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The term dependency, as it is used in personality theory and research refers to a personality orientation (or “style”) wherein an individual: (1) perceives him or herself as helpless, powerless, and ineffectual, and therefore (2) turns to others for support, advice, and reassurance rather than attempting to cope with tasks and challenges in an autonomous, self-directed manner. Individuals who consistently display a passive, help-seeking orientation in a variety of situations and circumstances are described as having a dependent personality. During the past several decades there have been hundreds of published studies examining the antecedents, correlates, and consequences of dependent personality traits. These investigations may be grouped into three broad areas: developmental, social, and clinical. Research in each of these areas is discussed in this paper.

OUTLINE

I. Historical Overview of Dependency Theory and Research

II. The Development of Dependency

A. Childhood Antecedents of Dependency

B. Dependency in Adolescence and Adulthood

C. Dependency in Older Adults

III. Interpersonal Correlates of Dependency

IV. Dependency and Psychopathology

A. Dependency and Depression

B. Dependency and Substance Use Disorders

C. Dependency, Obesity, and Eating Disorders

D. Dependent Personality Disorder

V. Dependency and Physical Disorders

VI. The Dependent Personality: Past, Present, and Future

VI. Bibliography

I. HISTORICAL OVERVIEW OF DEPENDENCY THEORY AND RESEARCH

Although Freud made little mention of the psychodynamics of dependent personality traits, several prominent psychoanalytic theorists (e.g., Karl Abraham, Otto Fenichel, Edward Glover) published papers on the dependent personality during the first few decades of the 20th century. These seminal papers stimulated clinicians’ and researchers’ interest in the topic of dependency, and not surprisingly, much of the early research on dependency came from a psychoanalytic perspective. Early psychoanalytic studies tested the hypothesis that a dependent personality orientation in adolescence or adulthood could be traced to events that occurred during the infantile “oral” period (i.e., during the first I to 2 years of life).

Specifically, the psychoanalytic model hypothesized that high levels of dependency resulted from overgratification or frustration during breastfeeding and weaning. Infantile experiences of frustration or overgratification were presumed to result in “oral fixation” and an inability to accomplish the developmental tasks associated with the infantile, oral stage (i.e., the development of a stable self-concept, along with feelings of autonomy, self-efficacy, and self-sufficiency). Although later studies indicated that dependency in adulthood was not directly related to infantile feeding or weaning experiences, the psychoanalytic model played a central role in bringing dependency research into mainstream psychology.

During the 1950s and 1960s, social learning models began to influence dependency theory and research, supplanting (to some degree) the classical psychoanalytic model. These social learning models differed in certain respects, although they shared the fundamental hypothesis that high levels of dependency result from the reinforcement of passive, dependent behavior in the context of the infant-caretaker relationship. Social learning models of dependency further hypothesized that–insofar as passive, help-seeking behavior was reinforced by the parents (and other authority figures) during early and middle childhood–the individual would continue to show high levels of dependency later in life.

By the early 1970s, the social learning view of dependency began to give way to ethological (i.e., attachment) theory, which was becoming increasingly influential in a number of domains within psychology. In contrast to the classical psychoanalytic and social learning models of dependency, attachment theory emphasized the innate, biological underpinnings of the infant-mother relationship as a primary factor in the development of dependent personality traits. Attachment models of dependency have not yet achieved the same status and influence as have the psychoanalytic and social learning models. Nonetheless, attachment theory stimulated a great deal of research examining the etiology and development of dependent personality traits, including some noteworthy studies examining infant-mother bonding in infrahuman subjects. Recent research in this area has focused on exploring the similarities between dependency and various forms of attachment behavior (e.g., insecure attachment) in children and adults.

