A personality disorder is a psychiatric condition in which the behavior of affected individuals deviates markedly from the norm and is expressed in rigid, recurring patterns of behavior. One form of this psychiatric disorder is asthenic personality disorder.
What is asthenic personality disorder?
In the literature, the terms dependent personality disorder are also used synonymously for asthenic personality disorder. Patients with this disorder rarely take personal responsibility and mostly subordinate themselves to others. A passive behavior and submissiveness towards fellow human beings can be observed. People with this disorder have little self-esteem and like to pass responsibility to other people. This implies a low degree of self-reflection and self-criticism, so that faults are not sought in one’s own behavior, but always in others. The basic mood of these people can be described as anxious-depressed, they suffer more from separation anxiety, feel helpless and destroyed if a relationship fails.
Causes
As with any psychiatric condition, asthenic personality disorder is thought to arise from an interaction of several factors. Genetic, psychological, and environmental factors all play a role. In psychoanalysis, research assumes that the cause of this disorder manifests itself in early childhood. Children who grow up in a particularly sheltered and at the same time authoritarian parental home are more frequently affected by this disorder. The parents have little confidence in their children, contribute little to the child’s detachment from the parents and bind their children to themselves through strict rules and authoritarian guidelines. As a result, the children cannot develop their own self-concept and feel dependent on their parents. This is maximized when parents positively reinforce what they consider to be dependent behaviors and punish children’s independent behaviors. If parents or one parent already behave in the same way, they pass these behaviors on to their children by acting as a model. Children are thus unable to develop confidence in themselves and experience themselves as ineffective and dependent on the protection and support of others.
Symptoms, complaints, and signs
Affected individuals with asthenic personality disorder have difficulty expressing their own opinions to others. Without the advice and reassurance of those around them, they find it difficult to make their own decisions. People with this clinical picture have no confidence in themselves, so that decisions cannot be made on their own initiative. Another characteristic is the fear of being alone or of being abandoned. Even unpleasant tasks are taken on just to please others. If it then comes to separations within relationship structures, sufferers feel helpless, inferior, inwardly empty and inadequate. They want to please others and for this reason put their own desires and needs aside, would subordinate themselves again and again.
Diagnosis and course
As with any other psychiatric disorder, the diagnosis is made in the context of a detailed medical history. For this purpose, the attending physician himself will talk to the patient and ask him questions regarding his life circumstances and personal biography. In this context, relatives can also be questioned. This is advantageous in that they experience the patient in his everyday life and can provide information in the context of the external anamnesis if the patient so wishes. In any case, special attention will be paid to the patient’s childhood and the dependency structures that prevailed at that time. The course of the disease will be positively influenced if the affected person recognizes these and enters psychiatric therapy.
Complications
People with asthenic personality disorder usually find it difficult to express their own needs. As a result, these needs often go unmet. Often underlying this silence about one’s own desires and interests is the fear of being rejected by others. In some cases, an additional anxiety disorder may develop as a result, for example, a social phobia with evaluation anxiety. The tendency to reject responsibility can lead to social complications.Particularly at work and in a partnership, this attitude is sometimes misunderstood as listlessness or disinterest. Partners and colleagues may also get the impression that the person concerned wants to avoid tasks. Particularly in a romantic relationship, there is a danger that an inequality between the partners will develop. Often the next of kin suffer indirectly from the asthenic personality disorder of the affected person. Social conflicts are also likely as a result. Another complication that often occurs is depression. Depression often results from the failure to meet actual needs. Due to the lack of initiative, sufferers often consider themselves unimportant and superfluous. In addition, feelings of guilt can arise from the relationship of dependency with another person, which also contributes to depression. Asthenic personality disorder is also often accompanied by another personality disorder. This is often borderline-type emotionally unstable personality disorder or anxious-avoidant personality disorder.
When should you see a doctor?
Once dependence on others reaches the level of a disorder, treatment is appropriate. Early intervention often reduces complications. The likelihood of successful treatment is also more favorable if patterns of experience and behavior have not yet become too entrenched. Often, asthenic personalities do not seek professional help until relationship problems arise or the pressure of suffering is very great. In case of doubt, a diagnostic discussion with a psychiatrist or psychotherapist can bring clarification. If the dependence on the partner is problematic, but has not (yet) crossed the threshold to asthenic personality disorder, counseling can already have positive effects. Both individual and couples counseling can be considered in this case. Asthenic personalities can turn to a psychotherapist to possibly obtain a therapy place. Licensed psychotherapists are generally able to treat personality disorders. However, some therapists specialize in personality disorders or partnership problems and may also be contacted. Alternative forms of treatment are offered by alternative practitioners with limited licenses (“Heilpraktiker für Psychotherapie”). However, the latter are not paid for by the statutory health insurance funds. In addition to psychotherapeutic treatment, medical treatment methods can also be considered. Psychiatric treatment can, for example, reduce further symptoms that typically also occur in asthenic personality disorder through the use of antidepressants or anxiety-relieving psychotropic drugs.
