DEPD

Question 1

DSM DEPD

Answer 1

Excessive need to be taken care of that leads to submissive/clinging behaviour and separation fear. 5om:

1. Difficulty making decisions wo advice/reassurance
2. Needs others to assume responsibility for major areas in their life
3. Diff expressing disagreement w others
4. Diff initiating projects/ doing things alone
5. Goes excessive lengths to obtain nurturance/support, to point of unpleasant
6. Feels uncomfortable when alone bc fear of not being able to take care of self
7. Urgently seeks new relation/source of care if one ends
8. Unrealistically preoccupied w fear of being left to take care of self

Question 2

Prev

Answer 2

General population; 1% (2/3 is woman)
Inpatient/outpatient: 5-10% / 2-3 %

Most comorbid;
Symptomatic: Depression, SAD, Agora and SUD
PDs: BPD AVPD and HPD

Often misdiagnosed (missed that its secondary/age onset)

Question 3

Genetic factors

Answer 3

Approx. 30% accounted for by genes. Most prominent as insecure attachment. School refusal

Question 4

Psychosocial

Answer 4

Overprotective parents
Authoritarian parents (rigid/inflexible_
Interpersonal vs individual are more at risk

Question 5

4 Dependency components

Answer 5

1. Motivational; Need for guidance/approval
2. Cognitive: Perceives self as inferior
3. Affective: anxious when required to function autonomously
4. Behavioural: use social influence strategies to strengthen potential caregivers.

Interaction is shown in the cognitive interactionist model (C/I)

Question 6

Treatment challenges

Answer 6

Best solved if: Explore patients transference and therapist’s countertransference

Patients transference:
- Idealisation
- Possessive (Narcissistic/jealous)
- Projective identification (patient adopts clinicians manners)

Countertransference:
- Frustration due to neediness
- Overindulgence (protecting fragile patient)
- Pleasure feelings of power (can lead to exploitation)

Question 7

Three key principles for case concept

Answer 7

1. Dependent patients are not invariably passive and compliant, can be active/assertive
2. Patients have varying degrees of insight in the underlying dep. striving. Multi method assessment is needed to see the dynamics
3. Treatment doesn’t just focus on lowering dependent behaviour, but aim to cognitive restructure. More adaptive dependency