Avoidant personality disorder Many people diagnosed with AvPD have had painful early experiences of chronic parental and/or societal criticism or rejection. The need to bond with the rejecting parents or peers makes the person with AvPD hungry for relationships, but their longing gradually develops into a defensive shell of self-protection against repeated criticisms.
I swear I'll never be such a father for my children. Not to be confused with antisocial personality disorder . (Clinically, the term "antisocial" denotes a disregard for society's norms and rules, not social inhibition.) Avoidant personality disorder (AvPD)[1] (or anxious personality disorder[2]) is a personality disorder recognized disorder recognized in the DSM-IV TR handbook TR handbook in a person over the age of eighteen years as characterized by a pervasive a pervasive
pattern of social social inhibition , feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of social social interaction. interaction. People with AvPD often consider themselves to be socially be socially inept or inept or personally unappealing, and avoid social interaction for fear of being ridiculed, humiliated, rejected, or disliked. AvPD is usually first noticed in early adulthood, and is associated with perceived or actual rejection by parents or peers during childhood. Whether the feeling of rejection is due to the extreme interpersonal monitoring attributed to people with the disorder is still disputed. People with AvPD are preoccupied with their own shortcomings and form relationships with others only if they believe they will not be rejected. Loss and rejection are so painful that these individuals will choose to be lonely rather than risk trying to connect with others. others. • • •
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Hypersensitivity to criticism or rejection or rejection Self-imposed social isolation Extreme shyness or social or social anxiety in social situations, though feels a strong desire for close relationships[4] Avoids physical contact because it has been associated with an unpleasant or painful stimulus Avoids interpersonal relationships Feelings of inadequacy Severe low self-esteem Self-loathing Mistrust of others Emotional distancing related to intimacy Highly self-conscious Self-critical about their problems relating to others Problems in occupational functioning
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Lonely self-perception Feeling inferior inferior to to others In some more extreme cases-- Agoraphobia Utilizes fantasy as a form of escapism of escapism and to interrupt painful thoughts[5]
Differential diagnosis: associated and overlapping conditions Research suggests that people with AvPD, in common with chronic social anxiety sufferers also called social phobics, phobics, excessively monitor their own internal reactions when they are involved in social interaction. However, unlike social phobics, they also excessively monitor the reactions of the people with whom they are interacting. The extreme tension created by this monitoring may account for the hesitant speech and taciturnity of many people with AvPD; they are so preoccupied p reoccupied with monitoring themselves and others that producing fluent speech is difficult. AvPD is reported to be especially prevalent in people with anxiety disorders, disorders, although estimates of comorbidity of comorbidity vary widely due to differences in (among others) diagnostic instruments. Research suggests that approximately 10–50% of people who have panic have panic disorder with disorder with agoraphobia have AvPD, as well as about 20–40% of people who have social phobia (social anxiety disorder ). ). Some studies report prevalence rates of up to 45% among people with generalized anxiety disorder and disorder and up to 56% of those with obsessive-compulsive disorder .[8] Although it is not mentioned in the DSM-IV, earlier theorists have proposed a personality disorder which has a combination of features from borderline from borderline personality disorder and disorder and AvPD, [9] called "avoidant-borderline mixed personality" (AvPD/BPD). Many people diagnosed with AvPD have had painful early experiences of chronic parental and/or societal criticism or rejection. The need to bond with the rejecting parents or peers makes the person with AvPD hungry for relationships, but their longing gradually develops into a defensive shell of self-protection against repeated criticisms. [4]
Treatment Treatment of AvPD can employ various techniques, such as social skills training, training , cognitive therapy, therapy, exposure treatment to gradually increase social contacts, group therapy for practicing social skills, and sometimes drug therapy. therapy.[12] A key issue in treatment is gaining and keeping the patient's trust, since people with AvPD will often start to avoid treatment sessions if they distrust the therapist or fear rejection. The primary purpose of both individual therapy and social skills group training is for individuals with AvPD to begin challenging their exaggeratedly negative beliefs about themselves. themselves.[13] Avoidant Personality Disorder has to date been a misunderstood and neglected entity—
