Psychological Dependency

Abstract

Psychological dependency is a personality disposition to lean on other people for advice, guidance and support. Researchers measure it chiefly as interpersonal dependency, using self-report inventories that break into several components or facets, and they distinguish dependency needs a person attributes to the self from implicit needs that tests of another kind detect. Dependency is not only passivity: an interactionist account treats it as an active strategy that shifts with context and can be adaptive. On one proposed account, dependency is one of two personality routes into depression, set against self-definition and self-criticism. Dependent personality disorder marks the far end of the range, and the phrase psychological dependence also has a separate meaning when it is applied to drugs, which belongs to the study of substance use.

Keywords: interpersonal dependency, dependent personality, dependent personality disorder, sociotropy, help seeking

Interpersonal dependency has been studied from developmental, social and clinical angles, and an early integrative review drew those strands together, tracing the trait to particular styles of parenting and linking it to a family of compliant, yielding social behaviours (Bornstein, 1992).

A later review from the same research programme set out a cognitive/interactionist model in which dependent people act on their environment rather than simply submitting to it, and in which reliance on others can serve a person well in some settings (Bornstein, 2012a). The movement from a deficit view to a strategic one runs through most of the work reviewed below.

What Psychological Dependency Is

MeSH defines Psychological Dependency as the tendency of an individual or individuals to rely on others for advice, guidance, or support. It lists Psychological Dependence among its entry terms and files the descriptor under personality.

In personality and clinical psychology the construct goes by the name interpersonal dependency, and the review literature examines it as a trait with developmental roots, social consequences and clinical relevance (Bornstein, 1992). Its clinical extreme is dependent personality disorder, a diagnosis whose definition has been revised across editions of the DSM and which is studied as a form of maladaptive dependency (Disney, 2013).

The entry term Psychological Dependence also has a pharmacological life: in addiction research it names reliance on a substance, and DSM-5 folded substance abuse and substance dependence into one diagnosis, substance use disorder (Hasin et al., 2013). That sense is taken up in its own section below; the rest of the article concerns reliance on people.

Measuring Dependency

One early and widely adopted instrument was a 48-item self-report inventory developed by Hirschfeld and colleagues on 220 normals and 180 psychiatric patients and then cross-validated in two additional samples (Hirschfeld et al., 1977). Analysis of the items gave three components: assertion of autonomy, lack of social self-confidence, and a third that the authors labelled emotional reliance on another person (Hirschfeld et al., 1977).

Pincus and Gurtman pooled items from several self-report dependency measures and placed each one within the 5-factor model of personality and also within the interpersonal circumplex, which separated interpersonal dependency into three distinct facets (Pincus & Gurtman, 1995). Three facets emerged, which they labelled love dependency, exploitable dependency and submissive dependency, and all three correlated positively with neuroticism (Pincus & Gurtman, 1995). The facets parted company on conscientiousness and openness to experience: love dependency correlated positively with both traits, whereas the links for exploitable and then submissive dependency grew more and more negative (Pincus & Gurtman, 1995).

Later instruments set healthy and unhealthy forms of reliance side by side. The Relationship Profile Test is a 30-item questionnaire with three subscales, scoring destructive overdependence, dysfunctional detachment and healthy dependency along a dependency-detachment continuum (Bornstein et al., 2003). In its validation study the subscales' intercorrelations and gender differences mostly fell in the expected pattern, comparisons with other tests supported each subscale's convergent and discriminant validity, and the reliability results were also generally supportive (Bornstein et al., 2003).

A neighbouring tradition measures sociotropy rather than dependency as such: the Personal Style Inventory introduced new measures of sociotropy and autonomy and reported preliminary validation studies of them (Robins et al., 1994). Sociotropy and autonomy are Beck's terms, and they play roughly the part in his work that dependency and self-criticism play in Blatt's (Zuroff et al., 2004).