During the 1980s researchers took a more eclectic view of dependent personality traits, combining aspects of the psychoanalytic, social learning, and attachment models in order to arrive at a more integrated, comprehensive perspective on dependency. Thus, relatively few studies during the past decade have focused exclusively on one theoretical framework. Rather, researchers have built upon the strengths of different theoretical models, integrating and synthesizing these models to formulate hypotheses that account for aspects of dependency which are best explained via attention to multiple theoretical perspectives. Recent research on dependency has emphasized the importance of unconscious, unexpressed dependency needs (a concept typically associated with the psychoanalytic model), along with an exploration of the impact of early learning and socialization experiences in the development dependent personality traits (an area of inquiry which originated in social learning theory). During the past decade there have also been increasing efforts to integrate the results of developmental, social, and clinical studies of dependency in order to understand the ways in which findings from these three areas of dependency research complement (and contradict) each other.

II. THE DEVELOPMENT OF DEPENDENCY

Developmental studies of dependency can be divided into three areas: (1) studies of the acquisition of dependent personality traits in infancy and early childhood; (2) investigations of the development of dependency during adolescence and adulthood; and (3) studies of dependency in older adults.

A. Childhood Antecedents of Dependency

The results of numerous studies indicate that overprotective, authoritarian parenting is a primary cause of exaggerated dependency needs during adolescence and adulthood. Prospective and retrospective studies of the parenting style-dependency link have produced highly similar results, allowing strong conclusions to be drawn regarding the etiology of dependent personality traits. Findings in this area confirm that when parents show one of these qualities (i.e., overprotectiveness or authoritarianism), the likelihood that their children will show high levels of dependency increases significantly. When parents show both of these qualities, high levels of dependency in their offspring are particularly likely to result.

It appears that overprotective, authoritarian parenting produces high levels of dependency in children largely because overprotective, authoritarian parents prevent the child from engaging in the kinds of trial-and-error learning that help to provide a sense of mastery, autonomy, and self-sufficiency in children. Consequently, the child of overprotective, authoritarian parents comes to perceive him- or herself as powerless and ineffectual, and continues to rely on others—especially figures of authority—for advice, guidance, and protection. As numerous researchers have noted, the child’s inability (or unwillingness) to behave in an assertive, autonomous manner exacerbates the situation, in that behaving in a passive, helpless way encourages figures of authority (e.g., parents, teachers) to continue to perform tasks for the child which the child is actually capable of doing on his or her own. Thus, the child’s expressions of dependency come to serve as cues which continue to elicit helping and caretaking behavior on the part of others, further reinforcing the child’s passive, dependent behavior and ultimately resulting in even greater levels of helplessness and dependency. Recent research confirms that the overt expression of dependency strivings does in fact serve as a help-eliciting cue in both children and adults.

B. Dependency in Adolescence and Adulthood

During adolescence, substantial sex differences in dependency emerge, with girls showing significantly higher levels of dependency than boys. This pattern of results is consistent across different cultures {e.g., American, British, Japanese, Indian, German, Israeli), and across different cultural groups within American society. Moreover, the finding that females show higher levels of dependency than do males has been replicated numerous times. Recent studies further suggest that traditional sex-role socialization practices may be largely responsible for the higher levels of dependency typically found in women relative to men. Insofar as traditional sex-role socialization practices tend to encourage passive, help-seeking behavior in girls to a greater extent than boys, these socialization practices would be expected to produce higher levels of dependency in women than in men. Not surprisingly, empirical studies confirm that–to the extent that a girl grows up in a household which emphasizes traditional sex-role socialization practices–she is likely to show high levels of dependency during adolescence and adulthood. Conversely, to the extent that a boy is exposed to traditional sex-role socialization practices (which emphasize assertive, autonomous behavior in boys), he is likely to show low levels of dependency later in life.

Not only do sex-role socialization practices play an important role in determining the expression of dependency needs in adolescents, but studies confirm that the object of an individual’s dependency strivings (i.e., the person toward whom dependency needs are expressed most readily) changes from childhood to adolescence. Although dependency needs in childhood are typically directed toward the parents and other authority figures (e.g., teachers), during adolescence the dependent individual directs his or her dependency strivings toward members of the peer group rather than toward figures of authority. This shift continues to occur throughout early adulthood, at which point romantic partners become primary outlets for the expression of an individual’s dependency needs. In addition, adults often express dependency strivings toward various “pseudoparental” authority figures (e.g., supervisors, physicians, therapists), and (to a lesser extent) toward peers, parents, and siblings.

