Avoidant Personality Disorder (APD) is caused by a person’s perceived or actual rejection by parents or peers during childhood: they think of themselves to be socially incompetent or personally unappealing, and treatment includes some medicinal prescriptions, social skills training or group therapy for practicing social skills. Interestingly, avoidant personality disorder occurs equally in the male species as in the female species. It has an affect on people from 0.5% to 1.0% of grown ups in the United States population, but it has been identified in about 10% of clinical outpatients (Fundukian, Wilson, 2008). What is meant by personality disorder? It is a long-term, unchanging pattern of maladaptive and inflexible personality traits that leads to impairment or distress (Gopal, Ropper, Tramontozzi, 2008).
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Persons with APD have an apparent or actual rejection by parents or peers during childhood; however, because they believe that they may have had rejection in childhood, it can cause numerous issues. They also have social inhibitions, feelings of inadequacy, and extra sensitivity to negative feedback. They avoid employment activities that involve a lot of interpersonal contact because of fear of criticism, disapproval, or rejection. They are unwilling to get involved with people unless they are certain of being liked. Also, they hold back within intimate relationships because of the fear of being shamed or ridiculed. Unfortunately, they are preoccupied with being criticized or rejected in social situations. Then they are inhibited in new interpersonal situations because of feelings of inadequacy. Lastly they view themselves as socially incompetent, personally unappealing, or inferior to others; and are unusually reluctant to take personal risks or to engage in any new activities because they may turn out embarrassing (Gopal, Ropper, Tramontozzi, 2008).
APD is not to be confused with antisocial personality disorder. They both have the same acronym, yet some professionals also use “AvPD” to help differentiate Avoidant Personality Disorder from Antisocial Personality Disorder. Antisocial Personality Disorder is when a person has these criteria: one specific sign of aggression (irritability and aggressiveness), three clearly nonaggressive signs (deceitfulness, impulsivity, and irresponsibility), and three nonspecific signs (they fail to conform on the usual actions regarding lawfulness, there’s recklessness for safety of self or others, and actually a lack of remorse) (O’Donohue, 2007). People with APD have extra sensitivity to rejection and criticism, the desire for uncritical acceptance by others, social withdrawal despite a desire for affection and acceptance, and low self-esteem. The behavior patterns linked with APD are persistent and severe, making it very difficult to work with others or maintain social relationships (Fundukian, Wilson, 2008).
APD persons fall under cluster C of the four different types of personality disorders. Here is a description of the personality clusters. Cluster A are persons with odd behaviors like paranoid, schizoid, or schizotypal. Cluster B are persons with dramatic behaviors like antisocial, borderline personality disorder (unusual levels of instability in mood; i.e., black and white thinking), histrionic personality disorder (a pattern of excessive emotionality and attention-seeking), and narcissism. People in Cluster C have anxious behaviors like avoidance, dependence, and obsessive compulsive tendencies. Cluster D is not specified. APD persons are preoccupied with their own shortcomings. They form relationships with others only if they believe they will not be rejected. Loss and rejection are so painful that these people will choose to be lonely rather than risk trying to connect with others (Jefferson, 2004). Quite a few of these people choose pets over people to be in their daily lives.
Many people show some avoidant manners at one point or another in their life. Random feelings of self-doubt and anxiety in fresh and unfamiliar group or personal relationships are not uncommon, nor are they unhealthy, because these experiences start feelings of inadequacy and the wish to hide from group contact in even more self-confident individuals. An example would be the anxious uncertainty of an immigrant in a country with a different language and unusual customs. Even though they are confident people, they do not feel confident in a new country. Avoidant signs are regarded as meeting the standards for a personality disorder only when:
they start to have a lasting negative influence on the afflicted person or
they lead to functional harm by greatly altering professional choice or lifestyle, or impacting the quality of life; and causing emotional upset (Fundukian, Wilson, 2008).
Symptoms are first noticed in early adulthood is when the ADP sufferer feels rejection from parents, family or friends. They are shy, fearful, or withdrawn, they end up developing a self-protected shell to prevent future harm, and there’s a breakdown of avoidant types with specific symptoms. Sometimes the APD person is petrified of any type of ridicule in close relationships, so then they become overly attuned to behavioral cues that may show disapproval or rejection. They will run from a situation if they think that others might switch sides on them. The person is always preoccupied with being criticized or rejected. A lot of thought and bodily energy is spent worrying about and keeping away from situations thought of as “dangerous.” The person avoids taking any social jeopardies in order to keep away from possible humiliation.
More symptoms or behaviors of avoidant people seek interactions that promise the best possible amount of acceptance while lessening the chance of embarrassment or rejection. They may go to a school dance, but stay in one corner talking with close instead of dancing on stage with someone they don’t know. Many of these people will be invited out by coworkers and make sure they sit next to the person they know the most and will have a drink in hand to help with their confidence in speaking up.
Symptoms showing shy and withdrawal temperaments are also true of APD persons. The person regards him or herself as socially incompetent. This self-doubt is very obvious when the person must make verbal contact with strangers. People with APD think of themselves as unappealing or inferior to others. They are afraid to join in social involvement without clear assurance that he or she will be accepted. They figure other folks are not safe to believe in until proven otherwise. Their acquaintances need to give support over and over again plus encouragement to get them to participate in a social event. The person is reserved in unusual people communicating places because of feelings of inadequacy. Bad self-esteem is unhelpful to his or her confidence in meeting and communicating with new persons (Fundukian, Wilson, 2008).
