Abstract
Interpersonal dependency—the tendency to look to others for nurturance, guidance, protection, and support, even in situations where autonomous functioning is possible—has become associated with passivity and submissiveness in the minds of mental health professionals. However, evidence suggests that dependent persons behave quite actively, even aggressively, in certain contexts. This chapter reviews research and clinical writing on interpersonal dependency and dependent personality disorder (DPD) to facilitate therapeutic work with dependent patients. The epidemiology of DPD, sex differences, prevalence rates, issues regarding differential diagnosis and comorbidity, and research documenting biological and environmental antecedents of DPD are described. We will describe an integrative framework, the cognitive/interactionist (C/I) model, which specifies the core cognitive, motivational, behavioral, and affective components of normal and pathological dependency. We also provide an overarching structure for conceptualizing contextual variations in dependencyrelated responding. Although dependency leads to increased risk for a number of negative outcomes (e.g., suicide and parasuicide, perpetration of domestic violence in men), it is also linked with an array of adaptive behavior patterns (e.g., conscientiousness in complying with medical and psychotherapeutic treatment regimens). A case formulation and discussion of treatment challenges in therapeutic work with dependent patients are presented; major psychosocial and pharmacological treatment approaches are evaluated; and guidelines for maximizing treatment efficacy are offered.