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Anxious personality disorder

Avoidant personality disorder
Avoidant personality disorder
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Anxious personality disorder, formally known as avoidant personality disorder, is listed by the American Psychiatric Association as one of three “Cluster C" or Anxious personality disorders. The other two being dependent personality disorder and obsessive-compulsive personality disorder (not to be confused with obsessive-compulsive disorder).

Avoidant personality disorder, abbreviated as AvPD, is believed to affect men and women in equal numbers however, its exact prevalence is unknown. Estimates range from as little as 2 percent to as high as 5 percent of the adult population.

“Individuals with AvPD view the world as unfriendly, cold, and humiliating. People are seen as potentially critical, uninterested, and demeaning; they will probably cause shame and embarrassment for individuals with AvPD. As a result, people with AvPD experience social anxiety and are awkward and uncomfortable with people.” Millon & Davis, 1996

It is similar in many ways to social phobia or social anxiety disorder; however, with those disorders the fear is more centered on people whereas with AvPD the fear tends to be focused on situations. Those with avoidant personality disorder generally feel inferior to others and often choose loneliness over the risk of being vulnerable or rejected.

For people who suffer with AvPD extreme shyness and fear of rejection make it extremely difficult to interact with others socially and professionally.

People with AvPD are uncomfortable and restrained in social situations, overwhelmed by feelings of inadequacy, and extremely sensitive to negative criticism. They are often so fearful of being rejected that they give no one an opportunity to reject or accept them.

People with this disorder believe themselves to be unappealing or inferior to others. They exaggerate the potential difficulties of new situations and seldom take risks or try new activities. They often feel alone and depressed. As a result, some people with this personality disorder develop an inner world of fantasy and imagination.

In order to receive a diagnosis of AvPD at least four of the following seven criteria must be met:

  1. Avoids activities that involve interpersonal contact.
  2. Avoids getting involved due to a fear of not being liked by others.
  3. Restraint in intimate relationships due to a fear of shame or ridicule.
  4. Marked preoccupation of being rejected or criticized by others.
  5. Stays away from new interpersonal situations due to feelings of inadequacy
  6. Views oneself as inferior, socially inept, or personally unappealing.
  7. Takes few if any personal risks in the engagement of new activities, for a fear of being embarrassed.

According to the cognitive theory of personality disorders set forth by Aaron Beck, the following statements represent the central cognitive distortions of the patient with AvPD:

  • I am socially inept and socially undesirable in work or social situations.
  • Other people are potentially critical, indifferent, demeaning, or rejecting.
  • I cannot tolerate unpleasant feelings.
  • If people get close to me, they will discover the "real" me and reject me.
  • Being exposed as inferior or inadequate will be intolerable.
  • I should avoid unpleasant situations at all costs.
  • If I feel or think something unpleasant, I should try to wipe it out or distract myself.
  • I should avoid situations in which I attract attention, or I should be as inconspicuous as possible.
  • Unpleasant feelings will escalate and get out of control.
  • If others criticize me, they must be right.
  • It is better not to do anything than to try something that might fail.
  • If I don’t think about a problem, I don't have to do anything about it.
  • Any signs of tension in a relationship indicate the relationship has gone bad; therefore, I should cut it off.
  • If I ignore a problem, it will go away.

The cause of Avoidant Personality Disorder is unknown. However, like other personality disorders it is believed to have both a genetic and environmental component.

Many people diagnosed with AvPD have had painful early experiences of chronic parental criticism or rejection. A combination of genetic traits and child abuse/neglect is most often associated with the disorder, but no conclusive study exists.

Like all personality disorders, the long-term outlook for these patients is not good. However, antidepressant medications can often reduce sensitivity to rejection. Psychotherapy, particularly cognitive-behavioral approaches, can also be helpful. A combination of medication and talk therapy may be more effective than either treatment alone.

A brief 11 question online test is available at Psymed to asses oneself for Avoidant personality disorder.

Source material: Psychologytoday.com, APA 2000, Psychiatric Times. Pttypes.com