Info on avoidance personality disorder

adam29 Joined: Jun 26, '10 Status: New User	2010-06-27 18:47:53
	I came across this info online and it was so spot on for me it was a little spooky. I must warn, if you're like me, its a little bit harsh to have my actions explained by someone I've never met. Here ya go: Avoidant Personality Disorder ---------------------------------------------------------------------- Avoidant personality disorder (APD) ís considered to be an active- detached personality pattern, meaning that avoidants purposefully avoid people due to fears of humiliation & rejection. It ís thought to be a pathological syndromal extension of the "normal inhibited" personality, which ís characterized by a watchful behavioral appearance, shy interpersonal conduct, a preoccupied cognitive style, uneasy affective expression & a lonely self-perception ( Millon & Everly ). According to this view, the avoidant pattern seems to range ín varying degrees along a symptomological continuum from mild to extreme. In mild cases, a person may be said to be normally shy, whereas extreme cases indicate personality disorder. APD vs. Generalized Social Phobia: The symptoms of APD overlap with those of generalized social phobia. Widiger (1992) reviewed 3 studies (Holt; Herbert; Turner et al. [1992]) which demonstrated that GSP & APD are based on the same underlying pathology & differ primarily ín the severity of social anxiety & social functioning, with APD being the more severe disorder. The evidence that most people diagnosed with APD will also meet the diagnostic criteria for GSP, but people with GSP do not necessarily have APD supports this view. DSM Criteria: The DSM-IV describes APD as: A pervasive pattern of social inhibition, feelings of inadequacy & hypersensitivity to negative evaluation, beginning by early adulthood & present ín a variety of contexts, as indicated by 4 (or more) of the following: avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval or rejection ís unwilling to get involved with people unless certain of being liked shows restraint within intimate relationships because of the fear of being shamed or ridiculed ís preoccupied with being criticized or rejected ín social situations ís inhibited ín new interpersonal situations because of feelings of inadequacy views self as socially inept, personally unappealing or inferior to others ís unusually reluctant to take personal risks or to engage ín any new activities because they may prove embarrassing. How does APD manifest itself? The usual onset for APD ís early adulthood, with an equal prevalence rate among women & men (APA). According to one study however, (Greenberg & Stravynski, 1985) most of the people being referred for professional help for social dysfunction, considered to be the same disorder as APD by Marks (1987), were single men. One suggested hypothesis for this finding ís that society expects men to be the initiators ín romantic relationships. Therefore, when they do not form relationships, ít ís seen as more of a problem than women who do not initiate relationships but are not expected to ín any case (Marks). Millon & Everly have suggested 6 dimensions onto which the symptoms of APD can be mapped. Behavioral Appearance: Avoidants do exhibit the stereotypical traits of shyness, timidity & withdrawing behavior. To those who know them well, the avoidants' mistrust of others may also be apparent as an almost constant wariness. However, Kantor (1993) argues that behavioral hostility ís also typical of those suffering with APD. Avoidants may use their shyness as a way to hurt others by preventing them from becoming close. Alternatively, they will demonstrate their hostility ín a more overt manner by insulting people who attempt to be friendly, for example. This reaction may be because they are identifying their aggressor & "deal with feared rejection by becoming rejecting themselves." These expressions of hostility could be seen as defensive fight responses. To protect themselves from being rejected, they reject others first. This ís maladaptive because the avoidants will tend to reject many people who would never have rejected them ín the first place. In terms of appearance, íf ít ís affected at all by APD, ít will tend to be affected ín one of 3 ways. 1st, avoidants may put considerable time & effort into making themselves attractive to others. The idea behind this ís, at least they will be liked for their looks, íf not for themselves. 2nd, they may consciously, or unconsciously, ensure that their appearance drives others away. This provides them with some control over their lives. Rather than waiting helplessly to be rejected, they ensure rejection from the start by their own actions. 