Dependent personality disorder — structured clinical viva

This is a longitudinal pattern consistent with dependent personality disorder, not a moral failure or simple clinginess. Confirm general PD criteria and ≥5 of 8 DSM features (decision-making dependence, needing others for major responsibilities, difficulty disagreeing, difficulty initiating, excessive lengths for nurturance, helpless when alone, urgent re-partnering, preoccupation with being left to care for self). Assess concurrent major depression and acute suicide risk after threatened abandonment — dual diagnosis is often correct rather than forced either/or.[1]

Differentials. Borderline PD (affective instability, identity disturbance, broader impulsivity — can co-occur; do not auto-default every abandonment crisis to BPD). Avoidant PD (evaluation fear vs caretaking need). Separation anxiety disorder. Cultural interdependence without impairment. Late-onset organic change unlikely if lifelong.[1][5]

Treatment. First-line is structured psychotherapy building graded autonomy, assertiveness, and tolerance of aloneness without abandoning the patient. Schema therapy is a named option when global modes dominate — Bamelis multicentre RCT supports schema therapy for personality disorders including Cluster C-relevant samples. Do not take over finances permanently; that rehearses the disorder. Medication does not cure personality; SSRIs treat comorbid depression — e.g. sertraline 50 mg orally daily with titration, early activation review, limited supply post-overdose. Network meta-analysis supports antidepressant options in adult MDD.[2][3][5]

Risk and safeguarding. Full risk assessment after overdose; medical clearance; means restriction; safety plan. Screen IPV/exploitation when dependency and control dynamics are present. Least-restrictive disposition matching risk; jurisdiction-specific legal frameworks without inventing section numbers.[1][4]