Avoidant Personality Disorder
The avoidant personality disorder is a disorder characterized by feelings of shyness, inadequacy and rejection. Patients feel inferior to others and become very sensitive to what others think of them. They are socially inhibited and feel socially inadequate. Due to such feelings they tend to avoid school, work or other activities involving social interaction with others. Only when the condition becomes very obvious and becomes distressing for the individual, it is diagnosed.
Individuals with this disorder often evaluate the movements, reactions and expressions of the people they meet. Others may disapprove their tense and fearful behaviour, which confirms their self-doubts about not being socially accepted. They get very anxious about crying and blushing when faced with criticism. Others describe them as being shy, timid, lonely, and isolated.
Their social and occupational functioning is also hampered as they avoid social situations, which are important for any job. Individuals with this disorder will choose loneliness rather than taking a risk by trying to connect with others. Their low self-esteem and hypersensitivity to being rejected, makes them restrict their interpersonal contacts, so they have a limited social support network. They have very few close friends, but are often very dependent on them. They have a desire for affection and acceptance and may dream about idealized relationships with others.
The avoidant behaviour often begins in infancy or childhood, characterized by shyness, isolation, and fear of strangers and new situations.
Often, Mood and Anxiety Disorders (especially Social Phobia), and other Personality Disorders (especially Dependent, Borderline, Paranoid, Schizoid and Schizotypal) co-occur with this disorder.
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No specific cause has been identified for avoidant personality disorder. Many theories have been proposed, and many researchers and professionals agree with the biopsychosocial model as a cause. This states that the disorder could be caused due to biological and genetic factors, social factors and psychological factors. Social factors like the person’s interactions with family and friends in childhood are also considered; and psychological factors like individual’s personality and nature developed in different kinds of environment and how the person dealt with stressful situations. Thus, no single factor is responsible but all three factors are important. But, research shows that a person suffering from a personality disorder is likely to pass the disorder to his or her children too.
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The main characteristics of Avoidant personality disorder are long-standing pattern of feelings of inadequacy, high sensitivity to what others think about them, and social inhibition. The following symptoms may manifests itself by early adulthood:
- Avoids occupational activities that involve a lot of interpersonal contact, they fear criticism, disapproval, or rejection.
- Unwilling to get involved with people unless certainty of being liked
- Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
- Preoccupied with being criticized or rejected in social situations
- Inhibited in new interpersonal situations because of feelings of inadequacy
- View themselves as socially inept, personally unappealing, or inferior to others
- Unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
Avoidant personality disorder is prevalent in about 0.5 and 1.0 percent of the general population.
The disorder has a chronic course. It is usually worse earlier in life and often improves in middle age. Unfortunately, for some, the avoidant behavior stays and intensifies into adulthood, when it is diagnosed. The occurrence of this disorder is equal in males and females.
No known means of prevention, just like other personality disorders, since it is mostly genetic. But, early detection signs of avoidance behaviour can be taken into consideration and changed through reinforcement. Forming affectionate relationships with children, helping in social skills development in an enriching social environment, can be helpful
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Individual psychotherapy is usually the preferred method, but group therapy can be beneficial too, if the patient agrees to come for the session. A detailed evaluation with a diagnosis that differentiates this disorder from other conditions like schizoid or borderline personality disorder should be conducted. Therapy is most effective when it is short term, and focuses on finding solutions for specific life problems.
The issues of low self-esteem and negative self evaluation should be addressed in therapy. A therapeutic relationship with good rapport formation and listening to the client’s problems is effective in treatment. Initial rapport formation can be difficult for this disorder, but once established, treatment becomes smoother. Termination of therapy is also an important part here, as a good therapeutic relationship serves as a model for a possibility of formation of new relationships
Medications should only be given for severe conditions. Anti-anxiety agents and antidepressants are often prescribed. Sometimes, physicians tend to prescribe more than required for complaints of anxiety present in this disorder. But this anxiety is situation specific, and medication will interfere with the therapeutic treatment.
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