Academic journal article Journal of Mental Health Counseling

Etiology and Treatment of Cluster C Personality Disorders

Academic journal article Journal of Mental Health Counseling

Etiology and Treatment of Cluster C Personality Disorders

Article excerpt

Of challenge to mental health counselor's (MHCs) is the management and treatment of personality disorders. This article will elaborate on the etiological development of Cluster C personality disorders (avoidant, dependant, and obsessive-compulsive), review the self-maintenance functions they provide, and review the cognitive-behavioral, group, and psychodynamic treatments for each of the three Cluster C personality disorders. The central aim of this manuscript is to assist MHCs in better understanding biological and environmental antecedents, treatment interventions, and to ensure that personality dynamics are not overlooked in the treatment process.


Historically, Axis II Personality Disorders have been recognized as being unresponsive and untreatable (Eskedal, 1998). This category of disorders has been viewed as long-standing and is distinguished by deeply ingrained maladaptive attitudes and behaviors that are ego syntonic, or one with the personality disordered client. These maladaptive beliefs and behaviors are recognized by Seligman (1998) as showing up in at least two of the following areas: perceptions and understandings of oneself and one's environment; expression, nature, range, and appropriateness of emotions; interpersonal skills and relationships; and impulse control. The attitudes, beliefs, and behaviors of the personality disordered individual are usually rigid and inflexible, causing significant impairment in the life of the affected individual.

Traditionally, the treatment of the personality disorders was relegated to the psychodynamic approaches and long-term psychotherapy was considered the treatment of choice (Kernberg, 1996; 2001). Generally, the goal was to change the character structure or life style; however, the outcomes were mixed even among those highly motivated for change (Eskedal, 1998). Treatment methods today differ in that the approach is more focused and structured, with the therapist taking a more active role in the therapy process (Millon, 1996; Pretzer & Beck, 1996).

As recognized by Millon (1996), personality disorders lend themselves to a three-category classification with regard to treatability, analogous to the DSM-IV-TR (APA, 2000) diagnostic categories: Cluster A (paranoid, schizoid and schizotypal), viewed as the treatment resistant category, is believed not likely to benefit or accept change; Cluster B (antisocial, borderline, histrionic, and narcissistic), viewed as the treatment with mixed results group, is often viewed as possessing both treatable and untreatable qualities depending upon the individual; and Cluster C (avoidant, dependant, and obsessive-compulsive), viewed as the treatment responsive category, is believed to have a high amenability.

This paper focuses on Cluster C, which represents behaviors manifested in anxious or fearful patterns and includes: avoidant personality disorder (AvPD), dependent personality disorder (DPD), and obsessive-compulsive personality disorder (OCPD). In the past, personality disorders were explained almost exclusively from a psychodynamic perspective. Most language used to conceptualize personality disorders is in terms of "character language," such as anal character. Despite biological tendencies in the field that emphasized temperament, the psychological tradition that emphasized character was utilized for most of the 20th century (Sperry, 1995). Currently, a paradigm shift has altered the field's perspective on personality disorders, which are now viewed as resulting from a combination of biological, psychological, and social factors (Sperry, 1995). It is recognized that personality disorders represent an enduring pattern of thinking, feeling, and behaving that is relatively stable over the life cycle, beginning in adolescence or early adulthood and continuing on throughout the life cycle. Over time, this maladaptive life-style places the individual at odds with his or her social and cultural environment, leading to distress and/or impairment (Eskedal, 1998). …

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