Dependent Personality Disorder and Infant Attachments

Dependent Personality Disorders: A Study in Attachment Theory

Corissa Barrow
PSYC 2102.03
T.C. Sim, Ph. D
October 27, 2015

Dependent Personality Disorder and Infant Attachments

Abstract
The present study aimed to determine if Attachment Theories and dependent personality disorder
(DPD) are distinct or overlapping social constructs. The quality of the early environment is
hypothesized to be an underlining influence on adolescent development thus becoming a key
factor in promoting the formation of Dependent Personality Disorders. Participants were
surveyed about parental marital status, parental mortality status and perceptions of childhood
treatment by parents, through The Structured Clinical Questionnaire for DSM-V-R Personality
Disorders and Adult Attachment Interview-Questionnaire. Expected results are to show a strong
correlation between those who met the qualifications for DPD and similar insecure adolescent
attachment patterns. Causations and findings should be at assistance for a greater understanding
of the origins of Dependent Personality Disorder and possible creations of more effective,
inexpensive treatments.
Dependent Personality Disorders: A Study in Attachment Theory
Dependent Personality Disorder, DPD, typically becomes apparent in early adulthood or
as the importance of adult relations become evident. DPD is often clinically defined as behaviors
displaying needy, passive, and clinging behavior, and have a fear of separation (Disney, 2013).
Individuals suffering from this become emotionally dependent on other people and spend great
efforts trying to please others (Disney, 2013). These behaviors tend to appear both across and
within a wide variety of situations in that they harm themselves and others. As early as 1994,
such as studies done by Chantry and Craig, have continuously reaffirmed such theories. In this
study it was found in a sample of 603 offenderspersonality styles of dependent and
narcissistic-antisocial appeared evenly across. Subjects consisted of child molesters (N=202),
adult rapists (N=195), and non-sexually aggressive felons (N=206), all in which separate duster

Dependent Personality Disorder and Infant Attachments

analyses of MCMI profiles were conducted. The results of this study suggested that the
personality styles of sexual offenders is heterogeneous, but that the styles of dependency are
more prevalent with this population (Chantry & Craig, 1994).
Other findings have also linked DPD to many problematic scenarios, such as in
Bornsteins results displaying high levels of trait dependency and DPD [being] associated with
elevated risk for physical illness, partner and child abuse, and suicidality, as well as with high
levels of functional impairment and increased health care expenditure (2012). Findings such as
these begin to highlight the underlining importance of this problem affecting society as a whole.
However, previously mentioned findings failed to display in how prevalent this condition is, not
in the context of harming others but themselves. In Echeburuas 2005 study, he aimed to define
which personality disorders in which were highly related to alcohol-dependency. Upon recruiting
patients, DPD were most prevalent in representing at 13.3% following by obsessive-compulsive
disorder at 10% (Echeburua, 2005). Giving the nature of the disorder and by offering some of the
accompanied negative events, a much clearer picture is than put into position. The question then
that arises, is of which possible causes could be the leading factor to the formation of DPD.
Throughout the years, much research has been conducted on the question of what causes
DPD, and specifically, the quality of the early environment shows a promising influence on the
development of dependency. The ideal approach for studies of these types tend to involve the
examination of dynamics in adolescent behavior in relation to attachment styles in adulthood. In
fact Patrick et al. found that there is growing empirical evidence connecting Borderline
personality disorder with patterns of insecure attachment reflected in representations of
childhood relationships with parents (Patrick, Hobson, Castle, Howard, & Maughan, 1994; Sack
et al., 1996; Stalker & Davies, 1995; West et al., 1994), thus creating this distinct characteristic
consistent with the diagnosis of personality disorders including DPD. More specifically, Livesley

Dependent Personality Disorder and Infant Attachments

et al. set out to establish a study to investigate the relationship between DPD and Attachment
problems, by emphasizing that current diagnosis [are a combination of] several forms of
interpersonal dysfunction that may have differential prognostic significance (pg 132, Livesley et
al., 1990). Results implied strong correlations between insecure attachments and dependency
thus promoting for a change to make insecure attachment and dependency the two defining
features of DPD (Livesley et al., 1990). The idea, then is, to examine how to help society
narrow down this disorder much more efficiently and quickly. Some possible treatments have
been developed to assess for many other hazardous health deficiencies, such as for forensic
mental health facilities. Studies that have been conducted by Adshead and Aiyegbusi shows that
research and practice from attachment theory are relevant to forensic mental health care and
signified the relevance of attachment insecurity to the risk of violence (Adshead & Aiyegbusi,
2014).
Bowlbys Attachment Theory (1969, 1982, 1973, 1980) theory, suggests that infants are
biologically predisposed to form selective bonds with special and proximate caring figures in
their environment. According to the theory, formative discrimination of attachment figures
begins in infancy, when proximity to significant others is of critical importance to the
maintenance and restoration of safety (Carr & Batlle, 2015). In other words, AT predicts that the
quality of early experiences provided by key caregivers help them to construct (or not) [their
perception of] security and help-seeking behaviors [which] function to protect them in
situations of distress and to facilitate their exploration of the social world in general (Duchesne
& Larose, 2007, p. 1502). (Carr & Batlle, 2015). On a much greater scale, studies conducted by
Carr and Batlle attempt to offer insight on the importance of AT. Results revealed them to
believe that frameworks such as AT (Bowlby, 1973, 1980) may hold particular significance
(Carr & Batlle, 2015). Further explaining how researchers (e.g., Bartholomew, 1990; Shaver,

