Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Dependent Personality Disorder


Related Terms

  • Inadequate Personality Disorder

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

  • Alcohol or substance abuse disorders
  • Anxiety
  • Other psychiatric disorders

Factors Influencing Duration

The extent of the condition, individual response to treatment, existence of other conditions, and relevant recent circumstances occurring within the individual's life all can influence length of disability.

Medical Codes

ICD-9-CM:
301.6 - Dependent Personality Disorder; Asthenic Personality; Inadequate Personality; Passive Personality

Overview

This disorder is characterized by a pervasive pattern of dependent, clinging, and submissive behavior. Individuals with dependent personality disorder demonstrate fears of separation, helplessness, docility, and search for support and reassurance. They appear to subordinate their own needs to those of others, and in a submissive way get others to assume responsibility for major areas of their lives. They are usually quite needy for attention, social contact, and encouragement from others. They appear self-deprecating, as they feel inferior and are willing to abdicate responsibility and self-control to others. They often tolerate intimidation and abuse in hopes of avoiding loneliness and abandonment. They may experience intense discomfort when left alone even for brief periods of time.

Individuals with this disorder tend to avoid positions of responsibility and have difficulty making decisions without an excessive amount of advice and reassurance from others. They become anxious if asked to assume leadership roles, as they prefer the submissive role.

Incidence and Prevalence: Outpatient mental health clinics report that dependent personality disorder is one of the most frequently reported personality disorders (DSM-IV-TR). The estimated prevalence of dependent personality is 0.6% (DSM-5).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Studies describe similar prevalence rates for males and females (DSM-IV-TR, DSM-5). Individuals with chronic physical illness in childhood may be prone to this disorder.

Source: Medical Disability Advisor



Diagnosis

History: The psychiatric interview and mental status exam are the primary methods utilized by the practitioner. The physician looks for symptoms of a pervasive and excessive need to be taken care of that lead to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts.

According to the Diagnostic and Statistical Manual of Mental Disorders, both 4th Edition, Text Revision (DSM-IV-TR) and 5th Edition (DSM-5), 5 or more of the following 8 personality traits must be present to justify the diagnosis: difficulty making everyday decisions without an excessive amount of advice and reassurance from others; need for others to assume responsibility in most major areas of his or her life; difficulty expressing disagreement with others because of fear of loss of support or approval (this does not include realistic fears of retribution); difficulty initiating projects or doing things independently because of lack of self-confidence in judgment or abilities rather than not enough motivation or energy; excessive measures to obtain nurturance and support from others, even volunteering to do things that are unpleasant; discomfort or helplessness when alone because of exaggerated fears of inability to provide self-care; urgency in seeking another relationship as a source of care and support when a close relationship ends; or an unrealistic preoccupation with fears of being left alone to care for himself or herself (DSM-IV-TR, DSM-5).

Physical exam: The physical exam is not helpful in diagnosing this disorder. Observation of the individual's orientation, dress, mannerisms, behavior, and content of speech provide essential signs to help diagnose the illness.

Tests: When used in combination with the history, standardized psychological assessment strategies such as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Structured Clinical Interview for Axis II Disorders (SCID-II) can be helpful in diagnosing personality disorders.

Note: It must be kept in mind that just because a physical diagnosis cannot be established as the cause of the presenting symptomatology, it does not necessarily mean that the cause is a mental one. That is to say that the presence of medically unexplained symptomatology does not necessarily establish the presence of a psychiatric condition. The first step in identifying the presence of a mental disorder is excluding the presence of malingering and/or of factitious disorder. Although factitious disorder is conscious and purposeful, it is classified as a psychiatric disorder. The strong need for this step is especially true whenever there is a medicolegal context associated with the presenting problem(s). Additionally, using DSM-5 and/or ICD-9-CM or ICD-10-CM, the clinician will find that many presentations fail to fit completely within the boundaries of a single mental disorder. There are systematic ways to go about making psychiatric diagnoses, however.