either entirely ignored or confused with another disorder, such as Social Phobia. The purpose of my revised Distancing is: * To broaden our dynamic understanding of Avoidant Personality Disorder. * To describe, understand and treat all avoidants, not just those who are shy and social phobic. * To develop a new therapeutic approach to avoidance, one I call “avoidance reduction.” reduction.” This is an eclectic method for treating avoidants av oidants composed of relevant techniques borrowed from psychoanalytic, cognitive-behavioral, interpersonal, existential, and supportive therapies. Many clinicians fail to recognize Avoidant Personality Disorder, instead diagnosing Social Phobia. Those who do Recognize Re cognize Avoidant Personality Disorder emphasize shyness and social phobia as its main features. However, these are not basic to all patients with AvPD. What is basic to Avoidant Personality Disorder is not shyness or social phobia but a severe and pervasive social and relationship anxiety, which is displayed in a variety of ways. Therefore, there are not one but four subtypes of Avoidant Personality Disorder, each of which requires a different psychotherapeutic approach. Type I avoidants, the classic avoidants, are withdrawn. There are two subtypes of withdrawn avoidants. A first is the shy individual who cann ot seem to tolerate, flinches in the face of, and pulls back from any form of social contact. The second suffers from a Social Phobia, which is a delimited pull-back from a situation or event that symbolizes relationships, for example, from public speaking or e ating in public. Though shy and social phobic Avoidants are the main and virtually exclusive focus of today’s scientific literature, these avoidants may not even be in a majority, but may represent only the tip of the avoidant iceberg. Types II and III avoidants, almost entirely ignored by the literature, also suffer from relationship anxiety but their relationship anxiety takes the form not o f shyness or Social Phobia but of unstable relationships due to a fear of commitment. Type II avoidants shift from relationship to relationship afraid of closeness due to a fear of commitment (“mingles” avoidants such as the perpetual bachelor or femme fatale). They are therefore the opposite of withdrawn. These are hyperrelated individuals who can relate easily, widely and well but have difficulty sustaining the relationships they form. Theirs are unstable relationships, marked by a tendency to abandon relationships before they fully develop, especially when closeness threatens and commitment looms. Type III avoidants form lasting relationships only to disrupt them after months or years of apparent functionality. These are what I call ca ll the “seven-year-itch” avoidants who form what appear to be solid relationships only to tire of them after a shorter or longer period of time then leave them with little warning. That is, they abandon their relationships after some time has passed, and they often do so suddenly and without warning. w arning. Type IV avoidants hide out in a codependent relationship with one person to avoid having healthy relationships with many people. They sink into on e relationship to avoid all others. Some are dependent on their family. Others are dependent on a lover with whom they form a merger relationship that protects them from the anx iety associated with relationships outside of the primary relationship. These are all patients with AvPD. Their dynamics are remarkably similar. They all require avoidance reduction. However, the significant differences in the ways they manifest their
avoidance require a different therapeutic emphasis in each case. For example, while exposure techniques may prove useful for Type I shy and social phobic avoidants, av oidants, they will likely be ineffective for Type II avoidants with a commitment p hobia, who are more likely to benefit from insight-oriented and cognitive therapy. Effective treatment of Avoidant Personality Disorder requires a devoted approach dedicated to reversing the underlying relationship anxiety via avoidance reduction. It will be applicable to reduction of avoidance in all its forms. Avoidance reduction should focus not n ot only on fear of criticism (the official dynamic explanation of avoidance) but also on the equally important fears of flooding, de pletion, and acceptance. Avoidants are not simply afraid of criticism and humiliation—the only reason for avoidance currently identified in the official literature. They are also afraid of being flooded by feelings they cannot tolerate, and of being depleted should they express these feelings. Most importantly, they fear acceptance as much as they fear rejection because they fear losing their identity and personal freedom. In practice Avoidance reduction involves a pastiche of familiar psychotherapeutic approaches in use today, including psychodynamic, cognitive-behavioral, interpersonal, and supportive approaches, selected elements of which are combined for a synergistic effect. My book is for psychotherapists who will be better able to identify, understand and manage Avoidant Personality Disorder from the detailed clinical descriptions, illustrative clinical vignettes (including those from real life) and thorough exploration of the psychodynamics, cognitive and interpersonal dynamics of the disorder included here. It is also for victims of avoidants who can learn to better manage the people in their lives who snub and otherwise neglect them. It is also a self-help manual for avoidants themselves, individuals attempting to surmount their relationship anxiety and form close, satisfying, meaningful relationships with others without fear and regret.