C. Dependency in Older Adults

There have been no published studies examining individual differences in level of dependency in older adults. However, research suggests that, in general, older adults tend to exhibit more pronounced dependency needs than do younger adults. To some extent, the higher levels of dependency shown by older adults relative to younger adults reflects the fact that older adults as a group are more dependent on others to carry out tasks associated with daily living (e.g., cooking, shopping, driving). In this context, it is not surprising to learn that those older adults who live in environments which encourage autonomy and independence tend to show lower levels of dependency than do those older adults who live in environments where passivity and dependency are permitted or encouraged. Several investigations have demonstrated that changes in older adults’ frequency of dependent behaviors can be traced directly to the contingencies which characterize the environments in which they live: Environments that directly or indirectly encourage the overt expression of dependency needs (e.g., certain nursing home environments and residential treatment facilities) actually appear to cause significant, long-term increases in the dependency levels of older adults.

III. INTERPERSONAL CORRELATES OF DEPENDENCY

In general, studies of the interpersonal correlates of dependency indicate that dependent persons adopt a passive, helpless stance in interpersonal interactions. Specifically, laboratory and field investigations indicate that individuals with a dependent personality orientation show high levels of suggestibility, cooperativeness, compliance, and interpersonal yielding. These results are not surprising when one considers the underlying goals and motivations of the dependent person. Clearly, being helped, nurtured, and protected is very important to the dependent person. In this context, one would expect that the dependent individual would exhibit behaviors that serve to strengthen and reinforce ties to potential nurturers and caretakers. Thus, dependent persons (1) tend to yield to the opinions of others in laboratory conformity experiments; (2) show high levels of suggestibility in both laboratory and field studies; and (3) are cooperative and compliant in social, academic, psychiatric, and medical settings.

Although the dependent person is generally suggestible, cooperative, compliant, and yielding, it is noteworthy that these dependency-related behaviors are even more pronounced when the dependent person is interacting with a figure of authority than when he or she is interacting with a peer. Apparently, figures of authority are perceived by the dependent individual as being particularly good protectors and caretakers. Consequently, the kinds of ingratiation strategies used by the dependent person with peers (e.g., compliance and interpersonal yieldings) are exhibited even more readily around figures of authority.

Dependent persons in social settings also show high levels of help-seeking behavior. The dependency-help-seeking relationship is found in both men and women, and is consistent across different age groups (i.e., children, adolescents, adults), and across different measures of help-seeking. The dependency-help-seeking relationship found in adults clearly reflects the early developmental experiences of the dependent person. To the extent that help-seeking behavior during childhood was reinforced by the parents and other authority figures, the dependent adolescent or adult will continue to show exaggerated help-seeking behaviors in a variety of situations and settings.

Performance anxiety and fear of negative evaluation might also play a role in encouraging the dependent individual to behave in a help-seeking manner in social situations. Although there have been relatively few studies examining directly the dependency-performance anxiety relationship, studies in this area indicate that (1) dependent persons show higher levels of performance anxiety (and fear of negative evaluation) than do nondependent persons; and (2)there is a positive relationship between the degree to which a dependent person reports high levels of performance anxiety and the degree to which that person shows high levels of help-seeking behavior in various situations and settings.

One final set of findings regarding the interpersonal correlates of dependency warrants mention in the present context. In a series of investigations conducted during the 1970s and 1980s, researchers demonstrated that dependent persons exhibit higher levels of interpersonal sensitivity (i.e., sensitivity to subtle verbal and nonverbal cues) than do nondependent persons. In fact, dependent persons are able to infer with surprising accuracy the attitudes and personal beliefs of strangers, roommates, teachers, and therapists. Although at first glance these results seem inconsistent with the oft-reported finding that dependency is associated with passivity and helplessness, findings regarding the dependency-interpersonal sensitivity relationship are actually quite consistent with these other findings. Clearly, to the extent that a dependent person is able to infer accurately the attitudes and personal beliefs of teachers, roommates, and therapists, the dependent person will be better able to develop strong ties to these potential nurturers, protectors, and caretakers.

