go but doubts that she has the confidence or ability to follow
through. (4)
Six months into couples therapy, Sharon had begun to take driving lessons.
About this same time, however, Brandy was killed in a car accident. The effect
on Sharon was devastating. With Brandy gone, Sharon began to slip into
depression and began to cling to Tom even more tightly. (7) She dropped
all of her classes and stopped going to work. In response, Tom now seems to be
in a process of extended emotional withdrawal and is threatening divorce.
Sharon feels destroyed, as though, “I have lost a part of myself I can never
get back,” and cannot imagine how she will possibly make it alone. Though Tom
insists that there is still a chance for reconciliation and though Sharon
realizes that there were problems all along that she didn’t want to face, she nevertheless
“knows” he will divorce her. (8)
DSM-IV Criteria
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 five (or more) of the following:(1) has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
(2) needs others to assume responsibility for most major areas of his or her life.
(3) has difficulty expressing disagreement with others because of fear of loss of support or approval. Note: Do not include realistic fears of retribution.
(4) 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).
(5) goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
(6) feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
(7) urgently seeks another relationship as a source of care and support when a close relationship ends.
(8) is unrealistically preoccupied with fears of being left to take care of himself or herself.
References
(1) Personality Disorders in Modern Life, second edition,
2000, 2004 by John Wiley & Sons, Inc.
(2)Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition. Copyright
1994 American Psychiatric Association.
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