## Pharmacotherapy of Cluster C Personality Disorders **Key Point:** Avoidant Personality Disorder (AvPD) is characterized by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. SSRIs are the pharmacological first-line because they target comorbid social anxiety, depression, and avoidance behaviors. ### Why Paroxetine (SSRI) is First-Line **High-Yield:** Paroxetine is the preferred SSRI in AvPD because: 1. **Anxiolytic effect:** Potent serotonergic activity reduces social anxiety and fear of rejection 2. **Antidepressant effect:** Addresses comorbid depressed mood and anhedonia 3. **Evidence-based:** FDA-approved for social anxiety disorder (SAD), which overlaps significantly with AvPD 4. **Functional improvement:** Reduces avoidance behavior by lowering anxiety threshold **Clinical Pearl:** AvPD and Cluster C disorders (Dependent, Obsessive-Compulsive PD) often present with anxiety and depression as *state symptoms*. SSRIs improve quality of life and social functioning more than any other drug class. ### Comparison of Options | Drug | Mechanism | Role in AvPD | Why Not First-Line | |------|-----------|--------------|--------------------| | **Paroxetine** | SSRI | ↓ anxiety, ↓ depression, ↓ avoidance | — FIRST-LINE | | **Chlorpromazine** | Typical antipsychotic | Sedation; no anxiolytic benefit | Antipsychotics not indicated; risk of tardive dyskinesia | | **Valproic acid** | Mood stabilizer | Minimal role in anxiety/avoidance | Not evidence-based for AvPD; used in impulsive/aggressive PDs | | **Propranolol** | Beta-blocker | Performance anxiety only | Insufficient for generalized social anxiety; no antidepressant effect | **Mnemonic: SSRI-AVOID** — SSRIs are first-line for Avoidant Personality Disorder (anxiety + avoidance + depression).
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