IV. DEPENDENCY AND PSYCHOPATHOLOGY

Because dependency has typically been conceptualized as a flaw or deficit in functioning, numerous studies have examined the relationship between level of dependency and risk for psychopathology. Studies of the dependency-psychopathology relationship can be divided into four areas: (1) studies of dependency and depression; (2) investigations of the dependency-substance use disorders relationship; (3) studies of dependency, obesity, and eating disorders; and (4) research on dependent personality disorder.

A. Dependency and Depression

Although laboratory and field studies confirm that there is a positive relationship between level of dependency and level of depression in children, adolescents, and adults, the dependency-depression relationship is more complex than early researchers had thought. On the one hand, exaggerated dependency needs do in fact place an individual at increased risk for the subsequent onset of depression. However, it is also the case that the onset of depressive symptoms results in increases in dependent thoughts, feelings, and behaviors in a variety of subject groups. Presumably, the feelings of helplessness, hopelessness, anhedonia, and anergia that are frequently associated with depression can manifest themselves in increases in overt dependent behaviors in depressed subjects.

The mechanism by which dependent personality traits place an individual at risk for depression is not completely understood, but initial findings suggest that dependency increases risk for depression by causing the dependent person to be particularly upset and threatened by experiences of interpersonal loss. To be sure, interpersonal stressors affect everyone to some degree. However, the dependent person’s lifelong tendency to look to others for nurturance, guidance, and protection may cause him or her to become extremely sensitive to the possibility that a potential caretaker will no longer be available to fulfill their protective and nurturing role. In this respect, dependency represents a vulnerability (or diathesis) that–when combined with interpersonal stressors–places the dependent person at increased risk for depression.

B. Dependency and Substance Use Disorders

Dozens of studies have examined the possibility that dependent persons might be at elevated risk for substance use disorders. The results of these investigations have been decidedly mixed. For example, although studies confirm that dependent persons are at increased risk for tobacco addiction, numerous investigations have failed to obtain the hypothesized relationship between dependency and risk for alcoholism. In fact, longitudinal studies of the dependency-alcoholism link indicate that the onset of alcoholism is followed by increases in dependent thoughts, feelings, and behaviors. However, there is no evidence that dependency actually places individuals at risk for alcohol abuse or dependence.
Similar findings have emerged in studies of dependency and other types of substance use disorders. Researchers have examined possible links between dependency and risk of opiate, cocaine, barbiturate, marijuana, and poly-drug abuse. The results of these studies have been relatively clear-cut: Dependent individuals do not show elevated risk for these substance use disorders, although–consistent with earlier findings regarding the dependency-alcoholism link–research confirms that the onset of an addictive disorder is often associated with elevations in dependent feelings, thoughts, and behaviors.

C. Dependency, Obesity, and Eating Disorders

The hypothesis that dependent personality traits would be associated with obesity and other eating disorders (i.e., anorexia and bulimia) can be traced to the classical psychoanalytic hypothesis (described earlier) that the etiology of dependency lies in “oral fixation.” There have been numerous studies examining the dependency-obesity relationship, and in general these investigations have found only weak relationships between dependency and obesity. Moreover, the dependency-obesity link (when it occurs at all) is somewhat stronger in women than in men. The disappointing results obtained in this area have caused researchers to shift their attention from examining the dependency-obesity relationship to examining the relationship between dependency and eating disorders such as anorexia and bulimia.

Studies of the relationship between dependency and anorexia and bulimia have produced much stronger and more consistent findings than did studies of the dependency-obesity link. Anorexic and bulimic subjects almost invariably show higher levels of dependency than do matched control subjects who do not have these disorders. The dependency-bulimia link appears to be somewhat stronger than the dependency-anorexia link, although additional studies will be needed to confirm and clarify these preliminary results. Studies in this area also suggest that interpersonal stressors (e.g., the breakup of a romantic relationship) might increase the dependent person’s risk for anorexia and bulimia in much the same way as they increase the dependent person’s risk for depression. Thus, a diathesis-stress conceptualization of the dependency-eating disorders relationship holds considerable promise for future research in this area.

