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Avoidant personality d/o Pervasive pattern o social inhibition, feeling inadequacy & hypersensitivity to ve evaluation, beginning by early adulthood

& present in variety of contexts, as indicated by 4 of following : 1. Avoid occupationl actvt that involve significant interpersonal contact, bcoz fears o criticism, disapproval or rejection 2. Is unwilling to get involved w ppl unless certain of being liked 3. Shows restraint w/in intimate r/ship bcoz of d fear o being shamed or ridiculed 4. Is preoccupied w being criticized or rejected in social situations 5. Is being inhibited in new interpersonal situations bcoz of feeling inadequacy 6. View self as socially inept, personally unappealing, or inferior to others 7. Is unusually reluctant to take personal risks or to engage in any new actvt bcoz they may prove embarrasing

DSM PERSONALITY D/O CLUSTER C Dependent personality d/o Obsessive-compulsive personality d/o Personalty d/o NOS A pervasive & excessive need to be taken A pervasive pattern of preoccupation with Refer to personality d/o that do not care of that leads to submissive & clinging orderliness, perfectionism & mental & meet criteria for any specific behavior & fear of separation, beginning interpersonal control, at d expense of personality d/o by early adulthood & present in variety of flexibility, opens, & efficiency, beginning by contexts, as indicated by 5 of following : early adulthood & present in a variety of 1. Has difficulty in making everyday contexts, as indicated by 4 of following : decisions w/out excessive amount of 1. Is preoccupied with details, rules, lists, advice & reassurance from others order, organization, or schedules to d extent 2. Needs others to assume responsibility that major point of actvt is lost for most major areas of his/her life 2. Shows perfectionism that interfere with task 3. Has difficulty expressing disagreement completion (e:g is unable to complete a with others bcoz of fear of loss support project bcoz his/her own overly strict or approval note: do not include realistic standards r not met) fear of retribution 3. Is excessively devoted to work & 4. Has difficulty initiating projects or doing productivity to d exclusion of leisure actvt & things on his/her own (bcoz of lack of friendship (not accounted for by obvious self confidence in judgement or abilities economic necessity) rather than a lack of motivation or 4. Is overconscientious, scrupulous, & energy) inflexible about matters of morality, ethics, or 5. Goes to excessive lengths to obtain values (not accounted for by cultural or nurturance & support from others, to d religious identification) point of volunteering to do things that r 5. Is unable to discard worn-out or worthless unpleasant objects even when they have no sentimental 6. Feels uncomfortable or helpls when values alone bcoz of exaggerated fears of 6. Is reluctant to delegate tasks or to work being unable to care for him/herself with others unless they submit to exactly 7. Urgently seeks another r/ship as a his/her way of doing things source of care & support when a close 7. Adopts a miserly spending style toward r/ship ends both self & others ; money is viewed as 8. Is unrealistically preoccupied with fears something to be hoarded for future of being left to take care of him/herself catastrophes 8. Shows rigidity & stubborns

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Personality disorder : Cluster C


Avoidant PD Dependent PD Show extreme sensitivity to rejection & may Px subordinate their own needs to those of others, get others lead to socially withdrawn life to assume responsibilities for major areas of their lives, lack self-confidence & may experience intense discomfort when Not asocial, show great desire of being alone companion but need unusually strong Aka passive-dependent personality gurantees of uncritical acceptance May hv inferiority complex Freud oral-dependent personality dimension : Dependence Passivity Pessimism Suggestibility Fear of sexuality Lack of perseverance Self-doubt Epidemiology 1%-10% of general population > Young children > older Dx In interview px appear compliant, try to cooperate, welcome Anxiety when talking to interviewer Nervous & tense manner appears to wax & specific question, look for guidance wane with their perception of whether interviewer likes them O-C PD Essential features : pervasive pattern of perfectionism & inflexibility Characterized by Emotional Orderlinens constriction Indecisivens Perseverance Stubborns Freud hypothesis these d/o a/w difficulties in anal stage of psychosexual dvlpmnt, generally around age of 2

CF

Central CF hypersensitivity to rejection by others When talking to someone express uncertainty, lack of self confidence, speak in self-effacing manner Afraid to speak up in public or make a request Apt to misinterpret other persons comment as derogatory or ridiculing

> > in 1st degree biological relatives of px with d/o In interview stiff. Formal, rigid demeanor Constricted affect Lack spontaneity Answer question w unsually detailed Defense mech ; Rationalization Intelectulization Isolation Rx 4mation Pervasive pattern of dependent & submissive behavior Preoccupied with Px cannot make decision w/out xs amount of advice & Rules Neatns reassurance from other Regulation Detail Avoid position of responsibility & anxious if asked to be a orderlinens Achievement of leader perfection Prefer submissive Lack flexibility & intolerant When on their own, difficult to perform task easier to Capable of prolong work perform task for other ppl Limited interpersonal skills few friends In folie a deux (shared psychotic d/o) : Formal, serious, lack or sense of humour 1 dependent PD + 1 submissive Fear of making mistake indecisive & ruminate about making decision OCD Symptoms r ego-dystonic OC-PD Symptoms r ego-syntonic

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Ddx

Course & prognosis

Tx

Dependent PD hv greater fear of being abandoned n unloved but clinical pict both may be indistinguishable Schizoid PD want to be alone BUT avoidant PD desire social interaction Borderline & Histrionic PD demanding, unpredictable & irritable Able to fx in protected environment Usually surrounded ONLY by family mmbr Easily fall into depression, anxiety & anger if support system fail Psychotherapy Solidifying an alliance w px Encourage px to face d world xpesially risk of humiliation, rejection & failure Group therapy Assertive training Pharmacotherapy Tx comorbid anxiolytic & anTdprssnt -blocker mx autonomic nervous syst hyperactvt serotonergic agent help rejection sensitivity

Delusional d/o coexist w personality d/o Can occur in px w agoraphobia Dependence is a prominent factor in px w histrionic & borderline PD BUT dependent PD hv long term r/ship w ONE person

Impaired occupational fx Limited social r/ship Psychotherapy Insight oriented therapies Behavioural therapy Assertivens training Family therapy Group therapy Pharmacotherapy Tx comorbid anTdpsnt & anxiolytic Imipramine px w panic attack & high lvl of separation anxiety Benzodiazepines Serotonergic agent

Either : Adult : warm, open, loving adult Adult : harbinger schizo or MDD Group therapy Behavioural therapy Pharmacotherapy Clonazepam sympt of severe OCD Clomipramine & serotonergic agents O-C s&s break through Nefazodone Psychotherapy

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