Lecture 5.4: Cluster C Diagnoses

Cluster C Phrase

Anxious or fearful

Avoidant Personality Disorder Symptoms

• A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

 

• Avoids interpersonal job activities

• Unwilling to get involved with others unless certain of being liked

• Is preoccupied with criticism and rejection in social situations

• Views self as socially inept, personally unappealing, or inferior to others

• Won’t try new things in case they are embarrassing

 

• Requires 4 of the 7 possible criteria

Avoidant Personality Disorder Symptoms

• General Population: 2.4%

• Treatment-Seeking Population: 10%

• Women > Men

• Early adulthood onset

• Of all PDs, they report the lowest quality of life

• Controversy over distinction between Avoidant PD and Generalized Social Anxiety

  • Estimate that 43% of people diagnosed with generalized social anxiety are also diagnosed with avoidant PD

Avoidant PD: Treatment

• Treatment is similar to social anxiety

  • Cognitive Behavioral Group Therapy (Acts kind of like exposure)

    • Studies suggest it is the best-treated of the personality disorders

Dependent Personality Disorder

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

  • Has difficulty making everyday & major decisions

  • Won't express disagreement because of fear of loss of support or approval

  • Fails to initiate projects on own due to lack of self-confidence

  • Feels uncomfortable or helpless when alone 

  • Urgently seeks another relationship when one ends

 

• Requires 5 of the 8 possible criteria

May be more likely to enter into abusive relationships

Dependent Personality Disorder Prevalence

• Prevalence

  • General Population: ~ 0.49%

    • More common among women in the general population

    • No gender difference in treatment-seeking populations

Dependent Personality Disorder Treatment

• Clinicians must be cautious of not becoming a “nurturer” and furthering problems

• Treatments using homework will present a challenge

Obsessive-Compulsive Personality Disorder Symptoms

• A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency

  • Preoccupied with rules, lists, details

  • Neglects family/friends because of devotion to work

  • Is over-conscientious about rules, ethics, values

  • Cannot discard worthless objects

  • Hoards money in case of disaster

  • Refuses to delegate tasks to others

• Requires 4 of the 8 possible criteria

Obsessive-Compulsive PD Prevalence

• General Population: up to 7.9%

• Treatment-Seeking: 3-10%

• No gender differences

• Don’t confuse with OCD

  • Most with OCPD do not have OCD

  • Those with OCPD are not distressed by their traits/behaviors

Obsessive-Compulsive PD Treatment

• Often addresses their need for control

• Uses relaxation techniques and distraction

Do Cluster C PDs belong together?

• Although they all have feature of fear or anxiety in common, there is little diagnostic overlap between the criteria for the 3 disorders

• Neurological factors

  • The anxiety that characterizes the 3 disorders indicates that the amygdala might be involved (but this is just speculation)

• Psychological factors

  • Temperament: high in harm avoidance

  • All 3 disorders have an avoidance component to them:

    • Avoidant PD: patients avoid social situations

    • Dependent PD: patients avoid making decisions/having responsibilities

    • Obsessive-compulsive PD: patients avoid making mistakes/ experiencing strong emotions

• Research on how these disorders both do and do not overlap is still sorely needed