Descriptive Psychopathology: The Signs and Symptoms of ...

358 Section 3: Examination domainsTable 15.4. Cluster C observable behaviorsAvoidant Dependent Obsessive–compulsiveInhibited (low spontaneity inconversation and actions, reducedemotional expression)Low energy“Mild” manneredAppears anxiousIndecisiveUnassertiveSubmissiveProvides overly detailed responses tothe examiner’s questions; hasdifficulty providing “yes” or “no”answers to relatively simple questionsMay be overly formalRigid and stubborn; not opento examiner’s suggestionsReduced emotional expressionfor avoidant and dependent personalities is high harm avoidance (behavioral inhibition).While obsessive–compulsive personality also shares high harm avoidancebehaviors, it is best considered an expression of illness within the OCD spectrum.Personality deviations and associated psychopathologyDeviance on several personality dimensions is associated with psychopathology.Dimensions of neuroticism and harm avoidance have been shown to predict nonmelancholicdepression. 40 Extraversion and novelty seeking are associated withconduct disorder and drug abuse. 41 Table 15.5 displays other associations.Abnormal personality from illness or injury“Epileptic” personalities 42Up to 60% of patients with epilepsy are reported to exhibit permanent changesin personality after several decades of illness.The adhesive or viscous personality is characterized by perseveration, stubbornness,a narrow field of interest and attention, loss of humor (humorless sobriety),circumstantial and cliché-filled speech, and a pedantic dry manner. Such patientsare plodding and repetitive in their conversations, which are limited to one or twotopics that are over-valued and constantly expressed at the slightest opportunity.They seem compelled to begin the conversation, to exhaust the topic regardless ofprevious iterations, and are reluctant to stop. Nothing is trivial. They lose sight ofthe “big picture” or the concept of their topic or theme, and focus on minutiae.Every detail must be mulled over. They “stick” to the topic and to the person towhom they are speaking. They are adhesive. They plod through their interactionsand thoughts as if embedded in some “viscous” substance.