Abstract
Avoidant personality disorder is characterized by an avoidance of social interaction and sensitivity to negative evaluation. The person seeks to avoid social contacts and any situation that might cause embarrassment or anxiety. The patient shows restraint within close relationships because of fears of being rejected or ridiculed. The patient might also be the object of criticism in social situations. Such patientsVarious anxiety disorders during childhood and adolescence might cause social inhibitions which are the characteristic of this disorder. This can include features like being shy, fearful and socially withdrawn.
Parental criticism and rejection are also believed to cause Avoidant personality disorder also have feelings of being personally unappealing, socially inept and inadequacy. This article provides an introduction to the disease. It than provides the symptoms associated with this disease. Finally it provides the various treatments which are best for treating this disorder. Research has proven that avoidant personality disorder patients are excellent for treatment. Various psychotherapeutic approaches have been found to be successful which depends on the patient’s goals, preferences and psychological mind ness. APD patients respond to kindness and positive regard.
Introduction
Avoidant personality disorder is characterized by an avoidance of social interaction and sensitivity to negative evaluation. The person seeks to avoid social contacts and any situation that might cause embarrassment or anxiety. These patients also avoid interaction with close people. The person suffering from this disease is constantly suffering anxiety attacks. A permanent wall of self protection against anxiety is developed by such patients (DSM-IV, 2005).
This disease becomes apparent during early adulthood. It has connections with rejection by parents and friends during childhood. There is a dispute whether the feelings of rejection have anything to do with extreme interpersonal monitoring. There are many signs and symptoms of this disease. Sometimes it becomes to dominate the personality of the affected person. At other times it goes unnoticed by people who interact with the patient (DSM-IV, 2005).
The patient avoids occupational or social activities that involve interpersonal contact. This might be due to fear of criticism and rejection. The second symptom of this disease is that the patient is unwilling to become friends with people unless the patient is liked. The patient shows restraint within close relationships because of fears of being rejected or ridiculed. The patient might also be the object of criticism in social situations. Such patients also have feelings of being personally unappealing, socially inept and inadequacy. Such patients usually have poor self esteem and have exaggerated fears of criticism, disapproval or rejection. Sometimes this disease is confused with antisocial personality disorder. This disease only causes social inhibitions rather than sociopathy.
Prevalence and Causes
Avoidant personality disorder is considered to be prevalent amongst people with anxiety disorders. Research has suggested that 20-40% of people with panic disorder suffer from APD. Other diseases thought to be linked with APD are obsessive compulsive disorder and borderline personality disorder. People with APD excessively monitor their internal reactions during social situations. They have difficulty producing fluent speech due to this excessive monitoring (Oldham, 2006).
The cause of APD has not been clearly defined as yet. However research suggests a combination of social, genetic and biological factors as being responsible for causing this disorder. Various anxiety disorders during childhood and adolescence might cause social inhibitions which are the characteristic of this disorder. This can include features like being shy, fearful and socially withdrawn. Parental criticism and rejection are also believed to cause Avoidant personality disorder. The lack of bonding with parents causes the person to eventually develop a defensive shield of self protection against repeated criticism (Oldham, 2006).
Symptoms
Avoidant personality disorder causes people to form relationships only if they are sure that they will not be rejected. Loss and rejection are considered too painful for these people. They prefer to be lonely than risk loss and rejection. Patients can be hypersensitive to criticism and rejection. They impose social isolation on themselves. They have extreme shyness in social situations and avoid interpersonal relationships. They also have low self esteem and mistrust of others. They have extreme shyness and timidity. They are highly self conscious. They feel inferior to others. They are vulnerable to chronic substance abuse.
Other symptoms of this disease include living alone. They only enjoy contact with family and friends for a short time period. Any prolonged contact can cause anxiety in such patients. They do not make contact with strangers. They try to make sure that such contact is brief. They develop phobias (for animals or objects). This occurs because such animals and objects are connected with the earlier appearance of anxiety attacks in social situations. The animal or object connected with such situations unleashes the anxiety and this assumes phobic characteristics. They have an awareness of abdicating certain life experience in order to avoid pain and suffering. They fantasize about situations which they avoid. They exclude the anxiety producing stimuli in their fantasies. They are professionally successful but have a chance of being more successful if they did not turn their backs on opportunities (Ward, 2004).