Not only temperament explains APD persons, but also the creation of a self-protective shell. There are many examples showing symptoms resulting in a defensive shell of self-protection. The person avoids professional activities that require a lot of interpersonal contact. Any profession positions might be rejected because the person’s own thoughts of his or her skills do not match the job description (Fundukian, Wilson, 2008). The person might make a close relationship and then break it off to avoid being rejected first, or they would only maintain one relationship and the rest would be ruined or never established. This would truly affect any romantic or marital promise for family in their lives. These would also be considered compromises or errors in thought processes (Kantor, 2003).
Here’s a breakdown of the different avoidant types of people: Avoidant parents irritate their kids to abandon them, then claim to be victims hurt and abandoned by their kids. Then there’s the avoidant adolescent who builds their self esteem by cruelty or making others feel less worthy. The avoidant middle-aged individual really confuses things by having midlife crisis mixed with becoming old before their time or young after their time. The avoidant elderly deny their personality problems by blaming isolation (caused by past/present avoidances) or on their age. Avoidant workers take their job more for acceptance and personal approval than for the salary. Avoidant bosses can be demotivating, non-empathic, sadistic, inflexible, too easy going, or hypomanic (Kantor, 2003).
Treatment includes antidepressant medications, psychotherapy, and social skills training or group therapy for practicing social skills. Below begins with medications.
Antidepressant medications can often reduce sensitivity to rejection. Martin Kantor in the book, Distancing found psycho pharmacotherapy to be very helpful for APD persons – especially the shy type avoidant personalities who can’t initiate relationships and others who have symptoms of social phobias. He has seen some patients will effectively self treat by having an alcoholic drink before entering the room of a party. He found some medications like beta-blockers for stage fright, benzodiazepines, antidepressant serotonin reuptake inhibitors, and monoamine oxidase inhibitors. But the side effects of any medication must be considered to determine if it is worth the physical effect on the body.
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There are some difficulties when using medications because some anxiety may appear to be biological when it is psychological. Patients aren’t hiding any of their past information they just don’t think it’s worth mentioning. Some medications have side effects, like making them fuzzy thinking when they need to concentrate on not being avoidant, they have reduced energy for making friends, or making the patient feel too well to need to solve their avoidant problems. Finally, some medications are addicting which creates more problems for the patients (Kantor, 2003).
Psychotherapy, especially cognitive-behavioral approaches, can be helpful. A combo of medication and talk therapy may be more effective than either treatment by itself (Jefferson, 2004). APD patients will most likely improve their group awareness and develop their social skills to some point, but these things usually don’t change that much. Since it usually comes from the patient’s family, some therapists think the only known deterrent option is a supportive, emotionally inspiring, and expressive family setting. The general goal of treatment for APD is the improvement of self-esteem and self-assurance. As the patient’s self-confidence and group skills improve, he or she will become more resistant to possible or real disapproval by others. It would be best to start therapy as early in the APD patient’s life as possible so the behaviors and patterns wouldn’t be so engrained.
Similarly, psychodynamic therapy approach is usually helpful; the therapist understands with the patient’s strong sense of disgrace and shortfall in order to create a rapport of trust. Therapy goes at a snail’s pace in the beginning because persons with APD are distrustful of others. Treatment that delves into their emotional state too fast may result in more protective withdrawal by the patient. As trust is established and the patient feels safer discussing details of his or her situation, he or she may be able to draw important connections between their deeply felt sense of shame and their behavior in social situations. This would help the patient recognize patterns in the future.
Cognitive-behavioral therapy assumes that faulty thinking patterns underlie the personality disorder, so it focuses on changing distorted cognitive patterns by looking at the validity of the assumptions behind them. If a patient feels he is inferior to his peers, unlikable, and socially unacceptable, a cognitive therapist would test if these assumptions were real by asking the patient to name friends and family who enjoy his company, or to describe past social encounters that were good for him. By showing the patient that others value his company and that social experiences can be enjoyable, the irrationality of his social fears and insecurities are exposed. This process is known as “cognitive restructuring.” It’s basically being logical and telling the patient the facts and he’d have to logically see the truth behind the facts.
There are many types of group therapies for APD persons. The type they chose is specific to their personality and what their therapist considers most beneficial. Loved ones in therapy can be useful for a patient who wants to break out of a family pattern that supports the avoidant behavior. The focus of marital therapy would include endeavoring to break the sequence of rejection, criticism or ridicule that typically symbolizes most avoidant marriages. If their confidence and trust for each other were focused on, the couple would do better and have a greater chance of staying together. Other approaches include aiding the pair to learn new constructive ways of relating to each other without shame.
Group therapy may provide patients with APD with group practices that expose them to feedback from others in a safe, controlled setting. But, they may be hesitant to go to group therapy because of their fear of social rejection. An understanding environment in the group setting can help each member overcome their group anxieties. The patient would get a big benefit from telling the group his experience and then hearing their feedback which would be supportive most likely. Social abilities training can also be brought into group therapy to improve social awareness and advice (Fundukian, Wilson, 2008).
There are many publications and information on APD diagnosis, symptoms, and treatment. It seems that only the psychologists and teachers have heard of this disorder. Knowing this must be wide-spread and difficult for an APD person, it would be nice if there was more public awareness. People could use this information to inspire themselves to be better parents or friends and to see people around them as sufferers rather than just “weird”. Then APD persons would receive that understanding from others and be better prepared to reach out to other peopleâ€¦
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