Definition :-

                 Persons with avoidant personality disorder show an extreme sensitivity to rejection, which may lead to a socially withdrawn life. They are not asocial and show a great desire for companionship but are shy; they need unusually strong guarantees of uncritical acceptance. Such persons are commonly referred to as having an inferiority complex.

Extent of problem :-

The prevalence of avoidant personality disorder is unknown. No information is available on sex ratio or familial pattern. Infants classified as having a timid temperament may be more prone to the disorder than are those high on activity-approach scales.

Clinical Features :-

Hypersensitivity to rejection by others is the central clinical feature of this disorder. Persons with the disorder desire the warmth and security of human companionship but justify their avoidance of forming relationships by their alleged fear of rejection. When talking with someone, they express uncertainty and a lack of self-confidence and may speak in a self-effacing manner. They are afraid to speak up in public or to a make requests of others, because they are hyper vigilant about rejection.

They are apt to misinterpret other people’s comments as derogatory or ridiculing.
In the vocational sphere, avoidant personality disorder patients often take jobs on the sidelines. They rarely attain much personal advancement or exercise much authority. Instead, at work they may seem simply shy and eager to please.
Persons with this disorder are generally unwilling to enter relationship unless they are given an unusually strong guarantee of uncritical acceptance. Consequently, they often have no close friends or confidants. In general, their main personality trait is timidity.

Course and Outcome :-

Many avoidant personality disorder patients are able to function, provided they are in a protected environment. Some marry, have children, and live their lives surrounded only by family. Phobic avoidance is common, and avoidant personality disorder patients may give histories of social phobias or go on to such phobias during the course of their illness.

Treatment :-

Psychotherapy :

Psychotherapeutic treatment depends on solidifying an alliance with the patient. As trust develops, the therapist conveys an accepting attitude toward the patient’s fears, especially that of rejection. The therapist eventually encourages the patient to move out into the world to take what are perceived as great risks of humiliation, rejection, or failure but the therapist should be cautious when giving assignment to exercise new social skills outside therapy, because failure may reinforce the patient’s already poor self-esteem.

Group therapy may help patients understand the effects that their sensitivity to rejection has on themselves and others.
Assertiveness training is a form of behavior therapy that may teach patients to express their needs openly and improve their self-esteem.
Pharmacotherapy. Pharmacotherapy has been used to manage anxiety and depression when present as an associated feature. Some patients are helped by beta Blockers, such as Propranolol, to manage autonomic nervous system hyperactivity, which tends to be high in patients with this disorder, especially when they approach feared situations.

Obsessive-Compulsive Personality Disorder

Definition:

The obsessive-compulsive personality disorder is characterized by emotional constriction, orderliness, perseverance, stubbornness, and indecisiveness. According to DSM-III-R, the essential feature of this disorder is a pervasive pattern of perfectionism and in flexibility.

Epidemiology :

The prevalence of the obsessive - compulsive personality disorder is unknown. It is more common in males than in females and is diagnosed most often in oldest children. The disorder also occurs more frequently in first degree biological relatives of persons with the disorder than in the general population. Patients often have backgrounds characterized by harsh discipline. Freud hypothesized that the disorder is associated with difficulties in the anal stage of psychosexual development, generally around the age of 2. However, in various studies that theory has not been validated.

Clinical Features :

Persons with this disorder are preoccupied with rules, regulations, orderliness, neatness, details, and the achievement of perfection. These traits account for a general constriction of the entire personality. Such persons are formal and serious and often lack a sense of humor. They insist that rules be followed rigidly and are unable to tolerate what they perceive be infractins. Accordingly, they lack flexibility and are intolerant. They are capable of prolonged work, provided it is routinized and does not require changes to which they cannot adapt.

Obsessive-compulsive personality disorder patients’ interpersonal skills are extermely limited. They alienate people, are unable to compromise, and insist that others submit to their needs. They are however, eager to please those whom they see as more powerful than themselves and carry out their wishes in an authoritarian manner. Because of their fear of making mistakes, they are indecisive and ruminate about making decisions. Although a stable marriage and occupational adequacy are common, obsessive compulsive personality disorder patients have few friends.
Anything that threatens to upset the routine of these patients lives or their perceived stability can precipitate a great deal of anxiety that is other-wise bound up in the rituals that they impose on their lives and try to impose on others.

Course and prognosis :

The course of obsessive–compulsive personality disorder is variable and not predictable. From time to time, obsessions or compulsions may develop in the course of the personality disorder. Some adolescents with obsessive-compulsive personality disorder evolve into warm, open and loving adults, but in others, these traits can be either the harbinger of schizophrenia or decades later and exacerbated by the aging process major depression and melancholia.

Persons with this disorder may do well in position demanding methodical, deductive, or detailed work, but they are vulnerable to unexpected changes, and their personal lives may remain barren. Depressive disorders, especially those of late onset, are common.

Treatment :

Psychotherapy. Unlike patients with the other personality disorders, obsessive-compulsive personality disorder patients often know that they are suffering, and they seek treatment on their own. Free association and nondirective therapy are highly valued by the overtained, oversocialized obsessive-compulsive personality disorder patients. However, the treatment of these patients is often long and complex, and countertransference problems are common.

Group and behavior therapy occasionally offer certain advantage. In both contexsts it is easy to interrput the patients in the midst of their maladaptive interactions or explanations. Having the completion of their habitual behavior prevented raises patients’ anxiety and leaves them susceptibale to learning new coping startegies. Patients can also receive direct rewards for change in group therapy, something less often possible in individual psychotherapies.

Pharmacotherapy :

Clonzepam ( Klonopin) is a benzodiazepine with anticonvulsant use that has reduced symptoms in patiens with severe obssesivel comulsive disorder is not known Clomipramine and fluxetine may be of use if obsessive-compulsive signs and symptoms break through.