Avoidant Personality Disorder

Wikipedia Updated: Oct 25th 2005

Avoidant personality disorder (sometimes abbreviated APD or AvPD), or anxious personality disorder, is a personality disorder characterised by a pervasive pattern of social inhibition, feelings of inadequacy, and extreme sensitivity to negative evaluation. People with avoidant personality disorder often consider themselves to be socially inept or personally unappealing, and avoid social interaction for fear of being ridiculed or humiliated.

Avoidant personality disorder usually is first noticed in early adulthood, and is associated with rejection by parent or peers during childhood. Whether the rejection is due to the extreme interpersonal monitoring attributed to people with the disorder is still an open question.

Diagnostic criteria (DSM-IV-TR)

The DSM-IV-TR, a widely used manual for diagnosing mental disorders (see also: DSM cautionary statement), defines avoidant personality disorder as a "pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
is unwilling to get involved with people unless certain of being liked
shows restraint within intimate relationships because of the fear of being shamed or ridiculed
is preoccupied with being criticized or rejected in social situations
is inhibited in new interpersonal situations because of feelings of inadequacy views self as socially inept, personally unappealing, or inferior to others
is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

Link with other mental disorders

Research suggests that people with avoidant personality disorder, in common with social 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 avoidant personality disorder. They are so preoccupied with monitoring themselves and others that producing fluent speech is difficult.

Avoidant personality disorder is reported to be especially prevalent in people with anxiety disorders, although estimates of comorbidity vary widely due to differences in (among others) diagnostic instruments. Research suggests that approximately 10-50% of the people who have a panic disorder with agoraphobia have APD, as well as about 20-40% of the people who have a social phobia. Some studies report prevalence rates of up to 45% among the people with a generalized anxiety disorder and up to 56% of the people with an obsessive-compulsive disorder (Van Velzen, 2002). Although it is not mentioned in the DSM-IV, earlier theorists have proposed a personality disorder which has a combination of features from borderline personality disorder and avoidant personality disorder, called "avoidant-borderline mixed personality" (APD/BPD) (Kantor, 1993, p.4).

Natural course of the disorder

People with avoidant personality disorder often experience vicious cycles of withdrawal in which the avoidant helps to create the anticipated rejection (Kantor, 1993, Chapter 5). Other people interpret the avoidance of the person with APD as a sign that the avoidant does not like them, and react by avoiding the person. This reinforces the avoidant's fear of rejection and encourages further withdrawal.

Another common development is the appearance of so-called "second-line defenses" in order to deal with the anxiety that the avoidance creates (ibid.). Examples of such defenses are a denial of the fear of rejection, or a replacement of their fear of rejection with a defensive insensitivity. The latter mechanism is called "hardening".

Treatment

Treatment of avoidant personality disorder can employ various techniques, such as social skills training, cognitive therapy, exposure treatment to gradually increase social contacts, group therapy for practicing social skills, and sometimes drug therapy (Comer, 1996). A key issue in treatment is gaining and keeping the client's trust, since people with APD will often start to avoid treatment sessions if they distrust the therapist or fear rejection. Normally, self-treatment is frowned upon in the professional community. However, the most recent data (Lybeck/John, 2004) indicates that starting a work-out program at the local gym can help bring about feelings of well-being (via increased endorphin production), increase positive self-attitude, as well as promote positive socio-interaction with fellow gym members. Exercise Therapy is rapidly being employed with great success in all aspects of APD therapy.

References

Comer, R. J. (1996). Fundamentals of abnormal psychology. Avoidant personality disorder, pp.428-430. Third edition. New York: Worth.
Kantor, M. (1993). Distancing: A guide to avoidance and avoidant personality disorder. Westport, Conn: Praeger Publishers. This book contains a review of the literature about avoidance, descriptions about the way psychological avoidance manifests itself in real life, and a description of an eclectical approach for decreasing avoidance. The treatment that Kantor advocates is a mixture of diverse techniques such as invoking the phobic parameter, total push, encouragement, positive feedback, reassurance, educational advice, and anxiolytic or antidepressant drug therapy.
Van Velzen, C. J. M. (2002). Social phobia and personality disorders: Comorbidity and treatment issues. Groningen: University Library Groningen. (online version)

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Avoidant Personality Disorder".

« Previous 1...23 24 25 26 27 28 29...35 Next »

Share:

Link: (Here's how to do it ... )

Related Articles:

Reader Comments
Discuss this issue below or in our forums.

Worthy Work - Pal Val - Dec 28th 2009

I'd like to encourage anyone struggling with any version of this "illness" to begin to do their own work. Not only is this disorder harmful to oneself, it is also hurtful to others who care about you. My own deep feelings of inadequacy, which were caused by my failure to live up to huge expectations placed upon me at an early age, were overcome with a lot of hard work. Intelligence does not make one immune from this disorder, and I believe it can be used to overcome it.

I learned to constantly challenged the habitual negative things I told myself. I was lucky to read of a suggestion to use visualization - of pushing the stop button on the tape recorder when the critical voices in my head would come up. It was a perfect image for me because I was an avid tape recorder back in those days of cassettes. Hopefully you will find something that will resonate with you. The insight above regarding exercise is really interesting and certainly something to try.

I also came to see that all my worrying about how others perceived me was taking up a lot of space and mental effort that could instead be filled with much more fulfilling things...like getting to know and experiencing real relationship with others.

Nobody ever said life was supposed to be easy, and you will always meet an occasional person who does not like you ( and these people can also offer you a fair amount of insight if you are willing to go there ! ) but it is worth it to work hard to learn to love and be comfortable with oneself, become comfortable with others, and in turn, have deep and meaningful give and take relationships with others. Good luck.