Dependent personality disorder

Dependent Personality Disorder (DPD). Like the borderline patient, those with DPD have an intense fear of abandonment. The two disorders, however, can be distinguished by the way that the patient responds to this fear. The DPD patient makes attempts at appeasement in an effort to sustain the relationship that (s)he fears losing. The borderline patient, however, may react with rage or resort to extortion to keep from losing the relationship. 

The so-called anxious disorders of Cluster C include avoidant personality disorder (APD), dependent personality disorder (DPD), and obsessive-compulsive personality disorder (OCPD). Like the Cluster A disorders, these personality disorders are typically unobtrusive and may escape clinical detection for many years. Over time, patients adapt their life styles to these illnesses by decreasing their social contacts in an effort to minimize anxiety. In so doing, they further decrease the likelihood of encountering mental health professionals. 

Dependent Personality Disorder (DPD). Apart from psychotherapy, which is essential, there is simply no data at this time to guide us in making psychopharma-cological treatment recommendations for DPD. However, these patients often suffer from comorbid depression or anxiety disorders that invariably require medication treatment. 

Gelemter, J., H. R. Kranzler, E. Coccaro, L. Siever, A. New, and C. L. Mulgrew. 1997. "D4 Dopamine-Receptor (DRD4) Alleles and Novelty Seeking in Substance-Dependent, Personality-Disorder, and Control Subjects." American Journal of Human Genetics 61 1144-52. 

Dependent personality disorder a pattern of submissive and clinging behavior related to an excessive need to be taken care of. 

James, 48, has had intermittent contact with psychiatric services and numerous diagnoses over the years, including schizophrenia, borderline LD, and dependent personality disorder. He s presented to ED for the third time this week, seeking help - but is vague about his needs and doesn t appear suicidal, depressed or psychotic. 

Lejoyeux et al. 1998). Similar to opioid-dependent persons, these patients reported that they use benzodiazepines to self-medicate anxiety, insomnia, and alcohol withdrawal and, less commonly, to enhance the effects of ethanol. Approximately l6%-25% of patients presenting for treatment of anxiety disorders abuse alcohol (Kushner et al. 1990 Otto et al. 1992). Controversy exists concerning appropriate benzodiazepine prescribing in this population (Cir-aulo and Nace 2000 Posternak and Mueller 2001). 

The symptoms during this phase of illness are not particularly specific to schizophrenia. They often resemble, in many respects, depression or even one of the Cluster A personality disorders. The decision to initiate antipsychotic medication at this stage depends on the degree of certainty of the diagnosis, the severity of the symptoms, and the risk and benefits of the medication. 

Drug abuse and dependence There have been no published reports of withdrawal signs or other signs of abuse. The risk of dependence is increased in patients with a history of alcoholism, drug abuse, or in patients with marked personality disorders. 

Panic disorder is comorbid with episodes of depression at some stage in the majority of cases (Stein et al. 1990), with social anxiety disorder and to a lesser extent GAD and PTSD, and with alcohol dependence and personality disorder. Comorbidity results in increased severity and poor response to treatment. Panic disorder is associated with a significantly increased risk of suicide, and this is increased further by the presence of comorbid depression (Lepine et al. 1993). 

Treatment with steroids may initially evoke euphoria. This reaction can be a consequence of the salutary effects of the steroids on the inflammatory process or a direct effect on the psyche. The expression of the unpredictable and often profound effects exerted by steroids on mental processes generally reflects the personality of the individual. Psychiatric side effects induced by glucocorticoids may include mania, depression, or mood disturbances. Restlessness and early-morning insomnia may be forerunners of severe psychotic reactions. In such situations, cessation of treatment might be considered, especially in patients with a history of personality disorders. In addition, patients may become psychically dependent on steroids as a result of their euphoric effect, and withdrawal of the treatment may precipitate an emotional crisis, with suicide or psychosis as a consequence. Patients with Cushing s syndrome may also exhibit mood changes, which are reversed by effective treatment of the hypercortisolism. 

Patients with drug or alcohol problems and those with chronic pain disorders or severe personality disorders almost certainly should not take benzodiazepines because of the high potential for developing benzodiazepine dependence. 

Ball SA (2007). Comparing individual therapies for personality disordered opioid dependent patients. Journal of Personality Disorders, 21, 305-21... 

ATOS). Addiction, 98, 1129-35 Darke S, Ross J, Williamson A, Mills KL, Harvard A Teesson M (2007). Borderline personality disorder and persistently elevated levels of risk in 36 month outcomes for the treatment of heroin dependence. Addiction, 102, 1140-6... 

