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
Risk factors
- Associated with anxiety disorders
- Affects women more commonly than men
Management
- Psychotherapy (first line)
- Pharmacotherapy for symptoms that impair functioning (e.g., anxiety, 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 [cluster B])
- Should be distinguished from:
- The voluntary social withdrawal associated with schizoid personality disorder (cluster A)
- Social anxiety disorder
- 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 with fear of being “left to take care of themselves”
Risk factors
- Associated with anxiety disorders
- Affects women more commonly than men
Management
- Psychotherapy (first line)
- Pharmacotherapy for symptoms that impair functioning (e.g., anxiety, depression, mood instability)
Clinical associations
- Regression is the predominant defense mechanism (i.e., the child-like need to be taken care of)
- Should be differentiated from 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:
- Unable to accept different views of morals or the “right” way of doing something
- Sticking to strict rules and routines: preoccupation with planning, lists, schedules, details, etc.
- Holding on to useless objects; excessively thrifty
Risk factors
- Associated with anxiety disorders
- Affects men more commonly than women
Management
- Psychotherapy (first line)
- Pharmacotherapy for symptoms that impair functioning (e.g., anxiety, 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 and its related disorders (e.g., hoarding disorder) due to its lack of compulsions, as well as the ego-syntonic nature of 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 |
|
|
| Defense mechanism | N/A | Regression | N/A |
| Differentials |
|
|
Obsessive-compulsive disorder (OCD) and other related disorders (e.g., hoarding disorder) |
| Management | Psychotherapy (first line) with low-dose pharmacotherapy for applicable symptoms (e.g., anxiolytics, antidepressants, mood stabilizers) | Psychotherapy (first line) with low-dose pharmacotherapy for applicable symptoms (e.g., anxiolytics, antidepressants, mood stabilizers) | 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. |
