Personality Disorders Cluster C

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Personality Disorders:

Cluster C

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Dependent : Excessive need to be taken care of, leading to submissive and clinging behavior and fear of separation

Avoidant: Pervasive pattern of social inhibition, feelings of inadequacy

Obsessive Compulsive: Pervasivepattern & preoccupation with orderliness, perfectionism,mental/interpersonal control at the expense of flexibility, openness, andefficiency

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Dependent Personality Disorder:Prevalence & Etiology

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- More common in women than men?

¤ Inclinical samples, females more frequently diagnosed

- Authoritarian parenting styles

- Social learning theory suggest thatlearned experience

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Dependent Personality Disorder:DSM-5 Criteria

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Pervasive and excessive need to betaken care of leading to submissive, clinging behavior and fears of separation,with 5+ of the following:

1. Reassurance required for decisions

2. Expressing disagreement difficult (due to fear of loss of support or approval)

3. Life responsibilities (needs to have these assumed by others)

4. Initiating projects difficult (due to lack of self-confidence)

5. Alone (feels helpless and discomfort when alone)

6. Nurturance (goes to excessive lengths to obtain nurturance and support)

7. Companionship (another relationship) sought urgently when close relationship ends

8. Exaggerated fears of being left to care for self

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RELIANCE

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DPD: perception/cognition

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- Tend to have dichotomous thinking; catastrophize (continuously think of worst-case scenarios)

- Prefernot to look too deeply into themselves

- Very suggestible, easily manipulated

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DPD: affect

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- Characterized by insecurity, anxiousness

- Timid or sad when stressed

- Avoid expressing anger, even covertly

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DPD: relationships

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Relationships in general

- Separation anxiety, fear taking care of self, prefers someone nearby

- Capable of empathy for others

Interpersonal relationships

- Assume passive and submissive role, seek approval

- Will submit to abuse/intimidation to avoid abandonment

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general and interpersonal

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DPD: self-view and view of others

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Self-view

- “I’m nice, but inadequate, fragile, weak, inept”

Worldview

- “Others are here to take care of me (because I can’t do it myself)”

Defense mechanisms

- Introjection: taking on opinions and others’ views as their own

- Idealize partners

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DPD: treatment goals

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short-term goal

- doing tasks or activities that are reachable and concrete

- then move on to other more complex tasks

long-term goal

- helping them to make their own decisions (autonomy)

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short-term vs. long-term

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Avoidant Personality Disorder: Prevalence & Etiology

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Relatively low prevalence:

- 5 % to 1% in general population

- 10% in clinical populations

Biological influence:

- Linkedto lowered autonomic arousal threshold

Parenting style:

- Authoritarian, highly controlling, tried to create impression of perfection

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Avoidant Personality Disorder:

DSM Criteria

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Pervasive pattern of social inhibition, feelings of inadequacy with 4+ of the following:

1. Certainty (of being liked required before willing to get involved with others)

2. Rejection (or criticism) preoccupies one's thoughts in social situations

3. Intimate relationships (restraint in intimate relationships due to fear of being shamed)

4. New interpersonal relationships (is inhibited in)

5. Gets around occupational activity (involving significant interpersonal contact)

6. Embarrassment (potential) prevents new activity or taking personal risks

7. Self viewed as unappealing, inept, or inferior

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CRINGES

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differential characteristics between avoidant, schizoid, dependent

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avoidant: Longs forclose interpersonal relations but fears humiliation, rejection andembarrassment => avoids anddistances self from others. Fears humiliation and rejection which leads tosocial timidity and withdrawal.

Schizoid: Little or no desire forclose interpersonal relationships => distancing and avoidance of others.

Dependent: Timid, submissive, and clinging dueto excessive need for attachment

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APD: Perceptions/cognitions

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Perceptions/cognition:

- Scan the environment for signs of danger

- Monitoring both self and others (vs. social phobia more likely to just monitor self)

- Believeothers regard them as defective, shameful

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APD: Affect

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Affect

- High anxiety: overt expressions of feelings kept in check

- Chronically fatigued, tense, self-conscious

- Self-critical,de-value achievements

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APD: Interpersonal relationships

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- Avoidcontact with others but desperately want approval and intimacy

- Escapesocial interactions when possible

- Live inprotective shell of isolation

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APD: Behavioral style

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Behavioral style

¤Social withdrawal, shy, distrustful, aloof¤Controlled behavior and speech (not impulsive)¤Apprehensive and awkward

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APD: Self-view vs. view of others

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Self-view

¤“I’m inadequate and frightened of rejection”

Worldview

¤“Life is unfair. People reject and criticize me, but I want someone to like me.Therefore, be vigilant, demand reassurance, and, if all else fails, fantasize and daydream.”

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APD: treatments

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Goals:

¤Increase self-esteem and confidence in relationships, desensitize to criticism

¤Common countertransference?

¤Treatment of Cluster C disorders most promising

- Short-term psychodynamic psychotherapy and cognitive therapy

¤Treatment Issues: Tend to beguarded, have intense sensitivity to negative evaluation

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Obsessive Compulsive Personality Disorder: Prevalence & Etiology

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Prevalence

¤1% in general population => 2-8%

¤3-10% in outpatient psychiatric populations => 8-9% in outpatient psychiatric setting

Parenting

¤Over controlling of affection and emotion

¤Child punished for imperfection, not rewarded for successes

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Obsessive Compulsive Personality Disorder: DSM Criteria

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Pervasive pattern of preoccupationwith orderliness, perfectionism, mental/interpersonal control at the expense offlexibility, openness, and efficiency with 4+ of the following:

1. Loses point of activity (due to preoccupation with detail)

2. Ability to complete tasks (compromised by perfectionism)

3. Worthless objects (unable to discard)

4. Friendships (and leisure activities) excluded (due to a preoccupation with work)

5. Inflexible, scrupulous, overconscientious (on ethics, values, or morality, not accounted for by religion or culture)

6. Reluctant to delegate (unless others submit to exact guidelines)

7. Miserly (toward self and others)

8. Stubbornness (and rigidity)

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LAW FIRMS

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Differential characteristics OCD vs. OCPD

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OCD: Anxiety Disorder; Recurring, unpleasant thoughts Driven to perform ritualized behaviors that are ego-dystonic

OCPD: Personality Disorder; Traits are adaptive, seldom distressing, and ego-syntonic

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OCPD: perception/cognition

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- Constricted, rule-based

- Thoughts catalogued into discrete compartments

- Thought patterns: Dichotomous thinking, Catastrophize

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OCPD: affect

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- Difficulty expressing close, warm feelings

- Likely to express anger, frustration, irritability if can’t maintain control (typically not expressed directly)

- Hold themselves back, may be formal and stiff

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OCPD: interpersonal relationship

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- Stilted,stiff behavior

- Overload others with details

- Inflexible ideals, sense of morality, may be deferent to authority figures, relate toothers by their rank

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OCPD: behavioral

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- Perfectionism

- Stubbornand possessive

- Tendto be indecisive and procrastinate

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OCPD: self-view vs. others view

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Self view

- “I’m responsible if something goes wrong”

- See self as reliable, competent, devoted to work - May have problems at work due to interpersonal difficulties

Worldview

- “Life is unpredictable and expects too much. Therefore, be in control, be right and proper, and don’t make mistakes.”

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OCPD: treatment

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Interviewing patients diagnosed with OCPD may be difficult /challenging - preoccupation with detail & need for control

Clinician’s empathy seen as irrelevant/annoying

Formation of therapeutic alliance verydifficult¤Goal: Keep patient in touch with anger, other feelings