Dependent Personality Disorder and Infant Attachments

Collins, & Clark, 1996) suggested that long-term effects of early attachment experiences are
predominantly a function of the persistence of internal working models into adulthood (Carr &
Batlle, 2015). The idea then posits that with the aid of investigation and the understanding of AT,
it is possible to gauge the causation and early predictions of DPD. As many of the earlier
mentioned studies conclude, research and information is at a limit for this particular topic and
urge for the importance of the AT concept to be acknowledged. As earlier mentioned, recent
studies by Carr and Battle that were conducted this year begin to highlight these urgencies. Thus
creating the notion that the same fundamental principle of AT in relation to DPD must continue
to be reiterated and investigated to promote the most efficient avenue in understanding,
diagnosing and predicting DPD.
All of this research not only leads to stability of this assumption but places highurgencies on the investigation of these psychological process. By examining early infant
attachments, through assessments of Attachment Theory, it is expected to be able to predict and
provide a strong correlation to displayed DPD behaviors, such as needy, passive, and clinging
behavior, and have a fear of separation (Disney, 2013). The theory behind this proposition can
easily be reinforced from the understanding of the previous collaboration of research. Crossapplying studies from Chantry, Craig and Echeburua, it then becomes evident that the effects of
this condition varies widely. Obligations then push for science to find the root of this disorder, in
the hopes for the promotion of the greatest good for the greatest number in the search for cures.
Cross-applying Carr and Batlle 2015, promising research illustrates the progress in the
understanding of AT and the confounding results in its relation to a variety of systematic
problems. This study proposes that the further examination of AT through assessments of
attachment patterns, perceptions of childhood relationships with parents and DPD, (which will

Dependent Personality Disorder and Infant Attachments

later be discussed in methods) will exhibit strong correlations, thus proposing the reliability of
predicting DPD through early infant attachments.
Method
Participants
A total number of 30 subjects participated in the present study. Fifteen patients having
been diagnosed with Borderline-personality disorder, including Dependent, as defined by DSMV-R, and 15 in which were non-clinical subjects. A special subject characteristic requires that
subjects must not have any previous attempts or yet to receive treatments. All participants were
recruited after completing consent form, which included goals, procedures, questionnaires being
assigned to intended sample, explanation of any dangers and information in which benefits can
be expected to be gained from present study. Clinical subjects were derived from a number of
Houston behavioral medical centers, in which were currently placed on waiting lists. Nonclinical population were recruited from a number of college students in community. Members of
both samples were closely matched to age, gender, and socioeconomic status.
Design
This will be a matched-pairs design, in which both clinical and non-clinical samples
included matched characteristics of sex, age, and social class status. The independent variable is
the prescreened, diagnosed personality (specifically of Dependent Personality Disorder) present
in individual. The control group will be observed along same procedures as treatment group. The
dependent variable to be observed is the fluctuations of attachment patterns, as defined by Adult
Attachment Interview-Questionnaire (George et al., 1985), displayed between the control group
and experimental group.
Materials
Materials necessary will include the use of the treatment facility in which clinical sample
were derived from (Houston, TX). Thirty experimental participants are required, in accordance to
testing procedures. A set of two trained therapists capable of assessing standardized diagnostic
questionnaires for The Structured Clinical Questionnaire for DSM-V-R Personality Disorders

