APD stands for Asthenic Personality Disorder. A personality disorder is understood to be a psychiatric clinical picture in which the behavior of those affected deviates significantly from the norm and manifests itself in rigid, recurring behavioral patterns. One form of this psychiatric illness is asthenic personality disorder.
What is Asthenic Personality Disorder?
In the specialist literature, the terms dependent personality disorder are also used synonymously for asthenic personality disorder. According to DigoPaul, patients with this disorder rarely take responsibility for themselves and usually submit to others. Passive behavior and submissiveness towards fellow human beings can be observed.
People with this condition have little self-esteem and are happy to pass responsibility on to other people. This implies a low level of self-reflection and self-criticism, so that mistakes are not sought in one’s own behavior, but always in others. The basic mood of these people can be described as anxious-depressive, they suffer more from separation fears, feel helpless and destroyed when a relationship fails.
As with any psychiatric disease, it is assumed that asthenic personality disorder also arises from an interplay of several factors. Genetic, psychological and environmental factors play a role here. 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 home are more often affected by this disease. Parents have little confidence in their children, do little to detach the child from their 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 the behavior that is dependent on them and punish independent behaviors of their children. If the parents or one parent already behaves according to the same pattern, they pass this behavior on to their children by acting as a model. Children cannot develop confidence in themselves, experience themselves as ineffective and depend on the protection and support of other people.
Symptoms, ailments & signs
Those affected with an asthenic personality disorder can hardly express their own opinion towards other people. Without the advice and approval 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 being abandoned. Even unpleasant tasks are taken on just to please others. If there are separations within relationships, the sick feel helpless, inferior, internally empty and inadequate. They want to please others and for this reason put their own wishes and needs aside, would always subordinate themselves.
Diagnosis & course
As with any other psychiatric disorder, the diagnosis is made as part of a detailed anamnesis. For this purpose, the treating doctor will speak to the patient himself and ask him questions about his living conditions and personal biography. Relatives can also be interviewed in this context.
This is advantageous in that they experience patients in their everyday life and can provide information within the framework of the external anamnesis if the patient so wishes. In any case, special attention will be paid to the patient’s childhood and the prevailing dependency structures at that time. The course of the disease is positively influenced when those affected recognize it and seek psychiatric therapy.
People with asthenic personality disorder usually find it difficult to express their own needs. As a result, these needs often remain unfulfilled. Often this silence about one’s own wishes and interests is based on the fear of being rejected by others. In some cases, this can lead to an additional anxiety disorder, such as a social phobia with evaluation anxiety.
The tendency to reject responsibility can lead to social complications. Especially 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.
In a love relationship, in particular, there is a risk of inequality between the partners. Often the next of kin suffer indirectly from the affected person’s asthenic personality disorder. This also makes social conflicts likely.
Another complication that is common is depression. Depression often arises from failure to meet actual needs. Due to the lack of initiative, those affected often consider themselves unimportant and superfluous. Being dependent on another person can also lead to feelings of guilt, which also contribute to depression.
Asthenic personality disorder is also often associated with another personality disorder. Often it is the emotionally unstable personality disorder of the borderline type or the anxious-avoidant personality disorder.
When should you go to the doctor?
As soon as the dependency on other people reaches the level of a disorder, treatment makes sense. Early intervention can often reduce complications. The likelihood of successful treatment is also more favorable if the experience and behavior patterns have not yet become too firmly established.
Asthenic personalities often only seek professional help when relationship problems arise or the level of suffering is very high. If in doubt, a diagnostic interview with a psychiatrist or psychotherapist can clarify the situation.
If the dependency on the partner is problematic, but has not (yet) exceeded the threshold of an asthenic personality disorder, counseling can already have positive effects. Both individual and couple counseling can be considered in this case.
Asthenic personalities can turn to a psychotherapist to possibly get a place in therapy. Licensed psychotherapists are basically able to treat personality disorders. However, some therapists specialize in personality disorders or partnership issues and can also be contacted. Alternative forms of treatment are offered by alternative practitioners with limited approval (“alternative practitioners for psychotherapy”). However, the latter are not paid for by the statutory health insurance companies.
In addition to psychotherapeutic treatment, medical treatment methods can also be considered. Psychiatric treatment, for example through the use of antidepressants or anxiety-relieving psychotropic drugs, can reduce other symptoms that typically also occur in asthenic personality disorder.
