Dedicated devotees...or "dependent personality disorder"?

74 views
Skip to first unread message

Nojdw

unread,
Aug 4, 1999, 3:00:00 AM8/4/99
to
Dedicated devotees...or "dependent personality disorder"?

Concerned former cult members are often frustrated and puzzled at the
continuing irrational and unspiritual attitudes of those remaining behind in
the cult. Written as an aid to psychiatrists, this clinical description of the
"dependent personality disorder" is a strikingly accurate picture of the often
bizarre attitudes of those choosing to remain in cults.

The following is from:

"DISORDERS OF PERSONALITY, DSM 3: AXIS 2"

by Theodore Millon

(Areas of particular interest appear in bold)

Chapter 4

Dependent Personality: The Submissive Pattern

Dependent personalities are distinguished from other pathological patterns by
their marked need for social approval and affection, and by their willingness
to live in accord with the desires of others. Dependent persons' "centers of
gravity" lie in others, not in themselves. They adapt their behavior to please
those upon whom they depend, and their search for love leads them to deny
thoughts and feelings that may arouse the displeasure of others. They avoid
asserting themselves lest their actions be seen as aggressive. Dependents may
feel paralyzed when alone and need repeated assurances that they will not be
abandoned. Exceedingly sensitive to disapproval, they may experience criticism
as devastating.

Dependent personalities tend to denigrate themselves and their accomplishments.
What self-esteem they possess is determined largely by the support and
encouragement of others. Unable to draw upon themselves as a major source of
comfort and gratification, they must arrange their lives to ensure a constant
supply of nurturance and reinforcement from their environment. However, by
turning exclusively to external sources for sustenance, dependents leave
themselves open to the whims and moods of others. Losing the affection and
protection of those upon whom they depend leads them to feel exposed to the
void of self-determination. To protect themselves, dependents quickly submit
and comply with what others wish, or make themselves so pleasing that no one
could possibly want to abandon them.

Dependents are notably self-effacing, obsequious, ever-agreeable, docile, and
ingratiating. A clinging helplessness and a search for support and reassurance
characterize them. They tend to be self-depreciating, feel inferior to others,
and avoid displaying initiative and self-determination. Except for needing
signs of belonging and acceptance, they refrain from making demands on others.
They deny their individuality, subordinate their desires, and hide what
vestiges they possess as identities apart from others. They often submit to
abuse and intimidation in the hope of avoiding isolation,

107

loneliness, and the dread of abandonment. Paralyzed and empty if left on their
own, they feel the need for guidance in fulfilling even simple tasks or making
routine decisions.

Many dependent individuals search for a single, all-powerful "magic helper," a
partner in whom they can place their trust and depend on to protect them from
having to assume responsibilities or face the competitive struggles of life
alone. Supplied with a nurturant partner, they may function with ease, be
sociable, and display warmth, affection, and generosity. Deprived of this
support, they withdraw into themselves and become tense, despondent, and
forlorn.

Despite the well-known prevalence of this personality pattern, there was only
passing reference to it in the DSM-I and no provision at all in the DSM-IL The
closest approximation in the DSM-II, though far from sufficient in either scope
or clarity, was the "inadequate personality." Fortunately, the DSM-III has
taken cognizance of this important syndrome and has given it the status of a
separate and major personality disorder. The following quote is taken from this
official manual, and it highlights the essential features and diagnostic
criteria selected to represent the syndrome:

The individual passively allows others to assume responsibility for major areas
of his or her life because of a lack of self-confidence and an inability to
function independently; the individual subordinates his or her own needs to
those of others on whom he or she is dependent in order to avoid any
possibility of having to be self-reliant.

Such individuals leave major decisions to others. For example, an adult with
this disorder will typically assume a passive role and allow his or her spouse
to decide where they should live, what kind of job he or she should have, and
with which neighbors they should be friendly. Generally individuals with this
disorder are unwilling to make demands on supporting people for fear of
jeopardizing these relationships and being forced to rely on themselves.

