Avoidant Personality Disorder(AVPD)
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| Avoidant Personality Disorder(PsychoDoctorr) |
Avoidant personality disorder (AVPD) is a long-term pattern of behaviour characterised by social inhibition, feelings of inadequacy, and sensitivity to rejection, which causes difficulties at work and in relationships. Avoidant personality disorder (AVPD) is included in "Cluster-C" of Personality Disorder chracterized by anoxious and Fearful.
AVPD is often linked to other mental health issues such as anxiety disorders, particularly social anxiety disorder. People with the disorder avoid situations because they are afraid of rejection or disapproval, which they find extremely painful. About 2.5 percent of the population is affected, with approximately equal numbers of men and women affected.
Symptoms of Avoidant Personality Disorder
key Symptoms
- Avoid Taking Risks
- Inferiority Complex
- Social Isolation
- Poor Self Esteem
- Nervousness and Fear
- Intense Fear of Rejection
- Preoccupied with negative perception
Others Signs may includes:
- Anhedonia (lack of pleasure in activities)
- Unwilling to try new things or take risks
- A want to be liked
- Avoid Sharing intimate emotions or avoiding intimate relationships
- Anxiety about saying or doing something inappropriate
- Anxiety in social environments is a common occurrence.
- Conflict avoidance (being a "people-pleaser")
- Avoiding interaction in the workplace or declining promotions
- Criticism or disapproval will easily injure you.
- Choosing not to make decisions
- Low self-confidence
- Fear of rejection causes people to avoid circumstances.
- Social circumstances or incidents are avoided.
- Self-consciousness at an all-time high
- Inability to make social contact
- Fearful and tense body language
- Inadequacy feelings
- Negative feedback makes you hypersensitive
- Insufficient assertiveness
- Lack of confidence in herself
- Negative situations are misinterpreted as neutral situations.
- You don't have any close pals and you don't have a social network.
- Isolation from others
- Inhibition in social situations
- Self-perception as socially inept or inferior
- Be on the lookout for signs of rejection or disapproval.
Avoidant Personality Disorder DSM-V Diagnosis
Only a qualified mental health professional can diagnose avoidant personality disorder using criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). While a family physician should provide the initial diagnosis, your doctor can refer you to a psychologist, psychiatrist, or other mental health professional for further evaluation.
A coherent pattern of avoiding social contact, being excessively sensitive to rejection and critique, and feeling inadequate must be demonstrated by at least four of the following criteria, according to the DSM-5:
- Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
- Is 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
- Is preoccupied with being criticized or rejected in social situations
- Is inhibited in new interpersonal situations because of feelings of inadequacy
- Views self as socially inept, personally unappealing, or inferior to others
- Is unusually reluctant to take personal risk or to engage in any new activities because they may prove embarrassing
Causes of Avoidant Personality Disorder
Genetic, environmental, socioeconomic, and psychological factors are believed to play a role in the development of avoidant personality disorder. If other factors are present, emotional abuse, critique, mockery, or a lack of affection or nurturing by a parent or caregiver during childhood may result in the development of this personality disorder. Peer rejection might also be a risk factor. Individuals with the disorder are often shy as children and do not grow out of it as they get older.
Treatment of Avoidant Personality Disorder
The majority of people who suffer from avoidant personality disorder do not seek help.
When they do, it's usually for a particular life problem or other kinds of symptoms like depression and anxiety, and they'll usually stop therapy until that problem is addressed.
Avoidant personality disorder, like all personality disorders, can be difficult to treat because it is a long-term pattern of behaviour, and it can be difficult for the person suffering from it to agree that psychotherapeutic assistance is required and advantageous.
Unfortunately, people with avoidant personality disorder who do not seek treatment have a poor prognosis—they tend to isolate themselves and use avoidance as their only coping strategy.
Treatment, on the other hand, will help to relieve symptoms and expand the range of coping techniques that a person can use to handle their anxiety when done correctly. A person with avoidant personality disorder will almost always be timid, but avoidance will not be their primary concern.
Psychotherapy for Avoidant Personality Disorder (AVPD)
Cognitive behavioural therapy (CBT), psychodynamic therapy, and schema therapy are examples of talk therapy for avoidant personality disorder.
Social skills training and group therapy may also be beneficial.
Psychodynamic therapy aims to be aware of how past experiences, pain, and conflict may be contributing to current symptoms. CBT is useful for learning how to alter unhelpful thought patterns, while psychodynamic therapy aims to be aware of how past experiences, pain, and conflict may be contributing to current symptoms.
Schema Therapy for avoidant personality disorder is an integrative approach that incorporates CBT and a variety of other therapeutic methods. It focuses on the therapeutic relationship between the therapist and the client with the goal of improving everyday functioning and gaining knowledge for change through the interpretation and re-engineering of early life experiences.
"Limited reparenting," in which the client communicates childhood needs and learns to cultivate and internalise a healthy parental voice, is a key feature of schema therapy.
Schema Therapy's for Avoidant Personality Disorder
The client learns four major ideas during schema therapy:
- How maladaptive schemas are lifelong trends.
- Disconnection and rejection, impaired autonomy and achievement, impaired boundaries, unreasonable obligation and norms, over-vigilance, and inhibition are the five domains in which these patterns can be found.
- How did you learn to cope as a kid? (e.g., escape, fighting back).
- What are the coping schema modes and how are they unhelpful? (e.g., avoidance, detachment, compliance, punishment).
- How to cultivate healthy adult coping mechanisms and meet one's basic emotional needs.
Medication for Avoidant Personality Disorder
While no drugs have been approved specifically for the treatment of avoidant personality disorder, if a person has any associated disorders such as depression or anxiety, drugs may be prescribed to assist with those symptoms.
