Making Sense of Cluster C Personality Disorders

The Diagnostic and Statistical Manual of Mental Disorders, DSM-5, identifies 10 unique personality disorders, each belonging to one of three groups known as "clusters." Cluster A contains paranoid, schizoid, and schizotypal disorders. In cluster B, one will find borderline, narcissistic, histrionic, and antisocial disorders. In cluster C, discussed below, the DSM outlines diagnostic criteria for avoidant, dependent, and obsessive-compulsive personality disorders.

1. Avoidant Personality Disorder

Avoidant personality disorder is characterized by feelings of extreme social inhibition, inadequacy, and sensitivity to negative criticism and rejection. Yet the symptoms involve more than simply being shy or socially awkward. Avoidant personality disorder causes significant problems that affect the ability to interact with others and maintain relationships in day-to-day life. About 1% of the general population has avoidant personality disorder.

Symptoms:

• Avoiding work, social, or school activities for fear of criticism or rejection. It may feel as if you are frequently unwelcome in social situations, even when that is not the case. This is because people with avoidant personality disorder have a low threshold for criticism and often imagine themselves to be inferior to others.
• Low self-esteem
• Self-isolation

When in social situations, a person with avoidant personality disorder may be afraid to speak up for fear of saying the wrong thing, blushing, stammering, or otherwise getting embarrassed. You may also spend a great deal of time anxiously studying those around you for signs of approval or rejection.

A person who has an avoidant personality disorder is aware of being uncomfortable in social situations and often feels socially inept. Despite this self-awareness, comments by others about your shyness or nervousness in social settings may feel like criticism or rejection. This is especially true if you are teased, even in a good-natured way, about your avoidance of social situations.

Social Impact of Avoidant Personality Disorder

Avoidant personality disorder causes a fear of rejection that often makes it difficult to connect with other people. You may be hesitant to seek out friendships unless you are certain that the other person will like you. When you are involved in a relationship, you may be afraid to share personal information or talk about your feelings. This can make it difficult to maintain intimate relationships or close friendships.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person diagnosed with avoidant personality disorder needs to show at least four of the following criteria:

• Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection.
• Is unwilling to get involved with people unless they are certain of being liked.
• Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
• Is preoccupied with being criticized or rejected in social situations.
• Is inhibited in new interpersonal situations because of feelings of inadequacy.
• Views self as socially inept, personally unappealing, or inferior to others.
• Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

Avoidant behavior may commonly be seen in children or adolescents, but a diagnosis of a personality disorder cannot be made in childhood because shyness, fear of strangers, social awkwardness, or being sensitive to criticism are often a normal part of child and adolescent development.

2. Dependent Personality Disorder

Dependent personality disorder (DPD) is one of the most frequently diagnosed personality disorders. It occurs equally in men and women, usually in early to middle adulthood.

Symptoms: People with dependent personality disorder become emotionally dependent on other people and spend great effort trying to please others. People with DPD tend to display needy, passive, and clinging behavior, and have a fear of separation. Other common characteristics of this personality disorder include:

• Inability to make decisions, even everyday decisions like what to wear, without the advice and reassurance of others.
• Avoidance of adult responsibilities by acting passive and helpless. Dependence on a spouse or friend to make decisions like where to work and live.
• Intense fear of abandonment and a sense of devastation or helplessness when relationships end. A person with DPD often moves right into another relationship when one ends.
• Oversensitivity to criticism.
• Pessimism and lack of self-confidence, including a belief that they are unable to care for themselves.
• Avoidance of disagreeing with others for fear of losing support or approval.
• Inability to start projects due to lack of self-confidence.
• Difficulty being alone.
• Willingness to tolerate mistreatment and abuse from others.
• Placing the needs of the caregivers above others.
• Tendency to be naive and to fantasize.

What Causes Dependent Personality Disorder?

Although the exact cause of DPD is not known, it likely involves both biological and developmental factors. Some researchers believe an authoritarian or overprotective parenting style can lead to the development of dependent personality traits in people who are susceptible to the disorder.

How Is Dependent Personality Disorder Diagnosed?

A diagnosis of dependent personality disorder must be distinguished from borderline personality disorder, as the two share common symptoms. In borderline personality disorder, the person responds to fears of abandonment with feelings of rage and emptiness. With dependent personality disorder, the person responds to the fear with submissiveness and seeks another relationship to maintain his or her dependency.

What Are the Complications of Dependent Personality Disorder?

People with DPD are at risk for depression, anxiety disorders, and phobias, as well as substance abuse. They are also at risk of being abused because they are willing to do anything to maintain their relationships with a dominant partner or person of authority.

3. Obsessive-Compulsive Personality Disorder

Obsessive-compulsive personality disorder (OCPD) is a mental health condition in which a person is preoccupied with rules, orderliness, and control.

Causes: OCPD tends to occur in families, so genes may be involved. A person's childhood and environment may also play roles. This disorder can affect both men and women. It most often occurs in men.

Symptoms: OCPD has some of the same symptoms as obsessive-compulsive disorder (OCD). But people with OCD have unwanted thoughts, while people with OCPD believe that their thoughts are correct. In addition, OCD often begins in childhood while OCPD usually starts in the teen years or early 20s.

People with either OCPD or OCD are high achievers and feel a sense of urgency about their actions. They may become very upset if other people interfere with their rigid routines. They may not be able to express their anger directly. People with OCPD have feelings that they consider more appropriate, like anxiety or frustration.

A person with OCPD has symptoms of perfectionism that usually begin by early adulthood. This perfectionism may interfere with the person's ability to complete tasks, because their standards are so rigid. They may withdraw emotionally when they are not able to control a situation. This can interfere with their ability to solve problems and form close relationships.

Other Signs of OCPD Include:

• Over-devotion to work
• Not being able to throw things away, even when the objects have no value
• Lack of flexibility
• Lack of generosity
• Not wanting to allow other people to do things
• Not willing to show affection
• Preoccupation with details, rules, and lists

Exams and Tests: OCPD is diagnosed based on a psychological evaluation that assesses the history and severity of the symptoms.

Treatment: Medicines may help reduce anxiety and depression from OCPD. Talk therapy is thought to be the most effective treatment for OCPD. In some cases, combining medicines with talk therapy is more effective than either treatment alone.

When to Contact a Medical Professional

See your health care provider or mental health professional if you or someone you know has symptoms of any of these personality disorders. To find a therapist, please visit the Psychology Today Therapy Directory.

©2021 Kevin Bennett Ph.D. All rights reserved.

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