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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
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