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Avoidant Personality Disorder (AvPD)

Avoidant Personality Disorder is characterized by a pattern of lifetime shyness, feeling inadequate or inferior, and extreme sensitivity to rejection or criticism. For a long time, doctors did not make much distinction between avoidant personality disorder and schizoid or dependent personality disorders. But in the last decade, these diagnoses have gotten more refined, and AvPD patients now have more specific diagnostic criteria. Avoidant Personality patients want close relationships but they are afraid of humiliation, or rejection. So these patients establish a distance between themselves and others. AvPD patients will scan their environment looking for possible threats. They are hypersensitive to rejection and criticism and will take small negative remarks to heart, feeling they are inferior and thinking only of their shortcomings. They have low self-esteem and will devalue even the most impressive of their accomplishments. AvPD patients are shy and apprehensive around others, and they often seem sad, lonely, and anxious. Under extreme stress they may talk about feelings of emptiness. Avoidant Personality Disorder patients function at different levels. The patient with the avoidant ‘style’ leads a relatively normal life, while those with the classic ‘avoidant disorder’ struggle to function. The disorder may be hereditary, and has been identified in infants as young as four months of age. It is believed that trauma, emotional or physical abuse, parental anxiety and overprotection can also contribute to AvPD. In studies, the degree of parental rejection among AvPD patients is particularly high. And if parental or family rejection is compounded by peer rejection the patient will be more heavily predisposed toward a personality disorder.

What are the symptoms?

• Low self-esteem, belief that they are unworthy of successful relationships, self-conscious, lonely, see accomplishments as little or no worth
• Exhibit little emotion; because of fear that showing emotions makes patient vulnerable to rejection, humiliation. Appears anxious or tense.
• Excessive monitoring of environment to process reactions of other people, not paying attention to the social interaction because of the focus on the other person.
• Easily hurt by criticism or disapproval
• Wariness
• Exaggerate potential difficulties
• Avoid activities or occupations that involve contact with others
• Escape into fantasy to express emotion, aggression or impulses that patient feels are otherwise inappropriate or uncomfortable in the real world. Reads, watches TV, daydreams to escape.
• Tests others to see if they are sincere. People often fail these tests and patient then avoids them because they may reject the patient. Difficult to begin and maintain relationships because of inability to trust.
• Lots of time and effort making themselves attractive to others, or making sure that their appearance drives others away, dressing in a style of the era when trauma occurred.
• Having no close friends
• Reluctance to become involved with people
• Frequent pauses in speech or speaking slowly, or overly talkative, trying to put people off with, insults to give patient control over how others react to them.
• Patients are perfectionists and can reject those who do not live up to their standards. Belief that their absence of relationships is not because they are unable to have them, but rather that they do not want to waste their time. Belief that giving to others reduces the energy they have for themselves
• Shyness, timid behavior or withdrawal in social situations

How is it diagnosed and treated?

To diagnose Avoidant Personality Disorder, doctors will look for a pattern of inhibition, and expressed feelings of inadequacy, and hypersensitivity to criticism. This pattern typically begins by early adulthood and includes four or more of the following signs:

• Avoids jobs or school activities that involve a lot of interpersonal contact.
• Shows lack of intimacy and fear of ridicule and embarrassment
• Poor peer relationships
• Apprehensive and anxious in social situations
• Does not get involved with others unless patient is certain they will be liked
• Reluctant to take personal risk or engage in new activities
• Conduct problems in school or at work
• Feels inadequate, incompetent and unappealing

Treatment(s) can include:

• Psychotherapy
• Group Therapy
• Cognitive Behavioral Therapy
• Assertiveness Training
• Family Therapy
• Medications like antidepressants as appropriate

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