Hi, I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
Today I'm talking about avoidant personality disorder,
and this is based on a question from Dee,
and here's excerpt of his question.
"Would you be willing to talk
"about avoidant personality in more detail?
"I'd like to hear more coping skills for it
"and what kinds of treatment and self-work,
"things I can do myself, to help with this.
"It certainly has had a marked impact on my relationships,
"including both friends and family."
Thanks, Dee, for your question.
First, let me define the disorder,
and this is based on the "Diagnostic and Statistical
Manual of Mental Disorders: Fifth Edition."
An essential feature of avoidant personality disorder
is a pattern of being socially inhibited,
feeling inadequate and hypersensitive to rejection
or criticism starting by early adulthood.
This pattern occurs pervasively,
which means that it spreads across all areas of your life,
so it's not something that you only notice
after being in a bad relationship with someone
who sucked your soul and tore you down emotionally.
After a relationship like that,
you will have some battle wounds
that can look like feeling inadequate.
Most of the personality disorders, including this one,
really start to manifest around
late adolescence and early adulthood,
and with avoidant personality disorder,
you can get hints of social awkwardness and insecurity
that seem excessive that the child
just doesn't seem to grow out of.
Here's a criteria, you need four or more of the seven.
Number one, avoids occupational activities
that involve significant interpersonal contact
because of fears of criticism, disapproval or rejection.
This would be more than saying, "I'll pass,"
whenever you're asked to do something.
Your fear of criticism is so strong,
that you risk being demoted or getting negative evaluations
because you're not following through on things
that you're expected to do.
So let's say you have a monthly activity
that involves working closely with people.
You don't outwardly say, "No, I'm not doing it
"because it makes me uncomfortable."
Instead, you miss meetings under the guise
of being sick, or late, or tied up with something else.
You find a way to get out of it
without looking like you're being defiant,
so you may not get in trouble for your absence,
but it still has negative consequences for you
because you're missing in action.
Number two, is unwilling to get involved with people
unless you're certain of being liked.
With this, you hang on the fringe of society.
You're around, but you won't step into the circle
and go beyond the superficial with people.
Since you're trying to get reassurance
that the person likes you first,
you end up relying on vibes
and intangible body language cues
to know whether or not the person likes you.
In this thought process of making assumptions
about what someone thinks is important
because it ties in to how to overcome these assumptions.
Number three, shows restrain within intimate relationships
because of fear of being shamed or ridiculed.
In relationships, you keep people
at an arm's distance emotionally,
and this can look like being afraid
to talk about deep things, so you just don't.
But a more subtle way you can do this
is working all the time, or staying too busy,
and this isn't entirely conscious,
meaning you don't set this up
as a strategy to avoid intimacy,
because at a deeper level you want intimacy,
but it's uncomfortable because of these fears you have
so you gravitate towards work and staying busy
because that's where you're most comfortable.
You tell yourself, and the person
that you have the relationship with,
that you can't control your business.
Number four, is preoccupied with being criticized
or rejected in social situations.
Usually your fixation on this is enough
to keep you out of social situations,
but if you do go out, you're very uncomfortable
because of worrying about what others think of you.
This is how avoidant personality disorder
can look like social anxiety.
I talk about social anxiety in this video,
and I'll have a link to this video in the Description.
Number five, is inhibited in new interpersonal situations
because of feelings of inadequacy.
This can look like shyness,
you don't speak much around people,
or you feel uptight and can't loosen up,
and to make things easier on yourself,
you just avoid dealing with unfamiliar people
if you can help it.
But if you can't help, you're inhibitions
may make you look awkward.
You may stutter, or not really say what you mean
because you're overthinking how you say it
or how the person's gonna take it.
And this is just an example of how this can look.
Number six, views self as socially inept,
personally unappealing, or inferior to others.
You can get to this point if you try
and push through your fears and inhibitions
and force the social interactions.
In other words, you can mount your own evidence
to prove this point by reflecting back on your experience.
So for example, some people get so anxious
that they sweat or choke up when they talk to people.
Or let's say you're in a small group,
and because you're worrying about what people think,
you draw blanks during a conversation
and don't know what to say,
or say the wrong thing that doesn't make any sense.