Individuals with this disorder invariably lack self-confidence. They tend to
belittle their abilities and assets. (p. 324)

HISTORICAL AND THEORETICAL ANTECEDENTS

Before elaborating the clinical picture of the DSM-III dependent personality it
will be useful and illuminating to briefly review formulations of a parallel
nature that have been published by early as well as contemporary clinical
theorists.

The features of passively allowing others to assume responsibility and the
characteristic receptivity to external influence were first described under the
labels of the "shiftless" type by Kraepelin (1913) and the "weak-willed"
personality by Schneider (1923). Both theorists made little reference to the
need for and the seeking of external support that typify dependent patients,

108

Historical and Theoretical Antecedents

stressing instead "their irresoluteness of will" and the ease with which they
can be "seduced" by others. Schneider noted, "as far as their pliable natures
will allow they are responsive to good influences, show regret for their lapses
and display good intentions" (p. 133). Kraepelin considered these types to be a
product of delayed maturation. Viewing them as readily "exploited to no good
end," both Kraepelin and Schneider conceived these personalities as not merely
minimally competent to handle their affairs and susceptible to influence, but
as easy prey to "bad notions" and ready targets for social forms of misconduct
such as addiction and thievery.

A distinct shift from the notion that these personalities were potentially
immoral characters was taken by psychoanalytic theorists who were also writing
in the first two decades of this century. Evolving their formulations in line
with libidinal or psychosexual stage theory, both Freud and Abraham gradually
constructed the "oral character" type and, more specifically, what has been
termed either the "oral-sucking" or "oral-receptive" character. Most clearly
presented by Karl Abraham in 1924, he writes of this major precursor of the
DSM-III dependent personality as follows:

According to my experience we are here concerned with persons in whom the
sucking was undisturbed and highly pleasurable. They have brought with them
from this happy period a deeply rooted conviction that everything will always
be well with them. They face life with an imperturbable optimism which often
does in fact help them to achieve their aims. But we also meet with less
favorable types of development. Some people are dominated by the belief that
there will always be some kind person--a representative of the mother, of
course--to care for them and to give them everything they need. This optimistic
belief condemns them to inactivity...they make no kind of effort, and in some
cases they even disdain to undertake a bread-winning occupation. (1924a, pp.
599-400)

Elaborating on this early statement, Fenichel highlighted other prime traits of
the oral character, particularly those individuals who have experienced
deprivation at this stage:

If a person remains fixated to the world of oral wishes, he will, in his
general behavior, present a disinclination to take care of himself, and require
others to look after him. . . . The behavior of persons with oral characters
frequently shows signs of identification with the object by whom they want to
be fed. Certain persons act as nursing mothers in all their object
relationships. They are always generous and shower everybody with presents and
help. (1945, p. 489)

Sullivan, although drawing from a different theoretical framework than
libidinal theory, described in his "inadequate" personality a series of
characteristics that correspond in many respects to the current DSM-III
criteria:

Some of these people have been obedient children of a dominating parent. They
go through life needing a strong person to make decisions for them. Some

109

of them learned their helplessness and clinging vine adaptation from parental
example. (1947, p. 84)

Perhaps the closest parallel to the DSM-III dependent personality is found in
the descriptive features of the "compliant" type as formulated by Karen Horney:

He shows a marked need for affection and approval and an especial need for a
"partner"--that is, a friend, lover, husband or wife who is to fulfill all
expectations of life and take responsibility for good and evil....

This type has certain characteristic attitudes toward himself. One is the
pervasive feeling that he is weak and helpless--a "poor little me" feeling....A
second characteristic grows out of his tendency to subordinate himself. He
takes for granted that everyone is superior to him....The third feature...is
his unconscious tendency to rate himself by what others think of him. His self-
esteem rises and falls with their approval or disapproval, their affection or
lack of it. (1945, pp. 49-54)

A similar set of traits was provided by Erich Fromm in his characterization of
the "receptive orientation."

