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Cluster C Personality Disorders

Personality disorders Personality Disorders A major deviation from normal patterns of behavior. Cluster A Personality Disorders are ego-syntonic behaviors that begin in childhood or adolescence and are classified into 3 clusters: A, B, and C. They can considerably interfere with a patient’s adherence to medical treatment for a variety of reasons. It is important to rule out organic causes of a mental disorder (e.g., endocrine hormone imbalances, medication adverse effects, alcohol and/or substance use, other mental health co-morbidities) before ascribing a personality disorder to a patient. Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders Personality Disorders A major deviation from normal patterns of behavior. Cluster A Personality Disorders, which can be behaviorally described as anxious and apprehensive.

Last updated: Jan 8, 2021

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Avoidant Personality Disorder

Key features

  • Low self-esteem 
  • Avoids social situations, interactions, or new activities out of fear of being embarrassed, ridiculed, or rejected → withdrawal not due to preference for solitude, but due to social anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder

Risk factors

  • Associated with anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder disorders
  • Affects women more commonly than men

Management

  • Psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy (first line)
  • Pharmacotherapy for symptoms that impair functioning (e.g., anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder, depression, mood instability)

Clinical associations

  • Very common in:
    • The general population (along with obsessive-compulsive personality disorder, which is discussed below)
    • Clinical populations (along with borderline personality disorder Borderline Personality Disorder A personality disorder marked by a pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts. Cluster B Personality Disorders [cluster B])
  • Should be distinguished from:
    • The voluntary social withdrawal associated with schizoid personality disorder Schizoid Personality Disorder A personality disorder manifested by a profound defect in the ability to form social relationships, no desire for social involvement, and an indifference to praise or criticism. Cluster A Personality Disorders (cluster A)
    • Social anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder disorder
    • Agoraphobia Agoraphobia Agoraphobia is fear or anxiety in a situation that would be difficult to leave or to obtain help in the event that one develops panic-like symptoms. Situations include being in public or open spaces, lines, crowds, or public transport. Agoraphobia

Dependent Personality Disorder

Key features

  • Fear of abandonment and of being alone:
    • Tendency to stay in abusive relationships
    • Clinging and submissive behavior
  • Low self-confidence in own abilities: 
    • Needing others to take on responsibility and lead for them, e.g., with making decisions in everyday life
    • Preoccupation Preoccupation Body Dysmorphic Disorder with fear of being “left to take care of themselves”

Risk factors

  • Associated with anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder disorders
  • Affects women more commonly than men

Management

  • Psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy (first line)
  • Pharmacotherapy for symptoms that impair functioning (e.g., anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder, depression, mood instability)

 Clinical associations

  •   Regression Regression Corneal Abrasions, Erosion, and Ulcers is the predominant defense mechanism Defense mechanism Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. Psychotherapy (i.e., the child-like need to be taken care of)
  • Should be differentiated from major depressive disorder Major depressive disorder Major depressive disorder (MDD), commonly called depression, is a unipolar mood disorder characterized by persistent low mood and loss of interest in association with somatic symptoms for a duration of ≥ 2 weeks. Major depressive disorder has the highest lifetime prevalence among all psychiatric disorders. Major Depressive Disorder
  • Should be differentiated from factitious disorder (i.e., the patient may sabotage their treatment in order to remain “cared for” by whomever they are dependent upon)

Obsessive-Compulsive Personality Disorder

Key features

  • Excessive devotion to work: 
    • Perfectionism: often keeping them from completing tasks on time
    • Difficulty sharing tasks and giving up control
    • Dispenses with leisure activities 
  • Rigidity Rigidity Continuous involuntary sustained muscle contraction which is often a manifestation of basal ganglia diseases. When an affected muscle is passively stretched, the degree of resistance remains constant regardless of the rate at which the muscle is stretched. This feature helps to distinguish rigidity from muscle spasticity. Megacolon:
    • Unable to accept different views of morals or the “right” way of doing something 
    • Sticking to strict rules and routines: preoccupation Preoccupation Body Dysmorphic Disorder with planning, lists, schedules, details, etc ETC The electron transport chain (ETC) sends electrons through a series of proteins, which generate an electrochemical proton gradient that produces energy in the form of adenosine triphosphate (ATP). Electron Transport Chain (ETC).
  • Holding on to useless objects; excessively thrifty