Test format also matters. A meta-analysis of 97 studies published since 1950 compared objective and projective dependency tests and found that women scored higher on objective tests, while on projective tests men scored slightly higher among adults and no sex difference appeared among younger respondents (Bornstein, 1995). The review framed the comparison in terms of implicit and self-attributed dependency needs and examined possible mediators, among them clinical status (Bornstein, 1995). That pairing of terms goes back to McClelland and colleagues, whose account of motives held that a motive scored from picture-story fantasies and the same motive as people describe it in themselves are not the same thing (McClelland et al., 1989).

Table 1 sets out four approaches to measuring dependency.

Origins and Development

On the question of origins, Bornstein's integrative review presented its conclusions about etiology as strong ones, though it worded the parenting link with a hedge: dependency appears to arise from overprotective and authoritarian parenting (Bornstein, 1992). Hirschfeld and colleagues named three conceptual sources for the construct: the ethological theory of attachment, social learning theories of dependency, and the psychoanalytic theory of object relations (Hirschfeld et al., 1977). The same review connected dependency with suggestibility, conformity, compliance, interpersonal yielding and affiliative behaviour, and proposed, again tentatively, that these behaviours seem to serve a wish to obtain and keep nurturant, supportive relationships (Bornstein, 1992). It discussed what these findings imply for theoretical models of dependency without testing those models directly (Bornstein, 1992).

Sex differences complicate any simple developmental story. Across 97 studies, women obtained higher scores than men on objective dependency tests, yet on projective tests adult men scored slightly higher and children and adolescents showed no difference (Bornstein, 1995). Sex role socialization was among the constructs the meta-analysis brought to bear on that divergence (Bornstein, 1995).

Dependency as an Active Strategy

The cognitive/interactionist model recasts the dependent personality style as something a person does, not merely something that happens to a person: dependent individuals behave actively and, depending on circumstances, adaptively (Bornstein, 2012a). The model divides dependency into four components, motivational, cognitive, affective and behavioural, and describes self-presentation strategies through which dependent people manage how others see them (Bornstein, 2012a).

The same review set out what remains unresolved. Subtypes of dependency have yet to be delineated, the DSM-5 symptom criteria for Dependent Personality Disorder still require validation, and treating dependent patients poses particular challenges under managed care (Bornstein, 2012a).

Dependency, Self-Criticism and Depression

Blatt's 1974 paper examined levels of object representation in two forms of depression, which it called anaclitic and introjective (Blatt, 1974).

Blatt and Zuroff later recast the distinction as two prototypes for depression, one organised around interpersonal relatedness and the other around self-definition (Blatt & Zuroff, 1992). The two poles were first measured as the Dependency and Self-Criticism factors of the Depressive Experiences Questionnaire, a 66-item instrument that Blatt and colleagues built and factor-analysed in samples of college students only (Blatt et al., 1976). Their review related each prototype to personality predispositions, to the stressful life events that act on them, to threats to self-esteem and to the parent-child relationship (Blatt & Zuroff, 1992). Zuroff and Mongrain tested the specificity idea in the laboratory with 45 female college students: dependent participants answered rejection, and only rejection, with anaclitic depression, and self-critical participants showed introjective depression after both events, though the dependent group unexpectedly reported high introjective depression too, a result that rests on an all-female student sample (Zuroff & Mongrain, 1987). The account has been contested: reviewing sociotropy-dependency and autonomy-self-criticism as personality diatheses for depression, Coyne and Whiffen judged that diathesis-stress models of this kind run into major conceptual and methodological challenges, and they argued that more complex, dynamic models are needed (Coyne & Whiffen, 1995). Replying to that critique, Zuroff, Mongrain and Santor concluded that the vulnerabilities described by Blatt and by Beck are continuous dimensions, nearly orthogonal to one another, and that each can be assessed separately from neuroticism, from depression and from social context (Zuroff et al., 2004).

Self-criticism, which sits at the self-definition pole, reaches well beyond depression. An updated systematic review of 48 studies of adults, drawn from five databases and covering 2012-2018, linked self-criticism to a broad range of disorders and named compassion-focused therapy and emotion-focused therapy as treatments (Werner et al., 2019). The authors noted that they reviewed only the recent literature, that harsh self-criticism resists change, and that possible functional forms of self-criticism need further study (Werner et al., 2019).

