CLUSTER C PERSONALITY

Cluster C: Anxiety and fearfulness dominated

characteristics, difficult, at times to
distinguish from anxiety based disorders

 AVOIDANT
 DEPENDENT
 OBSESSIVE COMPULSIVE PERSONALTY
DISORDER
 AVOIDANT PERSONALITY DISORDER
 Hypersensitivity to rejection or social
derogation
 Fear of rejection tends to inhibit initiation
of relationships
 Shyness
 Cognitive themes of self depreciation
 Beliefs that unpleasant thoughts or
emotions are intolerable and an
assumption that the expression of real
self to others leads to rejection
 Loneliness, sadness and anxiety in
interpersonal relationships
 Inability to relate to others due to low self
esteem and excessive self criticism
 Difficulty in enjoying being alone
ICD-10 criterion for APD
 Persistent and pervasive feelings of tension and
apprehension
 Belief that one is socially inept, personally
unappealing, or inferior to others
 Excessive preoccupation with being criticized or
rejected in social situations
 Unwillingness to become involved with people unless
certain of being liked
 Restrictions in lifestyle because of need for physical
security
 Avoidance of social/occupational
activities that involve significant
interpersonal contact because of
fear of criticism, disapproval,
or rejection
Is APD a Distinct Disorder?
 High diagnostic co-occurrence between APD and various
anxiety disorders and other Axis I disorders
(Alden et al., 2002)

 APD v/s Schizoid PD

◦ Both involve social withdrawal
◦ In APD the need for social contact exists but is overcome by
excessive fear of rejection. In SPD, there is ambivalence towards
others and need to be a loner
(Millon, 1969)
 APD v/s Dependent PD
◦ Both share feeling of inadequacy and hypersensitivity
◦ APD are more socially timid and avoid relationships rather than be
rejected, whereas the dependent seeks out relationships with
others in spite of the fear of being rejected
(Hirschfeld, Shea & Weise,1995)
Dependent Personality Disorder
 Show extreme dependence on other people,
particularly the need to be taken care of
 Clinging and submissive behavior
 Show acute discomfort at the possibility of

separation
 Difficulty in making everyday simple decisions

without a great deal of advice and reassurance

 Allow others to take over the major decisions in
their lives
 Difficulty standing up for themselves or express
disagreement
ICD-10 criterion for DPD
 Encouraging or allowing others to make most of one's
important life decisions
 Subordination of one's own needs to those of others on
whom one is dependent, and undue compliance with
their wishes;
 Unwillingness to make even reasonable demands on the
people one depends on
 Feeling uncomfortable or helpless when alone, because
of exaggerated fears of inability to care for oneself
 Preoccupation with fears of being abandoned by a
person with whom one has a close relationship, and of
being left to care for oneself
 Limited capacity to make everyday decisions without an
excessive amount of advice and reassurance from others
 Associated features may include perceiving oneself as
helpless, incompetent, and lacking stamina.
Obsessive Compulsive Personality
Disorder
 Perfectionism- dysfunctional in nature such that it
can result in never finishing project
 Preoccupied with rules, regulations & orderliness
 Disciplined, competent, achievement striving and
organized as well as quite inflexible about moral
or ethical issues (Widiger & Francis, 1994)
 Interpersonal functioning- difficulty in delegating
tasks to others, rigid and stubborn
 Prone to damage personal relationships by being
critical of those who don’t live up to their lofty
ideals
 Lack spontaneity, with usually serious mood
ICD-10 criterion for OCPD
 Feelings of excessive doubt and caution
 Preoccupation with details, rules, lists, order,
organization or schedule
 Perfectionism that interferes with task completion
 excessive conscientiousness, scrupulousness, and
undue preoccupation with productivity to the
exclusion of pleasure and interpersonal relationships
 Excessive pedantry and adherence to social
conventions; rigidity and stubbornness
 Unreasonable insistence that others submit to exactly
his or her way of doing things, or unreasonable
reluctance to allow others to do things
 Intrusion of insistent and unwelcome thoughts or
impulses
OCD v/s OCPD
6% to 16% of patients with OCPD only meet
criteria of OCD (Baer et al,1990,1992)

OCD OCPD
 persistent intrusion of  lifestyle characterized
particular undesirable by over
thoughts or images, conscientiousness,
distress is reduced by inflexibility &
compulsive rituals perfectionism

 Usually Ego dystonic  Ego syntonic

 People have more  People usually don’t
willingness to seek seek treatment
treatment
 ETIOLOGICAL THOERIES
FOR CLUSTER C
PERSONALITY DISORDERS
PSYCHODYNAMIC PERSPECTIVE
 Theory of Personality Organization - Otto Kernberg
(1975, 1984, 1996)
 Proposed a continuum of pathology, from chronically
psychotic levels of functioning, through borderline
functioning through neurotic to normal functioning
 Borderline functioning- entails severe personality
disorders including
◦ Maladaptive modes of regulating emotions including reality
distorting defenses such as denial and projection (primitive
defenses)
◦ Difficulty in forming mature, multifaceted representations of
themselves and significant others (identity diffusion)

 Cluster C falls at a less severe region, in the

continuum of severity of this borderline organization
of personality (Westen and Shedler, 1999)
APD
◦ Shyness, shame and avoidant behaviors are conceptualized as
defenses against humiliation, embarrassment and failure
(Gabband, 1990)

DPD
◦ Oral fixation (not supported by research evidence)
◦ Vicious cycle- Impulse-defense conflicts (urge to be cared for
conflicts with societal expectations regarding acceptable adult
behavior)

