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Termination of therapy with a person who has dependent personality disorder is an extremely important issue to consider. While termination should always be a joint decision between the clinician and the client, people with this disorder often don't know "how much is enough" therapy. The therapist, therefore, may need to prod the patient toward ending therapy. As the end of therapy approaches, the patient is likely to re-experience feelings of insecurity, lack of self-confidence, increased anxiety and perhaps even depression. This can be typical of individuals with this disorder terminating therapy and should be treated appropriately. The clinician should not allow the patient to use these new symptoms, though, as a way of prolonging the current therapy. The goal is to end a relationship at an agreed-upon time and way. The client should be reinforced for the positive gains made in therapy and encouraged to explore their new-found autonomy or improved management of their anxious feelings.

Medications

As with all personality disorders, medications should only be prescribed for specific problems suffered by the individual. Sedative drug abuse and overdose is common in this population and should be prescribed with additional caution. Anti-anxiety agents and antidepressants should be prescribed only when there is a clear Axis I diagnosis in conjunction with the personality disorder. Physicians should resist the temptation to overprescribe to someone with this disorder, because they often present with multiple physical complaints or anxiety. The anxiety in this instance is clearly situationally-related and medication may actually interfere with effective psychotherapeutic treatment.

Giving any individual with a personality or mental disorder a placebo drug for its perceived value by the patient is ethically questionable. Doctors rarely have need to prescribe a vitamin or other non-psychoactive substance unless a patient's medical condition clearly indicates it. When such a prescription is made, it should be made with the clear understanding what it is being prescribed for. Any indirect suggestion that such a medication will help an individual overcome their feelings of insecurity, inadequacy, need for dependence, etc. should be avoided. A medication should not be prescribed because of its "magical" effects, and more expensive medications should not be prescribed over less-expensive medications just because they are "newer." Prescriptions should always be written for a specific medication because of the research suggesting its effectiveness with the patient's specific medical complaint or diagnosed mental disorder and avoidance of intolerable side-effects.

Self-Help for Dependent Personality Disorder

Individuals should likely avoid using a support group as the only means of treatment for this disorder, since it is likely to encourage additional dependent relationships.

Sources:

• American Psychiatric Association
• National Institutes of Health
• National Library of Medicine

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Reviewed: 04/2006