In the receptive orientation a person feels "the source of all good" to be
outside, and he believes that the only way to get what he wants--be it
something material, be it affection, love, knowledge, pleasure--is to receive
it from that outside source.... They are dependent not only on authorities for
knowledge and help but on people in general for any kind of support. They feel
lost when alone because they feel that they cannot do anything without help.
This helplessness is especially important with regard to those acts by which
their very nature can only be done alone--making decisions and taking
responsibility. (1947, pp. 67-63)

As noted earlier--and quite surprisingly given its extensive reference in the
literature--the dependent personality syndrome was accorded only brief mention
in the DSM-I, noted as a subvariant of the passive-aggressive disorder, and it
was totally overlooked in the DSM-IL Features of dependency were most closely
represented in the inadequate personality disorder, but these failed to provide
either a comprehensive or coherent picture of the clinical type. For reference
purposes, the salient aspects of the inadequate personality were noted as
follows:

This behavior pattern is characterized by ineffectual responses to emotional,
social, intellectual and physical demands. While the patient seems neither
physically nor mentally deficient, he does manifest inadaptability, ineptness,
poor judgment, social instability and lack of physical and emotional stamina.

(P. 44)

Of potential interest are factor analytic studies of "oral character" traits.
For example, in a series of cross-validated projects designed to assess the
factorial

110

unity of certain presumed psychoanalytic types, Lazare, Klerman, and Armor
(1966, 1970) identified the following characteristics as covarying to a high
degree in what they termed the "oral factor": dependence, pessimism, passivity,
self-doubt, fear of sexuality, and suggestibility. Along similar lines, Walton
and Presley (1973a, 1978b) rated a population of patients on an inventory of
personality traits and extracted a major component that they labeled
"submissiveness"; it was composed of the following items: timidity, meekness,
submissiveness, intropunitiveness, indecisiveness, and avoidance of
competition. In noting possible parallels to this component in the clinical
literature, Walton and Presley referred to the "obviously related" dependent
personality, a classification well known to practicing professionals but one
that did not appear in either the DSM-II or the ICD system.

Millon drew upon his theoretically derived passive-dependent personality
pattern (1969), and in 1975 he provided the following descriptive features and
criteria as the initial working draft for the personality subcommittee of the
DSM-III Task Force.

This pattern is typified by a passive-dependency, general social naivete and a
friendly and obliging temperament. There is a striking lack of initiative and
competitiveness, self-effacement of aptitudes and a general avoidance of
autonomy. Appeasing and conciliatory submission to others is notable, as is a
conspicuous seeking and clinging to supporting persons. Except where dependency
is at stake, social difficulties are cognitively denied or neutralized by an
uncritical and charitable outlook. Since adolescence or early adulthood at
least S of the following have been present to a notably greater degree than in
most people and were not limited to discrete periods nor necessarily prompted
by stressful life events.

1. Pacific temperament (e.g., is characteristically docile and noncompetitive;
avoids social tension and interpersonal conflicts).

2. Interpersonal submissiveness (e.g., needs a stronger, nurturing figure, and
without one feels anxiously helpless; is often conciliatory, placating, and
self-sacrificing).

3. Inadequate self-image (e.g., perceives self as weak, fragile and
ineffectual; exhibits lack of confidence by belittling own aptitudes and
competencies).

4. Pollyana cognitive style (e.g., reveals a naive or benign attitude toward
interpersonal difficulties; smooths over troubling events).

5. Initiative deficit (e.g., prefers a subdued, uneventful and passive life
style; avoids self-assertion and refuses autonomous responsibilities).

In a second draft revision of the criteria, the following list was written by
the author in 1977 for review by his DSM-III Task Force associates.

Excessive dependency (e.g., displays a chronic and conspicuous need for
supporting or nurturant persons).

Isolation anxiety (e.g., cannot tolerate being alone for more than brief
periods).

111

Lack of confidence and initiative (e.g., perceives self as weak, belittles
aptitudes and is non-competitive). Submissive and socially conciliatory (e.g.,
avoids self-assertion, is self- sacrificing and pollyanna-like). E. Abdication
of responsibilities (e.g., seeks others to assume leadership and direction for
one's affairs).

