Avoidant Personality Disorder - an Overiew

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As the name suggests, individuals with avoidant personality disorder avoid situations and interpersonal interactions that make them feel uncomfortable. As with all personality disorders, the maladaptive patterns of behaviors and negative self-perception of avoidant individuals are deeply ingrained, inflexible, and resistant to change.

Individuals with avoidant personality disorder have significant problems in many areas of their life. Their avoidant behavior, which stems from extreme feelings of inadequacy and hypersensitivity to rejection and criticism, almost always has a negative impact on their work relationships and career aspirations, their friendships and social life, and their intimate relationships.

Symptoms

Avoidant PD stems from deep feelings of inadequacy and a high sensitivity to any type of negative scrutiny or response from others. Individuals with this disorder are often quiet, very shy, and painfully inhibited in social situations. They protect themselves by isolating, avoiding new friendships and intimate relationships, and / or going out of their way to avoid any potentially uncomfortable social interactions. They are often reluctant to try new things or take personal risks of any kind.

Avoidant individuals often regard themselves as:

  • Socially inept
  • Inadequate
  • Undesirable
  • Inferior

Their avoidant behavior protects them from:

  • Rejection / not being liked
  • Disapproval
  • Criticism
  • Ridicule
  • Shame
  • Embarrassment / humiliation

In order to feel comfortable with anyone, individuals with Avoidant PD typically require a lot of reassurance. They generally won’t risk developing a relationship with anyone or engage socially unless they are certain they will be liked and accepted.

Treatment

As a general rule, personality disorders are very difficult to treat. Many individuals with Avoidant PD won’t seek treatment on their own, since the very nature of therapy requires them to be vulnerable. When they do seek help, it’s often due to pressure from a significant other, family member, or employer.

Psychotherapy is the primary treatment for individuals with Avoidant PD. One of the initial (and crucial) goals of therapy is to establish trust and develop a strong therapeutic rapport. While these two elements are always important, they are particularly important for individuals with Avoidant PD in order for them to feel emotionally safe enough to stay in therapy. Cognitive behavioral therapy, for example, can help avoidant individuals learn to identify and change the irrational thought patterns and erroneous beliefs that drive their avoidant behavior. It can also help them develop new social skills and behaviors.

Medication is not generally recommended for the treatment of Avoidant PD, as its effectiveness will be very limited, at best. However, it can be beneficial for treating the symptoms of a co-occurring mood or anxiety disorder. Even then, it should be used in conjunction with psychotherapy and not as the sole treatment.

Avoidant PD and Frequent Co-Occurring Disorders

It’s quite common for avoidant individuals to have other co-occurring psychiatric disorders. These include mood disorders such as depression, anxiety disorders, and another personality disorder. Two of the most frequently co-occurring disorders with Avoidant PD are Panic Disorder with Agoraphobia and Dependent Personality Disorder. The latter is largely due to the fact that avoidant individuals typically have a very limited group of people with whom they feel comfortable and emotionally safe, and they tend to become quite dependent upon them. Other personality disorders that often co-occur include Borderline, Paranoid, Schizoid, and Schizotypal.

There is a significant amount of overlap between the symptoms of Social Phobia, “generalized” (when there is a fear of most social situations) and Avoidant PD. Some experts regard them as essentially the same condition, and a diagnosis of both disorders is sometimes warranted. Keep in mind, however, that many individuals with Social Phobia experience anxiety in only one or a few specific social situations and would not also meet the criteria for Avoidant PD.

Photo by Benoit Derrier

 
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