Personality disorders Cluster C

Hello people, welcome back to the blog! Last week, we finished with the Cluster B personality disorders, borderline, histrionic, and narcissistic personality disorders. This week, we’ll complete the entire series with the Cluster C “anxious and fearful” disorders: avoidant personality disorder, dependent personality disorder and obsessive compulsive personality disorder, not to be confused with obsessive compulsive disorder OCD. 

Avoidant Personality Disorder

AvPD or APD is characterized by extreme shyness, feelings of inadequacy, and extreme sensitivity to criticism. The key word here is avoid. People with AvPD are often unwilling to get involved with other people unless they’re certain they’ll be liked, otherwise, they’re not going to take the chance of being rejected. They’ll sooner avoid all social interaction than risk being ridiculed, humiliated, or disliked. They’re constantly preoccupied with how they’re being perceived, are hypervigilant of criticism, and may view themselves as not being good enough or socially inept. They typically avoid new activities or meeting strangers like the plague. For many of them, just the thought of something as simple as asking a stranger for the time is inconceivable. As a result of these constant fears, they’re extremely restrained, even in their intimate relationships. They can appear very socially awkward, not only due to lack of experience, but also because they tend to excessively monitor internal reactions, their own and everyone else’s, and this keeps them from engaging naturally in social situations. As with many personality disorders, a vicious cycle can take over in which the more they monitor their internal reactions, the more inept they feel; and the more inept they feel, the more they monitor their internal reactions.

Signs and symptoms of AvPD may include:

-Anhedonia, lack of pleasure in activities

-Self-isolation

-Severe anxiety in social situations

-Avoiding conflict, being a “people-pleaser”

-Avoidance of social interaction despite a strong desire for intimacy

-Avoiding interaction in work settings or turning down promotions

-Avoiding making decisions

-Avoiding situations due to fear of rejection

-Easily hurt by criticism or disapproval

-Extreme self-consciousness, lack of assertiveness

-Fearful and tense demeanor, lack of trust in others

-Constant worry about being ridiculed, shamed, or ‘found out’ and rejected

-Feeling inadequate, inferior, or unattractive

-Misinterpreting neutral situations as negative

-No close friends/lacking a social network

-Unwilling to take risks or try new things

AvPD affects about 2.5 percent of the population, with roughly equal numbers of men and women being afflicted. As you can probably guess, AvPD is strongly associated with anxiety disorders, especially social anxiety, and can be associated with actual or felt rejection by parents or peers in childhood. In fact, childhood emotional neglect and peer group rejection are risk factors for development of AvPD, but it can occur without any notable abuse or neglect history. Generally speaking, people with the diagnosis are typically very shy as children, but Captain Obvious says that not every child who is shy goes on to develop the disorder, and not every adult who is shy has it. We all have people, places, and things we don’t like, or which make us anxious, that we’d like to avoid. The difference lies in how the person experiences them. With AvPD, even just the fear of rejection or disapproval can be an extremely painful experience, and this makes them struggle to maintain relationships in their personal and professional lives.  

Dependent Personality Disorder

DPD is characterized by an inability to be alone. People with DPD rely on other people for comfort, reassurance, advice, and support regarding all areas of their lives. They develop symptoms of anxiety when they’re lacking these outside sources of guidance. They fear separation, and are most often described as clingy or needy. They are submissive and passive by nature, and allow others to direct their lives because they are unable to do so themselves. They tend to be indecisive and unable to take the initiative, allowing other people such as spouses or parents to make all the major life decisions, including where to live, what type of career to pursue, and where to work. They have difficulty initiating projects or doing things on their own due to a lack of self-confidence in judgment or abilities, as opposed to a lack of motivation or energy. Because of their reliance on others, they may not learn the skills of independent living, and this perpetuates their dependency. Being often preoccupied with the thought of being left to fend for themselves, if they ever do disagree with any decision made for them, they would rarely express it; they would simply adjust their opinion to match that of their champion for fear of abandonment. In fact, the idea of being alone may cause such discomfort that some will go to considerable lengths to secure and maintain relationships. As you can imagine, this can be a big problem if they get roped in with an individual who doesn’t have their best interests in mind. This can be a very dangerous and destructive situation, especially when they believe that they are under the protection of someone who they idealize as competent and powerful, someone who’s their hero champion, and towards whom they behave in a self-effacing and ingratiating manner. People with DPD often end up with people with a cluster B personality disorder, as the latter feed on the unconditional regard in which the former holds them. I’ve had many patients that have coupled up in this manner, and it can be an unholy nightmare to untangle. Generally speaking, people with DPD maintain a naïve perspective, and have limited insight into themselves, and certainly even less into others. This entrenches and perpetuates their dependency, leaving them vulnerable to abuse and exploitation.

Signs and symptoms of DPD may include:

-Difficulty making everyday decisions

-Requiring others to assume responsibility for most major areas of his or her life

-True fear of having to provide self-care or fend for themselves if left alone

-Submissive or clingy behavior

-Tendency for naiveté

-Lack of self-confidence, requiring excessive advice and reassurance from others 

-Instinctively agree with others for fear of disapproval

-Going to excessive lengths to obtain support from others, even if it includes unpleasant tasks

-Tolerance of poor or abusive treatment, even when other options are available

-Feeling uncomfortable, anxious, bored, or helpless when alone

-Difficulty doing projects due to lack of confidence in abilities

-Urgent need to start a new relationship when a close one has ended

People with DPD normally first show signs in early to mid-adulthood, and males and females are generally equally diagnosed. True DPD is somewhat rare, with an estimated prevalence ranging from 0.49 to 0.6 percent. People with DPD are very prone to separation anxiety, and can become devastated when relationships and friendships are severed. When alone, a person with DPD may experience severe anxiety, panic attacks, and hopeless despondence. Clearly, some of these symptoms are the same for people with anxiety disorders, but people with medical conditions such as depression or even menopause may also experience some of these symptoms. Some factors that might contribute to the development of this disorder include having a history of a neglectful or an abusive upbringing, having overprotective or authoritarian parents, and

having a family history of anxiety disorders.

