Introduction

Cluster-C Personality Disorders, classified in the DSM-5 under the group of “anxious and fearful” personality patterns, are characterized by pervasive anxiety, chronic fearfulness, and maladaptive behaviors driven by insecurity, avoidance, or excessive need for control and reassurance. Individuals within this cluster typically struggle with feelings of inadequacy, dependency, or obsessive rigidity, which significantly interferes with interpersonal functioning, occupational roles, and overall emotional well-being.

Personality traits observed in Cluster-C disorders are consistent, enduring, and inflexible across contexts. They become maladaptive because they cause distress, limit adaptability, and impair relationships. Unlike temporary anxiety states, these patterns appear early in life, remain stable over time, and affect cognition, affectivity, interpersonal functioning, and impulse control—the core DSM-5 criteria for personality pathology.

Read More: Cluster B Personality Disorder

1. Avoidant Personality Disorder (AvPD)

Avoidant Personality Disorder is characterized by extreme social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Individuals desire social connection but avoid interactions due to overwhelming fear of criticism or embarrassment.

Avoidant Personality Disorder

Diagnostic Features

Some diagnostic features include:

1. 1. Extreme Sensitivity to Criticism: Even mild feedback feels deeply hurtful, causing withdrawal.
   2. Social Inhibition: They avoid social situations due to fear of embarrassment or judgment.
   3. Feelings of Inadequacy: They believe they are socially inept, inferior, or unappealing.
   4. Avoidance of Interpersonal Contact: They avoid friendships or intimacy to protect themselves from rejection.
   5. Restriction of Lifestyle: They avoid new activities fearing failure or humiliation.
   6. Low Self-Confidence: Persistent self-doubt influences personal and professional decisions.
   7. Desire for Relationship but Fear of Rejection: They want closeness but believe rejection is inevitable.

Causes and Risk Factors

Some causes include:

1. 1. Genetic Predisposition: Inherited temperaments such as shyness can evolve into AvPD.
   2. Childhood Rejection or Criticism: Harsh parenting reinforces beliefs of inadequacy.
   3. Emotional Abuse or Bullying: Peer rejection contributes to lifelong social fear.
   4. Overprotective Parenting: Children develop dependence, avoidance, and fear of failure.
   5. Cognitive Distortions: Negative beliefs like “I will be rejected” become core schemas.

Treatment

Some treatments include:

1. 1. Cognitive-Behavioral Therapy (CBT): Challenges distorted thoughts and gradually exposes the person to feared situations.
   2. Schema Therapy: Targets deep-rooted schemas involving shame, defectiveness, and fear of rejection.
   3. Psychodynamic Therapy: Explores early relational patterns that shaped feelings of inadequacy.
   4. Social Skills Training: Builds confidence in communication and interpersonal behavior.
   5. Medications (SSRIs/SNRIs): Reduces comorbid anxiety and depression.

2. Dependent Personality Disorder (DPD)

DPD involves excessive need to be cared for, leading to submissive, clinging behavior and intense fears of separation or abandonment. Individuals struggle to make decisions without extensive reassurance and rely heavily on others for emotional security.

Dependent Personality Disorder

Diagnostic Features

Some diagnostic features include:

1. 1. Difficulty Making Decisions: They rely on others for everyday choices due to fear of being wrong.
   2. Need for Others to Assume Responsibility: They depend on others to manage major areas of their lives.
   3. Difficulty Expressing Disagreement: Fear of losing support prevents them from challenging others.
   4. Difficulty Initiating Tasks: Low confidence inhibits independent activity.
   5. Excessive Need for Nurturance: They go to great lengths to obtain approval and support.
   6. Discomfort When Alone: Being alone triggers feelings of helplessness and fear.
   7. Urgent Search for Replacement Caregiver: They seek new relationships quickly when one ends.