CLINICAL PICTURE

With the foregoing as a precis, there is a reasonable foundation for detailing
the major clinical characteristics of the dependent personality. Although the
analysis is separated into four sections, the traits described should be seen
as forming a coherent picture. Congruity among the four descriptive realms of
behavior, self-report, intrapsychic processes, and interpersonal coping style
should be expected since a distinguishing characteristic of a personality trait
is its pervasiveness--that is, its tendency to operate in all spheres of
psychological functioning. It should not be surprising, therefore, that each
section provides a clinical impression similar to the others.

Behavioral Features

Among the most notable features of dependents is their lack of self-confidence,
a characteristic apparent in their posture, voice, and mannerisms. They tend to
be overly cooperative and acquiescent, preferring to yield and placate rather
than be assertive. Large social groups and noisy events are abhorrent, and they
go to great pains to avoid attention by underplaying both their attractiveness
and their achievements. They are often viewed by friends as generous and
thoughtful, and at times as unduly apologetic and obsequious. Neighbors may be
impressed by their humility, cordiality, and graciousness, and by the
"softness" and gentility of their behavior. Beneath their warmth and affability
may lie a plaintive and solemn quality a searching for assurances of acceptance
and approval. These needs may be especially manifest under conditions of
stress. At these times, dependents are likely to exhibit overt signs of
helplessness and clinging behaviors. They may actively solicit and plead for
attention and encouragement. A depressive tone will often color their mood, and
they may become overtly wistful or mournful. Maudlin and sentimental by
disposition, they may also become excessively conciliatory and self-sacrificing
in their relationships.

Self-Descriptions and Complaints

It is characteristic of dependents to limit awareness of self and others to a
narrow sphere, well within comfortable boundaries.They constrict their world
and are minimally introspective and pollyanna like with regard to difficulties
that surround them. From an introspective view dependent personalities tend

112

Clinical Picture

to be naive, unperceptive, and uncritical. They are inclined to see only the
"good" in things, the pleasant side of troubling events. Underneath their
pollyanna veneer, dependent personalities often feel little of the joy of
living. Once their "hair is let down" they may report feeling pessimistic,
discouraged, and dejected. Their "suffering" is done in silence, however, away
from those for whom they must appear pleased and content with life.

Dependents see themselves, at least superficially, as considerate, thoughtful,
and cooperative, disinclined to be ambitious and modest in their aspirations.
Closer probing, however, is likely to evoke marked feelings of personal
inadequacy and insecurity. Dependents tend to downgrade themselves, claiming to
lack abilities, virtues, and attractiveness. They are disposed to magnify their
failures and defects. When comparing themselves to others they minimize their
attainments, underplay their attributes, note their inferiorities, and assume
personal blame for problems they feel they have brought upon others. Of course,
much of this self-belittling has little basis in reality. Clinically, this
pattern of self-deprecation may best be conceived as a strategy by which
dependents elicit assurances that they are not unworthy and unloved. Hence, it
serves as an instrument for evoking praise and commendation.

Inferred Intrapsychic Dynamics

By claiming weakness and inferiority, dependents effectively absolve themselves
of the responsibilities they know they should assume but would rather not. In a
similar manner, self-depreciation evokes sympathy and attention from others,
for which dependents are bound to feel guilt. Maneuvers and conflicts such as
these are difficult for dependents to tolerate consciously. To experience
comfort with themselves, dependents are likely to deny the feelings they
experience and the deceptive strategies they employ. Likewise, they may cover
up their obvious need to be dependent by rationalizing their inadequacies--that
is, by attributing them to some physical illness, unfortunate circumstance, and
the like. And to prevent social condemnation, they are careful to restrain
assertive impulses and to deny feelings that might provoke criticism and
rejection.

Dependents' social affability and good-naturedness not only forestall social
deprecation but reflect a gentility toward the self, a tender indulgence that
protects them from being overly harsh with their own shortcomings. To maintain
equilibrium, they must take care not to overplay their expressions of guilt,
shame, and self-condemnation. They are able to maintain a balance between
moderate and severe self-deprecation by a pollyanna tolerance of the self,
"sweetening" their own failures with the same saccharine attitude that they use
to dilute the shortcomings of others.

