User:Lshay/sandbox

Article Selection
The article that I selected was "Dependent Personality Disorder", in which there was a lack of information about the disorder. It was listed as start-class quality and rated as mid-importance. I want to add context to the history, symptoms, and causes of the personality disorder. As well as adding more information to the differential diagnosis and epidemiology section and making minor edits.

Dependent Personality Disorder
Dependent personality disorder is a Cluster C personality disorder, characterized by excessive fear and anxiety. It begins by early adulthood, and it is present in a variety of contexts and is associated with inadequate functioning. [4]

Psychoanalytic Theory
The conceptualization of dependency, within classical psychoanalytic theory, is directly related to Freud's oral psychosexual stage of development. Frustration or over-gratification was said to result in an oral fixation and in an oral type of character, characterized by feeling dependent on others for nurturance and by behaviours representative of the oral stage. Later psychoanalytic theories, shifted the focus from a drive-based approach of dependency to the recognition of the importance of early relationships and establishing separation from these early caregivers, in which the exchanges between the caregiver and the child become internalized, and the nature of these interactions becomes part of the concepts of the self and of others.

Causes
Dependent traits in children tended to increase with parenting behaviours and attitudes characterized by overprotectiveness and authoritarianism. Thus the likelihood of developing dependent personality disorder increased, since these parenting traits can limit them them from developing a sense of autonomy, rather teaching them that others are powerful and competent.

Traumatic or adverse experiences early in an individual's life, such as neglect and abuse or serious illness, can increase the likelihood of developing personality disorders, including dependent personality disorder, later on in life. This is especially prevalent for those individuals who also experience high interpersonal stress and poor social support.

There is a higher frequency of the disorder seen in women than men, and thus it is theorized that expectations relating to gender role may contribute to a better understanding of why this is.

Diagnosis
Clinicians and clinical researchers conceptualize dependent personality disorder in terms of four related components:
 * Cognitive. A perception of oneself as powerless and ineffectual, coupled with the belief that other people are comparatively powerful and potent.
 * Motivational. A desire to obtain and maintain relationships with protectors and caregivers.
 * Behavioural. A pattern of relationship-facilitating behaviour designed to strengthen interpersonal ties and minimize the possibility of abandonment and rejection.
 * Emotional. Fear of abandonment, fear of rejection, and anxiety regarding evaluation by figures of authority.

DSM
The diagnosis of personality disorders in the fourth edition Diagnostic and Statistical Manual of Mental Disorders, including dependent personality disorder, has been found to be problematic due to reasons such as excessive diagnostic comorbidity, inadequate coverage, arbitrary boundaries with normal psychological functioning, and heterogeneity among individuals within the same categorial diagnosis.

In the DSM-5, there is one criterion by which there are eight features of dependent personality disorder. The disorder is indicated by at least five of the following factors :
 * 1) Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
 * 2) Needs others to assume responsibility for most major areas of their life.


 * 1) Has difficulty expressing disagreement with others because of fear of loss of support or approval.
 * 2) Has difficulty initiating projects or doing things on their own (because of a lack of self confidence in judgment or abilities rather than a lack of motivation or energy).
 * 3) Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
 * 4) Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves.
 * 5) Urgently seeks another relationship as a source of care and support when a close relationship ends.
 * 6) Is unrealistically preoccupied with fears of being left to take care of themselves.

SWAP-200
The SWAP-200 is a diagnostic tool that was proposed with the goal of overcoming limitations, such as limited external validity for the diagnostic criteria for dependent personality disorder, to the DSM. It serves as a possible alternative nosological system that emerged from the efforts to create an empirically based approach to personality disorders - while also preserving the complexity of clinical reality. Dependent personality disorder is considered a clinical prototype in the context of the SWAP-200. Rather than discrete symptoms, it provides composite description characteristic criteria - such as personality tendencies.

Based on the Q-Sort method and prototype matching, the SWAP-200 is a personality assessment procedure relying on an external observer’s judgment. It provides: The traits that define dependent personality disorder according to SWAP-200 are:
 * a personality diagnosis expressed as the matching with ten prototypical descriptions of DSM-IV personality disorders.
 * a personality diagnosis based on the matching of the patient with 11 Q-factors of personality derived empirically.
 * a dimensional profile of healthy and adaptive functioning.
 * 1) They tend to become attached quickly and/or intensely, developing feelings and expectations that are not warranted by the history or context of the relationship.
 * 2) Since they tend to be ingratiating and submissive, people with DPD tend to be in relationships in which they are emotionally or physically abused.
 * 3) They tend to feel ashamed, inadequate, and depressed.
 * 4) They also feel powerless and tend to be suggestible.
 * 5) They are often anxious and tend to feel guilty.
 * 6) These people have difficulty acknowledging and expressing anger and struggle to get their own needs and goals met.
 * 7) Unable to soothe or comfort themselves when distressed, they require involvement of another person to help regulate their emotions.

Psychodynamic Diagnostic Manual
The Psychodynamic Diagnostic Manual (PDM) approaches dependent personality disorder in a descriptive, rather than prescriptive sense and has received empirical support. The Psychodynamic Diagnostic Manual includes two different types of dependent personality disorder: The PDM-2 adopts and applies a prototypic approach, using empirical measures like the SWAP-200. It was influenced by a developmental and empirically grounded perspective, as proposed by Sidney Blatt. This model is of particular interest when focusing on dependent personality disorder, claiming that psychopathology comes from from distortions of two main coordinates of psychological development: The anaclitic personality organization in individuals exhibits difficulties in interpersonal relatedness, exhibiting the following behaviours: Introjective personality style is associated with problems in self-definition.
 * 1) Passive-aggressive
 * 2) Counter-dependent
 * 1) The anaclitic/introjective dimension.
 * 2) The relatedness/self-definition dimension.
 * Preoccupation on relationships, show
 * Fear of abandonment and of rejection,
 * Seeking closeness and intimacy,
 * Have difficulty managing interpersonal boundaries.
 * Tend to have anxious-preoccupied attachment style.

Borderline Personality Disorder
There are similarities between individuals with dependent personality disorder and individuals with borderline personality disorder, in that they both have a fear of abandonment. Those with dependent personality disorder do not exhibit impulsive behaviour, unstable affect, and poor self-image experienced by those with borderline personality disorder, differentiating the two disorders.

Epidemiology
The prevalence of Dependent Personality Disorder in the general adult population is 0.49% according to the DSM-5. Women are found to be 40% more likely to be diagnosed with dependent personality disorder than men, in both questionnaire and interview based studies.