Treatment & Therapy
Psychotherapy comes first in the treatment of asthenic personality disorder. Sufferers often seek out a therapist when they feel helpless and exhausted, often after the loss of a loved one or after a breakup. The primary goal of the practitioner is then to strengthen the patient’s self-confidence and enable him to develop a positive self-concept.
The personal responsibility and various everyday skills of the patient are strengthened in such a therapy, so that the person concerned can gain confidence in himself and gain his own social skills. In the field of psychoanalysis, the patient is made gradually aware of the unconscious inner conflicts of childhood with the aim of resolving them.
The patient learns to perceive his own wishes, interests and needs and to represent them. Group therapy can also achieve lasting results for people with asthenic disorders. 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, the patients learn to communicate their position and feelings to the other. You will learn how others deal with their problems and can thus appear more self-confident. The doctor may also prescribe psychotropic drugs for this type of personality disorder. This is the case when the asthenic personality disorder is accompanied by depression. Neuroleptics are used when the disease is associated with an anxiety disorder.
Outlook & forecast
Asthenic personality disorder usually lasts for many years. Professionals don’t make the diagnosis until symptoms have been on for at least two years. People with asthenic personality disorder often do not seek out a doctor or therapist on their own initiative. This can significantly delay the start of treatment. As part of psychotherapy, those affected can learn to deal better with their fear of loss and their submissive behavior.
Nevertheless, the general prognosis is based on an average reduction in symptoms. Most of those affected suffer severely from their personality disorder, especially in young adulthood. In many cases, however, the influence of mental illness diminishes in middle and older age.
Under unfavorable conditions, for example in a very unstable environment and high stress, the asthenic personality disorder can remain the same despite increasing age. Overall, the likelihood of suffering from another mental illness in addition to a personality disorder is very high. The individual prognosis can always deviate from the general expectations and tendencies in individual cases.
However, positive trends are also possible. For a long time, personality disorders were considered untreatable: therapy focused on treating symptoms, social skills and general stabilization of the patient. However, recent studies indicate that psychotherapy can also lead to extensive success.
Since the cause of this personality disorder usually lies in childhood, preventive measures are difficult to take. Discussing unusual behavior with people you trust in good time can prevent serious problems later on. It is important to enable those at risk to build a positive and stable sense of self-worth.
The asthenic personality disorder often does not go away completely, even with psychotherapy, but therapy can help to improve the symptoms significantly. The transition between an asthenic (dependent) personality disorder and an attached personality style is fluid.
For follow-up care, it is therefore important that patients repeatedly question their own behavior in a self-critical manner in order not to cross the line into a personality disorder. It can be useful to include the feedback from the partner or other caregivers in order to realistically assess the situation.
After psychotherapy has been completed, asthenic personalities should continue to put what they have learned into practice. Relationship crises, in particular, are often a challenge for those affected. Asthenic personalities can also endeavor to continue improving their social skills and become more self-confident overall during follow-up care.
Other mental illnesses often coexist with asthenic personality disorder and need to be considered in follow-up care. A relapse into depression or anxiety disorder, in particular, can increase the risk of the asthenic personality disorder worsening.
If an asthenic personality takes medication, they should not stop taking them on their own after the end of therapy. Instead, she should discuss this step with the treating doctor. In some cases, drugs are used as part of relapse prevention for comorbidities such as depression and anxiety disorders.
You can do that yourself
The profound pattern on which the asthenic personality disorder is based is mainly worked through psychotherapeutically. As a support, those affected can do behavioral exercises at home. Reflecting on conscious thinking and behavior in therapy helps to recognize old patterns, to overcome them and to learn new ones.
Sufferers should focus their attention on their needs and practice expressing their opinions to others, rather than adjusting excessively due to insecurity. The conscious drawing of boundaries strengthens self-confidence and prevents you from becoming dependent again.
In order to overcome fears that can be associated with the asthenic personality disorder, exposure exercises should also be carried out repeatedly outside of the therapeutic setting. This also applies to typical avoidance behavior, such as avoiding conflicts.
It is also advisable to talk to 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 stamina, because the risk of falling back into old patterns is great, especially after setbacks. In the group, asthenic personalities are caught and strengthened to continue on their way undeterred.