Avoidant Personality Disorder

Avoidant Personality Disorder

Many of us struggle with shyness, but approximately two percent of the population suffer from avoidant personality disorder. Extreme shyness and fear of rejection make it difficult for some people to interact socially and professionally.

What Causes Avoidant Personality Disorder and How is it Treated?

Every person is endowed with his/her own personality that is unique and absolutely different from the other. However, there are people, who have personalities which are considered as a disorder as they do not suit the social norms. The Avoidant Personality Disorder or AvPD is one such disorder that is seen to occur in 1.8-6.4% in the normal population. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has listed Avoidant Personality Disorder or AvPD as a "Cluster C" which encompasses fearful or anxious disorders. If not diagnosed on time, Avoidant Personality Disorder or AvPD can lead to severe conditions in which the person's day-to-day interactions with others and maintaining relationships with them will be affected.

Definition

Personality disorders are long-lived patterns of behavior that cause problems with work and relationships. Avoidant personality disorder is a psychiatric condition characterized by a lifelong pattern of extreme social inhibition, feelings of inadequacy, and sensitivity to rejection. People with avoidant personality disorder may avoid work activities or decline job offers because of fears of criticism or disappointment from others. They may be inhibited in social situations as a result of low self-esteem and feelings of inadequacy. Additionally, they may be preoccupied with their own shortcomings and form relationships with others only if they think they will not be rejected. Loss and rejection are so painful to these individuals that they will choose loneliness rather than risk trying to connect with others. About two percent of the population, equally divided between the sexes, have this disorder.

Definition of Avoidant Personality Disorder:

Avoidant Personality Disorder or AvPD is a mental condition that is characterized by feelings of inadequacy, extreme shyness and sensitivity to rejection, along with an inferiority complex. The condition is diagnosed only when such behaviours become long-term and persistent and are very distressing or disabling.

Signs and Symptoms

Signs and Symptoms of Avoidant Personality Disorder:

The general sign of Avoidant Personality Disorder or AvPD is associated with feeling extremely shy and also being concerned about and be over-sensitive to what others think of the person. A sense of inadequacy and inferiority makes the person suffering from Avoidant Personality Disorder or AvPD feel socially inept. Due to such recurrent feelings that cannot be changed easily with familial support, the Avoidant Personality Disorder patient gradually starts to avoid work, school and other social interactions. Usually troubled with extreme self-doubts and no amount of self-confidence, they are quite vulnerable to criticism and often react to criticism with crying.

What makes the situation even worse for people suffering from Avoidant Personality Disorder or AvPD is that due to their lack of self confidence, hypersensitivity to rejection and low self-esteem, they gradually become relatively isolated. As a result, to avert such isolated circumstances and crisis situations, Avoidant Personality Disorder patients do not have any social support network. In personal grounds, their desire and need for acceptance and affection leads them to fantasize about ideal relationships that practically do not exist; and in work field, they try to avoid any and every kind of social situations in which they might have to meet people in order to cater to job needs.

Signs

Some common signs of avoidant personality disorder include:

* Easily hurt by criticism or disapproval

* No close friends

* Reluctance to become involved with people

* Avoidance of activities or occupations that involve contact with others

* Shyness in social situations out of fear of doing something wrong

* Exaggeration of potential difficulties

* Showing excessive restraint in intimate relationships

* Feeling socially inept, inferior, or unappealing to other people

* Unwilling to take risks or try new things because they may prove embarrassing

Symptoms

The general symptoms are associated with the following personality traits that are seen in almost every single person suffering from Avoidant Personality Disorder.

* Due to fear of criticism, rejection and disapproval, a person suffering from Avoidant Personality Disorder or AvPD avoids significant interpersonal contact and occupational activities

* Avoidant Personality Disorder person is preoccupied with the thought of being rejected, even before facing the situation

* With the fear of being disliked and unwilling to be involved with others, Avoidant Personality Disorder sufferers get associated with only those, with whom they feel comfortable or are not afraid to be rejected

* People suffering from Avoidant Personality Disorder would have a persistent feeling of inferiority to others, unappealing to others and socially inept

* Even in intimate relationships, shows restraint

* Reluctant to take any personal risks

* Catastrophising or always considering the possibility of a "worst" situation to occur

* Giving importance to the source of the occurrence of a bad situation or blame the reason, rather than finding a solution

Causes

The cause of avoidant personality disorder is unknown. Genetics or environmental factors, such as rejection by a parent or peers, may play a role in the development of the condition.