Dependent Personality Disorder and Infant Attachments

(Spitzer, Williams, & Gibbon, 1987) for diagnosis of Cluster C personalities (Dependent,
Obsessive-Compulsive and Avoidant) and a set of two rated psychologists that have been
specifically trained in coding and decoding the three main attachments (Secure, Dismissing,
Insecure) from instruments required by Adult Attachment Interview-Questionnaire (George et al.,
1985). Scoring of assessments focused on written responses immerged from individual. The
clinical assessment is a structured, diagnostic questionnaire for assessing DSM-V-R, the three
personality disorders within regime of Cluster C. Instrument retains a set of 30 questions,
characterizing behavior from individual by overviewing usual behavior, relationships and the
capacity of self-reflection. Advantages of the self-reported diagnostic tool aids by shortening
length time of administration. The AAI-Q (George et al., 1985) is a semi-structured questionnaire
that aims to obtain information of current representations of an individuals childhood
representations. Protocol is designed to inquire about present/past relationships with perceived
attachment figures, reactions of separation/loss, understanding of the self, strategies of regulating
emotions and response to theme of attachment. Questionnaires possess rating scales of 1-9 and
set of 30 questions. Instruments include require familiarization of analyzing in-depth questions
and vast experience with criteria (Main & Goldwin, 1994). Both sets of conductors were used to
promote inter-rater reliability and required to be kept blind of diagnosis from both clinical and
non-clinical samples.
Procedure
Non-clinical sample will be selected from random, active participants of the community
through higher academic institutions, volunteers of such government facilities etc. Both samples
are intended to be matched with equal numbers relating to gender, range of age and to be within
parameter of same social class. Control of characteristics are to reveal, if any, fluctuations occur,
not including initial differences assessed by Adult Attachment Interview-Questionnaires. This

Dependent Personality Disorder and Infant Attachments

quasi-experimental variable is to aid in any confounding extrinsic causations that might be

present. After recruitment and completion of consent forms, participants included in clinical
sample are required to complete initial assessments for content-validity, such as The Structured
Clinical Questionnaire for DSM-III-R Personality Disorders (SCID-II) (Spitzer, Williams, &
Gibbon, 1987). While both samples, wait in seated area with snacks and drinks as incentives,
questionnaires were conducted by a set of two trained therapists, who were not involved in
treatments, diagnosis or experiment of patients. Both samples are to be escorted into two
different testing rooms, due to DPD assessment of treatment group. Both sample groups will
follow exact procedures, with the exception of control group being exempted from DPD
assessment. Samples will be escorted into testing room, where set amount of desk/chairs,
intended questionnaires and pencils will be displayed. Participants are instructed to take a seat of
preference, until further instructions. Participants are informed of the confidentiality of each
assessment is of priority, and that the two conductors in the room are to be at assistance if any
further questions are of concern. Upon completion of questionnaire(s), participants are to return
the assessment(s), and reassured of free refreshments and snacks upon exiting facility. Both
evaluations were organized to specifically diagnosis every intended indiviuals for the assurance
of present Dependent Personality Disorder, and suggested Attachment Pattern. Results of DPD
are to assess reliability of dependent variable, displaying correlational of personality to
attachment pattern. Completed questions will be compiled and then statistically examined,
thereby finishing the experiment phase of the study and beginning the assessment of the data.
Results
A statistical test will be used to evaluate associations between sub-groups gender,
presence of DPD and attachment patterns of insecurity. After comparing statistical findings
between both samples, it is expected that correlations between individuals within clinical sample

Dependent Personality Disorder and Infant Attachments

and patterns of insecurity/disorganization will be more likely to be exhibited rather than those of
the control group. Characteristics, such as gender, reveal to have no effect. By highlighting the
presence of the independent variable, DPD, it is expected that the dependent variable, attachment
patterns, will suggest a strong association in those of the clinical sample than those that were not.
Discussion
Current experiment fails to take into account other extraneous variables associated with
the development DPD, but increases internal validity by revealing data that suggests strong
preliminary causations. Limitations occur within sub-population in sample groups. Future
experiments ought to be based off this design but further progress should be in the interest of
increasing external validity, such as generality in sample groups. Experiment possibilities might
include observations in better representation of population. longitude studies or case studies. By
observing infants throughout course of lifespan, a greater understanding of unknown variables
can be of service. Increasing generalization of findings would establish a much more valid causal
relationship among variables. Although the present study is at a limit and does not strive towards
mentioned suggestions, findings does endeavor strong relationships between DPD and
Insecure/Disorganized attachments.
Expected results of the study will be that great distress in attachments during
adolescences will significantly impact the increase of DPD behaviors, such as needy, passive,
and clinging behavior, and have a fear of separation (Disney, 2013). These findings correlate
with other examinations by looking at DPD and patterns in attachments. By cross-applying
Livesley et al., 1990, it is even said that great modification of defining the features of DPD ought
to include investigation of insecure attachments. This study, as well as previously mentioned
studies, further provides implications of the proposed theory. Overall interpretations of results on
this topic can imply that the fluctuations in childhood can be a both a predictor and red flag for
the development of DPD associations.

