Dependent Personality Disorder Biological Therapies

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Four studies have explored the use of medications in the treatment of dependent personality disorder, and two studies have investigated their use in the treatment of dependent traits. Diagnostic and other limitations of the studies prevent firm conclusions about the efficacy of medications.

Klein and colleagues compared placebo with either imipramine or chlorpromazine in hospitalized patients with passive-aggressive and passive-dependent personality disorders that had been diagnosed according to DSM criteria. None of the patients showed a positive drug response.

Lauer (1976) gave tricyclic antidepressants to patients who had passive-dependent traits in addition to their primary diagnoses. On follow-up questionnaires, patients who had received active drugs reported less anxiety, along with increases in available energy, assertiveness, and outgoing behavior in day-to-day life. The results suggested that some patients with dependent personality disorder respond to antidepressants in the presence of an Axis I disorder, but, in any event, the benefits were not very striking.

As reported earlier in this chapter, patients with major depressive disorder and an anxious-cluster personality disorder, many with dependent personality disorder, showed significant improvement in depression with imipramine or psychotherapeutic treatment. Fewer patients with Cluster C disorders fully recovered, however, and social adjustment problems remained.

Tyrer et al. drew a similar conclusion after studying patients with “general neurotic syndrome,” which includes mixed anxiety-depression and dependent or obsessive personality. Although such patients initially appeared to be as responsive as others to 10-week treatments, including dothiepin (an antidepressant), diazepam, placebo, cognitive-behavioral therapy, or self-help, at 2-year follow-up, they had greater symptom levels and did significantly worse than other outpatients.

Ekselius and von Knorring studied 145 depressed patients, 61% of whom scored in the personality disorder range by self-report questionnaire, who received sertraline or citalopram for 24 weeks. From baseline to termination, the percentage above the cutoff score for dependent personality disorder improved significantly (21% versus 8%) as did the mean number of dependent personality disorder criteria met by the whole sample (3.3 versus 2.3). The self-reported change in dependent personality disorder criteria was significant, even after controlling for change in observer-rated depressive symptoms. Although the comparison across two different measurement perspectives complicates these findings, self-reported dependent symptoms seem to improve with 24 weeks of selective serotonin reuptake inhibitor treatment. Whether this generalizes to observer-rated improvement in life functioning is unknown.

Fahlen examined changes in dependent traits among individuals with social phobia recruited for a 12-week randomized controlled trial of brofaromine, a monoamine oxidase-A inhibitor with serotonin-inhibiting properties. Compared with placebo, the drug yielded a significant decrease in the number of avoidant and dependent criteria present as scored by the clinician. On self-report, drug treatment was associated with a decrease in indecisiveness-risk avoidance. Anecdotally, the author reported a rise in self-esteem among drug responders.

Drug treatments of dependent personality disorder may effect some improvement in symptoms of concurrent Axis I disorders (e.g., depression), but full recovery in these patients is less likely than in those without personality disorder. Although the idea is popular, and the studies of Ekselius and von Knorring and Fahlen are suggestive, little evidence suggests long-term benefits in personality functioning from pharmacotherapy.

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