3rd, ín the case of avoidants who are suffering from PTSD, for example, they may dress ín the style of the era when the trauma occurred. This form of dress ís an indication that they are living ín the past. Speech ís may also be affected ín APD. Avoidants may be quite silent. As Jerome Kagan explains, "For a rabbit, freezing on a lawn ís a sign of fear. I believe that speechlessness ís a similar diagnostic sign for us… There's a circuit ín the brain that controls our vocal cords & becoming quiet can be one sign of fear." (Galvin, 1992). When they do speak, avoidants may use frequent pauses & speak slowly (Millon & Everly). This ís contrary to what we read regarding social phobia, where pauses ín speech tended to be avoided because they were thought to be a sign of lack of knowledge. Avoidants may also be overtalkative, possibly due to an adrenic discharge or a false belief, such as continuously talking will prevent death. For avoidants who try to put people off with their behavior, insults or social faux pas are commonly used as a way to assure rejection (Kantor). While this does essentially realize their worst fear, ít does again give avoidants some control over how others react to them. Interpersonal Conduct: Avoidants often test others to determine whether or not they are being sincere ín their friendliness. Because they may frequently see rejection where ít does not exist, people will tend to fail these tests & then later be avoided because they may reject or humiliate those with APD (Millon & Everly). They will, therefore, frequently have difficulty beginning & maintaining relationships (Kantor), partly because they have difficulty trusting others & thus, are very reluctant to share their feelings or allow themselves to be vulnerable. As a protective measure against the humiliation & rejection, they may become avoidant of others. On the other hand, avoidants may form relationships, even making an effort to meet new people. However, these people are kept at a distance. Therefore, this group of avoidants ís avoiding intimacy, rather than avoiding people altogether. Cognitive Style: Avoidants excessively monitor the situation to the extent that they are trying to process so much information, they are no longer paying sufficient attention to the interaction itself (Millon & Everly). The literature on social phobia suggests that the phobics are unable to follow the interaction because they are so focussed on their internal reactions. However, the research on avoidant personality disorder also emphasizes that the avoidants are engaged ín external monitoring of the other person's reactions as well. This additional processing of information could contribute to the increased severity of APD over social phobia. The excessive monitoring by avoidants, combined with a hypersensitivity to rejection makes their perception of rejection almost inevitable. Their dysfunctional thought processes may also include fear of being vulnerable, because ít makes
adam29 Joined: Jun 26, '10 Status: New User	2010-06-27 19:34:17
	The ICD-10 (1994, p. 232) has a personality disorder called the anxious (avoidant) personality disorder characterized by feelings of tension, apprehension, insecurity and inferiority. These individuals wish to be liked and accepted but experience hypersensitivity to rejection and criticism. Personal attachments are restricted. People with the anxious personality disorder have a tendency to avoid activities by a habitual exaggeration of the potential dangers or risks involved. They believe that they are socially inept, personally unappealing and inferior. Millon & Davis (1996, pp. 253-256) call AvPD the withdrawn pattern. These are individuals who are oversensitive to social stimuli and are hyperreactive to the moods and feelings of others. Individuals with AvPD are chronically overreactive and hyperalert, with affective disharmony, cognitive interference, and interpersonal distrust. They are disposed toward the more severe schizophrenic disorders. Historically, this pattern has been described as being preoccupied with security and strained in associating with people. Everly (Retzlaff, ed., 1995, pp. 25-3 states that the most severe pathology found in AvPD is in the area of self-image. In AvPD there is the failure of the core personality to adapt in a competent manner to interpersonal adversity -- presumably both past and present. Stone (1993, p. 355) also sees the key traits of AvPD as social reticence and avoidance of interpersonal activities. These individuals are easily hurt by criticism and fear showing their anxiety in public. They would like to be close to others and to live up to their potential, but are afraid of being hurt, rejected, and unsuccessful (Beck, 1990, p. 43). There is overlap between AvPD and social phobia, generalized type (DSM-IV, 1994, pp. 663-664). The essential feature of social phobia (social anxiety disorder) is a marked and persistent fear of social or performance situations that may provoke embarrassment. Most often, the social or performance situation is avoided though it may be endured with dread. The avoidance, fear or anxious anticipation must interfere significantly with daily routine, occupational functioning, or social life or cause significant personal distress (DSM-IV, 1994, p. 411). Sutherland & Frances (Gabbard & Atkinson, eds., 1996, p. 991) suggest that AvPD and social phobia are constructs that differ only in the severity of dysfunction. Frances, et.al. (1995, p. 376) propose the possibility that they are two different constructs for the same condition. Benjamin (1993, p. 294) notes that the interpersonal patterns for generalized social phobia are very similar to AvPD; both groups avoid social contact and restrain themselves because of fear of humiliation or rejection. She proposes that social phobia is diagnosed if symptoms of pervasive anxiety or panic are present. Millon and Martinez (Livesley, ed., 1995, p. 222) believe that the avoidant personality is essentially a problem of relating to people while social phobia is largely a problem of performing in situations. Stone (1993, pp. 355-356) suggests that social phobia, agoraphobia, and OCD often have an underlying AvPD. It