Can you then see how you could draw
your own conclusion that you're socially inept?
Number seven, is unusually reluctant to take personal risks
or to engage in any new activities
because they may prove embarrassing.
This may look like the 38-year-old person
who wants so much to find a partner and get married,
but can't bring himself to ask out this woman
who's sending obvious signals that she's interested.
It's the lowest hanging fruit that he'll ever have,
and he just can't reach for it.
He already knows it will turn into a disaster
that he won't be able to recover from emotionally.
There is a lot of overlap between social anxiety disorder
and avoidant personality disorder.
However, with social anxiety, the fear and anxiety
is limited to social interactions
and you realize that your fears
are unreasonable at some level,
but you're still anxious about it
and you can still have close, personal relationships.
But with avoidant personality,
there's a deep belief that there's something wrong with you,
and because of that, you hyperfocus on sublet cues
that people are rejecting or criticizing of you.
The threshold for seeing something as critical is very low,
meaning it doesn't take much for you
to feel insulted or hurt by someone's remarks.
Your reaction to this is just to stay away
and avoid dealing with people in any way that you can.
Now, rejection-sensitivity is not unique
to avoidant personality disorder.
There are other types of people and personalities
that are sensitive to criticism.
For example, a person with a more aggressive
personality style may respond to perceived criticism
by attacking others first,
stick it to other people before they stick it to you.
That person is not avoiding interactions,
they stay in the game and they just fight their way through.
But you see the difference there?
I just use that example to illustrate
that no one likes criticism,
and not everyone who is sensitive to criticism or rejection
responds to it in an avoidant way.
With avoidant personality, the avoidance is about
avoiding relationships and closeness
because of feeling inadequate and fearing rejection
or criticism in some form.
The treatment for this is cognitive therapy.
There may be some behavioral exercises
that a therapist can help set up for you,
but generally the approach is addressing
your distorted beliefs about yourself.
I talk about cognitive distortions in this video.
I think it would be hard to adequately address this
from a self-help approach because you need someone
to help you identify some of your distorted thoughts.
But you may get by talking through some of your thoughts
with a trusted friend.
So let's summarize some of the common beliefs
that you can have with avoidant personality disorder.
You are inadequate.
People disapprove of your and want to criticize you.
If someone gets to know you, they won't like you,
so you can't expose yourself to them.
Your feelings aren't safe around others
because they will mock you.
These are a starting place for you.
If you can identify with these, then write them down.
Then, to add more of your own thoughts,
think about situations that have caused problems for you,
like the examples that I gave with work,
and needing to interact with small groups,
and things like that.
Have you had trouble at work because of your assumptions
about what people are thinking?
Take an inventory of your relationships.
Do you have close friends?
Do you have a romantic partner?
Most people with avoidant personality disorder
are deeply lonely, but they lack the desire
to do the things that it takes to get close to someone
because of how uncomfortable it makes them feel.
So part of getting past that is being resolved
to deal with the discomfort to get to the end goal.
That means you should expect the process to be hard,
and you'll have to keep going at it.
But I will say, in looking for a partner,
you'll probably be more suited for someone
who's more emotionally hands off like you are.
You won't do well with a person who's more emotionally needy
and wants a lot of your attention.
You can improve in this area of being
more revealing of yourself,
but you can only go so far with it.
So you don't need someone who's pressing you all the time
to talk and share your feelings.
Identifying what's behind your behavior
is an important step and gives you insight,
but then you need to challenge your beliefs,
and that's the part that may not be
so easy to do on your own.
In this video I give you one way
to challenge your distorted beliefs.
There are other ways to challenge beliefs,
but with avoidant personality disorder,
I think you need someone to help you navigate through it.
Another thing that can help
with avoidant personality disorder is skills training.
This would be getting help with having conversations
or how to carry yourself in public.
You could also get help on how to nurture a relationship.
For example, asking people questions
and following up on their answers.
This shows that you're interested in them.
And you can learn how to reveal things about yourself
so people can feel close to you.
Also with skills training you can get feedback
on what are appropriate things to share with people.
So there's a lot here and I do think that,
even if you don't have a therapist,
understanding what holds you back
can still help you make some changes
to improve your relationships.
Thanks again, Dee, for the question.
See you next time.