Is it AvPD, or Social Anxiety?

I don't know if this information is still relevant to this discussion, but I am going to post it anyways. If I am disrupting the flow of conversation, please feel free to ignore me.

I have a book called Personality Disorders in Modern Life by Theodore Millon. In it, he details all of the diagnostic criteria for AVPD in easy to understand terms and uses lots of examples. Something that I thought people might be interested in is the section on co-morbidity. More specifically, co-morbidity with social anxiety. He touches on the debate of whether they are one and the same and also talks about some of what he thinks the key differences between the two are.

I will paraphrase, since I don't want to steal. If you can get this book from Amazon or from the library, I really highly recommend it. It's an interesting read and it is so in depth. I will post a link at the end of the post.

Anyways, Mr. Millon says that AVPD contains more specific behaviour that people with social anxiety do not generally display. For example, people with AVPD try really hard to keep up an appearance of self-control and calm. This usually conceals an inner anger that stems from a childhood rife with mockery. It is not necessary for people with social anxiety to do this.

Also, one of the key troubles for people with AVPD is their desire for close companionship and deep relationships, but they believe that such relationships are impossible for them to achieve because of who they are. They believe that, even if all their social anxiety were to disappear tomorrow, they are such an undesirable person that no one would want to be close to them. People with social anxiety do not need to believe that.

Social anxiety and AVPD are very frequently co-morbid and it is actually written in the DSM-IV that if a patient has generalized social phobia (as opposed to situation-specific social phobia, like a lot of people have), that AVPD should be looked at as an additional diagnosis.

Research shows that people who have a diagnosis of social anxiety alone have a far better response to therapy than people with social anxiety and AVPD. People with AVPD and social anxiety are also more likely to have another co-morbid diagnosis. This suggests to Mr. Millon that AVPD has traits that separate it from social anxiety and make it harder to treat.

There are some who argue that AVPD is a more extreme form of social anxiety and others still who say that AVPD is a more specific form of social anxiety, although it is counter- argued that the main reason for the major overlap in diagnostic criteria between the two has less to do with the disorders and more to do with the process through which the DSM is revised.

In this book, there's also a really great section on the four sub-types of AVPD that Wikipedia mentions briefly. They're really fleshed out and they make an interesting read.

So, that's it then. If anyone else has read this book or wants to talk about it, please PM me because I am very interested in discussing it. It would not be a bother at all.

Here is the link to the book, like I promised!

This information is helpful to me. I wondered the same thing---what is the difference?

I think my problem might point more to AvPD than to social anxiety.

I am working on my fears of ppl, but still have an innate feeling of undesirability.

Billi

I also read somewhere that people with AVPD feel like they are hiding a dark secret and that secret is their true self. Even when people with AVPD get married and have relationships, they keep themselves at an arms length. When their partner says "I love you", the person with AVPD says "I love you too" but they are thinking "You only THINK you love me. If you really knew me, you wouldn't be saying that. I will never tell you what I really am because if you find out, you will reject me and I would never recover from that."

It is very stressful because the person with AVPD always feel like they are acting around other people. It is like having to keep up a complicated series of lies. Before they talk, they have to check over in their mind "Is this in keeping with the persona that I have created or is it too much like my real self?" There is a constant fear of discovery, although most of the time, the person with AVPD is not really sure what it is that they are hiding.

Sometimes, when someone finds out their secret and accepts it, the AVPDer has a feeling of relief for a few hours/days/weeks that they don't have to hide or lie anymore. Inevitably, the person with AVPD will start ruminating about themselves and will "remember" ANOTHER deep, dark secret that no one must know and the cycle will continue.

I can definately relate to keeping up appearances. In fact, I came to a point fairly early on in life of not showing too much emotion at all. The thought that someone else would think that I am not all together and have some kind of weakness scares me to death. I do sometimes feel like I am just going through the motions in life, which probably explains all this anxiety I deal with an a constant basis.

Brian

The 1st question comes to my mind is what is AvPD?

Avoidant Personality Disorder

There is a Personality Disorder Test which I took when I suggested to my therapist that I had AvPD. Sure enough, I was at the top of the scale. I am a textbook case.

Yes, secrets. Yes to terror at the "real me" being discovered. At this moment, a friend has invited me to come visit. I am practically housebound out of fear of people at this point in my life. This is an effort to reconnect after years of not seeing each other due to work, family, etc. I love her, but am terrified to go. I think: Why would she want to see me? What do I have to offer her since I am such a empty blank person? What will I wear so that I will fit in and not be out of place and thus ridiculed (not by her but by others around us)? She is reaching out to me, she is non-judgmental and supportive always, and I am even afraid of her. I am ashamed of who I am and afraid she will see how pathetic I am.

