Dependent personality disorder: signs, causes and support in the UK

The NHS explains that a person with a personality disorder thinks, feels, behaves or relates to others very differently from the average person. There are several types, and dependent personality disorder is one of the ten categories used until 2019, according to the Royal College of Psychiatrists.

Rethink Mental Illness describes someone living with dependent personality disorder as possibly allowing others to take responsibility for parts of their life. They might not have much self-confidence, may put other people's needs first, feel hopeless at times, be afraid of being alone, feel abandoned by others or let them make decisions for them.

Most people need others and value closeness. The disorder is different because the reliance is persistent and pervasive, affects day-to-day functioning and relationships, and causes significant distress. The Royal College of Psychiatrists says personality traits exist on a scale, and that a diagnosis is only considered when they make it extremely difficult to manage emotions and relationships.

The Royal College of Psychiatrists says personality disorders are now organised by severity and by how someone presents with one or more of five traits: negative affectivity, detachment, dissociality, disinhibition and anankastia. The aim is a classification that is less rigid and stigmatising than the older list of types.

The NHS says a person may be diagnosed with mild, moderate or severe personality disorder rather than a named type, and that a mental health professional can talk through what the diagnosis means. The older terms, such as dependent, are however still sometimes used by services and clinicians.

This means that someone told they have moderate personality disorder with negative affectivity may recognise the pattern described as dependent, without the label being used. The RCPsych also describes some people finding it more helpful to describe their difficulties as complex PTSD or complex emotional needs.

There is no single checklist in the sources used here beyond the descriptions of the pattern, and the experience varies. Examples consistent with Rethink's description include the following.

• Letting other people make important decisions, from where to live to what to wear.

• Struggling to start things or do them alone because of low self-confidence.

• Putting other people's needs ahead of your own to keep them close.

• Fear of being left alone, abandoned or unable to cope without someone.

• Difficulty ending unhealthy relationships because of this fear.

• Other mental health problems such as depression or anxiety; the NHS says someone with a personality disorder may also have other mental health problems.

The NHS says it is not clear exactly what causes personality disorders, but they are thought to result from a combination of the genes a person inherits and early environmental influences, for example a distressing childhood experience such as abuse or neglect.

The Royal College of Psychiatrists says that how personalities develop can be strongly influenced by childhood, environments and early experiences, and that for some people these early experiences are difficult or traumatic.

A GP can listen, check for other conditions such as depression or anxiety, and refer you to a community mental health team or a psychological therapies service. Rethink explains that only a psychiatrist can diagnose a personality disorder, that you can see your GP to begin with, and that the two manuals usually used in England are ICD-11, which diagnoses by severity, and DSM-5, which continues to identify 10 types.

The NHS says a mental health professional will discuss what the diagnosis means for you. The Royal College of Psychiatrists adds that a formulation, which looks at current challenges, why they came about, why they continue and your strengths, can help the people supporting you to understand what help you need.

If you feel unsafe or in crisis, the NHS advises contacting NHS 111 or going to A&E, and calling 999 in an emergency.

The NHS says treatment for a personality disorder usually involves a talking therapy, and can also include therapeutic communities and medicine to treat associated problems such as depression, anxiety or psychotic symptoms. Treatment can last several months or years, depending on severity and other problems.

The Royal College of Psychiatrists says most people receive treatment from community mental health services, that some services have a dedicated personality disorder service, and that it is quite likely you will have to wait for psychological therapy. It describes therapies including DBT, MBT, schema focused therapy and psychodynamic therapy, noting that the research focuses mainly on borderline personality disorder.

For dependent traits specifically, therapies that build self-confidence, independent decision-making and healthier relationship patterns are the usual aims, but the sources used here do not set out a treatment specific to dependent personality disorder, so the choice is tailored to the individual by the treating team.

The NHS says many people with a personality disorder recover over time, that psychological or medical treatment is often helpful, and that there is no single approach that suits everyone. The Royal College of Psychiatrists says that with the right help and support people with a personality disorder diagnosis can improve and lead fulfilling lives, though some experience more persistent difficulties.

The NHS points to support for family and friends through Mind, Rethink Mental Illness and the Royal College of Psychiatrists, and suggests asking a GP about local support groups. It also notes that people may need extra support in pregnancy and after a child is born.

On the NHS, access is through the GP to community mental health services, a psychological therapies service or a specialist personality disorder service where one exists locally. Availability varies and waits for psychological therapy can be long.

Some people choose to see a private psychologist, psychotherapist or psychiatrist. It is sensible to ask about experience with personality difficulties, the number and length of sessions expected, and how care will be coordinated with the GP.