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 Jack
Jack,
a 54-year-old unemployed male, was referred for therapy by his family
physician. His wife, Joan, accompanies Jack to all of his appointments. He had
just been laid off from his job of 22 years. Joan
was adamant that Jack suffered from fatigue and crippling back pain, although
Jack himself seemed oblivious to why he should be seen and constantly looked to
his wife to take the lead in responding to questions. He was seriously
physically disabled, she maintained, and should be collecting disability
insurance.(1) When
no physical cause could be found for his pain, he was referred for a
psychological assessment.
Jack
is the youngest child and only son in a family with six children. His mother
kept careful watch over him, limited his responsibilities, and restricted most
of his outdoor activities, fearing that he would be hurt. Throughout childhood
and adolescence, Jack’s sisters and parents protected him so much that he
either learned many important skills late or not at all. Because he seemed
naturally unassertive, Jack accepted this comfortable role. Jack recalls that
he never went through that “teenage rebellion thing.”
In
high school, Jack’s mother and sisters arranged his social life, even finding
him a date for his senior prom. They chose his electives and after-school
activities. At the age of 20, Jack’s mother fixed him up with Joan, the
daughter of a family friend. Joan was five years older than Jack and very eager
to take care of him. They were married six months later. Joan efficiently ran
the home, assuming all responsibilities for bill paying and household
management. (2)
Jack
worked for many years as a general assistant in his father’s bookkeeping
business. Instead of assuming some managerial responsibilities of the company,
as his father hoped, Jack failed to learn even the most basic computer or
administrative skills. As a consequence, he became the office gopher, fetching
coffee for others and delivering the office mail. He was known as a good-natured
fellow afraid to disagree with anyone, but he was also the butt of much joking
behind closed doors. (3) His
daily responsibilities grew to include getting sandwiches, coffee, and
cigarettes for the office staff. (5)
Joan often ridiculed Jack’s lack of ambition and his lack of competence.
Throughout
the years, Jack has been content to have others take care of him. He is aware
that he has not attained the goals that others have set out for him, but he is
not troubled by it. Indeed, he seems ambitionless by almost every standard,
desiring simply to “fit in,” never to lead. He never followed through on a
single company project assigned to him. (2) There
is a naïveté and childlike quality to him. His expression conveys the question,
“What is everyone making such a big fuss over?” (4)
With
money already tight, tensions between Joan and Jack escalated. On multiple
occasions, she has threatened to leave him. Each time, Jack would make some
half-hearted attempt to work, but he would eventually slide back into his old
form and beg her to stay, arguing that he’ll be helpless without her. On the
day the divorce papers were to be served, Jack developed debilitating back pain
that forced him to remain in bed with Joan as his constant attendant. She has
agreed to remain in the marriage until he recovers.
(6)
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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