PSYC 238 Cluster C Personality Disorders

Characteristics of cluster C

Characterized by anxious, fearful, or avoidant behaviors
¤ Avoidant PD
¤ Dependent PD
¤ Obsessive-Compulsive PD

Least studied

Little diagnostic overlap between these 3 (unlike Cluster A and B)

Avoidant PD

pattern of *social inhibition*, feelings of *inadequacy*, and *hypersensitivity to negative evaluation*
4+ of the following
~Avoids interpersonal job activities
~Unwilling to get involved with others unless certain of being liked
~Restraint in intimate relationships because of fear of being shamed or ridiculed
~Preoccupied with criticism/rejection in social situations
~Inhibited in new interpersonal situations
~Views self as socially inept, personally unappealing, or inferior to others
~Won't try new things in case they are embarrassing

Avoidant PD vs social anxiety

• Some argue there is no difference
• Some argue Avoidant PD is a more severe presentation of Social Anxiety Disorder (increased social withdrawal, Fewer friends, Nonspecific)

43% of people diagnosed with Social Anxiety Disorder are also diagnosed with Avoidant PD

Avoidant PD etiology

Parents less affectionate, more rejecting, and less encouraging of achievement

Abuse, neglect, overprotection

Expectations and hypervigilance for negative interactions

Avoidant PD Epidemiology

General Population: Less than cluster A, B(minus histrionic), OCPD
Treatment-Seeking Population: 10%
Women > Men
Early adulthood onset
Of all PDs, they report the lowest quality of life

Avoidant PD treatment

Treatment is similar to social phobia

Cognitive Behavioral Group Therapy
• Exposure is built-in
• Avoidant PD best-treated of the personality disorders

Avoidant PD 5-factor model

Low: Openness, extroversion, agreeableness
Mid: conscientousness
High: neuroticism

Dependent Personality Disorder

pervasive and *excessive need to be taken care of* that leads to *submissive* and *clinging* behavior and *fears of separation*

(5+ of the following)
¤ Difficulty making everyday and major decisions
¤ Needs others to assume responsibility for most major areas of life
¤ Won't express disagreement because fear losing support/approval
¤ Fails to initiate projects on own due to lack of self-confidence
¤ Goes to extreme lengths to obtain nurturance/support from others
¤ Feels uncomfortable or helpless when alone due to exaggerated fears of being unable to take care of him/herself
¤ Urgently seeks another relationship when one ends
¤ Unrealistically preoccupied w/ fears of being left to take care of self

Dependent PD epidemiology

- General Population: lowest of all PD's
- More common among women

Dependent PD treatment

- Clinicians must be cautious of not becoming a "nurturer" and furthering problems
- Treatments using homework will present a challenge

Dependent PD 5 factor model

Low: openness, conscientiousness, extrovertness
Mid: Agreeableness
High: neuroticism

Obsessive-Compulsive PD

pattern of preoccupation with *orderliness*, *perfectionism*, and mental and interpersonal *control*, at the expense of flexibility, openness, and efficiency (4+)

need for control and lack of tolerance for uncertainty

OCPD symptoms

(4+)

¤ Preoccupied with rules, lists, details
¤ Perfectionism that interferes with task completion
¤ Neglects family/friends because of devotion to work
¤ Rigidity and stubbornness
¤ Over-conscientious about rules, ethics, value ¤ Cannot discard worthless objects
¤ Refuses to delegate tasks to others
¤ Spends very little

OCPD vs OCD

OCPD doesn't have obsessions, compulsions, or as much distress/dysfunction as OCD

Most with OCPD don't have OCD

OCPD epidemiology

General Population: Highest C, more than A, B
Treatment-Seeking: 3-10%
No gender differences

OCPD treatment

Often addresses their need for control
Uses relaxation techniques
CBT or DBT

OCPD 5 factor model

Low: openess, extroversion
Mid: agreeableness
High: conscientiousness, neuroticism