Avoidant personality disorder

Avoidant personality traits are very common in a sample of psychiatric patients. These and obsessive-compulsive traits are among the most common that I see in my practice.

Avoidant Personality Disorder is characterized by 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 initiating intimate relationships because of the fear of being ashamed, ridiculed, or rejected due to severe low self-worth;
  • 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.

There is a big overlap between this personality type and other anxiety disorders, especially social anxiety disorder. All people with avoidant personality are socially anxious but not all people with social anxiety have Avoidant Personality Disorder.

These people are difficult to engage in therapy sometimes because of their fear of evaluation. Therapy of various types has been tried but today usually consists of a combination of cognitve-behavioural therapy, social skills training and medication. Several antidepressants can be helpful in making people less sensitive to criticism quite independently of their antidepressant effects. In cognitive-behavioural therapy various techniques are used to encourage greater social involvement. As with other fears, exposure to what is feared is a necessary part of recovery. Of course, this exposure must be positive. These people will not do well in an environment of harsh criticism or ridicule and forcing someone to do things against their will is also not therapeutic.

This personality type is often associated with other psychiatric disorders, such as depression and anxiety disorders, which also have to be dealt with. The treatments for both the personality traits and the depression and anxiety are complementary.

Much of the responsibility for these traits is genetic but environmental factors can ameliorate or exaggerate these in-born traits. A timid child in an abusive environment will be far worse off than the same child in an encouraging, supportive environment. They do need to be encouraged to go beyond their comfort level rather than coddled and encouraged in their avoidance.

The problem is that they may well have parents who share the same traits who will enable the avoidance behaviour rather than encouraging counter-phobic behaviour. This is where extracurricular activities can be helpful so that they have some exposure to alternative coping styles. Involvement in sports or clubs with peers who are less timid can be very therapeutic.

 

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