Linda struggled with depression and anxiety. It clung to her like ivy wrapping around the trunk of a tree. Frayed nerves, fatigue, and gloom had been daily companions for the past two years. At the age of 35 she was feeling old. A sense of optimism eluded her, and in its place was the steady hum of worry.
Recently, things had become worse, and by the time she called to make an appointment with me the stress was taking a toll on Liinda’s physical health.
It was late Spring when Linda first came to my office and described the panic attacks and sadness that had taken over her life. As with each person who begins psychotherapy, we closely examined what was occurring in her life at that moment.
After completing that part of the interview, I asked Linda to tell me something of her history.
With a look of surprise, she asked “All of it?”
“Just what you think is important. Why don’t we begin when you were a young child” I responded.
Patients sometimes ask why we need to pay any attention to their past. The reason, I explain, is that it provides clues for better understanding the present.
For example, it’s important to know why anxiety has become especially problematic at this point in someone’s life rather than year before. Is something else happening that has made it unbearable? Perhaps it’s impacting their marriage or their job? In addition it can be revealing to see how the problem first developed to find clues regarding how it is now being maintained, even if unconsciously.
When looking at Linda’s past an obvious pattern emerged that traced its origins to her early years of grammar school. During that time, she learned that the easiest way to make and keep friends was, in her words, to “Avoid being a pain in the ass.”
This meant always following the lead of her peers. Doing what her friends wanted, and never asserting herself.
Having a stable set of friends had taken on special importance because her parents had recently divorced. Making the loss even more upsetting was the fact that her stepmother then moved to another city 30 miles away. Although she was not close with her stepmother, her two stepsisters had been her best friends.
Their loss was crushing, and like many youngsters in that position she could not make sense of their sudden absence. Searching for a reason she ended up blaming herself.
“Even though it seems silly now, when I was a child it seemed to make sense that the divorce was my fault. I just thought it probably had something to do with me needing too much attention, and my neediness had driven them apart.”
The loss of her sisters sparked a sense of desperation to keep what friends remained. By focusing on pleasing her remaining friends, especially by making no demands on them, she was rewarded with a sense of security and stability.
From the perspective of a young child, it worked.
In fact, it worked so well that eventually it became second nature. Linda didn’t have to think about it – being passive and docile became automatic.
Throughout high school her ‘Don’t make anyone angry’ strategy continued to work and won her even more friends. She became popular, joined various school clubs, and was known as the girl who helped everyone and always did so with a smile.
College was much the same, although the academic demands meant that Linda had to work even harder to juggle her time between succeeding in her coursework and pleasing the growing number of friends who frequently requested her help.
Marriage and raising children followed shortly after graduation. If the competing demands of college had stretched her energies, this next phase of life brought them to the breaking point.
The solution for fighting fears of abandonment that Linda had latched onto as a child, and had initially worked so well, was exacting a huge toll on her. The cost of having spent her life pushing down her deepest desires, preferences, and dreams in order to please others was now overwhelming.
Bouts of anxiety and depression had become so frequent that they had become her ‘new normal.’ A dull ache settled in her heart. She felt as though she were grieving, but unsure what had been lost.
One morning as we met in my office she leaned forward, sitting on the edge of her chair, and in a pleading tone said “I have everything I ever wanted. Children, a loving husband, friends, a beautiful home and a steady job. What’s wrong with me? I should be the happiest person on earth. But instead, I just feel defeated and lost.”
Learning To Be Confident
Linda came to understand that the answer to her question was very simple. She had learned the wrong lesson on how to form and keep close relationships. The childhood guilt and panic attached to abandonment had led her to a solution that, as an adult, required her to pay a price she could not bear.
Passivity and dependency required that she forfeit most of independence, and robbed her of knowing genuine intimacy.
Because the love and affirmation she craved could only be gained by hiding much of herself behind a wall of unassuming meekness, she never felt that others genuinely knew the ‘real Linda.’