is common for persons with AvPD to have comorbidity with other personality disorders. AvPD is most often diagnosed with DPD, BPD, PPD, SPD, or StPD (DSM-IV, 1994, p. 663). Frances, et.al (1995, p. 376) note the considerable overlap between AvPD and DPD. These two personality disorders share interpersonal insecurity, low self-esteem, and a strong desire for interpersonal relationships. Benjamin (1993, p.301) describes the desperate attempts to avoid being alone that may be seen in DPD as an exclusionary indicator for AvPD. AvPD is found equally in males and females (DSM-IV, 1994, p. 663). Self-Image Individuals with AvPD are preoccupied by the unpleasant and perplexing personal definition they hold of themselves as defective, unable to fit in with others, being unlikable, and being inadequate. This self-image usually results from childhood rejection by significant others such as parents, siblings, or peers. These individuals then believe that others throughout their lives will react to them in a similar fashion. They are often unable to recognize their own admirable qualities that make them both likable and desirable (Will, Retzlaff, ed., 1995, p. 97). Rather, they see themselves as socially inept and inferior. They believe that they are personally unappealing and interpersonally inadequate. They describe themselves as ill at ease, anxious, and sad. They are lonely; they feel unwanted and isolated. Individuals with AvPD are introspective and self-conscious. They usually refer to themselves with contempt (Millon & Davis, 1996, p. 263). For individuals with AvPD, their deflated self-image references their entire being. Nothing about them escapes their own self-derision (Millon & Davis, 1996, p. 264). Doubts about their social competence and personal appeal become especially severe in the presence of strangers (DSM-IV, 1994, p. 662). View of Others Individuals with AvPD view the world as unfriendly, cold, and humiliating (Millon & Davis, 1996, p, 265). People are seen as potentially critical, uninterested, and demeaning (Beck, 1990, pp. 43-44); they will probably cause shame and embarrassment for individuals with AvPD. As a result, people with AvPD experience social pananxiety and are awkward and uncomfortable with people (Millon & Davis, 1996, p. 261). However, they are caught in an intense approach-avoidance conflict; they believe that close relationships would be rewarding but are so anxious around people that their only solace or comfort comes in avoiding most interpersonal contact (Donat, Retzlaff, ed., 1995, p. 49). Individuals with AvPD tend to respond to low-level criticism with intense hurt. To make matters worse, they become so socially apprehensive that neutral events may well be interpreted as evidence of disdain or ridicule by others (Donat, Retzlaff, ed., 1995, p. 49). They come to expect that attention from others will be degrading or rejecting. They assume that no matter what they say or do, others will find fault with them (DSM-IV, 1994, p. 662). Even memories for individuals with AvPD are comprised of intense, conflict-ridden, problematic early relationships. They must avoid the wounds inside of them at the same time they are avoiding the external distress of contact with others. The external environment brings no peace and comfort and their painful thoughts do not allow them to find solace within themselves (Millon & Davis, 1996, pp. 263-264). Relationships Individuals with AvPD are "lonely loners." They would like to be involved in relationships but cannot tolerate the feelings they get around other people. They feel unacceptable, incapable of being loved, and unable to change. Because they retreat from others in anticipation of rejection, they lead socially impoverished lives. They have immature and unrealistic expectations of relationships; they believe that they can have no imperfections if they are to be accepted and loved. Interpersonally, they are ill at ease, awkward and tense. They experience unremitting self-consciousness, self-contempt and anger toward others (Oldham, 1990, pp. 188-193). Individuals with AvPD will develop intimacy with people who are experienced as safe. Nevertheless, they will often engage in triangular marital or quasi-marital relationships which provide intimacy while maintaining interpersonal distance. These individuals like to foster secret liaisons as a "fall-back" position in case the key relationship does not work out (Benjamin, 1983, pp. 307-308). As sexual partners and parents, people with AvPD appear self-involved and uncaring (Kantor, 1992, p. 109) as they preserve distance from others through defensive restraint and withdrawal. Even so, these individuals long for affection and fantasize a
bcat Joined: Jul 3, '10 Status: New User	2010-07-03 22:14:12
	some of those were close.what if your younger than the age group the specified
purplerain Joined: Jun 3, '10 Status: Junior User	2010-07-03 22:27:06
	hello ya had alot to say and i am just responding because i am very avoidant, i fear rejection and sense humiliation so I stay away from public at all cost. I just now started leaving the house again, I have been like a recluse for the last year, but finally sought help , it is vtaking a while but the struggle is worth the battle, so I wwant you to know you are not alone and there are many people that care. purplerain
lillyyy Joined: Nov 29, '09 Status: New User	2010-07-03 23:30:38
	spam
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