Zimpapers Logo

This week I will look at the last cluster, Cluster C, of personality disorders and the possible management for this mental condition. They are very common and the persons are usually labelled as “difficult people”. A greater understanding will help families understand their relatives and seek psychiatric care for them.

Cluster C Personality Disorders are characterised by anxious, fearful thinking or behaviour. They include:

Avoidant Personality Disorder

• Too sensitive to criticism or rejection
• Feeling inadequate, inferior or unattractive
• Avoidance of work activities that require interpersonal contact
• Socially inhibited, timid and isolated, avoiding new activities or meeting strangers
• Extreme shyness in social situations and personal relationships
• Fear of disapproval, embarrassment or ridicule
• Dependent Personality Disorder
• Excessive dependence on others and feeling the need to be taken care of
• Submissive or clingy behaviour towards others
• Fear of having to provide self-care or fend for yourself if left alone
• Lack of self-confidence, requiring excessive advice and reassurance from others to make even small decisions
• Difficulty starting or doing projects on your own due to lack of self-confidence
• Difficulty disagreeing with others, fearing disapproval
• Tolerance of poor or abusive treatment, even when other options are available
• Urgent need to start a new relationship when a close one has ended

Obsessive-compulsive ,Personality Disorder

• Preoccupation with details, orderliness and rules
• Extreme perfectionism, resulting in dysfunction and distress when perfection is not achieved, such as feeling unable to finish a project because you do not meet your own strict standards
• Desire to be in control of people, tasks and situations, and inability to delegate tasks
• Neglect of friends and enjoyable activities because of excessive commitment to work or a project
• Inability to discard broken or worthless objects
• Rigid and stubborn
• Inflexible about morality, ethics or values
• Tight, miserly control over budgeting and spending money

If one has signs or symptoms of a personality disorder consultation with a psychiatrist or psychologist is warranted. Untreated PDs can cause serious problems in your life that may worsen over time. Personality disorders are caused by a combination of genetic and environmental influences. Risk factors including:

• Family history of Personality Disorders or mental illness
• Abusive, or chaotic family life during childhood
• Being diagnosed with childhood conduct disorder

Personality disorders may cause problems with relationships, work or school, and can often lead to social isolation or alcohol or drug abuse.

Treatment of choice depends on your particular personality disorder, its severity and your life situation. Psychotherapy is the main way to treat personality disorders.

There are no medications specific to treat personality disorders. However, medications help with various personality disorder symptoms. Antidepressants are useful if you have a depressed mood, anger, impulsivity, irritability or hopelessness, which may be associated with personality disorders.

Mood stabilisers help with mood swings and to reduce irritability, impulsivity and aggression. Antipsychotics are used if psychosis is present. Anti-anxiety medications help if there is anxiety, agitation or insomnia amongst the symptoms.

Personality disorder may be severe to entail the need admission to a hospital for psychiatric care, this is recommended if the patient is in immediate danger of harming self or others.

DISCLAIMER: This column contains information about mental health related issues. However, the information is not advice, and should not be treated as such. No liability is accepted for any consequences arising from this article.

• Dr S. M. Chirisa is a passionate mental health specialist who holds an undergraduate medical degree and postgraduate Master’s degree in psychiatry both from the University of Zimbabwe. He is currently working as a Senior Registrar in the Department of Psychiatry at Parirenyatwa Group of Hospitals and is also the current national treasurer of the Zimbabwe Medical association (ZiMA). He can be reached at [email protected]