Treatment and therapy
First and foremost in the treatment of asthenic personality disorder is psychotherapy. Affected individuals often seek out a therapist when they feel helpless and devastated, often after the loss of someone close or after a breakup. The primary goal of the therapist is then to strengthen the self-confidence of the sufferer and to enable him or her to build up a positive self-concept. The patient’s personal responsibility and various everyday skills are strengthened in such therapy, so that the person concerned gains confidence in himself and acquires his own social competence to act. In the field of psychoanalysis, the patient is made aware, piece by piece, of the unconscious inner conflicts of childhood with the aim of resolving them. In this way, the patient learns to perceive his own wishes, interests and needs and to represent them. Group therapy can also achieve lasting success with asthenically disturbed personalities. The affected person realizes that he is not alone with his problems and that other people also have to struggle with the same problems. In the group, patients learn to communicate their position and state of mind to others. They learn how others deal with their problems and can thus appear more self-confident. In some circumstances, the doctor may also prescribe psychotropic drugs for this type of personality disorder. This is the case when depression accompanies asthenic personality disorder. Neuroleptics are used when an anxiety disorder is associated with the disorder.
Outlook and prognosis
Asthenic personality disorder usually lasts for many years.Specialists only make the diagnosis when the symptoms have been present for at least two years. People suffering from asthenic personality disorder often do not seek out a doctor or therapist on their own. This can significantly delay the start of treatment. In the course of psychotherapy, affected individuals can learn to better deal with their fears of loss and their submissive behavior. Nevertheless, the general prognosis assumes an average reduction in symptoms. Most affected individuals suffer greatly from their personality disorder, especially in young adulthood. In middle and older age, however, the influence of the mental illness diminishes in many cases. Under unfavorable conditions, for example a very unstable environment and high stress, asthenic personality disorder can remain the same despite increasing age. Overall, the probability of suffering from another mental illness in addition to a personality disorder is very high. The individual prognosis can always differ from the general expectations and tendencies in individual cases. However, positive courses are also possible. For a long time, personality disorders were not considered treatable: therapy focused on symptom management, social skills, and general stabilization of the patient. However, recent studies indicate that psychotherapy can also lead to comprehensive success.
Prevention
Because the cause of this personality disorder is usually rooted in childhood, preventive measures are difficult to take. Timely discussions with trusted persons in the event of conspicuous behavior can prevent later serious problems. It is important to enable the person at risk to build a positive and stable self-esteem.
Aftercare
Asthenic personality disorder often does not disappear completely even with psychotherapy, but therapy can help improve symptoms significantly. The transition between asthenic (dependent) personality disorder and clingy personality style is fluid. For follow-up care, it is therefore important that patients repeatedly question their own behavior self-critically so as not to cross the line into personality disorder. It can be useful to include feedback from the partner or other caregivers in order to assess the situation realistically. After completing psychotherapy, asthenic personalities should continue to put what they have learned into practice. Relationship crises in particular often pose a challenge for those affected. Asthenic personalities can also strive to continue to improve their social skills and become more confident overall during aftercare. Other mental illnesses often co-occur with asthenic personality disorder and must be considered during aftercare. In particular, a relapse into depression or anxiety disorder can increase the risk of asthenic personality disorder becoming more severe. If an asthenic personality is taking medication, she should not discontinue it on her own after therapy ends. Instead, she should discuss this step with her treating physician. In some cases, medications are used as part of relapse prevention for concomitant disorders such as depression and anxiety disorders.
Here’s what you can do yourself
The profound pattern underlying asthenic personality disorder is addressed primarily through psychotherapy. Supportively, affected individuals can perform behavioral therapy exercises at home. Reflecting on thought and behavior patterns made conscious in therapy helps to recognize and overcome old patterns as well as to learn new ones. Affected individuals should focus their attention on their needs and practice expressing their opinions to others instead of over-adapting due to insecurity. Consciously drawing boundaries strengthens self-confidence and prevents falling into renewed dependency. To overcome anxiety that can accompany asthenic personality disorder, exposure exercises should be done repeatedly outside of the therapeutic setting. This also applies to typical avoidance behaviors, such as avoiding conflicts. It is also advisable to exchange ideas with other people affected.In Internet forums or self-help groups, asthenic personalities find support and motivation to work on their problems. It is important to strengthen perseverance, because the danger of falling back into old patterns is great, especially after setbacks. In the group, asthenic personalities are caught and strengthened to continue their path unwaveringly.
