The man who never grew up and remained under the care of his mother

Case description

One day a 33 years old man reports to a psychologist with a complaint of feeling depressed because he broke up with his girl friend 2 years back.
While describing the incident he said that he loved his girl friend dearly but he broke up because his mother did not wanted him to get married with her. His mother has a strong influence in his life. He cannot go against his mother to marry that girl and stay separately with her.  He further narrated that her mother has been sincere and always taken care of him right from his childhood till now. He says that he cannot imagine himself to be away from his mother. She knows about him from childhood, she has supported him  this way till now and she knows the best about him what to do in future.

In his education  years he has lived at home entirely except for one semester away at college.  He returned home at the end of the semester because he was homesick, and did not go back.

He reports of no loss of appetite, normal concentration or energy.  He claims that he performs “adequately” at work and has no job-related problems. He works for an accounting firm in an entry-level position even though he has been there for several years.  He says that he has turned down promotions in the past because he knows that he “couldn’t possibly supervise anyone or make decisions for them.”

This man has two childhood friends whom he has to talk every day several times. They are great support for him and without them he feels empty and lost.

The results of his mental status examination are normal except for revealing a depressed mood (although affect is full range).

Analysis

The traits indicate Dependent Personality Disorder

General characteristics of a dependent personality.

• Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
• Needs others to assume responsibility for most major areas of his or her life.
• Has difficulty expressing disagreement with others because of fear of loss of support or approval (this does not include realistic fears of retribution)
• 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)
• Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant
• Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself .
• Urgently seeks another relationship as a source of care and support when a close relationship ends
• Is unrealistically preoccupied with fears of being left to take care of himself or herself

Treatment Approach

• Insight-oriented therapies can often be helpful. Behavioral therapy, assertiveness training, family therapy, and group therapy have all proven useful with selected patients as well.
• Pharmacotherapy can be used to treat specific symptoms such as anxiety and depression as they arise.
• Dependent personality disorder, like all personality disorders, is difficult to treat.
• Patients can respond to psychosocial support groups in the face of loss of their usual support systems.
• Long-term psychodynamic psychotherapy might eventually help, but many patients do not have either the motivation or the insight needed to successfully undergo treatment.

Differential Diagnosis

Patients with agoraphobia can be dependent, but the dependent behavior usually does not start until the panic attacks or anxiety do—thus there is no pervasive, lifelong pattern of dependency.

Some information about Dependent Personality Disorder

Patients with dependent personality disorder have a pervasive need to be taken care of by others. They are dependent and submissive and are uncomfortable when alone because they do not believe they can take care of themselves.

Physicians should reassure these patients of their availability but set limits as to how often the patient can contact them. If feeling “burned out” by the patient’s extreme dependence, they should be careful not to reject the patient.

Dependence is a prominent factor in several personality disorders, including histrionic and borderline disorders. Patients with dependent personality disorder tend to stick to one caregiver, such as a parent or spouse, for the long term and tend to be less manipulative.

References

DSM IV Handbook for differential Diagnosis for PDA
Case Files Psychiatry
A Quick reference to APA practice guidelines