What is avoidant personality disorder (AVPD)?

Quick Answer
Persons with avoidant personality disorder show a pattern of excessive sensitivity to being rejected. This fear of rejection from other people leads to a pattern of withdrawing from social situations and avoiding interactions with people. While fearing rejection, the person with avoidant personality disorder wants to have friendships and be socially active.
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Introduction

Avoidant personality disorder is one of the psychiatric disorders described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders: DSM-V (5th ed., 2013) and is included in the category of personality disorders. Personality disorders are problems in personality development that begin in childhood and continue to cause problems for a person throughout adulthood. Personality is a combination of a person’s behavioral tendencies and inner feelings. Development of personality begins in childhood, and once formed, personality remains essentially stable throughout adulthood. Persons with personality disorders develop certain feelings about themselves and behaviors toward other people that can cause problems in their everyday functioning.

The individual with avoidant personality disorder fears rejection from other people and avoids social situations. Although uneasy in social situations, the person with avoidant personality disorder desires or wishes for companionship and social interaction. Avoidant personality disorder is often described as an inferiority complex, which means that the person feels a lack of competence in social skills and is highly self-critical. The inferiority complex produces a wide variety of negative feelings about the self that inhibit confidence in social situations. Avoidant personality was first formally included among psychiatric disorders in 1981.

Who and Why

Avoidant personality disorder is considered to be a fairly common condition. The National Institute of Mental Health (NIMH) cited a 2007 report stating that the condition affects 5.2 percent of the US adult population . According to the same report, sex and race were not shown to be associated with personality disorders, including avoidant personality disorder.

In attempts to identify the possible causes of avoidant personality, researchers have focused on innate or inborn characteristics exhibited by an infant and early childhood experiences. Infants have been found to display different types of temperaments, including one that is inhibited. Considered to be innate or inherited, the inhibited temperament is characterized by a timid orientation to the external world. Whenever an inhibited infant encounters new situations, the infant’s response is subdued and fearful. This early inhibited temperament has been found to be consistent throughout infancy and early childhood before developing into a pattern of shyness whenever around people.

In addition to the innate temperament, persons with avoidant personality often have experienced some negative events in their infancy and early childhood. As they go through childhood, these children are often punished or shamed in a manner that promotes their fears of being humiliated. Apparently persons who develop avoidant personality disorder did not receive parental affection and were subjected to rejecting behavior from their parents.

The combination of an inhibited temperament in infancy and rejecting behavior on the part of parents appears to produce an individual with low self-esteem and fears of being publicly humiliated. These feelings solidify into an avoidant personality or inferiority complex that then prevents a person from engaging in satisfying social interactions despite the desire to do so.

Diagnosis

The person with an avoidant personality disorder exhibits high levels of anxiety in any social situation. The person appears tense and vulnerable to criticism whenever being asked to engage in social exchange. The formal diagnosis of avoidant personality disorder requires that the person demonstrate a continuing social inhibition, feel inadequate, show hypersensitivity to being evaluated, avoid situations that involve interpersonal contact, be very restrained in expressing feelings, have a preoccupation with being criticized, be fearful of being embarrassed, and view the self as socially inept. Hypersensitivity toward any signs of being rejected by other people is a prominent characteristic of the disorder.

Avoidant personality disorder is often confused with three other psychiatric diagnoses: schizoid personality, social phobia, and agoraphobia. The schizoid personality also shows a pattern of avoiding social situations, but the key difference is the presence of indifference toward and disinterest in social situations. This is unlike the person with avoidant personality, who has a desire for social interactions. Social phobia is diagnosed among persons who are fearful of performance situations such as speaking in public. However, outside the performance situation, the person has comfortable social interactions, unlike the person with avoidant personality. Agoraphobia is the condition in which a person may avoid crowds or social situations because of fears of having a panic attack, which is not true of persons with avoidant personality.

Treatment Options

The typical treatment for persons with avoidant personality is a combination of psychotherapy and medications. Psychotherapy is used to help the patient overcome fears of rejection and humiliation in social situations. The therapy focuses on methods to cope with these fears and helps to guide the patient toward engaging in an increasing number of social activities. Assertiveness training or group therapy is often a part of the psychotherapy process. Both provide the patient with opportunities to learn effective ways to interact with other people without the fear of rejection. Psychoactive medications that alleviate anxiety are usually prescribed for the patient. With anxiety controlled, the patient is able to enter into social situations. Patients with avoidant personality disorder often experience depression because of their isolation from other people. In cases in which depression is present, an antidepressant medication is added to the treatment regimen.

Bibliography

DePanfillis, C., et al. “Parental Bonding and Personality Disorders: The Mediating Role of Alexithymia.” Journal of Personality Disorders 22 (2008): 496–508.

Dobbert, Duane L. Understanding Personality Disorders: An Introduction. Westport: Praeger, 2007. Print.

Kantor, Martin. Distancing: Avoidant Personality Disorder. Rev. ed. Westport: Praeger, 2003. Print.

Kienast, T., et al. “Psychotherapy of Personality Disorders and Concomitant Substance Abuse.” Current Opinions in Psychiatry 21 (2008): 619–624. Print.

Miller, J., et al. “Scoring the DSM-IV Personality Disorders Using the Five-Factor Model: Development and Validation of Normative Scores for North American, French, and Dutch-Flemish Samples.” Journal of Personality Disorders 22 (2008): 433–450. Print.

National Institute of Mental Health. "The Numbers Count: Mental Disorders in America." National Institute of Mental Health. National Institutes of Health, n.d. Web. 19 Feb. 2014.

Rogge, Timothy. "Avoidant Personality Disorder." MedlinePlus. MedlinePlus, 3 Feb. 2014. Web. 19 Feb. 2014.

Sellborn, Martin. "Personality Disorders in the DSM-5 and Beyond." Gavel. APA Division 18: Psychologists in Public Service, July 2013. Web. 19 Feb. 2014.

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