They try to avoid occupational activities that involve significant interpersonal contact. They are unwilling to get involved with people unless they are certain of being accepted and liked. They are preoccupied about being criticized in social situations. They are inhibited in new interpersonal situations. They view themselves as being inferior to others and are usually reluctant to take personal risks which might prove to be embarrassing (Kantor, 2005). The person suffering from this disease gives up facing situations which might generate fear. They avoid anxiety generating situation as much as possible. They also make sure that they are not noticed. The feelings of criticism and rejection can be painful for patients suffering from avoidant personality disorder.
Treatment
Avoidant personality disorder is treated using social skills training, cognitive training, and exposure treatment to social contacts, group therapy and drug therapy. The most important issue is gaining the patient’s trust because of their social inhibitions. Individual therapy and social groups training tries to make individuals suffering from APD to challenge their negative beliefs about the self (Ward, 2004).
There are many obstacles to successfully treating APD. The patient does not seek help if there is lack of motivation to change. The self protected mechanisms inside these individuals is structured which causes involvement to be very slow. There is also resistance to proposals that may speed up the process. The patient can also easily give up the treatment (Ward, 2004).
Research has proven that avoidant personality disorder patients are excellent for treatment. Various psychotherapeutic approaches have been found to be successful which depends on the patient’s goals, preferences and psychological mind ness. APD patients respond to kindness and positive regard. But any kind of annoyance cannot be tolerated by such patients. Individuals with APD are motivated to seek change because of their personality disorder is difficult to tolerate. They have found to describe social and occupational problems. They would have rarely been able to develop a social network that would have been strong enough to cope with personal crisis. They only see the negative in life. They cannot look at situations and interactions in a positive manner.
Adlerian therapy can be used to treat APD. It stresses on the positive views of human nature. It states that we are in control of our own fate. The goal of Adlerian therapy is to challenge and encourage the patient to set up goals which are useful socially and to help them feel equal. These goals can be from any component of life such as career, relationship, ending substance abuse, etc (Bruce, 2005).
Another type of successful therapy is behavioral therapy. It teaches that we are a product of our environment and that behaviors are learned. It stresses the need to learn new behavior to eliminate unwanted behavior. It focuses on assertion, coaching, cognitive restructuring, modeling, relaxation methods and new social skills. This form of therapy also involves anxiety management, developing communication skills and assertiveness training (Bruce, 2005).
Cognitive therapy effectively addresses APD cognitive distortions. It recognizes the sense of competency and self-worth. It assists individuals to identify their negative thoughts and their origins. They are informed that others also struggle with similar issues and that they are not alone (Hunter, 2004).
Existential therapy focuses on shaping one’s own life. It teaches one to be responsible for shaping their lives. It also tries to create self determination and self awareness. It focuses on the present and the future. The patients are made to see the possibilities of their future. The patients are challenged to recognize themselves as responsible for the events in their lives. Existential therapy has been found to be beneficial in many avoidant personality disorder patients (Hunter, 2004).
Psychoanalytic psychotherapy is also beneficial for patients suffering from avoidant personality disorder. This therapy focuses on the unconscious and believes it influences human behavior. People are driven by aggressive and sexual impulses. It focuses on the early childhood and how these events influenced the personality. Repression of conflicts can create personality problems in life. This therapy helps patients make these repressed conflicts conscious in the patient. This helps to work through them (WHO, 2006).
Another type of effective therapy is interpersonal therapy. This builds the ego strength to recognize situations that generate regressive patents. APD patients are taught about maladaptive patterns and their roots. They are taught about decision making abilities. They are taught new patterns. This therapy consists of facilitating collaboration, helping the individual learn new patterns and blocking maladaptive patterns.
Group therapy provides confidence by providing supported social exposure. This can cause significant change. APD patients cannot tolerate the anxiety associated with group therapy but they do have motivation to change. Group therapy provides them the success to join a social group. Shame and self doubt are initially felt by individuals but eventually being accepted allows them to join the group (WHO, 2006).
Self hypnosis has been found to be an effective self help tool in combating avoidant personality disorder. Feelings of inferiority and timidity are rooted in imagination. Techniques of hypnotherapy and self hypnosis aim to manipulate the force of imagination upon the subconscious. This is an effective means of implementing willpower. Self hypnosis has offered some help in avoidant personality disorder patients.
Another process used to treat this disorder is visualization. In this process an image is actively created in the mind of the patient. The patient holds the image over a period of time. By shaping this mental image in a relaxed and receptive state changes the derogatory nature of the inner voice. It helps to make the patient the person which they wish to be. The visualization should include as many details as possible. Obstacles must not be created by creating steps need to reach the goal. Repeating the visualizations can benefit avoidant personality disorder patients. Visualization has been proven effective in treating avoidance personality patients (Lahmeyer, 2006).