The avoidant behavior typically starts in infancy or early childhood with shyness, isolation, and avoidance of strangers or new places. Most people who are shy in their early years tend to grow out of this behavior, but those who develop avoidant personality disorder become increasingly timid as they enter adolescence and adulthood.

Treatments

Antidepressant medications can often reduce sensitivity to rejection. Psychotherapy, particularly cognitive/behavioral approaches, may be helpful. A combination of medication and talk therapy may be more effective than either treatment alone.

People with this disorder may have some ability to relate to others, and this can be improved with treatment. Without treatment, those with avoidant personality disorder may become resigned to a life of near or total isolation. They may go on to develop a second psychiatric disorder such as substance abuse or a mood disorder such as depression. It is important to get help from a health-care provider or a psychiatrist if shyness or fear of rejection overwhelm one's ability to function in life and form relationships.

Avoidant personality disorder is characterized by feelings of extreme social inhibition, inadequacy, and sensitivity to negative criticism and rejection. Yet the symptoms involve more than simply being shy or socially awkward. Avoidant personality disorder causes significant problems that affect the ability to interact with others and maintain relationships in day-to-day life. About 1% of the general population has avoidant personality disorder.

Types

Types of Avoidant Personality Disorder:

Each and every person with the Avoidant Personality Disorder consists of a range of personality or characteristic traits that do not necessarily match with the other. Hence, depending on the symptoms and the major prominence of the traits, they can be divided into four subtypes and they are:

1. Phobic Type of Avoidant Personality Disorder: In this condition, the general apprehensiveness is usually displaced and instead repugnancy, qualms and disquietude, dreadful situations, avoidable tangible precipitant takes its place.

2. Conflicted Type of Avoidant Personality Disorder: Usually the person suffers from an internal discord and fears any sort of dependency. Hesitation, confusion, angst and unreconciled within the self and severe torment overpowers the person.

3. Hypersensitive Type of Avoidant Personality Disorder: extremely panicky, terrified and hyper-suspicious regarding anything and everything. This gradually leads to terror; a sense of being wary and timorous overpowers the condition. It most often even leads to become thin-skinned, feeling prickly and petulant.

Self Deserting Type of Avoidant Personality Disorder: A deep sense of self awareness leads to discarding all the images and memories that are painful and gradually suicidal tendencies overpower.

Avoidant Personality Disorder Symptoms

Avoidant personality disorder symptoms include a variety of behaviors, such as:

Avoiding work, social, or school activities for fear of criticism or rejection. It may feel as if you are frequently unwelcome in social situations, even when that is not the case. This is because people with avoidant personality disorder have a low threshold for criticism and often imagine themselves to be inferior to others.

* Low self-esteem

* Self-isolation

When in social situations, a person with avoidant personality disorder may be afraid to speak up for fear of saying the wrong thing, blushing, stammering, or otherwise getting embarrassed. You may also spend a great deal of time anxiously studying those around you for signs of approval or rejection.

Causes and Risk Factors of Avoidant Personality Disorder:

There has not yet been any discovery of the specific cause of the Avoidant Personality Disorder to occur. However, scientists often associate the gene factors as well as environmental and social conditions of the person as the cause of Avoidant Personality Disorder. To highlight the social conditions, the scientists have highlighted and focussed on the factors such as how a person in his early developmental stage has learned to interact with friends and family. However, on the other hand, to deal with the psychological factors, the person's ability to cope with a situation, to deal with stress and how the environment plays a role over temperament and personality of the individual, are mostly considered and given importance to.

Those, who have had a condition of repeated rejections in the past and have been severely criticised during a tender mental condition, might develop Avoidant Personality Disorder gradually. If it persists, it will become a personality and changing a personality that has already been established is quite difficult. The occurrence of Avoidant Personality Disorder is limited and can be seen only in 2.36% in the American general population, according to the National Epidemiologic Survey on Alcohol and Related Conditions, 2001-02. It has been seen that those, who have been extremely shy as children are more likely to develop Avoidant Personality Disorder, but it is not necessary that all the shy children will have AvPD.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person diagnosed with avoidant personality disorder needs to show at least four of the following criteria:

* Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection.

* Is unwilling to get involved with people unless they are 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 risks or to engage in any new activities because they may prove embarrassing.

Avoidant behavior may commonly be seen in children or adolescents, but a diagnosis of a personality disorder cannot be made in childhood because shyness, fear of strangers, social awkwardness, or being sensitive to criticism are often a normal part of child and adolescent development.