D. Dependent Personality Disorder

Although the vast majority of studies of the dependency-psychopathology relationship have explored possible links between dependency and other forms of psychopathology (e.g., depression), in recent years there has been an increasing emphasis on conceptualizing exaggerated dependency needs as a separate and distinct form of psychological illness. The most prominent framework used to examine the pathological aspects of the dependency is the concept of “dependent personality disorder” as this disorder is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM framework argues that individuals who show exaggerated, inflexible dependency needs which cause social or occupational impairment may be diagnosed as having a dependent personality disorder. Unfortunately, because the diagnostic category of dependent personality disorder was first discussed in 1980, with the publication of the third edition of the DSM series, there has been relatively little research on this disorder. Initial findings regarding the correlates and consequences of dependent personality disorder can be grouped into three areas and summarized simply.

First, studies confirm that individuals with dependent personality disorder are at increased risk for a wide range of psychopathologies, including depression, anxiety disorders, eating disorders, and somatization disorders. Individuals diagnosed with dependent personality disorder also show elevated risk for certain other personality disorders (e.g., border-line, avoidant, passive-aggressive). To some extent, findings regarding the links between dependent personality disorder and other forms of psychopathology dovetail with findings regarding the dependency-psychopathology relationship in general: As discussed earlier, studies to date suggest that dependent individuals show increased risk for a wide range of psychopathologies.

Second, epidemiological research suggests that the prevalence of dependent personality disorder in community samples is relatively low, with about 5% of community subjects showing clinically significant dependent personality disorder symptoms. As expected, the frequency of dependent personality disorder symptoms and diagnoses in clinical (i.e., psychiatric inpatient or outpatient) samples is somewhat higher, with many studies reporting base rates of this disorder in clinical subjects of about 10-15%. Although dependent personality disorder appears to be somewhat more prevalent in women than in men, the magnitude of the sex difference in dependent personality disorder diagnosis rates is not great.

Third, studies confirm that dependent personality disorder symptoms predict some important aspects of psychological treatment. For example, clinicians report elevated rates of help-seeking behaviors (e.g., requests for emergency sessions, requests for feedback and advice) among dependent personality disorder patients relative to nondependent patients. Along slightly different lines, recent research in this area suggests that dependent personality disorder is associated with cooperativeness and compliance with therapeutic regimens. Finally, several studies indicate that patients diagnosed with dependent personality disorder remain in psychological and medical treatment significantly longer than do nondependent patients, presumably because treatment termination involves giving up a relationship with an important caretaking figure, which the dependent person is reluctant to do.

V. DEPENDENCY AND PHYSICAL DISORDERS

One of the most interesting and noteworthy findings to emerge from recent studies of the dependent personality has to do with risk for physical disorders. Research indicates that dependent persons are at increased risk for a wide variety of physical illnesses, including infectious diseases, ulcers, heart disease, and cancer. Longitudinal (i.e., prospective) studies and archival (retrospective) studies have produced highly consistent findings in this area. The dependency-disease link has been found in men and women, and in both children and adults. Furthermore, the magnitude of the dependency-disease relationship is quite substantial. In fact, a recent direct comparison of the magnitude of the disease risk associated with dependency and the magnitude of the disease risk associated with other “illness-related” personality variables (e.g., hostility, compulsiveness, introversion) revealed that the magnitude of the relationship between dependency and risk for physical illness is actually larger than the personality-illness risk relationship found for all other illness-related personality variables. Clearly, dependency must be regarded as an important component of the “disease-prone personality.”

