Cluster C: Avoidant, Dependent, Obsessive-Compulsive

Question 1

Avoidant PD- DSM-IV

Answer 1

Social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, 4 or more of the following:

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

Question 2

Avoidant PD: Differentials

Answer 2

Social Phobia
Panic Disorder with Agoraphobia
Schizoid, Dependent

Question 3

Avoidant Prototype

Answer 3

High on self-protection, average on pleasure seeking
Active attempts to avoid rejection
Both self and other focused
Self image as alienated
Core beliefs focus on importance of social relationships, as well as their own inadequacies

Question 4

Treatment of Avoidant PD

Answer 4

Cognitive restructuring: view social interactions as less threatening, source of enjoyment
Social skill assessment and treatment
Improve emotion regulation skills 
May not be open/honest with therapist
May avoid therapy
Unwilling to do homework
Maintain support/encouragement
Pace therapy in order to prevent defensive reaction

Question 5

Dependent Personality Disorder- DSM_IV

Answer 5

excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, 5 or more:

1. difficulty making everyday decisions without an excessive amount of advice and reassurance from others
2. needs others to assume responsibility for most major areas of his/her life
3. Has difficulty expressing disagreement with other because of fear of loss of support or approval
4. has difficulty initiation projects/doing things on his/her own due to lack of self confidence
5. goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant
6. feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for oneself
7. urgently seeks another relationship as as source of care and support when a close relationship ends
8. is unrealistically preoccupied with fears of being left to take care of oneself

Question 6

Dependent PD: Differentials

Answer 6

Dependency as a result of Axis I or GMC
Borderline PD
Histrionic PD
Avoidant PD

Question 7

Dependent Prototype

Answer 7

Average in both pleasure seeking/pain avoidance
Passive/accommodating style
Stronger other focus; limited self-focus
Self-image as helpless, incompetent

Question 8

Treatment of Dependent PD

Answer 8

Increase ability to function independently
Seek pleasurable events outside of relationships
Increase confidence in competence
May be focused on affective relief vs. changing dependent style
Not prepared to work at therapy
May undermine therapy to maintain dependence
Slow pace
Don’t threaten current relationships
Attend tow hat client wants in a relationship- beyond being taken care of

Question 9

OCPD DSM-IV Criteria

Answer 9

Preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, must have 4 or more:

1. preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
2. shows perfectionism that interferes with task completion
3. is excessively devoted to work and productivity to the exclusion of leisure activities/friendships
4. is overconscientious, scrupulous, and inflexible about matters of morality, ethics or values
5. is unable to discard worn-out or worthless objects even when they have no sentimental value
6. is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
7. adopts miserly spending style towards self and others
8. shows rigidity and stubbornness

Question 10

Compulsive Prototype

Answer 10

Weak in pleasure seeking
Passive orientation
Strong other-orientation, weak self-orientation
Overburdened by responsibilities
Beliefs: I need rules to survive, any flaw will lead to catastrophe

Question 11

Treatment of Compulsive PD

Answer 11

Increase flexibility
Decrease perfectionist standards
Structure session, move on to modeling flexibility
Avoid confrontation, use reflection/Socratic questioning