In addition, having a diagnosis of separation anxiety disorder or a history of chronic illness during childhood can increase the risk of developing DPD. Most people deal with feelings of insecurity at some point in their lives. It’s natural and perfectly normal to need other people to care for us or give us reassurance at times. The difference is that people with DPD require reassurance from others to simply function in their daily lives. A healthy balance involves being able to both depend on others as well as being independent enough to fend for oneself.

Obsessive Compulsive Personality Disorder

Aka Anankastic Personality Disorder

OCPD is characterized by a preoccupation with orderliness, perfectionism, and mental and interpersonal control, even at the expense of efficiency. People with OCPD have an obsessive need to follow rules and regulations, and they have a strict moral and ethical code from which they will not deviate… they’re always right. They often have such a level of perfectionism that they cannot finish tasks because they become too fixated on the details. They generally have an unwillingness to delegate or share tasks, unless the person they’re working with agrees to perform them exactly as they ask. They may be so preoccupied with details and order that the major point of the activity is lost. The rigidity that accompanies having OCPD often interferes with the person’s ability to relate to others and vice versa. While they can often improve their quality of life if they seek treatment, they rarely perceive that there’s a problem, so the condition tends to go untreated. As you can imagine, people with OCPD can be extremely difficult to work with or have a relationship with because they typically only see things their way. They believe that their approaches are the best way, and usually cannot understand another person’s point of view. They are often excessively devoted to work and productivity, to the exclusion of leisure activities and friendships. They generally have a miserly spending style toward both themself and others; money is something to be hoarded for future catastrophes. They are often unable to discard worn-out or worthless objects, even when they have no sentimental value. OCPD should not be confused with OCD, obsessive compulsive disorder. While some mannerisms and compulsions are similar, there is a BIG difference: people with OCD are aware that their compulsions are illogical, while people with OCPD are not. In fact, in their way of thinking, their thinking is logical, and if other people followed their rules, everything in their life would be fine. Just ask them, they’ll tell you… sometimes you don’t even have to ask! The problem comes in especially when rules and procedures don’t dictate the correct answer; decision making can become a painful, time-consuming process. In this case, the person with OCPD may have such difficulty deciding which tasks take priority or what’s the best way of doing a certain task, that they may never get started on anything, let alone finish. They’re prone to anger in situations in which they’re unable to maintain control of their physical environment, although they don’t typically express it directly. They’ll often find a more passive aggressive way to express it; for example, leaving a poor tip at a restaurant instead of speaking to management. When anger is expressed, it’s usually done with righteous indignation, often over a seemingly minor matter.

Signs and symptoms of OCPD may include:

-Overwhelming need for order and perfection, such that it interferes with task completion 

-Fixation on organization, detailed schedules, list making 

-An overwhelming need to be punctual

-Strict personal moral and ethical codes

-Excessive devotion to work at the expense of family or social relationships

-Often seen as ungenerous or frugal

-Display hoarding behaviors, such as refusing to throw things away

-Significant rigidity and stubbornness

-Inability to share or delegate work due to fear it won’t be done right

-Often feel righteous, indignant, and angry

-Socially isolated

-Stiff, formal, or rigid mannerisms

In relationships, people with OCPD are very aware of their relative status, and they tend to display excessive deference to an authority they respect, and excessive resistance to an authority they don’t. When they express affection, it’s done in a very controlled manner, and they’re very uncomfortable when they’re around other people who are emotionally expressive. Their everyday relationships have a formal quality to them, and they’re usually very stiff in situations where most others are smiling and happy. They’re often so preoccupied with logic and intellect, they tend to carefully hold themselves back in conversations until they’re sure that whatever they say will be the perfect thing. 

As with most personality disorders, the intensity of OCPD symptoms will decrease with age, and the most extreme symptoms have usually nearly ceased by the time the majority of people are in their 40s or 50s. OCPD is approximately twice as prevalent in males than females, and occurs in between 2.1 and 7.9 percent of the general population, making it the most prevalent personality disorder. A childhood with very controlling or protective parents or caregivers, or one in which they were often unavailable, may increase the risk of developing OCPD. But Captain Obvious says a person may have OCPD without any of the above factors as causes. In some case studies, adults can recall experiencing OCPD from a very early age. They may have felt that they needed to be a perfect or perfectly obedient child. This need to be good and follow the rules then carries over into adulthood. People with OCPD often experience anxiety that occurs with depression; and OCPD is generally seen as a coping mechanism, a way for the person to establish order in their lives and deal with their feelings. People experiencing OCPD often don’t recognize that their behavior is problematic, so they generally take some convincing before they agree to seek treatment. This can be very overwhelming to family members, especially if they’re dealing with constant criticism. The good news is that with time and treatment, many people with OCPD can find the motivation to change.

Personality Disorder not otherwise specified 

Each person is an individual and behaves in unique ways, so not everyone fits neatly into the personality disorders I’ve discussed. If a person doesn’t have enough symptoms to fully meet the criteria of a specific type, PD-NOS is the diagnosis used in this case. This may also be known as personality disorder trait specified PD-TS. These names can sound like opposites, but they both focus on the fact that the person has some personality disorder traits, but not enough of one specific type to fit in the box.

And as for personality disorders, in the words of Porky Pig… that’s all folks! 

I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA