Avoidant personality disorder, also known as anxious personality disorder, is a Cluster
C personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders
handbook as afflicting persons when they display a pervasive pattern of social inhibition,
feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of social
interaction.
Individuals afflicted with the disorder tend to describe themselves as ill at ease, anxious,
lonely, and generally feel unwanted and isolated from others.
People with avoidant personality disorder often consider themselves to be socially inept
or personally unappealing and avoid social interaction for fear of being ridiculed, humiliated,
rejected, or disliked.
Avoidant personality disorder is usually first noticed in early adulthood.
Childhood emotional neglect and peer group rejection are both associated with an increased
risk for the development of AvPD.
There is controversy as to whether avoidant personality disorder is a distinct disorder
from generalized social phobia and it is contended by some that they are merely different conceptualisations
of the same disorder, where avoidant personality disorder may represent the more severe form.
This is argued because generalized social phobia and avoidant personality disorder have
similar diagnostic criteria and may share a similar causation, subjective experience,
course, treatment, and identical underlying personality features, such as shyness.
Signs and symptoms People with avoidant personality disorder
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 alone rather
than risk trying to connect with others.
They often view themselves with contempt, while showing an increased inability to identify
traits within themselves which are generally considered as positive within their societies.
Childhood emotional neglect—in particular, the rejection of a child by one or both parents—has
been associated with an increased risk for the development of AvPD, as well as rejection
by peers.
Hypersensitivity to rejection/criticism Self-imposed social isolation
Extreme shyness or anxiety in social situations, though the person feels a strong desire for
close relationships Avoids physical contact because it has been
associated with an unpleasant or painful stimulus 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
Lonely self-perception, although others may find the relationship with them meaningful
Feeling inferior to others In some extreme cases, agoraphobia
Uses fantasy as a form of escapism and to interrupt painful thoughts
Causes Causes of avoidant personality disorder are
not clearly defined and may be influenced by a combination of social, genetic, and psychological
factors.
The disorder may be related to temperamental factors that are inherited.
Specifically, various anxiety disorders in childhood and adolescence have been associated
with a temperament characterized by behavioral inhibition, including features of being shy,
fearful, and withdrawn in new situations.
These inherited characteristics may give an individual a genetic predisposition towards
AvPD.
Childhood emotional neglect and peer group rejection are both associated with an increased
risk for the development of AvPD.
Millon's subtypes Psychologist Theodore Millon notes that because
most patients present a mixed picture of symptoms, their personality disorder tends to be a blend
of a major personality disorder type with one or more secondary personality disorder
types.
He identified four adult subtypes of avoidant personality disorder.
Diagnosis World Health Organization
The World Health Organization's ICD-10 lists avoidant personality disorder as anxious personality
disorder.
It is characterized by at least four of the following:
persistent and pervasive feelings of tension and apprehension;
belief that one is socially inept, personally unappealing, or inferior to others;
excessive preoccupation with being criticized or rejected in social situations;
unwillingness to become involved with people unless certain of being liked;
restrictions in lifestyle because of need to have physical security;
avoidance of social or occupational activities that involve significant interpersonal contact
because of fear of criticism, disapproval, or rejection.
Associated features may include hypersensitivity to rejection and criticism.
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also
satisfy a set of general personality disorder criteria.
American Psychiatric Association The DSM-IV-TR also has an Avoidant Personality
Disorder diagnosis.
It refers in general to a widespread pattern of inhibition around people, feeling inadequate
and being very sensitive to being evaluated negatively since early adulthood and occurring
in a range of situations.
In addition, four of seven specific criteria should be met, which are:
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 risk
or to engage in any new activities because they may prove embarrassing
Other Earlier theorists proposed a personality disorder
with a combination of features from borderline personality disorder and avoidant personality
disorder, called "avoidant-borderline mixed personality".
Differential diagnosis Research suggests that people with avoidant
personality disorder, in common with sufferers of chronic social anxiety disorder, 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.
According to the Diagnostic and Statistical Manual of Mental Disorders, avoidant personality
disorder must be differentiated from dependent, paranoid, schizoid and schizotypal personality
disorders.
Comorbidity Avoidant personality disorder is reported
to be especially prevalent in people with anxiety disorders, although estimates of comorbidity
vary widely due to differences in diagnostic instruments.
Research suggests that approximately 10–50% of people who have panic disorder with agoraphobia
have avoidant personality disorder, as well as about 20–40% of people who have social
phobia.
Some studies report prevalence rates of up to 45% among people with generalized anxiety
disorder and up to 56% of those with obsessive-compulsive disorder.
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.
A key issue in treatment is gaining and keeping the patient's trust, since people with avoidant
personality disorder 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 avoidant personality disorder to begin challenging their exaggerated negative beliefs
about themselves.
People with AvPD can improve social awareness and skills, but with deep-seated feelings
of inferiority and significant social fear, these patterns usually do not change dramatically.
MAOIs such as Phenelzine can be very helpful by increasing confidence and the feeling of
wanting to become more socially active.
Epidemiology According to the DSM-IV-TR, avoidant personality
disorder occurs in approximately 0.1% to 0.5% of the general population.
However, data from the 2001-02 National Epidemiologic Survery on Alcohol and Related Conditions
indicates a prevalence rate of the disorder of 0.36% in the American general population.
It is seen in about 10% of psychiatric outpatients.
History The avoidant personality has been described
in several sources as far back as the early 1900s, although it was not so named for some
time.
Swiss psychiatrist Eugen Bleuler described patients who exhibited signs of avoidant personality
disorder in his 1911 work Dementia Praecox: Or the Group of Schizophrenias.
Avoidant and schizoid patterns were frequently confused or referred to synonymously until
Kretschmer, in providing the first relatively complete description, developed a distinction.
See also
Attachment theory Counterphobic attitude
Highly sensitive person Inferiority complex
Experiential avoidance Avoidance coping
Social: Hermit
Hikikomori Loner
Recluse Solitude
Taijin kyofusho References