Dependent Personality Disorder: Cluster C - Essay Example

? Dependent Personality Disorder-Cluster C Persons with personality disorders have personality traits that are inflexible and maladaptive. A positive diagnosis on a personality disorder requires a psychiatrist’s observation on a patient’s functional impairment or subjective distress. Dependent personality disorder is a cluster C personality characterised among the anxious and fearful type of personal disorders. A person with a dependent personality disorder exhibits a clinging and submissive behaviour. A person with a dependent personality disorder suffers from the excessive need of been taken care of this is evident from the patients fear of separation. Psychiatrists suggest that a dependent personality disorder may begin at early adulthood. In the case of dependent personality disorder, a person finds a difficulty in making decisions in the absence of advice and reassurance from others. Persons with dependent personality disorder live passively they depend on others to take responsibility of major areas in their lives (American Psychiatric Association, 2000). Persons with a dependent personality disorder fear the loss of support or disapproval therefore most times they fail to express their disagreements. Psychiatrists state that the lack of self-confidence prevents these persons from initiating projects. The patient is overly dependent on the support of others. Psychiatrists consider a dependent personality disorder as being an unreasonable dependence on others where patients suffer from extreme levels of fear. Most DPD patients feel helpless when left alone. The unrealistic fear of taking care of oneself leads them to take up relationships as a means of obtaining the support and care they need. According to the American psychiatric association for a positive diagnosis, there must be a multiple criteria. Psychiatrists require at least five or more of the criteria listed in the DSM manual to make a diagnosis on DPD. Psychiatrists consider factors such a medical conditions, substance abuse before making a conclusive diagnosis on Dependent personality disorder (American Psychiatric Association, 2000). Sperry states that research shows that women suffer from dependent personality disorder than men (Sperry, 2003). Research demonstrates that out of all cases of personality disorders 25% are cases of personality dependent disorders. In the treatment of dependent personality disorders psychiatrist focus on helping the patient, become independent and assertive. Some of the methods utilised in the treatment of dependent personality disorder include psychotherapy, behavioural therapy, assertiveness training, family, and group therapy. According to Corner, medication is used when treating symptoms like anxiety and mood disorders, which are common in patients with this disorder. According to Corner (2010), it is common for patients with dependent personality disorder to seek treatment for anxiety and mood disorders before seeking help from professionals. Corner states that the treatment of DPD is difficult; however, it is important for psychiatrist to get the patient to accept the psychiatric problem they are experiencing. Therapists who treat DPD patients need to focus of promoting a patients self-reliance, self-expression and independence in safety promotion. Corner mentions that for successful treatment of DPD the patients need to take responsibility for their actions. A patient needs to develop some level of confidence when acting independently (Corner, 2010). Sperry considers cognitive behavioural therapy for DPD patients as a way of increasing the patients’ self-efficacy and assertiveness. In this approach therapist, allow the patients to participate in scenarios that encourage patients to develop self-dependent attitudes. The therapists aim in this therapy is to identify what triggers the patients’ maladaptive patterns. Understanding the patients’ fears allows the therapist to assist the patient in developing adaptive ways of dealing with issues. Therapist utilise behavioural techniques such as assertiveness, training, relaxation training and role-playing in assisting the patients (Sperry, 2003). Corner states that group therapy is another successful treatment method for DPD patients. However, this method is not good for patients with severe impairment. Therapists need to determine which group is best for the patient. There are groups that deal with dependency issues, and mixed personality issues. Corner states that group sessions can be challenging for patients when the patient feels lost. According to Eskedal and Demetri day and residential therapies is suitable for DPD patients who are in need of high level of support and treatment intensity. Eskedal and Demetri explain that DPD patients who require high levels of support and intense treatment suffer from co-occurring Axis I and Axis II disorders. Day and residential therapies involve a mixture of group, individual, occupational and expressive therapies (Eskedal and Demetri, 2006). Leichsenring and leibing state that psychodynamic therapy when coupled with medication is an efficient method of treating personality disorders. They explain that psychodynamic therapy entails the transference of dependency (Leichsenring and Leibing, 2003). Psychodynamic therapy as Gabbard explains entails