Another effective technique is meditation which can increase satisfaction, reduce stress, increase ability to focus, provide greater capacity for intimacy and provide emotional stability. This treatment addresses the variation and needs of different individuals. Meditation has proven beneficial in reducing the social inhibitions which avoidant personality disorder patients suffer from (Lahmeyer, 2006).
Transactional analysis is another form of treatment which focuses on the client’s cognitive and behavioral functioning. In this the patient evaluates their past decisions and how they have affected their present life. Self defeating behavior and feelings can be defeated by awareness of them. According to therapists avoidant personality disorder patients have a personality that is composed of parent, adult and child. They believe that it is important for patients to examine past decisions to help them make better and new decisions. Transactional analysis has been found to be effective in treating avoidant personality patients (Krijn, 2006).
Most recently avoidant personality disorder was treated only by psychotherapeutic interventions. There was no talk of pharmacological treatments. The problems were that many patients feared medications and their side effects. Another problem of these medications was that they were used in suicide attempts. Recently however it has been suggested by data that medications is effective in treating extreme social anxiety. This is because APD overlaps with generalized social phobia. Medications like Parnate, Marplan, Nardil, and Phenelzine have improved fears. They have also induced confidence and assertiveness in patients (Fedoroff, 2006).
Therapists recommend that medication should be accompanied by psychotherapeutic intervention. Medication alone is not sufficient to produce permanent changes in the brain. Learning new ways to think and acting on those thoughts helps avoidant personality disorder patients to change. Also important is that medications are not always recommended in every case. Other considerations like physical health and dietary restrictions are also important factors in determining the need for medication. It has been shown the combined treatment of psychotherapy and medications has provided the best result for moderate and severely disordered patients (Fedoroff, 2006).
There are many different types of therapy which have proven to be beneficial for avoidant personality patients. Behavior therapy, self hypnosis, group support, transactional analysis has been proven to be the most effective in reducing fear and anxiety in avoidant personality disorder patients. These therapies have also allowed the patient to examine their past decisions to make new and better decisions in their present life. A combination of medication and therapy is useful to treat this disorder.
Conclusion
Avoidant personality disorder is characterized by an avoidance of social interaction and sensitivity to negative evaluation. The person seeks to avoid social contacts and any situation that might cause embarrassment or anxiety. This disease becomes apparent during early adulthood. It has connections with rejection by parents and friends during childhood. There is a dispute whether the feelings of rejection have anything to do with extreme interpersonal monitoring.
The cause of APD has not been clearly defined as yet. However research suggests a combination of social, genetic and biological factors as being responsible for causing this disorder. Avoidant personality disorder causes people to form relationships only if they are sure that they will not be rejected. Loss and rejection are considered too painful for these people. They prefer to be lonely than risk loss and rejection. Patients can be hypersensitive to criticism and rejection (Fedoroff, 2006).
They try to avoid occupational activities that involve significant interpersonal contact. They are unwilling to get involved with people unless they are certain of being accepted and liked. They are preoccupied about being criticized in social situations. They are inhibited in new interpersonal situations.
Therapists recommend that medication should be accompanied by psychotherapeutic intervention. Medication alone is not sufficient to produce permanent changes in the brain. Learning new ways to think and acting on those thoughts helps avoidant personality disorder patients to change. Also important is that medications are not always recommended in every case. These therapies have also allowed the patient to examine their past decisions to make new and better decisions in their present life.
References
- American Psychiatric Association (1994), Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Washington, DC: American Psychiatric Association
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- Ward RK. Assessment and management of personality disorders. American Family Physician. 70(8):1505-1512, October 2004
- Bruce, KR Bulimia nervosa with co-morbid avoidant personality disorder: behavioural characteristics and serotonergic function. Psych Med 2005; 34:113-124.
- Hunter EC, Sierra M, David AS (2004) The epidemiology of depersonalisation and serializations: A systematic review. Soc Psychiatry Psychiatr Epidemiol. 39:9-18.
- World Health Organization (2006) International Classification of Mental Disorders: ICD-10, Chapter V (F), Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO.
- Lahmeyer, HW Biologic markers in borderline personality disorder: a review. J Clin Psychiatry 2006
- Krijn, M Virtual reality exposure of anxiety disorders: a review. Clin Psychol Rev 2006; 24:259-281.
- Fedoroff IC, Taylor S. Psychological and pharmacological treatments of social phobia: a meta-analysis. J Clin Psychopharmacol 2006; 21:311-324