Source: Medical Disability Advisor



Treatment

Effective psychotherapy for this disorder focuses on developing coping strategies and self-reliant behavior. The therapist should reassure the individual about being available and accessible, within realistic limits. Insight-oriented, cognitive-behavioral, assertiveness training, family, and group therapy have all been used, with successful outcomes in many cases. Long-term psychotherapy is contraindicated because it may lead to increased dependency. Termination of therapy is often difficult, as the individual often becomes dependent on the therapist. If at the end of the therapy the individual cannot move on to become more self-reliant, the reason may be that he or she was seeking solution-focused therapy rather than life-changing therapy, and this should not always be regarded as a therapeutic failure.

Pharmacotherapy has been used to deal with depression and anxiety that commonly accompany dependent personality disorder. Anti-anxiety agents and antidepressants have been useful in treating high levels of anxiety and panic attacks associated with this disorder. However, drugs should be avoided when possible in these individuals, as they are at a high risk of drug dependence and abuse. Hospitalization is rarely needed, except in situations of severe loss or emotional crisis.

Source: Medical Disability Advisor



Prognosis

Dependent personality disorder is generally not as disabling as the other personality disorders. Treatment with one or more of the psychotherapies often leads to successful outcome. The most common problem areas involve work and relationships.

Source: Medical Disability Advisor



Complications

Individuals with dependent personalities require a relationship to feel validated. Complications will most likely occur when difficulty arises in relating to other people at work or at home. Loss of the person upon whom they depend can lead to an episode of major depression, generalized anxiety, phobias, or panic. Individuals with dependent personality disorder are also at risk of being abused.

At work, particular problems might arise if individuals with dependent personalities are assigned to work independently or without close supervision.

A coexisting psychiatric disorder (major depression, panic attacks, and general anxiety) may intensify their already dysfunctional behavior, as can the use of illegal substances. These individuals are at higher risk of dependence on or abuse of prescribed medications.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work accommodations may include use of a job coach to establish consistent, predictable work behaviors; development of a structured, consistent set of work activities; communication of clear expectations for work performance; and close supervision.

Risk: Individuals with dependent personality disorder may need to avoid leadership roles and positions of responsibility, including job tasks that might require the affected individual to alert coworkers about safety issues. Individuals with this disorder risk being abused by management and coworkers who may take advantage of their dependency.

Capacity: Capacity is typically unaffected by this disorder. Once the individual is successfully engaged in his or her familiar role at work, no impairment of productivity is anticipated.

Tolerance: Tolerance is usually not a concern with this diagnosis.

Source: Medical Disability Advisor



Maximum Medical Improvement

MMI is expected at 12 months of treatment or less.

Note: MMI is estimated under the assumption that the vagaries involved in psychiatric diagnoses have been taken into consideration.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual display a submissive, clinging behavior with fear of separation? Does individual's behavior fit the criteria for dependent personality disorder?
  • Did a comprehensive physical exam rule out any underlying physical conditions?
  • Were other psychiatric disorders, such as histrionic and borderline personality disorders, ruled out?
  • Was diagnosis confirmed?

Regarding treatment:

  • Is individual currently involved in the type of psychotherapy that focuses on solutions to specific life problems that individual is currently experiencing?
  • Does individual also have a coexisting psychiatric condition? Is this condition being adequately addressed? Does the psychiatric condition interfere with treatment for the dependent personality disorder?
  • What medications are being taken and for what purpose?
  • What has individual been told about the medication he or she is taking? Is the medication's purpose clear and valid?
  • Does individual also take medication prescribed by any other health care provider?
  • Has the primary physician/therapist reviewed all medication currently being taken to ensure that individual is not abusing it?
  • Is individual involved in group therapy? Could individual be using the group to supplement existing or develop new dependent relationships? Is this the only therapy individual is involved in at this time?
  • What can be added to balance the treatment plan?

Regarding prognosis:

  • As the end of therapy approaches, is individual re-experiencing feelings of insecurity, lack of self-confidence, increased anxiety, and perhaps even depression?
  • Has therapist adequately prepared individual for therapy termination?
  • Does individual appear to be realistically facing termination of therapy?
  • Was individual seeking a solution to current conflicts rather than life-changing therapy?
  • Was individual encouraged to explore newfound self-reliance?
  • Does individual appear ready and able to move on with his or her life?

Source: Medical Disability Advisor



References

Cited

Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. American Psychiatric Association, 2013.

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.

Source: Medical Disability Advisor






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