In the DSM-5 main section for clinical diagnoses, psychopathology in Cluster C (Anxious-Fearful) is represented by three personality disorders: Avoidant, Dependent, and Obsessive-Compulsive. However, characterization of persistent anxious-fearful psychopathology has varied historically, and it appears that the cluster formation may not be retained with the next iteration of personality disorder diagnoses. This chapter examines the historical development of anxious-fearful personality disorders, and examines the different ways that associated symptoms and problems have been characterized and grouped to elucidate core features in order to clarify visions looking forward. There is an emphasis on avoidant behaviors, when describing the clinical manifestation of these personality disorders, and it is suggested that focusing on mechanisms for this kind of personality pathology, as well as explicitly addressing the issue of grain size, would enhance continuing efforts to improve diagnostic conceptualizations of personality pathology involving anxiety, fear, and avoidance.

This rejoinder responds to commentaries offered by Cain (this volume) and Arntz (this volume). The authors reiterate their view that incorporating mechanisms into research will open new pathways for understanding the nature of anxious fearful personality pathology and for improving diagnosis. They agree with and value the interpersonal theory for better understanding personality disorders, and for guiding treatment. They further argue that particular attention be paid to grain size in the study and conceptualization of anxious fearful personality pathology.