Dear Patti,

My husband’s sister, Tammy, is a wonderful person, always helping others, volunteering at church or the homeless shelter where no job is beneath her. Both my husband and I are very close to Tammy and, while we’re very proud of her, we feel she barely has a life. She’s 41, afraid to live alone and has always lived with her mother. Tammy hasn’t had a boyfriend or much of a social life for years. She has very little self-confidence and relies on her family to make decisions. She speaks four languages, is extremely smart and yet works as a hostess in a restaurant where they constantly take advantage of her. She never says anything as she’s afraid of conflict.

At our persistent prompting, Tammy saw a psychotherapist who diagnosed her as having a dependent personality disorder and was told it’s extremely difficult to treat. Tammy is resigned and has given up on trying changing. We’re afraid she’s going to wake up someday, realize her life has been wasted, and it’ll be too late. Are we unrealistic in believing Tammy’s problem is fixable?

Thanks for your help.
— Susan

Dear Susan,

Everyone’s personality is unique when it comes to how they experience emotions and interact with others. For example, your reaction to someone hurting your feelings might be to withdraw; your husband’s response, however, may be to take a confrontational approach. No matter which behaviors a mentally healthy person chooses, he or she is still open to trying others if a particular action proves ineffective.

Such is not the case for people suffering from personality disorders who, by early adulthood, have a set of traits they operate from; a rigid, inflexible and inappropriate set of rules that impair their lives and their ability to have quality relationships and general happiness. Their maladaptive responses to situations are considered personality disorders only when they cause significant functional impairment.

While those who have this condition are distressed about their lives and the harmful consequences, they tend to avoid seeking help because — since they’ve always been this way — they’re unaware that their own thoughts and actions are causing the problem. Therapists often have difficulties treating personality disorders because the clients have convinced themselves that their feelings and behaviors are normal.

Only when they become motivated to regain control of their lives is healing possible. Therefore, it’s essential to select an experienced psychotherapist with an understanding of the person’s patterns of coping.

People with dependent personality disorder (DPD) — one of the 10 recognized personality disorders — feel intensely insecure, inadequate, and uncomfortable about taking care of themselves and, thus, have a pervasive need to be nurtured. This not only leads them to engage in submissive behavior, but to also hand over responsibility for even the simplest decisions to someone else. The fear of rejection and/or abandonment immobilizes them into a state of thinking and believing they are helpless. In order to maintain these relationships, which they believe validate their existence, they’ll go to extreme lengths, make extraordinary self-sacrifices, and even submit to abuse/intimidation just so they won’t end up alone.

Successful treatment of DPD may take a long time. Individuals like Tammy need to acknowledge their dependent behavior and the high price they’ve been paying to maintain these destructive patterns. The therapist may repeatedly point out the painful results and reinforce the message that things keep happening over and over unless the individual decides to break the cycle.

Psychotherapists who work with DPD cases also realize treatment goals shouldn’t contradict the basic personality of the patient. Accordingly, they respect and support positive skills, such as the ability to be thoughtful and considerate, being a team player and a good listener, but they work toward a more functional version of these characteristics. The treatment goal is not independence but autonomy — which is the capacity for independence and the ability to develop intimate relationships.
With the help of a professional therapeutic relationship, Tammy can learn to identify the sources of her stress, take responsibility for her actions and work toward freeing herself from her imprisoned life.