Cluster C Personality Disorder

1. See Also
   1. Personality Disorder
2. Definition
   1. Anxious or fearful personalities
3. General features of all Cluster C personalities
   1. Isolation
      1. Orderly
      2. Controlled
      3. Anxious
      4. Remembers truth with affect
      5. Compulsive or Obsessive-Compulsive
   2. Passive-Aggression
      1. Self-chosen failure
      2. Masochistic
      3. Dysthymic
4. Type: Avoidant Personality (common)
   1. Characteristics
      1. Socially inhibited, shy and lonely
      2. Sense of being inadequate with low self esteem
      3. Hypersensitive to criticism
      4. Reluctant to take risks or try new activities as they might be embarrassing
      5. Desperate for relationships
         1. But avoid social contact for fear of disapproval, criticism or rejection
         2. Impacts work, social situations, intimacy
   2. Altered interpretation of illness and physician
      1. Not forthcoming with information
      2. Will not question or disagree with doctor
   3. Recommended physician approach
      1. Reassure and validate concerns
      2. Encourage talking about concerns in future
5. Type: Obsessive Compulsive Personality
   1. Characteristics (often successful men)
      1. Inhibited, stubborn, rigid and a perfectionist - interferes with task completion
      2. Preoccupied with orderliness or perfection, rules, lists, order, organization or schedules (obscures the major point of activity)
      3. Excessively devoted to work and productivity and excludes recreation and friendships
      4. Reluctant to delegate tasks to others unless they will perform those tasks exactly as he or she directs
      5. Miserly spending habit; hoards money in case of future catastrophe
      6. Unable to throw away worthless items (without sentimental value)
      7. Mental and interpersonal control
      8. Worry about loss of emotional control
   2. Altered interpretation of illness and physician
      1. Prolongs illness behavior to obtain attention
      2. Demands urgent attention
   3. Recommended physician approach
      1. Reassure
      2. See in clinic regularly (set limits on availability)
      3. Identify support network to assist patient
      4. Avoid rejecting patient
6. Type: Dependent Personality
   1. Characteristics (more common in women)
      1. Difficulty making everyday decisions without significant advice and reassurance from others
      2. Need to be taken care of, passive, unsure - others need to assume responsibilities for most areas of their life
      3. Submissive behavior as they fear disagreement and the loss of support or approval
      4. Difficulty initiating independent projects
      5. Volunteers to perform unpleasant tasks to obtain the nurture and support of others
      6. Urgently needs to replace one relationship when another one ends
      7. Fear of separation
      8. Sensation of helplessness
      9. May appear passive-aggressive
   2. Altered interpretation of illness and physician
      1. Exhaustive questioning
      2. Attention to minute detail
      3. Angry when routines are disrupted
   3. Recommended physician approach
      1. Careful history and examination
      2. Thorough explanations
      3. Do not emphasize uncertainty
      4. Involve patient in treatment program
   4. Evaluate for comorbid conditions
      1. Anxiety Disorder
      2. Major Depression
7. Management
   1. Target symptoms
      1. Anxiety
      2. Behavior
      3. Obsessions
   2. Medications
      1. SSRIs
      2. Consider Benzodiazepine for short-term use
8. References
   1. Tomb (1992) Psychiatry, p. 147-52
   2. (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Washington D.C., APA
   3. Angstman (2011) Am Fam Physician 84(11): 1253-60
   4. Ward (2004) Am Fam Physician 70(8):1505-12