interpersonal development in the treatment process. Psychodynamic therapies rely on a patient’s re-enactment of their internal object relationships. Gabbard describes that this process is dependent on a patient’s externalization of childhood patterns. Psychiatrists term this process as projective identification. This process allows a psychiatrist to conform to the patients projections (Gabbard, 2005). Sperry (2003) explains that psychodynamic therapy helps DPD patients cope with object loses or previous separations. A clinician’s success in developing a therapeutic relationship with the client allows the transference to occur. This allows the clinician to understand the clients’ issues and provide solutions. Projections by a patient during psychodynamic therapy allow the recreation of an experience from childhood or during a separation because of its familiarity and predictability. The reactions developed from during a psychodynamic therapy have proven to be useful in diagnostic understanding (Gabbard, 2005). Gabbard asserts that psychodynamic therapies produce long-lasting changes in the treatment of personality disorders. This happens because research indicates that patients memorise the supportive dialogue and use them for their well-being. Gabbard explains that to be able to come up with an effective treatment clinicians need to understand what is going on in the patients’ internal world. The process of projective identification makes patients to transform their clinicians into transference objects. On the other hand, psychiatrists unconsciously enact old patterns with their patients. Sperry explains that long-term psychodynamic therapies are important for they allow greater transference, which will be good for promoting emotional growth (Gabbard, 2005). Patients with great degree of separation anxiety do not benefit from psychodynamic therapy, however, Sperry (2003), suggests that in such a case supportive treatment is appropriate. Gabbard (2005) observes that there are times when therapist and clients try to rid themselves of the distressing countertransference feelings arising in therapy. Gabbard (2007) observes that there are five types of transference and counter transference barriers likely to arise in the treatment of DPD. Gabbard explains that DPD clients are likely to make demands for advice or help from the therapist. A therapist’s failure in meeting these demands leads to termination of therapy by the patient. A therapists control over such demands can receive a countertransference response of emotional withdrawal by the patient. Gabbard looks at a DPD patient who constantly invites the therapist to take responsibility of his life. A therapist may assume the position of controlling the patient’s life. This move by the therapist endangers the patients’ recovery process because the patient becomes overly reliant on the therapist and fails to develop independent ways of coping. Gabbard considers a third barrier where a DPD patient stays in therapy due to the emotional attachment he develops with the therapist. In this case, the patient avoids adopting the changes suggested in therapy. A DPD patient adopts a compliant attitude, which is mistaken for cooperation. The danger of this countertransference response is the reinforcement of the patients’ passivity. Therapist need to develop ways of dealing with the patients’ problem of avoiding change. The fourth barrier is when DPD patient experiencing a self-defeating relation evokes the therapist desire to control the patients’ self-defeating attitude. Challenging the patient to be self-assertive may increase anxiety. A patient in this case is anxious of emotional detaching from his partner. On the other hand, if the patient fails to change he stands to face the therapist punishment. Such conflicting emotions may make a DPD patient abandon therapy. Gabbard looks at the fifth barrier where DPD patient may refuse to confront his separation issues. Confronting this issues may require mourning past disappointments. Therapist compliance to this avoidance may be due to a countertransference fantasy of wanting to be there for the patient or fear of provoking panic on the patient. A DPD patient who fails to confront this avoidance issue will fail to make the changes that are of significance in his life. Such an approach by the therapist will lead to deterioration in the patient’s condition (Gabbard, 2007). References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders-text revision (4th ed.). Washington, DC: American Psychiatric Association. Corner, R. J. (2010). Abnormal psychology (7th ed.). New York, NY: Worth Publishers Eskedal, G. A., and Demetri, J. M. (2006). Etiology and treatment of Cluster C personality disorders. Journal of Mental Health Counselling, 28, 1-18. Gabbard, G. O. (2005). Psychodynamic approaches to personality disorders. Focus, 3, 366 367. Gabbard, G. O. (2007). Gabbards treatment of psychological disorders. Washington, DC: American Psychiatric Association. Leichsenring F, and Leibing, E. (2003). The effectiveness of psychodynamic therapy and cognitive behaviour therapy in the treatment of personality disorders: a meta-analysis. Am J Psychiatry, 160(7): 1223-32. Sperry, L. (2003). Handbook of diagnosis and treatment of DSM-IV-TR personality disorders (2nd ed.). New York, NY: Brunner-Routledge Publishers. Read More