Cluster C personality disorders

Cluster C disorders make up the most prevalent personality disorder group globally, characterised by anxious and fearful symptoms. People with cluster C personality disorders develop a range of behaviours aimed at avoiding their intense emotions and anxieties.

Article by Katie Loader

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The term personality disorder refers to a set pattern of characteristics and maladaptive behaviours that cause people to think, feel and relate to others in ways that are not in keeping with social norms (World Health Organization, 2019). The International Classification of Diseases (ICD-10) lists ten different personality disorder types which are commonly grouped into clusters – A, B and C – depending on their shared characteristics and aetiology.

Cluster C personality disorders include:

obsessive-compulsive personality disorder
anxious/avoidant personality disorder
dependant personality disorder

People with cluster C personality disorders are often considered to be anxious and fearful; they develop a range of behaviours aimed at avoiding their intense emotions and anxieties. Cluster C disorders make up the most prevalent personality disorder group globally (Winsper et al, 2020), and people with these disorders are the most likely to seek treatment. Obsessive-compulsive personality disorder is the most prevalent personality

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Common symptoms of obsessive-compulsive personality disorder, also termed anakastic personality disorder include:

  • feelings of doubt
  • perfectionism
  • extreme conscientiousness
  • being detail orientated
  • stubbornness
  • cautiousness
  • rigidity (World Health Organization, 2019)

People with an obsessive-compulsive personality disorder are preoccupied with perfection, order and control. Their ability to complete tasks is affected by the excessive time and detail they put into gaining perfection (Pinto et al, 2022). They experience difficulties in social activities and within relationships, and hold extremely high standards and moral values which they expect others to follow. Therefore, people with an obsessive-compulsive personality disorder are seen as rigid and stubborn. However, experiencing obsessive thoughts and impulses do not meet the criteria for an obsessive-compulsive disorder (World Health Organization, 2019; Pinto et al, 2022).

Common symptoms of anxious personality disorder, also termed avoidant personality disorder, include:

  • being apprehensive, insecure, hypersensitive, avoidant
  • feeling inferior
  • wanting to be liked
  • fearing rejection and criticism
  • lacking

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The exact cause of personality disorders is not known, but is commonly viewed as a combination of genetic, neurobiological and environmental factors (Maass, 2019). In cluster C personality disorders, the personality and behavioural traits are rooted in genetic differences, which are then influenced by childhood experiences and early relationships (Siever and Weinstein, 2009).


Evidence from twin and family studies show that cluster C personality disorders can run in families, suggesting a genetic component (Lampe and Malhi, 2018; Maass, 2019; Marincowitz et al, 2022).

Wider genome studies have found genetic differences within the serotonin and dopamine pathways of people with neurotic and avoidant traits. However, these studies are not specific to cluster C personality disorders; more research in this area is needed to better understand the role of genetics (Marincowitz et al, 2022).


Neuroimaging in people with obsessive compulsive disorder show multiple brain areas are

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There are no clinical guidelines for the assessment and management of cluster C personality disorders. Although there are assessment tools that can support a diagnosis, no single approach has been found to be superior (Maass, 2019). Diagnosis is based on the clinical symptoms listed above.

When diagnosing a person with a personality disorder, the clinician must conduct a thorough assessment of the patient’s mental state to understand their behavioural patterns over time and the context of their childhood experiences. People with personality disorders do not tend to see their behaviours as products of their personality traits, but because of their social environment. Clinical judgement is needed to determine which behaviours are understandable within the person’s social and cultural contexts and which are indicative of personality disorder traits (Lehtinen et al, 2023).

Understanding the common comorbidities and differential diagnoses of cluster C personality disorders strengthens accurate diagnosis and treatment (Maass, 2019).

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Cluster C personality disorders benefit from a wider range of treatment options compared to clusters A and B, because of an overlap with social anxiety disorder and obsessive compulsive disorder, which have more established treatment options. There are currently no licenced medications for cluster C personality disorders, but certain medications have been found to help with anxious and depressive symptoms. The main approach to treatment is psychological, which aims to understand the person’s past experiences and current maladaptive coping strategies. Behavioural interventions support the patient to develop new skills.


People with obsessive-compulsive and anxious personality disorders can benefit from selective serotonin and serotonin-noradrenaline reuptake inhibitor antidepressants for mood and anxiety symptoms, especially if there is comorbid depression (Lampe and Malhi, 2018; Pinto et al, 2022).


Several psychological treatments have been recommended for each of the cluster C personality disorders (Daniëls et al, 2023). A

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Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages

Part 2: Procedures for the planning, provision and management of person-centred nursing care

3. Use evidence-based, best practice approaches for meeting needs for care and support with rest, sleep, comfort and the maintenance of dignity, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions

11. Procedural competencies required for best practice, evidence-based medicines administration and optimisation

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Daniëls M, Van HL, van den Heuvel B, et al. Individual psychotherapy for cluster-C personality disorders: protocol of a pragmatic RCT comparing short-term psychodynamic supportive psychotherapy, affect phobia therapy and schema therapy (I-FORCE). Trials. 2023;24(1):260. https://doi.org/10.1186/s13063-023-07136-z 

Disney KL. Dependent personality disorder: a critical review. Clin Psychol Rev. 2013;33(8):1184-1196. https://doi.org/10.1016/j.cpr.2013.10.001
Lampe L, Malhi GS. Avoidant personality disorder: current insights. Psychol Res Behav Manag. 2018;11:55-66. https://doi.org/10.2147/PRBM.S121073 

Lehtinen M, Voutilainen L, Peräkylä A. 'Is it in your basic personality?' Negotiations about traits and context in diagnostic interviews for personality disorders. Health (London). 2023;27(6):1033-1058. https://doi.org/10.1177/13634593221094701 

Maass V. Personality disorders: elements, history, examples, and research. 1st edn. California: Praeger; 2019

Marincowitz C, Lochner C, Stein DJ. The neurobiology of obsessive-compulsive personality disorder: a systematic review. CNS Spectr. 2022;27(6):664-675. https://doi.org/10.1017/S1092852921000754 

Pinto A, Teller J, Wheaton MG. obsessive-compulsive personality disorder: a review of symptomatology, impact on functioning, and treatment. Focus (Am Psychiatr Publ). 2022;20(4):389-396. https://doi.org/10.1176/appi.focus.20220058 

Siever LJ, Weinstein LN. The neurobiology of personality disorders: implications for psychoanalysis. J Am Psychoanal Assoc. 2009;57(2):361-398.

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