Cluster ‘C’ Personality Disorders (Avoidant, Dependent and Obsessive-Compulsive)

Quick Reference

Overview: Often referred to as the anxious and fearful disorders due to the behaviours which are symptomatic of the individual disorders.

Link to Offending: Generally likely to be low risk and obsessive-compulsive traits may actually be a protective factor for risk of recidivism. However, Dependent PD may be associated with domestic violence and avoidant and dependent PD’s are some of the most commonly found PD’s in child sexual offenders.

Tips: Avoid confrontational approaches, reward compliance and work towards developing greater autonomy and assertiveness over time.

PD View of Self View of Others Main Beliefs Main Strategy
Avoidant Inadequate, worthless Critical, demeaning “It’s terrible to be rejected, put down” “If people know the real me they’ll reject me” Avoid
Dependent Weak, helpless Strong, overwhelming “I need people to survive, be happy” “I need to have a steady flow of support, encouragement” Attach/Be submissive
Obsessive Compulsive Responsible, competent Irresponsible, incompetent “I know what’s best” “Details are crucial” “People should do better” Control

 

Profile of the Cluster C PD’s

Cluster C PD’s are sometimes referred to as the anxious and fearful disorders, due to the underlying sense of anxiety which is common to all. The pathology may be less obvious than some of the other PD’s making them easy to miss.

Avoidant PD is characterised by high levels of social anxiety, which stems from an underlying sense of defectiveness and inadequacy. Individuals with avoidant PD are typically socially withdrawn, apprehensive, shy and awkward. Due to an inner sense of inferiority, they are ever vigilant for signs of rejection and failure and avoid situations in which they fear that their perceived shortcomings will become apparent to others. They may desire close personal relationships, but are also hypersensitive to rejection. Substance misuse may be used as an escape.

Dependent PD is characterised by a negative self concept associated with core feelings of helplessness and inadequacy and a corresponding need to be taken care of. They fear being alone and actively attach themselves to others who they feel will be able to meet their needs. They may be highly suggestible and struggle to make decisions without considerable help and reassurance. Emotionally they suffer with pervasive feelings of anxiety and behaviourally they are passive, under assertive and submissive.

Obsessive Compulsive PD is characterised by excessive self-control, a pre-occupation with order, rules, hierarchies and an unwavering conviction in their high moral, ethical and professional standards. Sufferers may be highly self-critical with any inability to attain their high standards being viewed as a catastrophic failure. They may also expect others to meet their high standards and be highly critical of those with different ideals. They are likely to possess a rigid and ruminative thinking style, be highly perfectionist, procrastinate for lengthy periods and therefore struggle to complete tasks. May be confused with schizoid PD.

Relationship to offending

Cluster C PD’s in general are not strongly associated with a high risk of serious offending and obsessive compulsive traits in particular confer a particularly low risk. Despite this, personality characteristics associated with cluster C PD’s may facilitate offending behaviour in a number of ways:

  • Dependent personality features are characteristic of an established typology of male domestic abusers. In such individuals violence may be facilitated by a pre-occupied and anxious attachment style, a resulting fear of abandonment and a tendency to experience jealousy.
  • Avoidant and Dependent PD’s are some of the most frequently identified personality disorders in child sexual offenders (and internet sexual offenders) and may be associated with difficulties establishing rewarding intimate relationships with adults, social withdrawal and loneliness.

Tips for working with Cluster C PD’s

Tips for one-to-one working:

Develop rapport through empathy:
Avoidant and dependent individuals are likely to be anxious and inhibited in supervision. Providing empathy, understanding and re-assurance may facilitate collaborative working.

Avoid confrontational approaches:
As these will trigger anxieties about rejection or criticism.

Expect forms of avoidance at certain times to manifest in supervision such as lateness, or missed sessions, dropping out of treatment and a reluctance to talk about thoughts, feelings and offending behaviour. This is despite cluster C individuals usually being compliant. It usually relates to negative feelings which cannot be expressed directly for fear of rejection.

Work towards developing greater autonomy and assertiveness over time:
With dependent individuals it is particularly important to avoid being drawn into being too directive and ‘taking control’ as this is likely to encourage further dependence and confirm feelings of helplessness. Instead, take gradual steps towards encouraging greater social integration and autonomy.

Plan for endings:
Be mindful of endings as they may be particularly destabilising and trigger fears of abandonment, which are not openly expressed. Sometimes, offending can occur within days of the ending, in order to resume contact with the practitioner. Explicitly planning the end of supervision and allowing a gradual reduction in the frequency of contact will help.

Tips for general offender management:

Offending behaviour programmes may provoke considerable anxiety, particularly for avoidant individuals but may ultimately be highly rewarding and particularly therapeutic. Anticipating concerns and providing additional support initially will help in the longer term. Occasionally you may need to liaise with GP or mental health services, as depression or anxiety can be used as means to avoid difficult group work.

Sentence planning:
Behavioural controls and sanctions are likely to be less important with cluster C individuals, who may be generally compliant, and experience the consequences of arrest and punishment as being highly aversive. Reward compliance and any evidence of trustworthiness and use restrictions sparingly.

However, where substance misuse is a relevant offence antecedent, this should be considered to be a priority target for intervention.