Diagnosis

Anxiety in Personality Disorder

Jerry Kennard Health Pro February 11, 2013
  • Personality disorders tend to be thought of as enduring conditions involving rigid thought and behavior patterns. These characteristics are sometimes so marked that we distinguish them from the average personality. If these personality traits cause significant distress or impairment the person may be diagnosed as having a personality disorder.

     

    Although personality disorders are currently thought of in terms of ‘clusters’ (i.e. cluster A, cluster B, cluster C) there are certain common features to all that include feelings of being overwhelmed by anxiety, anger, worthlessness, emotional disconnectedness, and problems sustaining a stable relationship. In all cases, symptoms worsen under stress.

     

    In this Sharepost I’m summarizing some of the features of the so-called Cluster C personality disorders as the main features include persistent and often overpowering sensations of anxiety and fear.

     

    It’s difficult to get a true picture of the numbers of people considered to have a personality disorder, especially as some have relatively mild symptoms that may only reveal themselves in times of acute stress. The National Institute of Mental Health has produced its own statistics relating to mental disorders. They state:

     

    “Among American adults ages 18 and over, an estimated 9.1% have a diagnosable personality disorder.”

     

    Personality disorder also remains a highly contentious diagnostic area and most people can relate to the various diagnostic features listed. The main case for personality disorder seems to rest on the extent to which personality traits negatively affect daily functioning.

     

    Within the Cluster C personality disorders there are three sub-categories: obsessive-compulsive, avoidant and dependent:

     

    Obsessive-compulsive: concerns about order, control, perfectionism and the detail in everything are features of this condition. Although many of the symptoms are similar to obsessive-compulsive disorder (OCD) the main distinguishing feature is that the unwelcome thoughts in OCD are not a feature of the personality disorder. Decision- making can be hard because of anxieties about doing the right thing. Standards may be so rigid that they find it frustrating and annoying if they are interrupted or interfered with. There follows a preoccupation with rules, high levels of sensitivity to criticism and difficulties in managing anger.

     

    Of all the personality disorders, this appears to be the most responsive to psychotherapy and/or medication. Even so, anxiety issues, social isolation and depression are common companions, especially later in life.

     

    Avoidant: inadequacy, sensitivity and reluctance to become involved in social or intimate relations are features of this disorder. The fear of rejection is often so strong that many choose to be alone rather than risk the pain of possible break up or loss. Despite the desire to be socially accepted there is an overwhelming sense of inferiority and fear about being criticized.

     

    The most effective treatments to date involve psychodynamic psychotherapy and cognitive behavioral therapy (CBT). Without some form of help and support there is a very great danger of a life of isolation, anxiety, depression and sometimes substance misuse.

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    Dependent: this is one of the most common personality disorders, where others are relied upon to make decisions. Daily tasks are a struggle, and the fear of losing a relationship may lead some to remain in abusive relationships. Such people are passive, easily hurt by disapproval, overly anxious about being abandoned and find great difficulty in expressing any form of disagreement.

     

    Like the personality disorders previously outlined some improvements can be seen with psychotherapy, usually long-term, and medication for the treatment of any related anxiety or depression.

     

    Sources:

    Blais M A, Smallwood P, Groves J E, Rivas-Vazquez R A. Personality and personality disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds (2008). Massachusetts General Hospital Comprehensive Clinical Psychiatry. Philadelphia, Pa: Mosby Elsevier