CLUSTER C

PERSONALITY DISORDERS
• Cluster C personality disorders are
characterized by anxious, fearful
thinking or behavior.
• They include avoidant personality
disorder, dependent personality
disorder and obsessive-compulsive
personality disorder.
• They are extremely anxious
about being criticized by
others and thus avoid
interactions in which there is
any possibility of being
criticized.
• They are terrified of saying something
silly or doing something that will
embarrass themselves.
• It occurs in 2% to 3% of the general
population
• Equally common in men and women
Etiology

Genetics or influence of environment

in which the child is taught to fear
situation or people who are harmful or
stranger.
Signs and Symptoms

• They are oversensitive and easily hurt by

criticism or disapproval.
• They have few, if any, close friends and are
reluctant to become involved with others
unless certain of being liked.
• They experience extreme anxiety (nervousness)
and fear in social settings and in relationships,
leading them to avoid activities or jobs that
involve being with others.
 Signs and Symptoms

• They tend to be shy, awkward, and self-conscious

in social situations due to a fear of doing
something wrong or being embarrassed.
• They tend to exaggerate potential problems.
• They seldom try anything new or take chances.
• They have a poor self-image, seeing themselves as
inadequate and inferior.
 DSM 5 Criteria for Avoidant Personality Disorder
301.82 (F60.6)
A pervasive pattern of social inhibition, feelings of inadequacy, and
hypersensitivity to negative evaluation, beginning by early adulthood and
present in a variety of contexts, as indicated by four (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.
DSM 5 Criteria for Avoidant Personality Disorder
301.82 (F60.6)
4. Is preoccupied with being criticized or rejected 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 unusually reluctant to take personal risks or to engage
in any new activities because they may prove
embarrassing.
Pharmacotherapy & Pharmacodynamics
Effective drug therapy includes:
Selective Serotonin Reuptake Inhibitors (SSRIs)
paroxetine (Paxil)
sertraline (Zoloft
venlafaxine (Effexor)
Benzodiazepines
Monoamine oxidase inhibitors (MAOIs)
Anticonvulsants (Gabapentin)
 For SSRIs

1.) Paroxetine (Paxil)

- used to treat depression, panic attacks, obsessive-compulsive
disorder (OCD), anxiety disorders, and post-traumatic stress
disorder.
- It works by helping to restore the balance of a certain natural
substance (serotonin) in the brain.

Common side effects

Nausea, drowsiness, dizziness, trouble sleeping, loss of appetite, weakness, 
dry mouth, sweating, blurred vision, and yawning may occur.
Rare/ serious Side effects
 rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, 
trouble breathing.
2.) Sertraline (zoloft)
- an antidepressant medication that works in the brain. It
works by helping to restore the balance of a certain natural
substance (serotonin) in the brain.

Common side effects

Headache, nausea, diarrhea, dry mouth, nervousness, restless, fatigued etc.

Rare/serious side effects

Low sodium blood levels

Teeth grinding, angle closure glaucoma
Serotonin syndrome
3.) Venlafaxine (Effexor)
4.) Benzodiazepines
- enhancethe action of the neurotransmitter gamma-aminobutyric acid
(GABA), which slows down the central nervous system. This produces the
calming, sedative effect that helps with anxiety.
Common Side Effects
• Drowsiness
• Confusion or difficulty concentrating
• Vertigo, feeling light-headed
• Extra sensitivity to alcohol
• Muscle weakness or slow movement
• Trouble remembering while you were under the influence of benzodiazepines
• Blurred vision
• Dry mouth
Monoamine oxidase inhibitors
 (MAOIs)
MAOIs work with the chemicals in your
brain called neurotransmitters that allow
brain cells to communicate with each
other.
Anticonvulsants (Gabapentin)
-  treats seizures by decreasing
abnormal excitement in the brain.
Gabapentin relieves the pain of PHN by
changing the way the body senses pain. It is
not known exactly how gabapentin works to
treat restless legs syndrome.
Therapy for AVPD

• Cognitive-behavioral therapy
• Supportive psychotherapy
• Psychodynamic psychotherapy
Nursing Responsibilities
Provide support and reassurance to the client.
In the nonthreatening context of the relationship,
the nurse should help them explore positive self-
aspects, positive responses from others, and
possible reasons for self-criticism.
Help clients practice self-affirmations and
positive self-talk.
Perform cognitive restructuring techniques such
as reframing and decatastrophizing.
Teach the client about social skills.
• Their desire to be loved and taken
care by others leads persons with DPD
to deny any of their own thoughts and
feelings that might displease others,
to submit to even the most
unreasonable demands, and to cling
frantically to others.
• People with DPD have beliefs such as “
I am needy and weak,” that drive their
dependent behaviors.
• Occurs 3x more common in females
than males.
 Etiology