The inadequacies that dependents see within themselves may provoke feelings of
emptiness and the dread of being alone. These terrifying thoughts are often
controlled by identification, a process by which they imagine

113

themselves to be an integral part of a more powerful and supporting figure. By
allying themselves with the competencies of their partners, they can avoid the
anxieties evoked by the thought of their own impotence. Not only are they
uplifted by illusions of shared competence, but through identification they may
find solace in the belief that the bonds they have constructed are firm and
inseparable.

Denial mechanisms also characterize the dependent's defensive style. This is
seen most clearly in the pollyanna quality of dependents' thoughts. Dependents
are ever-alert to soften the edges of interpersonal strain and discomfort. A
syrupy sweetness may typify their speech, and they may persistently cover up or
smooth over troublesome events. Especially threatening are their own hostile
impulses; any inner feeling or thought that might endanger their security and
acceptance is quickly staved off. A torrent of contrition and self- debasement
may burst forth to expiate momentary transgressions.

Interpersonal Coping Style

What interpersonal behaviors do dependents use to manipulate their environment,
and how do they arrange their relationships to achieve their aims.

A major problem for dependent individuals is that they not only find little
reinforcement within themselves but feel that they are inept and stumbling, and
thus lacking in the skills necessary to secure their needs elsewhere. As they
see it, only others possess the requisite talents and experience to attain the
rewards of life. Given these attitudes, they conclude that it is best to
abdicate self-responsibility, to leave matters to others, and to place their
fate in others' hands. Others are so much better equipped to shoulder
responsibilities, to navigate the intricacies of a complex world, and to
discover and achieve the pleasures to be found in the competitions of life.

To achieve their goals, dependent personalities learn to attach themselves to
others, to submerge their individuality, to deny points of difference, to avoid
expressions of power, and to ask for little other than acceptance and support--
in other words, to assume an attitude of helplessness, submission, and
compliance. Moreover, by acting weak, expressing self-doubt, communicating a
need for assurance, and displaying a willingness to comply and submit,
dependents are likely to elicit the nurture and protection they seek.

Dependents must be more than meek and docile if they are to secure and retain
their "hold" on others. They must be admiring, loving, and willing to give
their "all." Only by total submission and loyalty can they be assured of
consistent care and affection. Fortunately, most dependents have learned
through parental models how to behave affectionately and admiringly. Most
possess an ingrained capacity for expressing tenderness and consideration,
essential elements in holding their protectors. Also important is that most
have learned the "inferior" role well. They are able, thereby, to provide their
"superior" partners with the feeling of being useful, sympathetic, stronger,
and competent--precisely those behaviors that dependents seek in their mates.

114

From many sources, then, dependent personalities have learned interpersonal
strategies that succeed well in achieving the goals they seek.

ASSOCIATED DISORDERS

Before detailing the disorders that frequently accompany the dependent
personality, it may be useful to reiterate an earlier discussion in Chapter 1
concerning distinctions between personality and symptom disorders. Essentially,
the behaviors that typify personality persist as permanent features of the
individual's way of life and seem to have an inner autonomy; that is, they
exhibit themselves with or without external precipitants. In contrast, the
behaviors that characterize Axis I symptom disorders arise as a reaction to
stressful situations and tend to be transient; that is, they are of brief
duration, subsiding or disappearing shortly after these conditions are removed.
The clinical features of personality are highly complex and widely generalized,
with many attitudes and habits exhibited only in subtle and indirect ways. In
contrast, symptom disorders tend to be characterized by isolated and dramatic
behaviors that often simplify, accentuate, and caricature the more prosaic
features of the patient's personality. That is, they stand out in sharp relief
against the background of more enduring and typical modes of functioning.
Furthermore, personality traits feel "right" to the patients. They seem to be
part and parcel of their makeup. In contrast, symptom disorders often are
experienced as discrepant, irrational, and uncomfortable. The behaviors,
thoughts, and feelings of disorders seem strange and alien not only to others
but to the patients themselves. They often feel as if they were driven by
forces beyond their control.