The initial goal of therapy was that she would realize that this was a tradeoff she had made as a young child. What she would do with this realization would determine where therapy went next.
One might think that grasping this insight would be enough to bring about change. But this is seldom the case. By the time these patterns of thought and behavior have become woven into the everyday fabric of life, it feels risky to act in any other way.
Asserting herself felt like a gamble. She might upset others and lose relationships.
If she were to choose making changes, to live life more fully, the solution would be simple, but it would not be easy.
It required that she make decisions on her own, speak up for herself, and take steps to follow her own interests and passions.
To her credit Linda chose to make those changes. To strike out on a new course in life.
We began by having her select several close friends with whom she would begin to assert herself in small but significant ways. This included declining invitations that her friends made that conflicted with other plans. It also included declining the frequent requests for help that often came her way.
Once Linda began to regularly assert herself with these friends, she would move on to bigger challenges that would feel even riskier.
Likewise, she needed to assert herself at home. Her husband was very supportive, and after a couple of meetings with the two of them we had a plan that included Linda making decisions about ‘date nights’ and weekend vacations they would take together.
In time she began to realize that her fears were overblown. Yes, some people might be put off by her becoming more confident. But if a friendship was based on her being a doormat, it was not worth keeping.
As she began asserting herself something odd happened. Something she had not expected. She felt excited. Going through the day and acting on her own judgement, not being a captive to the wishes of others, was a new experience.
Linda came to realize that whatever conflicts arose from her newfound assertiveness were not cataclysmic. When friends became disappointed, she didn’t need to worry that they would then abandon her.
Saying “No” to family members did not lead to unbridgeable chasms in their relationship.
In time, this new way of approaching life caused Linda to see herself very differently. Her self-esteem grew stronger, a sense of optimism replaced anxious doubt. And as she began to explore long repressed interests and passions her energy, vibrancy and excitement about the future re-emerged.
What causes dependent personality disorder (DPD)?
Research has not found what causes some people to become extremely passive and dependent upon others. As with most mental health disorders it is believed to be a combination of genetics and early learning.
When someone’s dependence on others is extreme, it is diagnosed as Dependent Personality Disorder (DPD).
For a diagnosis of DPD, five of the following attributes need to be found:
An intense, unrealistic fear of being abandoned.
Anxious or helpless feelings when alone.
A chronic inability to manage life responsibilities without seeking help from others.
Problems stating an opinion due to fear that it will lead to a loss of support or approval.
And urgent desire to receive support from others, even when this requires frequently doing what you would otherwise be objectionable.
Trouble making everyday decisions without gaining feedback or reassurance from others.
Difficulty beginning and/or completing projects due to a lack of self-confidence or an inability to make decisions.
A strong sense of urgency to find a new relationship after a close relationship ends.
The Way Forward
Because most of these diagnostic signs are simply extreme examples of tendencies that many people experience from time to time, it is easy for one to read that list and immediately conclude that they fit the criteria for DPD.
Take a step back from the ledge. These qualities, in order to meet DPD criteria, need to exist as a predominate and chronic quality of one’s life. Not just an occasional struggle, or a mild concern.
Nevertheless, a lack of confidence, fear of assertiveness, and an over dependency on others can still be a significant problem in life even when it does not rise to the level of receiving a diagnosis of DPD.
Consequently, if you examine the list of criteria and conclude that many of these descriptors fit your experience, although in milder form, it would be a good idea to make some changes.
To make the most of your life, of your unique skills and abilities, you need to be able to confidently pursue your interests and goals. You cannot do this if you are constantly worried that by doing so you are risking the relationships that mean the most.
As the vignette above demonstrates, there are straight forward ways to challenge the fears that hold you back. Once you begin to feel the freedom that comes with being rid of these worries, you will never want to return to the old stale mindset that put your dreams and passions in a straitjacket of dependency.