The mechanism by which dependency increases an individual’s risk for physical illness parallels closely the mechanism by which dependency increases an individual’s risk for depression. Specifically, it appears that dependency acts as a diathesis which–when coupled with experiences of interpersonal stress or loss-win creases an individual’s risk for various forms of illness. Preliminary findings in this area further suggest that the dependency-interpersonal stress-illness relationship may be mediated by the immune system: Dependent persons who experience significant interpersonal stressors show measurable deficits in immune function. The diminished immunocompetence associated with dependency and interpersonal stress may represent the common pathway through which the dependent individual is placed at increased risk for various forms of illness. However, additional studies will be needed to confirm and extend these initial results.

Ironically, although the dependent person is at increased risk for physical illness, the personality traits associated with dependency (e.g., cooperativeness, compliance, help-seeking) may actually help the dependent person to respond well to various treatment regimens. Physicians and other healthcare professionals consistently report that dependent individuals are compliant, cooperative patients who adhere particularly well to difficult treatment regimens. In addition, the dependent person is inclined to seek the advice and help of a physician relatively quickly when physical symptoms appear. This “medical help-seeking” tendency is certainly consistent with findings regarding the help-seeking behaviors of dependent persons in social settings. In addition, the help-seeking tendencies of the dependent person clearly represent a positive, adaptive quality of dependency. To the extent that the dependent person seeks help relatively quickly when physical symptoms appear, the likelihood of successful treatment should increase.

VI. THE DEPENDENT PERSONALITY: PAST, PRESENT, AND FUTURE

Early research on the dependent personality was concerned primarily with two issues: (1) the exploration of personality traits and behaviors that were hypothesized to be associated with dependency (e.g., passivity, low self-esteem); and (2) the examination of psychoanalytic hypotheses regarding the etiology and dynamics of dependency (i.e., studies of oral fixation and oral dependency). Needless to say, the focus of dependency research has changed considerably during the past several decades. It is worthwhile to review some of these changes in order to get a sense of the directions in which dependency research is likely to head during the coming years.

One important shift in this area has occurred with respect to the focus of dependency research. Whereas early studies in this area tended to focus on understanding the antecedents of dependent personality traits, recent studies have instead focused on understanding the consequences of dependency. Many of these recent investigations have examined the interpersonal (i.e., social) consequences of dependency, although other studies have assessed the effects of dependent personality traits on risk for physical or psychological illness.

A second shift characterizing the study of dependency has involved the research methodologies used in this area. Many early investigations of the dependent personality employed correlational designs. Moreover, many of these early studies took place in field settings (e.g., schools) rather than in the laboratory. In contrast, recent research in this area has tended to use experimental (rather than correlational) designs, and most recent investigations of dependency have taken place in laboratory rather than field settings.

A third shift characterizing research in this area has to do with clinicians’ and researchers’ conceptualization of dependency. For most of this century, dependency has been regarded primarily as a flaw or deficit in functioning. However, in recent years researchers have begun to examine the positive, adaptive qualities of dependency (e.g., compliance with medical regimens, willingness to seek help when symptoms appear). Thus, psychologists have moved from conceptualizing dependency solely in terms of deficit and dysfunction to conceptualizing dependency in a way which recognizes that dependency is associated with both positive and negative qualities.

Fourth, the emphasis in dependency research has shifted from a more-or-less exclusive focus on dependency-related behaviors (e.g., help-seeking), to the study of dependency-related emotions and cognitions. Recent studies in this area have suggested that the disparate behaviors of dependent individuals can be understood more completely (and predicted more accurately) if the dependent individual’s cognitive style is assessed directly. As researchers have increasingly emphasized the ways in which the dependent person’s self-concept and perceptions of other people mediate his or her behavior, many apparent inconsistencies in previous studies of dependency-related behaviors have been resolved.

Finally, researchers are beginning to examine more closely the interaction of dependent personality traits and aspects of the situation or setting in which behavior is exhibited. Although dependency is often associated with passivity and helplessness, recent studies suggest that situational variables (e.g., the status of the person with whom the dependent individual is interacting, the type of environment in which an interaction occurs) also play a significant role in directing the behavior of the dependent person. In this respect, traditional trait models are beginning to give way to interactionist models of dependency. This shift has already generated some noteworthy findings, and the interactionist perspective on dependency is likely to produce many more important advances in dependency theory and research during the coming years.

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