Causes and Risk Factors

Some causes of this include:

1. 1. Genetic Temperament: Biological sensitivity and anxiety may predispose dependence.
   2. Overprotective or Authoritarian Parenting: Children learn to rely on others instead of developing autonomy.
   3. Childhood Illness or Insecurity: Early medical issues or instability increase reliance on caregivers.
   4. Cultural Reinforcement: Some cultures encourage submissiveness and compliance.
   5. Cognitive Distortions: Beliefs such as “I cannot survive alone” reinforce dependence.

Treatment 

Some treatments include:

1. 1. Cognitive-Behavioral Therapy (CBT): Enhances decision-making, assertiveness, and independence.
   2. Assertiveness Training: Helps the individual express needs and opinions confidently.
   3. Schema Therapy: Targets schemas of incompetence and fear of abandonment.
   4. Psychodynamic Therapy: Explores dependency patterns rooted in early caregiver relationships.
   5. Medications (if comorbid): Treats associated anxiety or depressive symptoms.

3. Obsessive-Compulsive Personality Disorder (OCPD)

OCPD involves excessive perfectionism, orderliness, and control, often at the expense of flexibility, efficiency, and interpersonal warmth. Unlike OCD, OCPD traits are ego-syntonic—they align with the person’s self-image.

Obsessive-Compulsive Personality Disorder (OCPD)

Diagnostic Features

Some diagnostic features include:

1. 1. Preoccupation with Rules and Order: They focus excessively on details at the cost of the bigger picture.
   2. Perfectionism Interfering With Task Completion: Fear of mistakes prevents them from finishing tasks.
   3. Excessive Devotion to Work: They neglect leisure and relationships for productivity.
   4. Inflexible Morality or Ethics: Rigid standards guide behavior with no room for compromise.
   5. Difficulty Discarding Items: They feel anxious about throwing things away, even without value.
   6. Reluctance to Delegate: They believe others will not meet their high standards.
   7. Stubbornness and Rigidity: They resist changes that challenge their sense of order and control.

Causes and Risk Factors

Some causes include:

1. 1. Genetic Factors: Temperaments involving rigidity and control may be inherited.
   2. Strict or Controlling Upbringing: Children develop perfectionism to gain approval.
   3. Fear of Mistakes: Perfectionism becomes a defense against criticism.
   4. Cultural Norms: Cultures valuing discipline may reinforce OCPD traits.
   5. Cognitive Schemas of Responsibility: Beliefs like “I must always be right” shape behavior.

Treatment

Some treatments include:

1. 1. Cognitive-Behavioral Therapy (CBT): Challenges rigid beliefs and reduces perfectionistic behaviors.
   2. Exposure and Response Prevention (ERP): Helps tolerate mistakes and uncertainty.
   3. Schema Therapy: Targets schemas of unrelenting standards and control.
   4. Interpersonal Therapy: Improves interpersonal flexibility and emotional expression.
   5. Medications: SSRIs may help reduce rigidity, anxiety, or irritability.

Conclusion

Cluster-C Personality Disorders represent enduring patterns of anxiety-driven behaviors centered on avoidance, dependence, or rigid perfectionism. While each disorder is distinct in motivation, all share difficulty coping with uncertainty, fear of disapproval, and maladaptive interpersonal patterns. With appropriate treatment—particularly CBT, schema therapy, and supportive psychodynamic approaches—individuals can develop autonomy, confidence, emotional balance, and healthier relationship patterns. Early recognition and intervention significantly improve long-term outcomes.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

Barlow, D. H., & Durand, V. M. (2005). Abnormal Psychology (4th ed.). Brooks/Cole.

Butcher, J. N., Hooley, J. M., & Mineka, S. (2014). Abnormal Psychology (15th ed.). Pearson.

Carson, R. C., Butcher, J. N., & Mineka, S. (2007). Abnormal Psychology (13th ed.). Pearson.

Nevid, J. S., Rathus, S. A., & Greene, B. (2014). Abnormal Psychology (9th ed.). Pearson.

Sarason, I. G., & Sarason, R. B. (2002). Abnormal Psychology (10th ed.). Pearson.

Sue, D., Sue, D. W., & Sue, S. (2006). Understanding Abnormal Behavior (8th ed.). Houghton Mifflin.