OCPD
◦ Anal fixation (not supported sufficiently by research evidence)
◦ Unresolved conflict between obedience and defiance
Vicious cycle- on the outside they submit and that leads to
internal sense of defiance and anger which in turns makes
them want to control these dangerous impulses (Millon, 1996)
◦ Defensive operations- intellectualization, isolation of affect, and
reaction formation
 Object Relations’ perspective of internal
representations- excessive parental control
or overprotection amounts to oscillation
between viewing the self as ‘all-good’ or ‘all-
bad’ emerging most of cluster C maladaptive
personality traits

 Retrospective and other studies

◦ APD- Perception of parents as shaming, guilt
engendering, less tolerant (Chorpita
& Barlow, 1998)
◦ DPD- Overprotection or authoritarian parenting
or a combination of both (Head, Baker & Williamson,
1991; Valliant, 1980)
TRAIT THEORY
 Gordon Allport (1937)
 Traits are emotional, cognitive, and behavioral tendencies on
which the individual varies

 Most common approach is Five Factor Model of Personality

(FFM) Costa and McCrae (1992)

 FFM consists of five broad dimensions of personality, namely

Openness to experience, Conscientiousness, Extraversion,
Agreeableness and Neuroticism

 Personality profile is represented by a culmination of each of

these 5 factors and a number of lower order subfactors.

 PD reflects extreme versions of normal personality and so a

same system can be used to diagnose normal and pathological
personality
APD
FFM cont..
◦ Extremely high scores on neuroticism could culminate int
anxiety related pathology
◦ characterized by high neuroticism (anxiety, depression , se
consciousness and vulnerability ) and low extraversion
(Widiger et al, 2002)
DPD
◦ high levels of trait dependency
◦ associated with elevated levels of neuroticism and low levels o
openness (Bronstein and Cercero, 2000)

OCPD
◦ extreme, maladaptive variant of conscientiousness
◦ tends to be low on compliance and altruistic facets o
agreeableness
◦ tendency to be oppositional and stingy
◦ Also low on some facets of openness to experience
(Widiger et al, 1994,2002)
Behavioral & Social Learning Model
 Presence of strong causal relationship between individual’s
experiences with parents and later capacity to make affectional
bonds
PD can be attributed to variations in this capacity
 Fearful style of attachment or attachment dimension ‘Anxiety
about Abandonment’ was found related to APD (Brennan &
Shaver, 1998)

APD- Engulfing or avoidant parenting behavior could lead to

ambivalence in desiring closeness yet fearing abandonment

DPD- Over protective parenting can lead to negative self- view like
feelings of inadequacy which makes them feel the need to have
excessive care. Pathological dependency due to mental
representations of self as weak and ineffectual

OCPD- imitation & modeling of rigid, controlling and obsessive

parents (Carr, 1974)
Cognitive-Behavioral Perspective
 Early life experiences, including family
routines and relationships, traumatic events,
formation of assumptions about the
world and in inter-personal relationships
automatic thoughts emotional
reactions and behavioral reactions

 Such rigid cognitive schemata develop over

time, each of which governs behavior and
reduces adaptability and responsiveness to
the environment
APD
– self: socially inept and incompetent
– others: potentially critical, uninterested and demeaning
– beliefs: the self as worthless and unlovable: ‘If people get close to
me, they will discover the real me and reject me – that would be
intolerable.’

DPD
– self: needy, weak, helpless and incompetent
– others: need a strong ‘caretaker’ in an idealized way; can function
well in their presence, but not without them
– beliefs: ‘I need other people – specifically a strong person – in order
to survive.’
Vicious cycle - each new challenge triggers a set of
cognitive responses that exacerbate the dependent
person’s feeling of helplessness.

OCPD
Maladaptive perfection schemas- “mistakes are
intolerable”, “I must be careful & thorough”
Stress Diathesis Model (Monroe &
Simons,1991)

 Non-reductionist and interactional theory

 Genes shape individual variability in
temperament and traits (diathesis)
 Traits become maladaptive only under certain

environmental conditions (stress)

 Interaction between the two is bidirectional
Cloninger’s Temperament and Character Model (1993)

Neurobiological Model
Provided with 7 factor model of personality divided in 2
domains
 4 Temperamental dimensions (automatic associative
responses to basic emotional stimuli)
 3 Character dimensions (self-aware concepts that
influence voluntary intensions and attitudes
 Each domain is defined by a mode of learning and
underlying neural systems that are involved in that
learning

Temperament Determinants
1. Novelty Seeking: Low novelty-seeking implies preference for
routine, order, details and social stability. Associated with
Dopamine
2. Persistence (Happiness Seeking):
Determination and tenacity to achieve a goal,
industrious, stable and resolute in the face of
frustration or fatigue. Associated with
Serotonin and Glutamate NS
3. Harm Avoidance: Intense response (fear,
timidity, pessimism) to aversive stimuli,
avoiding behaviors that may expose them to
punishment or loss. Associated with
Serotonin and GABA NS
4. Reward Dependence (Security-Seeking, Social
attachment, openess): Responds to rewards
of social approval or sympathy. Low reward
dependence implies introversion, self-
reliance and self-directedness. Associated
Character determinants

1. Self directedness- responsibility, purposefulness,

self acceptance. It is considered the major
determinant for the presence/absence of PD

2. Cooperativeness- empathy, compassion, helpfulness

3. Self transcendence- spirituality, idealism,

enlightenment

All PDs are found to be low on self directedness and

cooperativeness (Cloninger,1998)