Theodore Millon describes the dependent as among the “imbalanced” personalities, alongside which we find antisocial, histrionic and narcissistic personality disorders. In the case of the histrionic and dependent personality disorders, they are predisposed to meeting the desires of others, whereas the narcissistic and antisocial personalities are predisposed to selfishly meet their own wishes and desires. The dependent and histrionic personalities are thus considered by Millon to be “imbalanced” because they are inordinately predisposed to meeting the wishes of others.
“To center one’s attentions and activities almost exclusively to gain the approval or nurturance of others is a clear form of imbalance, a placing of oneself in a secondary position by depending on others or arranging one’s life to fulfill “their” wishes. Similarly, a disinclination to value others, and to be satisfied only when meeting one’s own needs and desires, is an equally problematic form of balance.”
On the one hand, the dependent and histrionic both distinguish themselves as individuals in need for social approval and affection. Millon says that their centers of gravity, so to speak, lie in others rather than in themselves. They thus tend to deny their own thoughts and desires if they are afraid that such desires or thoughts would incur the disapproval of others. These personality types need continual reassurance that they will not be abandoned and are highly sensitive to criticism or disapproval.
While the histrionic and dependent both share this other-orientedness, individuals with dependent personality disorder require others to orient their lives because they are passive. Those with histrionic personality disorder are active, however, and take the initiative to
“modify the ecological circumstances of their lives, ensuring first and foremost that the attentions and approval they need from others will be forthcoming. They do not sit passively, waiting for the competencies and skills of others to give shape to their lives. They do not cling or seek nurturance, as does the dependent personality. Rather the principal goal is securing attention and approval, a means to avoid disinterest and abandonment. In contrast to the dependent, they possess the will and the ability to take charge of their lives; however, they are deeply insecure, unsure of whether they are desirable, if not truly loved.”
Those with DPD tend to downplay their own accomplishments. They derive their self-esteem, not through personal accomplishments, but through the affirmation of others. This puts them at the whim of others, Millon notes, and means that they continually accommodate themselves to others in order to avoid abandonment. They need an individual in whom they can put all of their trust in order to avoid having to face responsibilities of life without assistance. It is only in such a person that they feel they can function with ease. Otherwise they tend to become depressed. In their attempt to achieve this, they tend to be very self-effacing:
“Dependents are also notably self-effacing, obsequious, ever-agreeable, docile and ingratiating. A clinging helplessness and a search for support and reassurance characterize them. They tend to be self-depreciating, feel inferior to others, and avoid displaying initiative and self-determination. Except for needing signs of belonging and acceptance, they refrain from making demands on others. They deny their individuality, subordinate their desires, and hide what vestiges they possess as identities apart from others. They willingly take a submissive role in the hope of avoiding isolation, loneliness and the dread of abandonment. Paralyzed and empty if left on their own, they feel the need for guidance in fulfilling even simple tasks or making routine decisions.”
DPD was anticipated briefly in the DSM-I and DSM-II, referred to in the latter as the “inadequate personality.” It was not until the DSM-III and DSM-IV, however, thatserious notice was taken of it. It was at this point that it became a distinct personality disorder. Before looking at its formal codification in the DSM manuals, let us look at proposals taken with respect to this personality throughout the 20th century.
Kraepelin and Schneider both described “shiftless” and “weak-willed” personalities, emphasizing a type of person who excessively sought external support. Their emphasis was on the “irresoluteness of will” of such individuals and the ease by which they are seduced by others. Schneider said “as ar as their pliable nature will allow they are responsible to good influences, show regret for their lapses and display good intentions.” Kraepelin said that such individuals exhibited a delay of maturation but Millon rejects the suggestions by Kraepelin and Schneider that such individuals are easily “exploited to no good end” or that they are “minimally competent to handle their affairs.”
Among early psychoanalysts, Freud and Aabraham both spoke of an “oral character” which they divided into the “oral-sucking” and “oral-receptive” character types. They saw these character steps as resulting from “an early history of unusual gratification during nurturant feeding and weaning” and distinguished these from “oral-pessimists” and “oral-sadists” whose early experiences tended to be frustrating. These latter cases would become the negativistic or pass-aggressive personality type. The oral-receptive type, described by Karl Abraham, anticipated the DSM-III concept of dependent personality disorder:
“According to my experience we are here concerned with persons in whom the sucking was undisturbed and highly pleasurable. They have brought with them from this happy period a deeply rooted conviction that everything will always be well with them. They face life with an imperturbable optimism which often does in fact help them to achieve their aims. But we also meet with less favourable types of development. Some people are dominated by the belie that there will always be some kind of person – a representative of the mother, of course – to care for the and to give them everything they need. This optimistic belief condemns them to inactivity …they make no kind of effort, and in some cases they even disdain to undertake a bread-winning occupation.”