Dependent Personality Disorder and Infant Attachments

10

By implicating findings, the use of psychological approaches could be devised for the
creation of more accurate therapeutic treatments. If the knowledge on Attachment Theory is
expanded upon, proposed number of suffers from DPD could be at a much more of an
understanding and possibly prevented. Findings could eventually lead to not only much more
efficient diagnosis and treatment, but, as cited by earlier examples, a possible decrease in
numbers seen in a variety of harmful acts worldwide.
References
Adshead, G., & Aiyegbusi, A. (2014). Four pillars of security: Attachment theory and practice in
forensic mental health care. In A. N. Danquah, K. Berry, A. N. Danquah, K. Berry (Eds.) ,
Attachment theory in adult mental health: A guide to clinical practice (pp. 199-212). New
York, NY, US: Routledge/Taylor & Francis Group.
Barone, L. (2003). Developmental protective and risk factors in borderline personality disorder:
A study using the Adult Attachment Interview. Attachment & Human Development, 5(1), 6477.
Barone, L., Fossati, A., & Guiducci, V. (2011). Attachment mental states and inferred pathways
of development in borderline personality disorder: A study using the Adult Attachment
Interview. Attachment & Human Development, 451-469.
Bartholomew, K. (1990). Avoidance of intimacy: An attachment perspective. Journal of Social
and Personal Relationships, 7, 147178. http://dx.doi.org/ 10.1177/0265407590072001
Bornstein, R. (2012). Illuminating a Neglected Clinical Issue: Societal Costs of Interpersonal
Dependency and Dependent Personality Disorder. Journal of Clinical Psychology J. Clin.
Psychol., 766-781.

Dependent Personality Disorder and Infant Attachments

11

Bowlby, J. (1969). Attachment and loss: Attachment (Vol. 1). New York, NY: Basic Books.
Bowlby, J. (1973). Attachment and loss: Separation: Anxiety and anger (Vol. 2). New York, NY:
Basic Books.
Bowlby, J. (1980). Attachment and loss: Loss: Sadness and depression (Vol. 3). New York, NY:
Basic Books.
Bowlby, J. (1982). Attachment and loss: Attachment (2nd ed., Vol. 1). New York, NY: Basic
Books.
Carr, S., & Batlle, I. C. (2015). Attachment theory, neoliberalism, and social conscience. Journal
Of Theoretical And Philosophical Psychology, 35(3), 160-176. doi:10.1037/a0038681
Chantry, K., & Craig, R. (1994). Mcmi typologies of criminal sexual offenders. Sexual Addiction
& Compulsivity, 215-226.
Chioqueta, A. P., & Stiles, T. C. (2004). Assessing Suicide Risk in Cluster C Personality
Disorders. Crisis: The Journal Of Crisis Intervention And Suicide Prevention, 25(3), 128133.
Disney, K. (2013). Dependent personality disorder: A critical review. Clinical Psychology
Review, 1184-1196.
Duchesne, S., & Larose, S. (2007). Adolescent parental attachment and academic motivation and
performance in early adolescence. Journal of Applied Social Psychology, 37, 15011521.
http://dx .doi.org/10.1111/j.1559-1816.2007.00224.x
Echeburua, E. (2005). Alcoholism And Personality Disorders: An Exploratory Study. Alcohol
and Alcoholism, 323-326.

Dependent Personality Disorder and Infant Attachments

12

George, C., Kaplan, N., & Main, M. (1985). Adult Attachment Interview Protocol (3rd edn.).
University of California at Berkeley: Unpublished manuscript.
Livesley, W., Schroeder, M., & Jackson, D. (1990). Dependent Personality Disorder and
Attachment Problems. Journal of Personality Disorders, 131-140
Loas, G., Baelde, O., & Verrier, A. (2014). Relationship between alexithymia and dependent
personality disorder: A dimensional analysis. Psychiatry Research, 484-488.
Main, M., & Goldwin, R. (1994). Adult Attachment Classification System. Version 6. University
of California, Berkeley: Unpublished manuscript
Patrick, M., Hobson, R. P., Castle, D., Howard, R., & Maughan, B. (1994). Personality disorder
and the mental representation of early social experience. Development and
Psychopathology, 4, 375388.
Shaver, P. R., Collins, N. L., & Clark, C. L. (1996). Attachment styles and internal working
models of self and relationship partners. In G. J. O. Fletcher & J. Fitness (Eds.), Knowledge
structures in close relationships: A social psychological approach (pp. 25 61).
Spitzer RL, Williams JBW, Gibbon, M. Structured Clinical Interview for DSM-V-R Personality
Disorders. New York: New York State Psychiatric Institute, Biometrics Research 1987.