Risk factors

  • Associated with anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder disorders
  • Affects men more commonly than women

Management

  • Psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy (first line)
  • Pharmacotherapy for symptoms that impair functioning (e.g., anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder, depression, mood instability)

Clinical associations

  • Very common in the general population (along with avoidant personality disorder, which is discussed above)
  • Should be differentiated from obsessive-compulsive disorder Obsessive-compulsive disorder Obsessive-compulsive disorder (OCD) is a condition characterized by obsessions (recurring and intrusive thoughts, urges, or images) and/or compulsions (repetitive actions the person is compelled to perform) that are time-consuming and associated with functional impairment. Obsessive-compulsive Disorder (OCD) and its related disorders (e.g., hoarding disorder) due to its lack of compulsions Compulsions Repetitive behaviors or mental acts that the individual is driven to perform in relation to an obsession. Obsessive-compulsive Disorder (OCD), as well as the ego-syntonic nature of personality disorders Personality Disorders A major deviation from normal patterns of behavior. Cluster A Personality Disorders and the ego-dystonic nature of obsessive-compulsive and related disorders

Summary

Cluster C disorder Avoidant Dependent Obsessive-compulsive
Key features Involuntary social withdrawal due to fear of criticism and rejection
  • Submissive
  • “Clingy”
  • Needs to be taken care of
  • Rigid
  • Controlling
  • Perfectionist
Defense mechanism Defense mechanism Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. Psychotherapy N/A Regression Regression Corneal Abrasions, Erosion, and Ulcers N/A
Differentials
  • Schizoid personality disorder Schizoid Personality Disorder A personality disorder manifested by a profound defect in the ability to form social relationships, no desire for social involvement, and an indifference to praise or criticism. Cluster A Personality Disorders
  • Social anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder disorder
  • Agoraphobia Agoraphobia Agoraphobia is fear or anxiety in a situation that would be difficult to leave or to obtain help in the event that one develops panic-like symptoms. Situations include being in public or open spaces, lines, crowds, or public transport. Agoraphobia
  • Major depressive disorder Major depressive disorder Major depressive disorder (MDD), commonly called depression, is a unipolar mood disorder characterized by persistent low mood and loss of interest in association with somatic symptoms for a duration of ≥ 2 weeks. Major depressive disorder has the highest lifetime prevalence among all psychiatric disorders. Major Depressive Disorder
  • Factitious disorder
Obsessive-compulsive disorder Obsessive-compulsive disorder Obsessive-compulsive disorder (OCD) is a condition characterized by obsessions (recurring and intrusive thoughts, urges, or images) and/or compulsions (repetitive actions the person is compelled to perform) that are time-consuming and associated with functional impairment. Obsessive-compulsive Disorder (OCD) ( OCD OCD Obsessive-compulsive disorder (OCD) is a condition characterized by obsessions (recurring and intrusive thoughts, urges, or images) and/or compulsions (repetitive actions the person is compelled to perform) that are time-consuming and associated with functional impairment. Obsessive-compulsive Disorder (OCD)) and other related disorders (e.g., hoarding disorder)
Management Psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy (first line) with low-dose pharmacotherapy for applicable symptoms (e.g., anxiolytics, antidepressants, mood stabilizers) Psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy (first line) with low-dose pharmacotherapy for applicable symptoms (e.g., anxiolytics, antidepressants, mood stabilizers) Psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy (first line) with low-dose pharmacotherapy for applicable symptoms (e.g., anxiolytics, antidepressants, mood stabilizers)
Epidemiology ♀>>♂ ♀>>♂ ♂>♀
Example A 22-year-old college student wants to try out for the volleyball team, but is afraid of not being accepted, so she stays home. A wife defers her medical treatment decisions to her husband, who has a history of spousal abuse. A 42-year-old man has an alphabetically organized baseball card collection, color-coded sock drawer, and a library numerically arranged by publication year.

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