Diagnosis

Diagnosis of Avoidant Personality Disorder:

Diagnosis of Avoidant Personality Disorder or AvPD is very important as it is the only way through which the exact difficulty and the problems that the person is suffering from or is troubled with, can be determined and gradually catered to. However, Avoidant Personality Disorder is a mental health condition that cannot be diagnosed with any kind of blood tests or lab test and can only be diagnosed by a trained and well equipped mental health professional, such as a psychiatrist or a psychologist.

The diagnosis of Avoidant Personality Disorder is made by the professional, depending on the symptoms and the characteristic traits that one possesses. Standardised questionnaires are administered to diagnose Avoidant Personality Disorder. If at least few of those conditions match with your personality, you will be considered to have Avoidant Personality Disorder or AvPD considering the in-detailed patient history. The questionnaire focuses on whether you have:

* Fear of criticism, disapproval, or rejection.

* Unwilling to get involved with unknown people

* Avoid intimate relation with the fear of rejection and humiliation

* A deep sense of inferiority

* Unlikely to participate in new activities

* Worried to take personal risks

* Afraid of embarrassment

Depending upon whether your conditions meet these criteria or not, the mental health professional will determine if you have Avoidant Personality Disorder or not.

Treatment

Treatment of Avoidant Personality Disorder:

The maximum difficulty with a person suffering from Avoidant Personality Disorder or AvPD is that he or she does not agree to proceed to a therapy or treatment. Additional to their fear of meeting people, they also develop a sense of rejected and distressed and feel that their family and friend are trying to get rid of them and send them to an even more difficult situation. However, with the treatment therapies for Avoidant Personality Disorder, they are usually given a better life, they are helped with identifying the trouble and helped with coping with those difficulties.

The therapies do not 'treat' the problem, as there is no disease to treat as such, but they are assisted with tools and equipment that can help them to overcome their fear and cope with them easily. The personality characteristics that they possess would not be completely changed with these therapies; that is to say, a shy person would not become bold, but the extent of shyness from everything, the fear of meeting unknown people and the fear or rejection will be controlled.

A mental health professional can assess your symptoms, make an accurate diagnosis, and suggest the appropriate treatment options.

The therapies that are used in this process of treating Avoidant Personality Disorder are:

Avoidant Personality Disorder Treatments

As with other personality disorders, a mental health professional will design a treatment plan that is appropriate for you. Avoidant personality disorder treatments vary, but they will likely include talk therapy. If a co-existing condition, such as depression or anxiety disorder, is also diagnosed, appropriate medications may also be used.

Psychodynamic Psychotherapy for Avoidant Personality Disorder

By having a talk or chat with the patient, the mental health professional discovers which past situations have influenced in the current behaviour. The professional assists in eliminating that thought and overcoming the situation by resolving those emotional conflicts.

Cognitive Behavioural Therapy for Treating Avoidant Personality Disorder

This is also a form of talk therapy in which the patient is helped with replacing the unhealthy beliefs and thought processes with healthier ones. The therapist will assist you on how to overcome difficulties and negative thoughts, feelings and actions with the positive ones.

Alternative Therapies That Can Help Treat Avoidant Personality Disorder

Once the patient suffering from Avoidant Personality Disorder has developed a considerable control over their negative emotions, with proper advice from the mental health professional, they can also start taking sessions for alternative therapies. Relaxation therapy is one such kind which is often used to calm down Avoidant Personality Disorder sufferers and help them to stabilize. Other alternative therapies include, yoga, meditation, music and drama therapy, dance movement therapy etc.

Sometimes, antidepressant medication is also given to reduce the sense of rejection aongh Avoidant Personality Disorder sufferers. If you have this mental health condition, seeking expert professional help will help you to overcome your fears and worries and sense of rejection or criticism.

Avoidant Personality Disorder and Other Conditions

Other mental health disorders can occur along with avoidant personality disorder. Treatments in these cases will be designed to help with the symptoms of each disorder. A few of the conditions that most frequently occur with avoidant personality disorder include:

* Social phobia, in which a person experiences overwhelming anxiety and self-consciousness in common social situations.

* Dependent personality disorder, in which people rely excessively on others for advice or to make decisions for them.

* Borderline personality disorder, in which people have difficulties in many areas including social relationships, behavior, mood, and self-image.

Many avoidant personality disorder symptoms are commonly shared among these other conditions, particularly in the case of generalized social phobia. Because of this, the disorders can be easily confused. It may take some time for a mental health professional to make a clear diagnosis and choose the appropriate treatments for you.

References

American Psychiatric Association, Diagnostic and Statistical Manual, Fifth Edition

National Institutes of Health

National Institute on Alcohol Abuse and Alcoholism

National Library of Medicine