Cluster C Anxious and Fearful Personality Disorders

Histrionic Personaiity Disorder (HPD). HPD has also received remarkably little study, but we can perhaps extrapolate from our experiences with BPD. HPD shares with BPD the target symptom of mood instability. Although medications seldom play a significant role in the treatment of HPD, SSRIs/SNRIs may provide some benefit in alleviating depression as well as in reducing affective lability. 

Narcissistic Personaiity Disorder (NPD). Medications have not been studied to any extent in the treatment of NPD. In our experience, antidepressants are often used to treat these patients, but more so for the common comorbid depression than for the personality disorder itself. It is not clear to what extent, if any, medications may be helpful in treating the target symptoms of NPD itself. 

The so-called anxious disorders of Cluster C include avoidant personality disorder (APD), dependent personality disorder (DPD), and obsessive-compulsive personality disorder (OCPD). Like the Cluster A disorders, these personality disorders are typically unobtrusive and may escape clinical detection for many years. Over time, patients adapt their life styles to these illnesses by decreasing their social contacts in an effort to minimize anxiety. In so doing, they further decrease the likelihood of encountering mental health professionals. 

DPD patients also have extreme difficulty making decisions. They do not trust themselves to make the right decision, but unlike the OCPD patient who does not trust anyone else s judgment, the dependent patient will gladly hand over decisionmaking to others. The defining characteristic of the dependent personality is an exaggerated need to be cared for such that patients develop an intense fear of abandonment. They allow others to make decisions for them and take responsibility for their lives. 

Like the other personality disorders. Cluster C disorders occur at a rate of about 1-2% in the general population. APD appears to be evenly distributed between men and women. DPD is somewhat more common in women, but OCPD is slightly more common in men. 

---