Personality Disorder Support Community

Personality Disorder Support Community

Avoidant Personality Disorder


Avoidant Personality Disorder afflicts about 1% of the general population, and is characterised by symptoms of social ineptitude, extreme sensitivity to criticism, feelings of inadequacy and a lack of social interaction. Although the symptoms are similar to those who have general social phobia, there are marked differences in terms of degree.

People with Avoidant Personality Disorder (AvPD) tend to:

  • Be extremely self conscious.

  • Have low self esteem.

  • Have self imposed isolation.

  • Be shy or anxious in social situations, often blush or stammer and get embarrassed easily.

  • Be hypersensitive to criticism, teasing or rejection, often looking out for any signs of disapproval or otherwise.

  • Feel inferior to others.

  • Fantasize and daydream in order to escape reality.


In order to be diagnosed with AvPD, you will have to meet certain criterion laid out by the DSM IV or the ICD-10.

For the DSM IV, the diagnostic criteria are as follows:


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:

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

  2. Unwilling to get involved with people unless certain of being liked.

  3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.

  4. Preoccupied with being criticized or rejected in social situations.

  5. Inhibited in new interpersonal situations because of feelings of inadequacy.

  6. Views self as socially inept, personally unappealing, or inferior to others.

  7. Unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.


The World Health Organisation's ICD-10 lists avoidant personality disorder as anxious (avoidant) personality disorder. It is characterized by at least four of the following:

  1. Persistent and pervasive feelings of tension and apprehension.

  2. Belief that one is socially inept, personally unappealing, or inferior to others.

  3. Excessive preoccupation with being criticized or rejected in social situations.

  4. Unwillingness to become involved with people unless certain of being liked.

  5. Restrictions in lifestyle because of need to have physical security.

  6. Avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection.

Associated features may include hypersensitivity to rejection and criticism.
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfy a set of general personality disorder criteria.

Excludes:

  • Social Phobia.

  • Generalized Type.

  • Panic Disorder With Agoraphobia.

  • Dependent Personality Disorder.

  • Schizoid Personality Disorder.

  • Schizotypal Personality Disorder.

  • Paranoid Personality Disorder.

  • Personality Change Due to a General Medical Condition.

  • Symptoms that may develop in association with chronic substance use.



Cause of AvPD

There is no definite cause of Avpd, but typically, people with Avpd tend to have a childhood with over critical parents who reject them. These experiences are usually painful, and the sufferers learn to develop some kind of self protection by withdrawing themselves from social contact. These experiences are further reinforced by peer rejection or criticism.

Treatment

Most treatments for AvPD are based on improving the self esteem, social skills and confidence of the sufferer. Psychotherapy may be offered, and may be effective by providing a safe and secure relationship where they begin to trust. Cognitive behavioural therapy (CBT) may also be effective by restructuring the perceptions of the sufferer. Sometimes, group therapy may also be offered, so the sufferer may also learn social skills and have social experiences in a controlled setting.
Medication may also be offered to ease anxiety and depressive symptoms.

Millon's subtype

Phobic Avoidant
This subtype is characterised by dependent features. People who belong to this subtype tend to have a general anxiety caused by things or situations that they can avoid. They also tend to have fears and anxiety represented by unacceptable and clearly defined and identifiable object or circumstance.

Hypersensitive Avoidant
Hypersensitive avoidants tend to have paranoid features where they feel extremely cautious and distrustful. They can be very fearful and afraid and then become peevish and prickly.

Conflicted Avoidant
This subtype is characterised by negativistic features and sufferers tend to have some kind of internal conflict whereby they are afraid to be both dependent and independent, and feel confused and tormented because they are unable to reconcile their internal worries.

Self Deserting Avoidant
Self Deserting avoidants tend to have melancholic features where they reject painful memories or thoughts that they think is untenable. They also tend to feel suicidal and reject or fragment their self awareness.

© PDChat 2013

References:

Avoidant Personality Disorder – Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)

Avoidant Personality Disorder – International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)

Millon, Theodore (2006). "Personality Subtypes Summary”. The Official Website for Theodore Millon, Ph.D., D.Sc.. DICANDRIEN, Inc. http://millon.net/taxonomy/summary.htm.

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