A Psychological Aspect of Susan Smith:
Dependent Personality Disorder
On October 25, 1994, Susan Smith drowned her two sons, Michael and Alex, in the
John D. Long Lake in Union County, South Carolina. For nine days she lied about
knowing where the boys were. On November 3, she confessed to the killings and
would soon go to trial.
Susan’s defense team hired a psychiatrist to conduct a psychiatric evaluation
of her. She was diagnosed as having dependent personality disorder. He
described her as a person who “feels she can’t do anything on her own”. “She
constantly needs affection and becomes terrified that she’ll be left alone” She
was only depressed when she was alone. The psychiatrist studied her family
history and concluded that based on her family history and his interviews with
her, Susan had a tendency toward depression that began in her childhood.
Susan’s attorney argued that his client was psychologically destabilized by a
lifetime of betrayal. A father who killed himself when she was just six, a stepfather
who sexually molested her as a child, a husband who cheated on her and a
boyfriend who toyed with her affections (Pergament).
Her boyfriend testified that “the pleasure she got from sex was not physical
pleasure, it was just in being close and being loved”. The psychiatrist
testified that Susan had sex with four different men during the six-week period
leading up to the murders and she had begun to drink heavily during this time
(Pergament). Alcoholism is a component of dependent personality disorder.
After only four days of testimony, the defense rested its case. Susan was
charged with two counts of murder and sentenced to life in prison with the
chance of parole in 30 years, the year 2025.
Dependent personality disorder is an inability to function without significant
reliance on a forceful or dominant person providing direction. Individuals
diagnosed with dependent personality disorder are usually quiet, and needy for
attention, valuation, and social contact. Lack of self-confidence and relying
on others are typical. Threatened with solitude or separation, a dependent
disorder person may panic with feelings of profound helplessness (Gillihan).
The person may be convinced that he/she is incapable of functioning on his/her
own. A dependent person seeks direction from others, even on insignificant
issues. The relationships of individuals with dependent disorder are usually
unbalanced. They tend to seek all-powerful helpers, or people they believe can
protect them from feelings of loneliness. They may jump from relationship to
relationship to avoid being alone. People with this disorder do not trust their
own ability to make decisions, and feel that others have better ideas. They may
be devastated by separation and loss, and they may go to great lengths, even
suffering abuse, to stay in a relationship (Gillihan). An individual may be
diagnosed with dependent personality disorder if they meet five or more of the
following criteria established in the Diagnostic and Statistical Manual of
Mental Disorders – Fourth Edition (DSM-IV):
1) Difficulty in making everyday decisions without excessive advice and
reassurance 2) Needs others to assume responsibility for major areas of his/her
life 3) Difficulty expressing disagreement with others and unrealistically fears
loss of support or approval if he disagrees 4) Difficulty initiating projects
or doing things on his/her own, due to lack of confidence in judgment or
abilities 5) Goes to excessive lengths to obtain nurturance and support, to the
point of volunteering to do things that are unpleasant 6) Uncomfortable or
helpless when alone due to exaggerated fears of being unable to care for
him/herself 7) Urgently seeks another source of care and support when a close
relationship ends 8) Unrealistically preoccupied with fears of being left to
take care of him/herself. (American Psychiatric Association, 1994)
DPD is classified as a Cluster C personality disorder in the DSM-IV. Cluster C
personality disorder is described as anxious or fearful. Females are more
likely than males to have a Cluster C personality disorder (Joseph Rey, 1996).
Childhood illness or separation anxiety disorder of childhood may be a
premorbid condition to DPD. Some experts believe that events occurring in early
childhood exert a powerful influence upon behavior later in life. Others
indicate that people are genetically predisposed to personality disorders. In
some cases, however, environmental factors may cause a person who is already
genetically vulnerable to develop a personality disorder (National Mental
Health Association).
What is the link between parental over protectiveness and authoritarianism and
the development of dependent personality traits in children? Parental over
protectiveness and authoritarianism serve simultaneously to 1) reinforce
dependent behaviors in children of both sexes and 2) prevent the child from
developing independent, autonomous behaviors (since the parents do not permit
the child to engage in the kinds of trial-and-error learning that are involved
in developing a sense of independence and mastery during childhood). Thus, when
parental over protectiveness or parental authoritarianism is characteristic of
the family unit, this will tend to produce high levels of dependency in
children, since both parental controls foster and encourage dependent behavior.
When both parental over protectiveness and authoritarianism are present within
the family unit, dependency in children is particularly likely to result
(Robert Bornstein, pg. 41).
Rey (1996) suggests that because personality is shaped by experiences during
childhood and adolescence, it is likely that mental disorders occurring during
these years may have an influence on personality development. He found that the
quality of the family environment before the age of 12 years was the “most
robust development predictor of personality disorder in young adults”.
There is no specific treatment for this disorder, although psychotherapy may be
useful in gradually helping people make choices that affect their own life.
This is the treatment of choice for dependent personality disorder.
Psychotherapy for patients with this disorder focuses on helping them see the
unconscious conflicts that are contributing to or causing their symptoms. It
also helps people become more flexible and is aimed at reducing the behavior
patterns that interfere with everyday living (NMHA). Long term therapy is not
recommended because it can reinforce a dependent relationship upon the
therapist. An important component of therapy is examining the client’s faulty
cognitions and related emotions such as lack of self-confidence. Assertiveness
training and other behavioral approaches have proven to be most effective in
treatment (Gillihan).
In conclusion, The National Mental Health Association suggests that:
There are many types of help available for different personality disorders.
Treatment may include individual, group, or family psychotherapy. Medications
prescribed by the patient’s physician may also be helpful in relieving some of
the symptoms of personality disorders including problems with anxiety and
depression.
References
American Psychiatric Association (1994). Diagnostic and Statistical Manual of
Mental Disorders: DSM-IV. (4th ed.). Washington, DC: Author
Bornstein, Robert F. (1993). The Dependent Personality. New York: Guilford
Press
Gillihan, Lori. (n.d). Dependent Personality Disorder. Retrieved March 1, 2002,
from http://cstl-coe.semo.edu
National Mental Health Association. (n.d.). Personality Disorders. Retrieved
from http://www.nmha.org
Pergament, Rachel. (n.d.). Susan Smith: Child Murderer or Victim? Retrieved
March 1, 2002 from http://www.crimelibrary.com
Rey, Joseph M. (1996) Antecedents of Personality Disorders in Young Adults.
Psychiatric Times, 13 (2). Retrieved March 1, 2002, from
http://www.mhsource.com