Dependent personality disorder (DPD), formerly known as helpless personality disorder, is a personality disorder characterised by excessive psychological dependence on others. It typically manifests as an over-reliance on the approval of others and a tendency to sacrifice one’s own needs in order to please others.
It is generally associated with a range of factors, including early family environment and parenting styles, and the symptoms are chronic and long-lasting.
According to the definition of dependent personality disorder published by the World Health Organisation, individuals must meet at least three of the following criteria:
Encouraging or allowing others to make decisions regarding the vast majority of important events in their lives;
Placing their own needs secondary to those of the person on whom they depend, and being excessively compliant with that person’s wishes;
Being reluctant even to make reasonable requests of the person on whom they depend;
Feeling uncomfortable or helpless when alone, due to a fear of being unable to look after oneself;
Being plagued by preoccupations with abandonment: a fear of being abandoned by those in close relationships, or of being left alone and having to look after oneself;
Lacking the capacity to make everyday decisions without extensive advice and reassurance from others.
Accompanying characteristics also include a perception of being helpless, incompetent and lacking in perseverance.
Xiao Ming is an individual with dependent personality disorder. At work, he always tries his utmost to meet the needs of his superiors and colleagues, frequently working late into the night to ensure tasks are completed to perfection.
If a colleague asks him for help, he will never refuse, as he fears that if he does, others will dislike him and he will lose his colleagues’ approval. The same applies to his personal life: he always prioritises meeting their needs before his own, and he rarely makes requests of others or expresses his own opinions. He worries that if he disagrees with others, he will lose their affection and approval.
During a team meeting, Xiao Ming had a unique idea regarding the project proposal, but he hesitated for a moment and ultimately chose to remain silent. He was concerned that his idea might be viewed as unconventional and could provoke resentment amongst other team members. However, he later learnt that had he shared his idea, it might have enhanced the team’s overall proposal and led to greater success for the project.
Excessively catering to the needs of others prevents individuals from having their own needs met, which can significantly impact their lives.
Avoidant Personality Disorder (AvPD) is typically characterised by the individual’s extreme avoidance of social situations and interpersonal relationships. They have an extremely low self-esteem and often feel unworthy of being liked or accepted by others; they are highly sensitive to rejection or criticism from others and consequently avoid participating in social activities and interacting with strangers or new environments.
Due to this excessive avoidance of social interaction, their social skills are generally poor.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association, a diagnosis of Avoidant Personality Disorder requires the individual to meet four of the following seven criteria:
Avoids social situations and close interpersonal relationships due to a fear of criticism, blame or rejection.
Is reluctant to become involved in others’ affairs unless it is certain that they will be welcomed.
Resists forming close personal relationships due to fear of humiliation or ridicule.
Is constantly anxious about being criticised or rejected in social situations.
Is preoccupied with one’s own flaws and shortcomings, leading to withdrawal when interacting with strangers.
Believes oneself to be socially inept, unattractive or inferior to others.
Chooses to avoid taking personal risks or participating in new activities for fear of making a fool of oneself.
Xiaohong is an individual with avoidant personality disorder. She often feels very uncomfortable in social situations and therefore tries her best to avoid attending gatherings or social events of any kind. Even at work, she frequently chooses to complete tasks on her own to avoid excessive interaction with colleagues.
One day, the company organised a team-building event, and all staff were required to attend. Upon hearing this news, Xiaohong began to feel extremely anxious and nervous. She worried that she would come across as clumsy and awkward in such a setting, whilst also fearing that others might judge her unfavourably. To prevent this from happening, Xiaohong decided to submit a leave request to avoid taking part in the event.
Although this allowed her a brief respite, she felt a deep sense of loneliness. Because Xiao Hong consistently chose to avoid social events, this affected her performance at work and in her interpersonal relationships; those around her often regarded her as an oddball and someone difficult to get along with.
Borderline Personality Disorder (BPD), also known as Emotionally Unstable Personality Disorder (EUPD), is characterised by emotional instability, unstable interpersonal relationships and a blurred sense of self. Individuals may experience extreme mood swings, often accompanied by an intense fear of abandonment and a sense of loneliness.
Furthermore, borderline personality disorder may lead to self-harming behaviour and a tendency towards impulsivity.
The World Health Organisation classifies borderline personality disorder into two subtypes: the impulsive type and the borderline type.
The impulsive type requires a diagnosis to meet at least three of the following five criteria, and must include criterion 2:
Marked impulsivity, without regard for consequences.
Frequent arguments and conflicts with others, particularly when impulsive behaviour is thwarted or criticised.
Frequent outbursts of anger or uncontrolled behaviour, with an inability to regulate these emotions.
Lack of persistence in activities that do not yield immediate rewards.
Unstable and changeable moods.
The borderline subtype requires a diagnosis to meet at least three of the criteria listed under the impulsive subtype, as well as at least two of the following:
Disturbances and uncertainty regarding self-image, goals and personal preferences.
A tendency to become involved in intense and unstable relationships, leading to emotional distress.
An intense fear of abandonment (note: fear of separation).
Recurrent self-harm through threats or actions (note: to avoid separation).
A persistent sense of emptiness.
Engaging in impulsive behaviours such as reckless driving, arson or substance abuse.
Xiao Ling is an individual with borderline personality disorder. She frequently experiences extreme emotional fluctuations; one moment she feels excited and optimistic, the next she may feel deeply depressed and despairing. These rapid emotional shifts are difficult even for her to predict.
One weekend, Xiaoling arranged to attend a party with her best friend. However, when she learnt just before the party was due to start that her friend had also invited some people she did not know, she suddenly felt extremely anxious and fearful. She began to worry that she would be excluded, so she decided at the last minute to cancel her plans to attend the party and chose to stay at home alone instead.
Whilst at home, she began to feel profoundly lonely and empty, even going so far as to question her own worth. She started to wonder whether her best friend did not care about her at all, and these negative thoughts caused her mood to sink even further. These rapid emotional fluctuations and her extreme sensitivity to abandonment make it very difficult for Xiaoling to maintain healthy interpersonal relationships.
Viewed in this light, borderline personality disorder appears very similar to the bipolar disorder we discussed earlier, but one key distinguishing feature is its cyclical nature. Bipolar disorder involves shifts between manic and depressive episodes, but the cycles of these episodes themselves are relatively stable: during a manic episode, the individual experiences extreme elation, whilst during a depressive episode, they experience extreme low mood.
Borderline personality disorder, on the other hand, involves rapid shifts between elation and despondency, which can occur within as little as half an hour, without any discernible cycle.
Understanding the characteristics, symptoms and causes of these disorders is crucial in helping patients seek professional treatment and build healthy interpersonal relationships. At the same time, concerted efforts are needed from all sectors of society to raise awareness of personality disorders, reduce prejudice and discrimination against those affected, and provide them with better support and assistance.
