Cluster C – Hibernator's Library

As mentioned in my opening post about personality disorders, personality disorders are split into three clusters -A, B, and C. This post will discuss cluster C. People with these disorders tend to be anxious and fearful.

Avoidant Personality Disorder is characterized by extreme social inhibition and introversion, which lead to few friends and a tendency to avoid social interactions. Unlike schizoid personalities, people with avoidant personality disorder want to have friends, but they are too afraid of rejection to attempt social interaction. They do not enjoy being alone, and are often bored. They generally have low self-esteem and high self-consciousness.

In order to be diagnosed with avoidant personality disorder, the individual must have four or more of the following characteristics, which create clinically significant problems in functioning: 1) avoids occupations that involve interpersonal contact; 2) unwilling to get involved with people unless certain of being liked; 3) shows restraint within intimate relationships for fear of being shamed or ridiculed; 4) preoccupied with criticism and rejection; 5) inhibited in new interpersonal situations; 6) views self as socially inept, unappealing, and inferior; 7) does not take personal risks or engage in new activities for fear of embarrassment.

Dependent personality disorder is characterized by extreme need to be taken care of. They tend to find one person to cling to, and they ask that person for advice on everyday decisions. They are terrified of separation from the person they are dependent upon. They sacrifice their own needs in order to please their chosen person, and often agree to do unpleasant things. They often remain in physically and emotionally abusive relationships. When their relationship is broken off, they desperately seek another person immediately, and often choose an inappropriate partner because of their fear that they are unable to take care of themselves.

In order to be diagnosed with dependent personality disorder, the individual must have five or more of the following traits, leading to clinically significant impairment of function: 1) difficulty making everyday decisions without excessive advice; 2) needs others to assume responsibility for most major areas of life; 3) has difficulty disagreeing with others; 4) has difficulty initiating projects or of doing things alone; 5) goes to excessive lengths to obtain nurturance and support of others; 6) feels uncomfortable or helpless when alone; 7) urgently seeks another relationship when his source of care is broken off; 8) is terrified of being left alone to take care of himself.

I met someone like this at a party once. He asked the entire group if anyone wanted to go wine tasting with a “bunch” of friends the next weekend, and I agreed. Within a day, he was asking me what to wear, how much money he should bring, and how early I thought we should be. He also told me that his wife had made him convert to Lutheran, and he felt extreme guilt over his conversion and wanted to be Catholic again – but he felt uncomfortable going to Mass alone. I naively volunteered to go to Mass with him a few times until he got used to the new church. “A few times” ended up to be every week. He began depending on me for every small decision in his life. Wanted to be around me every day. Said that he couldn’t eat alone and couldn’t exercise alone, so: could I come over and do those things with him? I was unemployed at the time (lots of time) and have an overly agreeable personality, so I got stuck helping him out way too much. I kept telling him I wasn’t interested in an intimate relationship, but he seemed not to understand this concept. (That may have been my fault for helping him out so much.)

Finally, I got sick of him and said that I couldn’t spend that much time helping him. He needed to learn to be independent. I even suggested that he had dependent personality disorder and ought to seek help. That was mean, perhaps, but I was annoyed. It was a sign of his dysfunctional inability to disagree that he agreed I was right: he must have dependent personality disorder.

Anyway, dependent personality disorder is one of the disorders that will be dropped if diagnosis switches over to the dimensional rather than cluster approach. Which I think is unfortunate since I’ve met someone who clearly has those features.

People with obsessive-compulsive personality disorder are the type of people that Freud would call “anally retentive.” They have an incredible need for symmetry, order, and perfection. They have specific rules and schedules and get very upset when those rules and schedules are broken by themselves or others. They tend to be dysfunctional because they are so obsessed with perfectionism that they aren’t able to finish projects. Unlike people with obsessive-compulsive disorder, they do not have true compulsive rituals like excessively washing hands.

In order to be diagnosed with obsessive-compulsive personality disorder, an individual must have at least four of the following traits, which cause clinically significant impairment of function: 1) preoccupation with details, rules, lists, order, organization, or schedules; 2) perfectionism that interferes with task completion; 3) excessively devoted to work and productivity to the exclusion of leisure activities; 4) overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values; 5) unable to discard worn-out or worthless objects even when they have no sentimental value; 6) reluctant to delegate tasks or to work with others unless they follow his instructions perfectly; 7) has miserly spending style towards self or others; 8) shows rigidity and stubbornness.

What do you know? I know someone like this, too! But I won’t discuss him on my blog. 🙂 Some of my readers know who he is, though.

This is a series of posts summarizing what I’m learning in my Abnormal Psychology course. Much of the information provided comes from reading my James N. Butcher’s textbook Abnormal Psychology. To read the other posts, follow these links:

The Definition of Abnormal
A History of Abnormal Psychology
Abnormal Psychology in Contemporary Society
Contemporary Viewpoints on Treating Mental Illness – Biology
Contemporary Viewpoints on Treating Mental Illness – Psychology
Frontline: New Asylums
Brave New Films: This is Crazy
Clinical Mental Health Diagnosis: Biological Assessment
Clinical Mental Health Diagnosis: Psychological Assessment
Does the DSM Encourage Overmedication?
Post Traumatic Stress Syndrome – The Basics
Panic Disorder
Obsessive Compulsive Disorder
Hoarding and Body Dysmorphic Disorders
Depression – an Overview
Personality Disorders – Clusters and Dimensions
Personality Disorders – Cluster A
Personality Disorders – Cluster B
Personality Disorders – Cluster C
Biological Effects of Stress on Your Body
Somatic Symptom and Related Disorders
Dissociative Disorders
Borderline Personality Disorder
Dialectical Behavioral Therapy
Paraphilic Disorders
Gender Dysphoria – Homosexuality and Transgender
Anxiety Disorders
Bipolar Disorder – The Basics

Suicide – An Overview

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 10: Personality Disorders. Abnormal Psychology, sixteenth edition (pp. 328-366). Pearson Education Inc.