Antidepressant medicines, for example, can assist with increasing mood and anhedonia, reducing anxiety symptoms, and reducing rejection sensitivity.
Coping with Avoidant Personality Disorder
Recognizing the signs of avoidant personality disorder is one of the first steps in improving quality of life. You'll be able to better work with your therapist to find ways to work around your special symptoms if you understand them.
Include friends and family in your treatment so they can better understand what you're going through and how they can help.
Finding healthy coping skills that keep you from turning to drugs or alcohol, smoking, overeating, or self-harm when you're having a hard time is also important.
Example of Avoidant Personality Disorder or Case Study
A 23-year-old male, B.E student from upper middle socio-economic status, accompanied by his parents, presented with the complaints of anger outbursts, inability to mingle with people and inability to study. Insidiously symptoms started over a period of 4 years and gradually worsened. For the past 2 years, he attended neither the classes nor the home tuitions. He could not clear 15 papers. Most of the activities, which he tried to do ended in failure and angry frustrations. Most of the time was spent in sleep, which was aided by sedative psychotropic medicines. He could not tolerate inactivity as it led to boredom and this was intolerable. Remaining small time in the day he displayed a “typical pattern” of behavior as noted by Pedesky and Beck[3] “they may discontinue a task or fail to initiate a task they had planned to do. They may turn on the television, pick up some things to read, reach for food or a cigarette, get up and walk around and henceforth.” He was more or less home bound. Neither patient nor his parents could explain his anger and other symptoms. Mental status of the patient was that of an inhibited plump person with expressionless serious face, answering questions minimally, but relevantly without any psychotic symptoms.
Most of his anger outbursts erupted and lasted only for a few seconds and a few are followed by grumbling and shouting for about 10 min. Anger resulted in yelling with angry gestures, banging, crumpling, throwing, tearing and breaking of objects (one per attack) such as shirt, pen, pencils, spectacles, remote control and rarely, mobile phones or computers. Anger was followed by remorse. These outbursts were not expressed in front of others as it was shameful. Daily there were countless yelling and at least 2 tares or breaks. His father had become an expert at fixing the spectacles.
He avoided close relatives, strangers and crowds as it induced severe fear and inhibition. He was scared to talk to house maid, lift operator in the apartment, traffic police and ladies. He avoided ladies just like how people avoid a cobra. He looked away from them and walked away at the prospect of an approaching lady. He avoided almost all activities outside home.
He had several other fears and phobias. He feared contamination with its health hazards. In fact his first visit to a Psychiatrist was due to fear of Lead contamination from wall paints. He was scared of black magic and masturbation and wanted to control it. His other fears were, being cursed by god, old and sick people if they are disturbed by mistake, fear of going deaf or blind by strong sounds or bright light. He had magical beliefs that bad words if heard in the early morning, they will spoil the whole day and if any bad word is heard while praying, god will curse. All these beliefs were the sources of his frustration and resulted in anger.
He had rigid moral values in the matters of sexuality, religion and right or wrongs. He got infuriated with matters such as Muslim religion, female gender, Britons, beef eaters and rule breakers. He was pre-occupied with his sagging chest and wore tight banyans to hide it. He wanted to have a perfect body. His fantasy was to become a business tycoon or a Scientist. During masturbation, frequently he had fantasy of sadomasochism, transvestic fetishism and autogynephilia.
His inability to study was the result of several factors. He wanted to understand the subject perfectly and this inability led to a sense of failure and frustration and anger. He wanted to exactly reproduce the figures and examples given in the text book. He gave importance to learning by wrote memory. Prospect of understanding led to an excitement and he could not focus. Frustrated, anxious and angry mental set also took away his focus.
Patient was born to a highly educated and well-employed couple hailing from upper socio-economic status. His first degree paternal uncle has a chronic psychotic illness, but he is too highly educated and regularly employed. There was no marital conflict between the parents. They do not appear to have any significant personality disorders and are physically healthy. There was no history of child abuse at home. He has one healthy sister. As a child he was quite sweet and was socializing reasonably well. However, he was noted to be angry and used to kick walls if he got angry. In 10th and 11th standard he was bullied frequently by few students and ridiculed for his sagging chest by touching it. Patient remained un-assertive and the abuse and emotional trauma inflicted was significant. During adolescence his inter personal problems started appearing. He deliberately failed in one subject, just because a teacher had insulted him. His past psychological assessments revealed above average intelligence and presence of several personalities disorder traits and low self-esteem.
He was treated by more than a dozen of Psychiatrist, exhausting all psychotropic medicines, including clozapine at 200 mg/day. He underwent psychotherapy for 1 year from a well-qualified Psychologist. None of these led to any improvement. When he visited the author he was on lithium 400 mg, fluoxetine 60 mg, amisulpride 100 mg, quetiapine 50 mg, clonazepam 3 mg, pregabalin 300 mg. He had undergone several Magico-Religious treatments. His global assessment of function at the time of presentation was at 30.
TREATMENT AND OUTCOME
Cognitive therapy espoused by Pedesky and Beck[3,4,5,6] was administered over 1½ years, weekly 1-2 sessions of 1-2 h duration. Patient was educated about the disadvantages of cognitive avoidance and encouraged to abandon it. Schema modifications, behavioral experiments, cognitive restructuring, brief repeated exposures (real and imaginary), exposure and/or response prevention for obsessional symptoms were used during therapy. Trauma of being bullied required only cognitive restructuring. Experiential techniques were not used. Dichotomous thinking was repeatedly corrected. Medications were tapered to sertraline 50 mg and aripiprazole 10 mg. He cleared 15 failed papers and is now attending his regular classes. Anger outbursts reduced to one tear or break per week. Socialization and ability to study individually improved. His current global assessment of functioning is at 70.( Reference: NCBI)
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