Avoidant personality disorder (AvPD)
Avoidant Personality Disorder (AvPD) is a psychiatric condition characterized by a pervasive fear of rejection, leading individuals to withdraw from social interactions despite a desire for companionship. It falls under the category of personality disorders, which are rooted in early personality development and often continue into adulthood. Individuals with AvPD typically exhibit high levels of anxiety in social situations, feeling inadequate and hypersensitive to criticism. This disorder often stems from a combination of innate characteristics, such as an inhibited temperament, and negative early childhood experiences, including a lack of parental affection and experiences of humiliation.
The prevalence of AvPD is estimated to affect approximately 2.5% of the adult population, with no significant associations found regarding race or sex. Diagnosis is based on specific criteria outlined in the DSM-5-TR, which requires the presence of particular behavioral patterns and emotional responses. Treatment generally involves a combination of psychotherapy, aimed at addressing fears of rejection and enhancing social skills, and medications to manage anxiety or depression that may accompany the disorder. With appropriate support and strategies, individuals with AvPD can work towards improving their social interactions and overall quality of life.
Avoidant personality disorder (AvPD)
- TYPE OF PSYCHOLOGY: Psychopathology
- Persons with avoidant personality disorder show a pattern of excessive sensitivity to being rejected. This fear of rejection leads to a pattern of withdrawing from social situations and avoiding interactions with people. While fearing rejection, the person with avoidant personality disorder wants to have friendships and be socially active.
Introduction
Avoidant personality disorder (AvPD) is one of the psychiatric disorders described in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), and is included in the category of personality disorders. Personality disorders are problems in personality development that begin in childhood and continue to cause problems for a person throughout adulthood. Personality development begins in childhood, and once formed, personality remains stable throughout adulthood. Persons with personality disorders develop certain feelings about themselves and behaviors toward other people that can cause problems in their everyday functioning.
An individual with avoidant personality disorder fears rejection from other people and avoids social situations. Although uneasy in social situations, the person with avoidant personality disorder desires or wishes for companionship and social interaction. AvPD is often described as an inferiority complex, which means that the person feels a lack of competence in social skills and is highly self-critical. The inferiority complex produces a wide variety of negative feelings about the self that inhibit confidence in social situations. Avoidant personality was first formally included among psychiatric disorders in 1981.
Who and Why
AvPD is a relatively uncommon condition. The National Institute of Mental Health (NIMH) cited a 2007 report stating that the condition affects 5.2 percent of the US adult population. According to the same report, sex and race have not been shown to be associated with personality disorders, including AvPD. Later research indicated this percentage to be closer to 2.5 percent.
In attempting to identify the possible causes of the disorder, researchers have focused on innate or inborn characteristics exhibited by infants and on early childhood experiences. Infants have been found to display different types of temperaments, including one that is inhibited. Considered innate or inherited, the inhibited temperament is characterized by a timid orientation to the external world. Whenever an inhibited infant encounters new situations, the infant’s response is subdued and fearful. This early inhibited temperament has been found to be consistent throughout infancy and early childhood before developing into a pattern of shyness whenever around people.
In addition to the innate temperament, persons with avoidant personality often have experienced some negative events in their infancy and early childhood. As they go through childhood, these children are often punished or shamed in a manner that promotes their fears of being humiliated. It is likely that persons who develop AvPD did not receive parental affection and were subjected to rejecting behavior from their parents.
The combination of an inhibited temperament in infancy and rejecting behavior on the part of parents appears to produce an individual with low self-esteem and fears of being publicly humiliated. These feelings solidify into an avoidant personality or inferiority complex that prevents a person from satisfying social interactions despite the desire to do so.
Diagnosis
An individual with AvPD exhibits high levels of anxiety in any social situation, appearing tense and vulnerable to criticism whenever asked to engage in social exchange. The DSM-5-TR outlines seven criteria for diagnosing AvPD, of which four must be present in an individual for a diagnosis. The formal diagnosis requires the person to demonstrate a continuing social inhibition, feel inadequate, show hypersensitivity to being evaluated, avoid situations that involve interpersonal contact, be very restrained in expressing feelings, have a preoccupation with being criticized, be fearful of being embarrassed, and view the self as socially inept. Hypersensitivity toward any signs of rejection by other people is a prominent characteristic of the disorder.
AvPD is often confused with three other psychiatric diagnoses: schizoid personality disorder (SPD), social phobia, and agoraphobia. The person with SPD also shows a pattern of avoiding social situations, but the key difference is that SPD presents with indifference toward and disinterest in social situations. This is unlike the person with AvPD, who has a desire for social interactions. Social phobia is diagnosed among persons who are fearful of performance situations such as speaking in public; however, outside the performance situation, the person has comfortable social interactions. Agoraphobia is a condition in which a person may avoid crowds or social situations because of fears of having a panic attack, which is not true of persons with avoidant personalities.
Treatment Options
The typical treatment for persons with AvPD is a combination of psychotherapy and medications. Psychotherapy is used to help the patient overcome fears of rejection and humiliation in social situations. The therapy focuses on developing methods to cope with these fears and helping guide the patient toward engaging in an increasing number of social activities. Assertiveness training or group therapy is often a part of the psychotherapy process. Both provide the patient with opportunities to learn effective ways to interact with other people without the fear of rejection. Psychoactive medications that alleviate anxiety are usually prescribed for the patient. With anxiety controlled, the patient is able to enter into social situations. Patients with AvPD often experience depression because of their isolation from other people. In cases in which depression is present, an antidepressant medication is added to the treatment regimen.
Bibliography
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