10 - The Anxious Cluster

Summary

This cluster of disorders is characterized by traits associated with anxiety. When these traits interfere either with the capacity to work or the ability to develop intimate relationships, we can diagnose a personality disorder.

Avoidant personality disorder

Avoidant personality disorder (APD), or its equivalent in ICD, anxious personality disorder, is characterized by a hypersensitivity to rejection that leads to avoidance of intimate relationships. This diagnosis was one of the most commonly made in the international study of personality disorders (Loranger et al., 1994).

The DSM-IV definition of APD requires the presence at least four of the following seven criteria (somewhat paraphrased): avoidance of interpersonal contacts at work; unwillingness to get involved with people unless certain of being liked; restraint in intimate relationships; preoccupation with criticism and rejection; inhibition in new interpersonal situations; view of self as inept, unappealing, or inferior; reluctance to take risks or engage in new activities.

Clinical example

A 32-year-old woman presented at a clinic for evaluation of lifelong social anxiety. Once she felt secure in any interpersonal situation, these difficulties would remit. For example, she was an effective secretary, having worked in the same office for over 10 years. She had also lived with the same female roommate for the last 4 years, and was quite comfortable either at home, or with her family. The patient had not, however, been able to sustain a significant relationship with a man. She had attempted to develop such relationships in her 20s, but had given up after several disappointments.