Simplifying Avoidant Personality Disorder based on reports of Rattew, Pataki, and Bressert
– By Memoon Zehra, Farooq Ali Khan, and Abhishek Kumar
Guided by Raamesh Gowri Raghavan and Sukant Khurana
Similar to other personality disorders, Avoidant personality disorder is a major component of a patient’s overall character and a central theme in an individual’s pattern of reality to others. It is an enduring pattern of inner experiences and behavior that deviates from the norms of the individual’s culture.
Its pattern is seen in the two or more of the following areas:
Cognition
Affect
Interpersonal functioning
Impulse control
The enduring pattern in AVOIDANT PERSONALITY DISORDER is inflexible and pervasive across a broad range of personal and social situations. It leads to significant impairment in social, work, or other areas of functioning. The pattern is stable and durable.
AVOIDANT PERSONALITY DISORDER is characterized with feelings of extreme social inhibition, inadequacy and sensitivity to negative criticism and rejection. Individuals with AVOIDANT PERSONALITY DISORDER have fearful and tense demeanor and are very anxious about probability that they would not be accepted by others and often react to criticism by blushing or crying. The patients often observe intently the movements and expressions of those with whom they come in contact to find whether they are being unaccepted or criticized or disliked by them. They don’t even come in contact with people about whom they aren’t sure that they will be liked. These individuals become relatively isolated and usually do not have a large social support network that can help in weather crises. They do desire affection and acceptance and may fantasize about idealized relationships with others as well.
The major problem associated with AVOIDANT PERSONALITY DISORDER occurs in social and occupational functioning. the low self-esteem and hypersensitivity to rejection are associated with rejection associates with restricted interpersonal contacts. The affected individuals try to avoid the types of social situations that , may be important for meeting the basic demands of the job or for advancement.
AVOIDANT PERSONALITY DISORDER typically decreases in intensity with age.
Symptoms
Low self-esteem
Self-isolation
Avoiding social activities
Fear of criticism or rejection
Feeling of frequently being unwelcome
Low threshold for criticism and imagining themselves inferior to others.
Fear of speaking up, blushing, stammering, getting embarrassed.
Studying signs of approval and rejection by people around.
Unwilling to contact with people unless certain of being liked.
Social impact of AVOIDANT PERSONALITY DISORDER
Fear of rejection makes it difficult to connect with people.
Uncertainty of being liked makes individual hesitant to seek out friendship.
Difficult to maintain intimate relationships and close friendships because they are afraid to share personal information or talk about feelings.
According to AMERICAN PSYCHIATRIC ASSOCIATIONS DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS; person with AVOIDANT PERSONALITY DISORDER needs to show the following criteria:
v Avoiding occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval or rejection.
v Is unwilling to get involved with people unless they are certain of being liked.
v Shows restrain within intimate relationships because of the fear of being ashamed or ridiculed.
v Is preoccupied with being criticized or rejection in social situation.
v Is inhibited in new interpersonal situations of feeling of inadequacy
v Views self as socially inept, personally unappealing, or inferior to others.
v Usually reluctant to take personal risks or to engage in any new activities because they could be embarrassing.
Disorders frequently occurring with AVOIDANT PERSONALITY DISORDER
Many symptoms of given disorders can be confused with those of AVOIDANT PERSONALITY DISORDER.
Social phobia
Person experiences overwhelming anxiety and self-consciousness in common social situation.
Dependent personality disorder
People rely excessively on others for advice or to make decision for them.
Borderline personality disorder
People have difficulty in many areas including social relationships, behavior, mood and self image.
Causes of AVOIDANT PERSONALITY DISORDER
Biopsychosocial model of biological, social [interaction in early development with peers] , genetic factors and psychological factors [personality, temperament and learned coping skills to deal with stress] .
Rather than a single factor, the complex and likely interlinked nature of all aforesaid factors are responsible and important. The chances of passing down this disorder in children are likely high.
Way of diagnosis
AVOIDANT PERSONALITY DISORDER is typically diagnosed by trained mental health professionals [psychologist or psychiatrist] ,because family physicians and general practitioners because they aren’t either well trained or well equipped to pick up one psychological disorder with 100% surety ,since symptoms could be confusing.
