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