Attachment theory supplies a related, though distinct, construct. Reviewing a decade of findings, Mikulincer and Shaver concluded that attachment insecurity, in the forms of attachment anxiety and attachment avoidance, shapes the strategies people use to regulate emotion and distress (Mikulincer & Shaver, 2019). Attachment orientations and interpersonal dependency overlap in subject matter.

Dependent Personality Disorder

The history of the diagnosis is the subject of a critical review that follows dependent personality disorder from one DSM edition to the next as far as DSM-IV-TR, and that also takes up comorbidity along with gender and cultural considerations (Disney, 2013). It judged the research body to have shortcomings and suggested improvements for future studies (Disney, 2013).

The disorder is uncommon in the general population. In a meta-analysis drawing on 10 community studies from Western countries (113 998 adults in all, although not every study contributed to every estimate), any personality disorder had a pooled prevalence of 12.16% (95% CI, 8.01–17.02%), while dependent personality disorder, at 0.78% (95% CI, 0.37–1.32%), was the least common of all the disorders estimated (Volkert et al., 2018). Those figures carry heavy caveats: heterogeneity was extreme (I2 = 99.60%), estimates depended on whether experts or respondents themselves did the rating, every included study was at high risk of bias from non-respondents, and few community studies exist at all (Volkert et al., 2018).

ICD-11 replaces named categories with a dimensional scheme. ICD-11 grades severity on a three-level scale (Mild, Moderate or Severe Personality Disorder), and Bach and First classified one of their cases as Personality Difficulty rather than Personality Disorder (Bach & First, 2018). The clinician can also record a Borderline Pattern qualifier and any of five trait domain qualifiers: Anankastia, Detachment, Disinhibition, Negative Affectivity and Dissociality (Bach & First, 2018). Bach and First illustrated the system with five brief clinical cases and judged it clinically applicable, while cautioning that its clinical utility still needs empirical testing and that its links to prognosis and treatment are only proposed (Bach & First, 2018).

In treatment, dependent patients tend to be compliant yet make heavy use of clinical resources, presenting pseudoemergencies and having difficulty with termination (Bornstein, 2005). Bornstein recommended that assessment integrate data from several sources and that treatment draw on more than one modality (Bornstein, 2005).

The costs extend beyond the clinic. A review spanning six domains associated trait dependency and dependent personality disorder with harm to the self and to others, including functional impairment, heavier health care utilization, partner and child abuse, suicidality and raised risk of physical illness (Bornstein, 2012b). Building on these costs, the review made the case that the diagnosis belongs in DSM-5 as a category of its own (Bornstein, 2012b). DSM-5, which the American Psychiatric Association issued in 2013, lists dependent personality disorder as one of its personality disorders (American Psychiatric Association, 2013).

Psychological Dependence and Addiction

Interpersonal dependency and substance dependence are different constructs that happen to share a word. In the substance sense, the DSM-5 work group recommended merging abuse and the dependence syndrome into a single substance use disorder, basing the change on a literature review, new analyses, and item response theory and factor analysis studies covering over 200,000 study participants, which bore on the unidimensionality of the criteria (Hasin et al., 2013). The group acknowledged that some issues rested on less data, that the legal problems criterion did not fit the single dimension, and that further studies were needed (Hasin et al., 2013).

Behavioural addiction raises a parallel definitional problem. Kardefelt-Winther and colleagues argued that the concept needs an operational definition with explicit exclusions, so that common behaviours are not pathologized, and they left that definition open to extension (Kardefelt-Winther et al., 2017).

Worked Example

Consider an illustrative profile on three subscales named after those of the Relationship Profile Test, destructive overdependence, dysfunctional detachment and healthy dependency (Bornstein et al., 2003). Suppose the scores are expressed as T-scores, with a mean of 50 and a standard deviation of 10, and that the profile reads 64 for destructive overdependence, 45 for dysfunctional detachment and 52 for healthy dependency. Take 60, one standard deviation above the mean, as an illustrative cut-off.

