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.The roughly similarhereditable and environmental components to these traits [122] is also inkeeping with this approach.The alternative view is to retain the category of the anxious cluster or itsindividual components (the latter is more difficult to argue) and use the co-axial approach when describing the common anxiety and depressivedisorders.Describing an anxiety or depressive condition without describingthe personality component also gives very limited information and covers awide range of potential intervention and outcomes.By at least pointing outthe possibility of a personality aspect (and initially it would be wise to callthis possible rather than probable because of our uncertainty whenthere is strong mental pathology), the clinician is at least wised up to theidea that something else may need to be addressed apart from the simplerelief of symptoms.When anxiety and depressive symptoms coexist withsuspected personality abnormality, we are in the territory of the generalneurotic syndrome, and whilst this may have to be bowdlerized into a termsuch as general negative affectivity disposition to satisfy the sensitivity ofour American colleagues, the condition is out there in clinical practice andcannot be ignored.A good diagnosis, as Kendell [123] has constantly reminded us, is a usefulone and, once there is an effective treatment for the anxious cluster or one ofits constituents, the point of the distinction between personality and mentalstate will become clear immediately [124].Of course, if the distinction is aphoney one, it will never be found but, even in that situation, every clinicianwill need to be aware of the range that covers those common mentaldisorders extending from brief stress reactions at one extreme through to aparalysing state of anxiety and anhedonia in which any relief is short-livedand the extent of lifetime suffering incalculable.SUMMARYConsistent EvidenceThere is now reasonable agreement between clinicians and researchers thatthe anxious cluster of personality disorders describes a significant clinicalgrouping.Even though there may be arguments about its boundaries andexact description, there can be no doubt that the combination of generalanxiousness and fearfulness with a proneness to help-seeking is indepen-dent from the general symptomatology of anxiety and needs some form ofgeneral description.There is also now a reasonable body of evidence, butnot completely uniform, that the presence of this condition makes individuals 368 __________________________________________________________________ PERSONALITY DISORDERSmore prone to relapse and have recurrent morbidity of anxious and associateddisorders.In the short term these differences are much less pronounced thanin the longer term.There is also consistency in the view that, although we have some clues asto treatment of this condition, we have no evidence-based interventions.This is a major handicap preventing full acceptance of the condition.Incomplete EvidenceThe boundaries of the anxious cluster remain extremely fuzzy and, evenaccepting that this group of conditions constitutes a continuum, there is aneed for much greater clarity.On the positive side, the presence of a groupvariously described as anxious/dependent, neurotic, negative affective bydifferent authors is robust and persistent in studies of both normal andabnormal personality and cannot be ignored.The separation of this traitgrouping from those with just anxious symptomatology is still extremelydifficult and this explains why, for example, social anxiety disorder is sodifficult to separate from anxious or avoidant personality disorder.Bothconditions are manifest early in life, tend to be persistent, are associatedwith secondary morbidity, and lead to marked persistent behaviouraldisturbance
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