module 14 pt. 4 (cluster c disorders)

Cluster C Personality Disorders

Avoidant, Dependent, Obsessive-Compulsive personality disorders (anxious-fearful cluster)

Avoidant Personality Disorder

Social inhibition, feelings of inadequacy, hypersensitivity to criticism, avoids new situations but still wants relationships

Avoidant PD vs Social Anxiety Disorder

Avoidant PD is more pervasive and personality-based; only about 25% also have social anxiety disorder

Avoidant PD Prevalence

About 2–3%, more common in women, comorbid with depression

Avoidant PD Etiology

Some shared genetic risk with social anxiety; emotional avoidance patterns

Dependent Personality Disorder

Strong need to be taken care of, difficulty making decisions, fear of being alone, trouble disagreeing with others

Dependent PD Prevalence

Less than 1%, more common in women, highly comorbid with mood, anxiety, eating, and somatic disorders

Dependent PD Theories

Biological heritability 30–60%; authoritarian or overprotective parenting; beliefs such as “I am helpless”

Dependent PD vs Codependency

Dependent PD is a diagnosable pattern of pervasive dependence, not just being overly attached to a partner

Obsessive-Compulsive Personality Disorder

Perfectionism that interferes with completing tasks, extreme orderliness, rigid, stubborn, overly devoted to work, reluctant to delegate

OCPD Prevalence

About 4.7%, slightly more common in men, only 20% have OCD

OCPD Associations

High harm avoidance, low novelty seeking, modest genetic influence; very common in anorexia (up to 60%)

Personality Disorder Treatment Difficulties

People are pushed into treatment by others, not self-motivated; personality traits interfere with forming therapeutic alliance

Limitations in PD Treatment Research

Very little research outside borderline PD; unclear best practices; clinicians adapt other treatments instead

Alternative DSM-5 Model

Uses impairments in functioning plus maladaptive trait dimensions

DSM-5 Pathological Traits

Negative affectivity, detachment, antagonism, disinhibition, psychoticism

Big Five Links

Neuroticism, extraversion, openness, agreeableness, conscientiousness correspond to DSM-5 traits

Hybrid Model

Combines dimensional traits with categorical diagnoses

DSM-5 Disorders Included

Antisocial, avoidant, borderline, narcissistic, OCPD, schizotypal

Schizotypal PD (Alternative Model)

High psychoticism, detachment, antagonism; aligns with high openness, low extraversion, low agreeableness

Borderline PD (Alternative Model)

High negative affectivity, high disinhibition, antagonism; aligns with high neuroticism, low conscientiousness, low agreeableness

Avoidant PD (Alternative Model)

High negative affectivity, high detachment, some disinhibition; aligns with high neuroticism, low extraversion

DSM Problems: Diagnostic Overlap

Most people meet criteria for more than one personality disorder

DSM Problems: High Comorbidity

PDs frequently occur with mood, anxiety, and other disorders

DSM Problems: Stability Assumption :

DSM claims PDs are stable, but symptoms vary in severity and number over time

DSM Problems: Arbitrary Cutoffs :

Diagnosis often requires “half plus one” symptoms with no scientific basis

DSM Problems: Heterogeneity :

People with the same PD diagnosis can have very different symptom combinations

DSM Problems: Gender Bias :

Histrionic, dependent, and borderline more often diagnosed in women; antisocial and paranoid more often diagnosed in men

DSM Problems: Racial Bias :

Paranoid and antisocial PD overdiagnosed in African American individuals

Avoidant PD is characterized by which feature?

Fear of negative evaluation

Which disorder involves difficulty making everyday decisions without reassurance?

Dependent PD

Which is true about OCPD?

Perfectionism interferes with task completeion

Which Cluster C disorder still desires close relationships?

Avoidant PD

Which disorder is strongly associated with anorexia nervosa?

OCPD

What percentage of Dependent PD heritability is estimated?

30–60%

Which PD is sometimes mistaken as a “more extreme” version of social anxiety disorder?

Avoidant PD

Which trait dimension is related to impulsivity?

Disinhibition

Which is NOT a DSM problem?

Strong biological tests available

In the alternative DSM-5 model, Avoidant PD is associated with:

High detachment

A woman avoids new social events because she is terrified of being judged, but she desperately wants close friendships. Which disorder best fits?

Avoidant Personality Disorder

A man cannot make basic decisions without asking his partner for guidance and panics at the idea of being alone. Which disorder?

Dependent Personality Disorder

A student spends hours rewriting a paper outline to make it perfect and misses the deadline entirely. Which disorder?

Obsessive-Compulsive Personality Disorder

A patient has multiple PD diagnoses, vague symptom boundaries, and different symptoms at different times. What DSM problem does this reflect?

Diagnostic overlap and instability over time

A clinician evaluates someone using trait dimensions like negative affectivity and detachment, then assigns a categorical PD. What model is being used?

The Alternative DSM-5 Hybrid Model

Cluster A disorders

odd eccentric

• Paranoid personality disorder

• schizoid personality disorder 

• Schizotypal personality disorder

Cluster B disorders

dramatic-emotional

• Antisocial personality disorder

• Histrionic personality disorder 

• Borderline personality disorder 

• Narcissistic personality disorder 

Cluster C disorders

anxious-fearful

• Dependent personality disorder 

• Avoidant personality disorder

• Obsessive compulsive personality disorder