The standard score for destructive overdependence is z = (64 − 50) / 10 = 1.4. Dysfunctional detachment gives z = (45 − 50) / 10 = −0.5 and healthy dependency gives z = (52 − 50) / 10 = 0.2. Only destructive overdependence passes the cut-off of 60. If the scores were normally distributed, z = 1.4 would place this score at about the 92nd percentile.

The profile, the T-score scaling and the cut-off are illustrative and are not the published scoring of any instrument; the only sourced fact here is that the Relationship Profile Test has these three subscales. The DependencyProfileDemo performs the same arithmetic for any profile entered.

Figure 1 plots the illustrative profile against the cut-off.

Figure 1

An Illustrative Dependency–Detachment Profile

Discussion

The measurement literature agrees that dependency is not one thing. Structural work on pooled self-report items separated love, exploitable and submissive dependency, and the common thread among the three was a positive association with neuroticism (Pincus & Gurtman, 1995). Where the measures part company is test format: sex differences ran in opposite directions on objective and projective tests among adults, a split the meta-analysis discussed in terms of self-attributed versus implicit dependency needs (Bornstein, 1995).

The interactionist account changes what a high score is taken to mean. If dependent people pursue active, context-sensitive strategies, then reliance on others is a behaviour to be understood in its setting rather than a fixed deficit (Bornstein, 2012a). The model as described here comes from its proponent's own narrative review (Bornstein, 2012a), and this article cites no independent appraisal of it.

At the clinical end, the disorder is estimated to be rare in Western community samples, at 0.78%, though the extreme heterogeneity across studies and the dependence of estimates on rating method make any single figure provisional (Volkert et al., 2018). When the disorder is present, a review spanning six domains ties it to functional impairment, heavier use of health care and harm to other people (Bornstein, 2012b).

Current Directions

In 2018, Bach and First called for empirical study of whether ICD-11's dimensional classification, which grades personality disorder by severity and describes it with trait domain qualifiers, is clinically useful (Bach & First, 2018). Self-criticism, the counterpart of dependency in the two-prototype account, is now studied across many disorders, with compassion-focused and emotion-focused therapies among the treatments under examination (Werner et al., 2019). On the addiction side, the open task is to define behavioural addiction tightly enough, with explicit exclusions, that everyday habits are not recast as disorders; Kardefelt-Winther and colleagues invited extensions of their definition through an Open Science Foundation framework (Kardefelt-Winther et al., 2017).

Common Misconceptions

Dependent people are simply passive.

The interactionist model describes dependent people as acting on their surroundings, using self-presentation strategies, and behaving adaptively in some contexts (Bornstein, 2012a). Early accounts did emphasise compliance and yielding.

Dependency is a single trait.

Structural analyses of self-report measures found three facets, love, exploitable and submissive dependency (Pincus & Gurtman, 1995), and an early, widely used inventory had already resolved into three components (Hirschfeld et al., 1977). A single total score hides that structure.

Psychological dependency means addiction.

MeSH scopes psychological dependency as reliance on other people for advice, guidance or support. Dependence on a substance is a different construct, and DSM-5 no longer diagnoses it separately, having merged abuse and dependence into substance use disorder (Hasin et al., 2013). The confusion is lexical: both literatures use the same word.

Dependent personality disorder is common.

A meta-analysis of Western community samples put its prevalence at 0.78%, against 12.16% for any personality disorder, although heterogeneity across the pooled studies was extreme (Volkert et al., 2018). Researchers study dependency as a personality trait that varies from person to person, but the full disorder turns out to be rare when community samples are surveyed.

Glossary

Anaclitic depression.

A form of depression that Blatt distinguished from introjective depression and examined in terms of levels of object representation.

Attachment anxiety.

One of two forms of attachment insecurity, alongside attachment avoidance, that shape how people regulate emotion and distress.

Dependent personality disorder.

The clinical extreme of interpersonal dependency, a personality disorder whose definition has changed across DSM editions.

Destructive overdependence.

One of the three subscales of the Relationship Profile Test, scoring the unhealthy pole of reliance on others.

Dysfunctional detachment.

The Relationship Profile Test subscale at the detachment end of the dependency-detachment continuum.

Exploitable dependency.