Generally, individuals don’t seek out treatment until the disorder starts to significantly interfere or otherwise impact person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other live events.
Treatment
PSYCHOTHERAPY.
Some people with AVOIDANT PERSONALITY DISORDER may be able to tolerate a long term therapy but most patients go into therapy only when they feel overwhelmed by stress which further exacerbates personality disorder’s symptoms. Such short term therapies will focus on the immediate problems in the person’s life, giving him some additional coping skills and tools to help. Once patient overcomes the problem which brought him to therapy, he typically leaves the treatment.
Patients of AVOIDANT PERSONALITY DISORDER have poor self-esteem and all the issues concerned with social interactions. They also focus only on negative in life and have difficulty in looking at situations and interactions in objective manner. THIS CAN INTERFERE WITH THEIR SELF-REPORT when they present for an initial evaluation, which may lead to MISSING LIFE HISTORY AND MEDICAL INFORMATION because patients deems it too unimportant to bother.
The clinician should be sensitive to nonverbal cues of the client during session, to evaluate when information is being withheld. The gaps in between the story told be patient should be recognized. This is essential for making a differential diagnosis with similar looking but vitally different disorders.
The patient isn’t likely to present him to therapy unless something have happened which their dysfunctional personality style cannot adequately cope. Thus forming initial rapport is likely difficult, since early termination is often an issue. Once rapport is formed, therapy is usually stable unless issues are brought up which are extremely difficult for patient to cope up.
TERMINATION of therapy is a delicate issue as well, the successful ending of therapy and the therapeutic relationship reinforces the base of new relationships.
Medication
Patients of AVOIDANT PERSONALITY DISORDER shall be refrained from being over prescribed because they experience anxiety in social situations or a feeling of disconnectedness with their feelings. The anxiety in this instance is clearly situation-related medications may actually interfere with effective psychotherapeutic treatment. some medicines like anti- anxiety agents and antidepressants should be prescribed for AVOIDANT PERSONALITY DISORDER only when other psychiatric problem co-exists.
Self-help
Self-help support groups won’t be any good approach because patient would simply avoid attending any such session.
Therapies suggested for AVOIDANT PERSONALITY DISORDER
Psychodynamic therapy
A form of talk therapy
Helps understanding how past experiences influence your current behavior.
Allows you examine and resolve past emotional pains and conflicts.
Helps moving forward with a healthier outlook about yourself and how others see you.
Cognitive behavioral therapy
Form of talk therapy
This helps you recognize and replace unhealthy beliefs and thought processes
Therapist will encourage you to examine and test your thoughts and beliefs to see if they have a factual basis.
Helps developing alternative, healthier thoughts.
Frequency and demographics
In general adult population, the prevalence of AVOIDANT PERSONALITY DISORDER is estimated to be 2.1–2.6%.
Among all the adults receiving outpatient psychiatry treatments, the rate has been reported to 3.6%.
A twin study found AVOIDANT PERSONALITY DISORDER rate higher in women [2.5%] than men [1.4%]
Mortality/ Morbidity
School refusal and poor performance
Children with significant social anxiety refuses to go school, because they fear n- body would be their friend after knowing about them and what they have ben through.
Conduct problem and oppositional behavior
Many individual with AVOIDANT PERSONALITY DISORDER refuses to participate in social activities and may have outbursts and panic attacks when placed in social situations.
Poor peer relations
Patients of AVOIDANT PERSONALITY DISORDER often have few friends and often refuse social invitations and interaction with relatives or unwillingly related peoples.
Lack of involvement in social activities
Demonstrate lower level of participation in common athletics, extra-curricular attention seeking activities, hobbies than those of depression or other personality disorders. They may even refuse employment or work related activities that involve too much interaction.
Substance abuse
Prone to drugs or alcohol abuse.
Major depression
Much chances of developing in individuals with AVOIDANT PERSONALITY DISORDER.
References
Writers of original reports
· David C Rattew
· Caroly Pataki
· Steve bressert