Personality disorders can complicate management (e.g., borderline disorder with a superimposed MDD). Dual depression occurs in patients who have chronic dysthymic disorder and then experience a superimposed MDD. Substance abuse and dependence are frequently co-morbid with mood disorders and substantially increase depression-related morbidity and mortality rates (see Drug-Induced Syndromes ). 

In summary, no more than one third of all patients treated with a BZD for longer than 2 months develop PBDS. The other two thirds may develop a physical dependency on the BZD, but neither dosage reduction nor gradual tapering evokes the anxiety symptoms manifested by PBDS patients. Hence, it is the patient s personality disorder or underlying anxiety disorder and not physical dependency on the BZD that is responsible. 

A few years ago, the Expert Committee on Drag Addiction of the World Health Organization advised the United Nations that barbiturates must be considered drugs liable to produce addiction. Some persons develop a physical dependence on barbiturates others may be able to stop using the drugs voluntarily. As in the use of other psychological supports, the need for continued barbiturates lies in the underlying personality disorder. 

No specific treatment programs have been developed for prescription sedative abusers. The problem is so often complicated by abuse of other drugs that it may be more expeditious to enroll the patient in a program designed for alcoholics or opiate-dependent persons. Patients with psychiatric disorders that can be defined, especially those with depression, may be treated with drug therapy specific for the underlying disorder. 

The HPA axis, the mediator of cortisol, also plays a central role in the homeostatic processes in human. Subjects with abdominal obesity show several signs of a perturbed regulation of the HPA axis. This is known to occur after chronic, submissive stress. In contrast, perceived environmental stress depends on personality characteristics [111]. Rosmond et al. found that men with cluster A personality disorders showed centralized body fat distribution independent of dexamethasone suppression. In contrast, men with impulsive (cluster B) and anxious (cluster C) personality disorders often have abdominal obesity in combination with a blunted dexamethasone suppression test, indicating a HPA axis disturbance [111],... 

A 34-year-old woman with a history of polysubstance dependence (alcohol, cannabis, and cocaine), depressive episodes associated with multiple suicide attempts, and borderline personality disorder, who had been incarcerated after conviction on charges of physical assault and possession of controlled substances, complained of difficulty in sleeping, poor impulse control, irritability, and depressed mood. She was given oral quetiapine 600 mg/day. On one occasion, she crushed two 300-mg tablets, dissolved them in water, boiled them, drew the solution through a cotton swab, and injected the solution intravenously. Apart from having the best sleep I ever had she described no dysphoric, euphoric, or other effects. She admitted to previous intranasal abuse of crushed quetiapine tablets. 

A 31-year-old man developed priapism after taking zuclopenthixol 30 mg/day for 8 days, the dose having been increased to 75 mg the day before, while he was still taking oral carbamazepine 600 mg/day and clora-zepate dipotassium 30 mg/day. He had a history of perinatal anoxic encephalopathy with severe motor sequelae and dyslalia, alcohol dependence, and a personality disorder. On the day before the priapism occurred, he had been physically restrained and given an extra dose of intramuscular clorazepate dipotassium 50 mg. When priapism occurred, all drugs except clorazepate were withdrawn and about 6 hours later the corpora cavernosa were washed and infused with noradrenaline in glucose (8 doses of 40 pg), after which the priapism resolved. 

Four cases of former drug or alcohol abusers with personality disorders have been described all developed dependence while taking high doses of zolpidem (36). 

The most important problem encountered with amphetamines is abuse and the development of dependence. The most rapid amfetamine epidemic occurred in Japan after World War II, where there had been little or no previous abuse (83). Although a high proportion of amfetamine users probably already have emotional and social difficulties, sustained abuse can result in serious psychiatric complications, ranging from severe personality disorders to chronic psychoses (84,85). Whereas signs of intense physical dependence are not thought to occur (SED-9, 9), withdrawal may be associated with intense depression (SED-9, 9) (86), and relapses in psychiatric disorders have often been noted. Some countries in which the problem became widespread banned amphetamines, and Australia restricted their use to narcolepsy and behavioral disorders in children. Amfetamine dependence developed into a serious problem in the USA (and to a lesser extent in the UK), where it followed the typical pattern of drug dependence (SED-9, 7,10). 

Costa L, Bauer LO. Smooth pursuit eye movement dysfunction in substance-dependent patients mediating effects of antisocial personality disorder. Neuropsychobiology 1998 37(3) 117-23. 

Also falling within the scope of modern psychiatric diagnostic systems are organic mental disorders (e.g. dementia in Alzheimer s disease), disorders due to substance misuse (e.g. alcohol and opiate dependence—see Chapter 10), personality disorders, disorders of childhood and adolescence (e.g. attention deficit/hyperactivity disorder, Tourette s syndrome) and mental retardation (learning disabilities). 

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