One of three facets of interpersonal dependency identified in structural analyses of self-report measures.

Healthy dependency.

The Relationship Profile Test subscale that scores adaptive reliance on others.

Implicit dependency.

Dependency needs contrasted, in meta-analytic work on test format, with the needs people attribute to themselves.

Interpersonal dependency.

The tendency to rely on other people for advice, guidance and support, studied as a personality trait.

Introjective depression.

The form of depression that Blatt set against anaclitic depression.

Love dependency.

One of three facets of interpersonal dependency; like the other two, it relates positively to neuroticism.

Self-attributed dependency.

Dependency needs a person ascribes to the self, set against implicit dependency needs in work on test format.

Self-criticism.

A clinical trait at the self-definition pole of depression vulnerability, linked to many disorders beyond depression.

Sociotropy.

A personality dimension measured, together with autonomy, by the Personal Style Inventory.

Submissive dependency.

One of three facets of interpersonal dependency identified in structural analyses of self-report measures.

Substance use disorder.

The single DSM-5 diagnosis that replaced the separate diagnoses of substance abuse and substance dependence.

Key Researchers

Sidney J. Blatt

(1928–2014). Psychologist and psychoanalyst at Yale University; distinguished anaclitic from introjective depression and, with David Zuroff, interpersonal relatedness from self-definition as two routes into depression. Wikipedia - Wikidata

Robert F. Bornstein

Psychologist at Adelphi University; his research on interpersonal dependency spans its development, its measurement, its implicit and self-attributed forms, and its clinical costs. Faculty Page

Robert M. A. Hirschfeld

(1943–2023). Psychiatrist at the National Institute of Mental Health and later chair of psychiatry at the University of Texas Medical Branch; first author of the Interpersonal Dependency Inventory. Obituary

Mario Mikulincer

Social psychologist at Reichman University; studies adult attachment orientations and emotion regulation. ORCID

Aaron L. Pincus

Personality psychologist at The Pennsylvania State University; works on interpersonal theory and, with Michael Gurtman, mapped the structure of self-report dependency measures. ORCID - Google Scholar - Faculty Page

David C. Zuroff

Clinical and personality psychologist at McGill University; studies dependency and self-criticism as vulnerabilities to depression. Faculty Page

Frequently Asked Questions

What is psychological dependency?

Psychological dependency is a tendency to rely on other people for advice, guidance and support. Researchers study it as interpersonal dependency, a trait an integrative review linked to suggestibility, conformity, compliance and interpersonal yielding (Bornstein, 1992).

How is interpersonal dependency measured?

It is usually measured by self-report. Hirschfeld and colleagues built an early 48-item inventory with 180 psychiatric patients and 220 normals, and it split into three components: lack of social self-confidence, assertion of autonomy, and emotional reliance on another person (Hirschfeld et al., 1977).

Are there different kinds of dependency?

Yes. Structural analyses of pooled self-report items identified love dependency, exploitable dependency and submissive dependency, and all three correlated positively with neuroticism (Pincus & Gurtman, 1995).

Is dependency always a weakness?

Not according to the interactionist model, which treats dependency as an active strategy that can be adaptive in some contexts, while noting that its subtypes still need delineating (Bornstein, 2012a).

How is dependency related to depression?

Blatt and Zuroff proposed two prototypes for depression, one centred on interpersonal relatedness and one on self-definition, each tied to personality predispositions and stressful life events (Blatt & Zuroff, 1992).

How common is dependent personality disorder?

A meta-analysis of community samples in Western countries estimated its prevalence at 0.78 percent, compared with 12.16 percent for any personality disorder, though the pooled studies varied enormously (Volkert et al., 2018).

Do women score higher on dependency than men?

On objective tests they do, across 97 studies. On projective tests adult men scored slightly higher and younger respondents showed no difference, so the answer depends on how dependency is measured (Bornstein, 1995).

Is psychological dependency the same as addiction?

No. Psychological dependency concerns reliance on people. Substance dependence is a separate construct, and DSM-5 merged substance abuse and dependence into a single substance use disorder (Hasin et al., 2013).

References