It is the contention of this book that a full understanding of Axis I symptom
disorders requires the study of Axis II personalities. Symptom disorders are
but an outgrowth of deeply rooted sensitivities and coping strategies. What
events a person perceives as threatening or rewarding, and what behaviors and
mechanisms he or she employs in response to them reflects a long history of
interwoven biogenic and psychogenic factors that have formed the person's basic
personality pattern.

Several qualifications should be noted lest the discussion imply an overly
simplified relation between Axis I and Axis II syndromes. First, symptom
disorders do not arise in one personality pattern only. Second, in many cases
several Axis I symptom disorders may be simultaneously present since they
reflect the operation of similar coping processes. Third, symptoms are likely
to be transient since their underlying functions wax and wane as the need for
them changes. And last, Axis I symptoms should, in large measure, be
interchangeable, with one symptom appearing dominant at one time and a
different one at another.

Despite the fact that Axis I symptom disorders often covary and are frequently
interchangeable, we would expect some measure of symptom

115

dominance and durability among different Axis II personalities. No one-to- one
correspondence should be expected, of course, but differences in lifelong
coping habits should lead us to anticipate that certain personalities would be
more inclined to exhibit certain symptoms than others. In the compulsive
personality, for example, where ingrained mechanisms such as reaction formation
and undoing have been present for years, we would expect the patient to display
symptoms that reflect these mechanisms. Similarly, histrionic personalities
should exhibit the more dramatic and attention- getting symptoms since
exhibitionistic histrionics have characterized their coping behaviors.

There are other reasons not to overstate the correspondence between personality
and symptom disorders. Thus, symptoms that are often indistinguishable from
those exhibited by pathological personalities arise also in normal persons.
More importantly, there are endless variations in the particular experiences to
which different members of the same personality syndrome have been exposed. To
illustrate, compare two individuals who have been "trained" to become dependent
personalities. One was exposed to a mother who was chronically ill, a pattern
of behavior that brought her considerable sympathy and freedom from many daily
burdens. With this as the background, the patient in question followed the
model observed in the mother when faced with undue anxiety and threat, and
thereby displayed hypochondriacal symptoms. A second dependent personality
learned to imitate a mother who expressed endless fears about every kind of
event and situation. In this case, phobic symptoms arose in response to
stressful and anxiety-laden circumstances. In short, the specific symptom
"choice" is not a function solely of the patient's personality but may reflect
particular and entirely incidental events of prior experience and learning.

Concomitant Axis I Symptoms

This section (also provided in each of the following chapters) briefly
discusses the prime Axis I disorders that often covary with the personality
syndrome under review. In addition to identifying the most frequent of these
accompanying difficulties, there is also a description of the more common
sensitivities and vulnerabilities that dispose this personality to react in a
"disordered" fashion. Further, note is made of several of the hypothesized
dynamics and secondary gains that characteristically occur among these
personalities when they exhibit the Axis I disorder under discussion. As noted
earlier, objective precipitants in symptom disorders play a secondary role to
those which exist internally. It is the patients' anticipatory sensitivities
that dispose them to transform innocuous elements of reality so that they are
duplicates of the past. As in a vicious circle, this distorted perception stirs
up a wide range of associated past reactions. To specify the source of an Axis
I disorder, then, we must look not so much to the objective conditions of
reality, though these may in fact exist, as to the deeply rooted personality
vulnerabilities of the patient.

Steven M. Stoltz

unread,
Aug 8, 1999, 3:00:00 AM8/8/99
to
Nojdw is not a representative of the great avatar Paramahansa Yogananda.
He is a fraud.

The exalted Yogi, however, does not treat gold and earth, saint and
sinner, with impartial indifference! He wisely recognizes their
dramatic differences on the mundane plane as perceived by other
material beings....the yogi recognizes relative values....He endorses
the activities of the virtuous who serve as harbingers of good to their
fellow man, and he denounces the activities of the evil who harm
themselves and others."

"God talks with Arjuna,"Paramahansa Yogananda Gita translation

Sent via Deja.com http://www.deja.com/
Share what you know. Learn what you don't.

Reply all
Reply to author
Forward
0 new messages