• Genetic, overprotective and authoritarian

parenting style that prevent the
development of feeling of self-efficiency.
• Attachment problem: child’s separation from
adult leads to anger and stress and feel
secure in the presence of figure of security,
failed in this process lead to this disorders.
Signs and Symptoms

• Avoidance of personal responsibility

• Difficulty being alone
• Fear of abandonment and a sense of
helplessness when relationships end
• Oversensitivity to criticism
• Pessimism and lack of self-confidence
• Trouble making everyday decisions.
DSM 5 Criteria for Dependent Personality Disorder
301.6 (F60.7)
A pervasive and excessive need to be taken care of that leads to submissive
and clinging behavior and fears of separation, beginning by early adulthood
and present in a variety of contexts, as indicated by five (or more) of the
following:

1. Has 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 or her life.
3. Has difficulty expressing disagreement with others
because of fear of loss of support or approval. (Note: Do
not include realistic fears of retribution.)
4. Has difficulty initiating projects or doing things on his
or her own (because of a lack of self-confidence in
judgment or abilities rather than a lack of motivation or
energy).
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 himself or herself.
7. Urgently seeks another relationship as a source
of care and support when a close relationship
ends.
8. Is unrealistically preoccupied with fears of
being left to take care of himself or herself.
Pharmacotherapy & Pharmacodynamics
No medication will cure dependent personality disorder, but
some medications may be helpful in addressing the
condition’s underlying symptoms.
Medications:

Antidepressants- may be able to improve the thought process of

the individual and may lead to more positive thinking. While
these medications may lessen negative thinking, they do not
always eliminate it entirely.
Zoloft
Paxil
Celexa
Sedatives- are a common medication used for sleep
disorders as well as multiple categories of anxiety.
benzodiazepines
Barbiturates

Tranquilizers - these medications create a calm

nervous system while removing both physical and
psychological effects of fear or anxiety
Valium
Librium
Xanax
 Therapy Options for Dependent
Personality Disorder
Psychotherapy
-Psychotherapy is the leading form of treatment for
people with dependent personality disorder.

Cognitive Behavioral Therapy

 -a form of talk therapy that focuses on how a
person thinks and behaves.
CBT strategies and skills can include:

• Identifying current life situations that cause

distress
• Identifying and facing fears rather than
avoiding them
• Using relaxation techniques to calm body and
mind
Identifying and restructuring distorted thinking
Nursing Responsibilities
The nurse must help clients express feelings of
grief and loss over the end of a relationship
while fostering autonomy and self-reliance.
Help clients identify their strengths and
needs.
Perform cognitive restructuring techniques
such as reframing and decatastrophizing.
Assist clients in daily functioning if they have
little or no past success in this area.
 The nurse may also need to teach problem-
solving and decision-making and help clients
apply them to daily life.
 The nurse must refrain from giving advice
about problems or making decisions for clients.
 The nurse can also help the client explore
problems, serve as a sounding board for
discussion of alternatives, and provide support
and positive feedback for the client’s efforts in
these areas.
Reassurance required
Expressing disagreement difficult
Life Responsibilities
Initiating project difficult
Alone
Nurturance
Companionship sought urgently
Exaggerated fears of being left to care for self
• Self-control, attention to detail,
perseverance, and reliability are
highly valued in many societies but
some people carry these traits rigid,
perfectionistic, dogmatic, ruminative,
and emotionally blocked.
• Time is poorly managed and leave most
important task to last moment, deadline is
missed.
• Flaws, defects, or mistakes are intolerable.
• It occurs in about 2% to 8% of the
population, affecting twice as many men as
women.
Etiology

• Genetics
• Freud: fixation at anal stage (2-4
years) and fear loss of control which
is handled by overcompensation
• Ericson theory: autonomy versus
shame
Signs and Symptoms
• Perfectionism to the point that it
impairs the ability to finish tasks
• Stiff, formal, rigid mannerism
• Extreme attention to detail
• An overwhelming need to be punctual
• Excessive devotion to work
• Overwhelming need for order
• Rigid adherence to rules and regulations
Signs and Symptoms

• A sense of righteousness about the way

things should be done
• A rigid adherence to moral and ethical
codes
 DSM 5 Criteria for Obsessive-Compulsive
Personality Disorder 301.4 (F60.5)

A pervasive pattern of preoccupation with orderliness,

perfectionism, and mental and interpersonal control, at the expense
of flexibility, openness, and efficiency, beginning by early adulthood
and present in a variety of contexts, as indicated by four (or more) of
the following:

1. Is preoccupied with details, rules, lists, order, organization, or

schedules to the extent that the major point of the activity is lost.
 DSM 5 Criteria for Obsessive-Compulsive
Personality Disorder (Cont.)

