From dysfunction to adaptation: an interactionist model of dependency.

Contrary to clinical lore, a dependent personality style is associated with active as well as passive behavior and may be adaptive in certain contexts (e.g., in fostering compliance with medical and psychotherapeutic treatment regimens). The cognitive/interactionist model conceptualizes dependency-related responding in terms of four components: (a) motivational (a marked need for guidance, support, and approval from others); (b) cognitive (a perception of oneself as powerless and ineffectual); (c) affective (a tendency to become anxious when required to function autonomously); and (d) behavioral (use of diverse self-presentation strategies to strengthen ties to potential caregivers). Clinicians' understanding of the etiology and dynamics of dependency has improved substantially in recent years; current challenges include delineating useful subtypes of dependency, developing valid symptom criteria for Dependent Personality Disorder in DSM-5 and beyond, and working effectively with dependent patients in the age of managed care.