Unit 2- Cluster C Personality Disorders

Cluster C

◦          High anxiety and outward signs of fear

◦          Inhibited, internalizing blame, even when not to blame

Avoidant Personality Disorder

·       pervasive feelings of social inhibition and   inadequacy, extreme sensitivity to negative evaluation

·       Prevalence – fairly common, 2.4% of US population

Characteristics: 

·       low self-esteem associated with social situations, feelings of inferiority compared to peers, reluctance to socialize with new people in unfamiliar situations;

·       subject to depression, anxiety, and anger; preoccupied with rejection, humiliation, and failure;

·       heightened sensitivity to criticism, views self as socially inept and inferior to others

Nursing guidelines:

·       Friendly, accepting, reassuring approach;

·       Don’t push!;

·       Acceptance of patient fears;

·       Group therapy;

·       Exercises to enhance new social skills;

·       Design exercises to prevent failures;

·       Assertiveness training

Treatment:

·       Individual and group therapy;

·       trust building;

·       assertiveness training;

·       antianxiety agents;

·       antidepressants (SSRIs) may be helpful

Dependent Personality Disorder

·       pervasive psychological need to be cared for by other people.

·       Prevalence:  0.5 %; associated with moderate to low problems in functioning; found to be 45% heritable

Characteristics:

·       have a high need to be taken care of;

·       helpless;

·       incompetent;

·       submissive;

·       immature;

·       withdraws from adult responsibilities;

·       sees self as fragile/weak;

·       fears of separation and abandonment;

·       manipulating others to take responsibilities;

·       intense anxiety when left alone even briefly.

Nursing guidelines:

·       Help address current stressors;

·       Set limits that don’t make the patient feel punished;

·       Be aware of strong countertransference;

·       Use therapeutic relationship as a testing ground for assertiveness training

Treatment:

·       Psychotherapy is treatment of choice including CBT, with goal to become more independent;

·       depression and anxiety may be treated with SSRIs

Obsessive Compulsive Personality Disorder

·       characterized by rigid conformity to rules, perfectionism and control

·       Prevalence: most prevalent 2% to 8%; genetic link

Characteristics:

·       rigidity, maintains a rule-bound lifestyle;

·       adheres closely to social conventions, unhealthy focus on perfection;

·       devotion to work;

·       may be miserly and stubborn;

·       inflexible standards for others and self;

·       constant rehearsal of social responses;

·       excessive goal-seeking that is self-defeating or relationship-defeating;

·       strict standards interfere with project completion.

Nursing guidelines:

·       refrain from power struggles;

·       remember that the patient has difficulty dealing with unexpected changes;

·       provide structure, but with time to complete habitual behaviors.

Treatment:

·       Group and behavioral therapy;

·       self-help groups;

Medications:

·       TCA clomipramine (Anafranil) or

·       SSRI e.g., fluoxetine (Prozac) for obsessions, anxiety, and depression.

Nurse/Client Relationship for Cluster C

·       Assist in setting small achievable goals

·       Assist to exploring feelings

·       Assist in trying new activities

·       Assist to decrease anxiety and need for perfection

·       Milieu: Assertiveness training, stress management, leisure skills

·       Most clients seen as outpatients

Outcomes

·       Outcomes should be realistic, modest, and obtainable.

·       Criteria might include the following:

·       Minimizing self-destructive behaviors

·       Reducing manipulating behaviors

·       Linking consequences to behaviors

·       Initiating alternatives to prevent crisis

·       Ongoing management of emotions

Creating lifestyle that prevents regression