2. Shows perfectionism that interferes with task completion (e.g., is

unable to complete a project because his or her own overly strict
standards are not met).
3. Is excessively devoted to work and productivity to the exclusion
of leisure activities and friendships (not accounted for by obvious
economic necessity).
4. Is over conscientious, scrupulous, and inflexible about matters of
morality, ethics, or values (not accounted for by cultural or religious
identification).
 DSM 5 Criteria for Obsessive-Compulsive
Personality Disorder (Cont.)

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 a miserly spending style toward both self and others;
money is viewed as something to be hoarded for future
catastrophes.
8. Shows rigidity and stubbornness.
Pharmacotherapy & Pharmacodynamics
 Optimal treatment for OCD combines
medication and Behavioral Therapy.

Medications

a.) SSRI Antidepressants b.) Second Generation

• Fluvoxamine (Luvox) Antipsychotics:
• Sertraline (Zoloft) • Risperidone (Risperdal)
• Venlafaxine (Effexor) • Quetiapine ( Seroquel)
• Olanzapine (Zyprexa)
OBSESSIVE COMPULSIVE DISORDER

fluvoxamine (luvox)
- is an antidepressant medication that works in
the brain.
- It is approved for the treatment of obsessive
compulsive disorder (OCD) in adults and children
ages 8 and older.
- And It works by increasing the amount of
serotonin, a natural substance in the brain that
helps maintain mental balance.
Common side effects Rare/serious side
effects
• Headache
• Nausea • Low sodium blood
• Diarrhea levels
• dry mouth • Teeth grinding,
• Dizziness angle closure
• increased sweating glaucoma
• feeling nervous • Serotonin syndrome
• Restless
• fatigued or having trouble sleeping (insomnia)
Sertraline (zoloft)
- is an antidepressant medication that works in the
brain.

Common side effects

Headache, nausea, diarrhea, dry mouth, increased

sweating, Feeling nervous, restless, fatigued, sleepy or
having trouble sleeping (insomnia)These will often
improve over the first week or two as you continue to
take the medication.
Venlafaxine (effexor)
- It works by helping to restore the balance of
certain natural substances (serotonin and
norepinephrine) in the brain.

Common side effects

- Same with Sertraline

Second generation antipsychotics:

1.) Risperidone (risperdal)

- It works by altering the levels of
dopamine and serotonin in the brain. And
helps balance the chemicals in the brain
and decreases psychotic and aggressive
behavior.
 Common side effects

• feeling sleepy in the day or difficulty falling asleep

at night
• problems with your movement – difficulty moving,
stiff muscles with movements which are difficult to
control, a slow shuffling walk, shakes and drooling
– this is known as dyskinesia. headaches. putting
on weight or changes in appetite.
 2.) Quetiapine ( Seroquel)
- works by blocking the receptors in the brain that
dopamine acts on.
Common side effects
- dizziness, feeling unsteady, pain in the joints, back, neck, or ears
- weakness
-dry mouth- vomiting- indigestion
-Constipation
-Gas
-stomach pain or swelling
- increased appetite
-excessive weight gain
 3. Olanzapine (Zyprexa)
- works by affecting naturally occurring chemical messengers
in your brain (neurotransmitters), like dopamine.

Common side effects

- difficulty falling asleep or staying asleep, weakness,
difficulty walking, constipation, weight gain, dry
mouth, pain in arms, legs, back, or joints, breast
enlargement or discharge,
Cognitive Behavioral Therapy(CBT)

- it is a type of treatment that helps

individuals cope with and change problematic
thoughts, behaviors, and emotions. The
treatment you are beginning is a specialized
type of cognitive-behavior therapy for
obsessive-compulsive disorder (OCD)
called Exposure and Response Prevention.
Exposure- involves assisting the client in
deliberately confronting the situations and
stimuli that he or she usually avoids.

Response Prevention- focuses on delaying

or avoiding performance of rituals.
Nursing Responsibilities
Help clients view decision-making and completion
of projects from a different perspective.
Help clients accept or tolerate less-than perfect
work or decisions made on time.
Perform cognitive restructuring techniques such
as reframing and decatastrophizing.
Encourage clients to take risks.
Teach the client to practice negotiation with
family or friends.
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