Personality disorders are a difficult topic for me. For one thing, they are highly stigmatized. And I think the term “personality disorder” encourages that stigma by suggesting that there is something terribly wrong with a person’s identity, rather than implying that people with these disorders respond to the world in a highly ineffective manner that creates problems for themselves and others. In fact, Butcher describes “personality disorder” in his textbook Abnormal Psychology as: characterized by “chronic interpersonal difficulties and problems with one’s identity or sense of self.” This description is good as long as we accept that the “problem with one’s identity” is that one’s self-esteem and view of one’s relationships with others is unstable.

Everybody exhibits some dysfunctional beliefs and behaviors, but they should not be diagnosed with a personality disorder unless the behavior is pervasive and inflexible, and causes “clinically significant” distress or impairment in functioning. People with personality disorders generally cause just as many problems for others as they do in their own lives. Most do not recognize the dysfunction in their own thoughts or behaviors; therefore, it is often friends, family, or the law that force people with personality disorders to seek treatment.

Personality disorders are grouped into three clusters:

Cluster A includes paranoid, schizoid, and schizotypal personality disorders. People with cluster A disorders tend to be suspicious, paranoid, and/or withdrawn.

Cluster B includes histrionic, narcissistic, antisocial, and borderline personality disorders. People with these disorders have a tendency towards drama, emotionality, and erratic behavior.

Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders. These people tend to experience anxiety and fear.

Most personality disorders are not caused by a few traumatic events, but by a build-up of many stressors throughout life – like childhood abuse, neglect, or criminal behavior in parents. A child’s natural temperament may also have a strong impact on the development of a personality disorder later in life.

Compared to the other mental illnesses, there is little research on personality disorders. This is because people with personality disorders often do not feel there is anything wrong with themselves, or if they realize there is something wrong, they have less-than-helpful personality characteristics (such as lack of empathy or withdrawn social interaction). Another difficulty in studying people with personality disorders is the large amount of misdiagnosing that occurs. The criteria for diagnosis are more influenced by a clinician’s judgement than are the criteria for other mental illnesses.

Due to these difficulties in diagnosis of personality disorders, much work has been done in developing dimensional systems as an alternative to the cluster model. A dimensional model would rate a person on a set of personality traits, thus providing an overall behavioral pattern. Such an analysis would theoretically be more empirical than the cluster model. Such changes were proposed for the DSM-5, but they were deemed too complex for rushed clinicians and were shunted off into the “Emerging Measures and Models” section.

One popular dimensional approach is the five-factor model. According to proponents of the Big Five, everyone’s personalities can be defined by our strengths and weaknesses in five traits: neuroticism, openness to experience, extraversion, agreeableness, and conscientiousness. Each of these traits are further separated into sub-traits.

Neuroticism: anxiety, anger/hostility, depression, self-consciousness, impulsiveness, and vulnerability.

Extraversion: warmth, assertiveness, gregariousness, activity, excitement seeking, and positive emotions.

Openness to experience: fantasy, aesthetics, feelings, actions, ideas, and values.

Agreeableness: trust, straightforwardness, altruism, compliance, modesty, and tender mindedness.

Conscientiousness: competence, order, dutifulness, achievement striving, self-discipline, and deliberation.

Using this model, when a patient comes in for analysis, she would be rated high or low for each of the factors. The overall pattern (combined with knowledge of whether the individual experiences clinically significant distress) can be used to diagnose a personality disorder. Using the five-factor model, only six of the personality disorders would remain: borderline, antisocial, schizotypal, narcissistic, obsessive-compulsive, and avoidant. The others (paranoid, schizoid, histrionic, and dependent personality disorders) would be dropped.

Hopefully much research will go into developing a more empirical approach to diagnosis of personality disorders, for I feel that patients would benefit greatly from treatments that target specific dysfunctional traits instead of a generalized “personality disorder.”

If you’re interested, there are quite a few Big Five tests on the internet. I just took the Truity test. If you take it, you don’t have to create an account. There’s a “skip” option. My scores were:

Open to experience: 80%

Conscientiousness: 85%

Extraversion: 57.5%

Agreeableness: 92.5%

Neuroticism: 52.5%

Apparently, a score of 50% is considered “average person.” This test was fun and gives you an idea of what types of questions might be asked with a dimensional approach to diagnosis; however, it was certainly too short and silly to accurately diagnose a personality disorder. I’m surprised I didn’t get a higher score on neuroticism because of my bipolar disorder. Hopefully the test developed by clinical psychologists is much more extensive and precise. 🙂

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 10: Personality Disorders. Abnormal Psychology, sixteenth edition (pp. 328-366). Pearson Education Inc.