In interactions with people, everything I say and do is measured to the nth degree for appropriateness so that no one will dislike me and/or verbally attack me. If they expressed those emotions to me, I would be paralyzed and devastated. I yearn for relationships, but I reject every single offer anyone makes toward me because I am so afraid. I am like a robot, constantly scanning my environment for {emotional} danger.

I need anonymity and like being invisible. A store clerk paying attention to me is painful unless I actively seek it out and need them. I want to be invisible, unnoticed and never the center of attention.

Criticism and rejection are always paramount in my mind. I won't subject myself to situations where that can happen. I stay as neutral and under-the-radar as possible so no one will notice me. If they don't see me, they can't take issue with me.

All of my romantic relationships are with men who sought me out. I paced myself to make ABSOLUTELY CERTAIN that they were a sure thing before I even allowed myself to share anything. One said early on: "talk to me." THAT coming from a MAN? (this is a man joke, see I do at least have a sense of humor!) is pretty unusual.

And with friendships, people who pursued friendship with me and were highly accepting and supportive were the only ones let into my inner circle. I have never exposed myself to the risk of attempting to make friends with someone. They must make the first move, and if I am interested and they pass the "sincerety/safety" test, then......maybe. Then I pushed them all away because of fear of unworthiness and shame. So finally, they quit asking. And of course I wouldn't pursue them, because of fear of rejection.

CBT? Yeah, it's ok. I get practically BEGGED by my therapist to take small steps to get out of the house and expose myself to social settings. I don't except for signing up for a class recently (it's structured so there is no pressure on me to talk to others).

I also started Diablectical Behavior Therapy (DBT). It teaches coping skills to deal with overhwelming emotions such as fear, shame, anger, sadness, etc. It's a group setting and you must participate. It was one of the most difficult steps I ever took, and I admit to taking tranquilizers before the first meeting. But it was ok. It actually is something I look forward to now. I think it's helping me with my panic and raging emotions. And I have to interact with people in a "safe" setting so it's a small step.

So anyway, sorry for the long post, but if you think you have AvPD, see if they will administer the MCMI-III Millon Clinical Multiaxial Inventory - III. I probably should't have had to figure out this diagnosis by myself - in retrospect, I think it was pretty obvious - but my therapist definitely was eager for me to take the test and help decipher the results.

The comments here are really helpful. I enjoy reading them. Thanks all

Wow. So much for baby steps, eh?

My first T made a big deal out of how few friends I have (re: none). Her advice on that that was basically "Well, instead of having no friends, could you try making a few friends?"

My response to that was "omg, I never thought of that before. Thanks for the insight!"

Er, I guess I didn't say that out loud, but you get the idea.

I dunno. I already know that my social circle is tiny and that it might be considered a problem. I don't need it thrown back in my face by someone who is supposed to be helping me. If I could just go out and make friends at the drop of a hat, I would have done that already.

Comments like that totally shut me down.

Sorry for the rant.

I so appreciate what everyone has said !!!! Daytimedreamer, you do not rant at all. you make total sense, and sound great.

I think it is just fine to say that. I sometimes say the wrong things too, so I try to be careful. A lot of my old posts are really embarrassing for me, so I just try not to think about them or look at them. I have wrestled with the urge to delete my account a few times, but I'm glad that I haven't. It's good to have a record of how things really happened so that I can't distort them in my mind and make things out to be worse (or better) than they really were.

I'm sorry that things are so awkward with your T. Even though T's can be good people, sometimes that doesn't translate into a good T-client connection and that can be hard to deal with.

At least for me, if T was an awful person, I wouldn't feel so bad about disappointing her or making mistakes, because then I wouldn't mind cutting her off completely. To keep up a good front for people who I like is stressful, especially if it is someone who is supposed to be seeing all of my bad points, because then I have to simultaneously reveal all my weaknesses while at the same time maintaining decorum and keeping that person's respect. No small feat.

Anyways, I know I just go on and on. Short version: I sympathize.

Oh my goodness, this sums up my life, too.

But for the moment, I have BALANCE in the approach of my therapists (yes, that's plural). If I had one who said "just get some friends" I would be distraught, too. But please think about some way to find other perspectives as well. You obviously respect this therapist... I just wonder how a session can be effective without seeing or hearing the nonverbal cues. Can you possibly do phone sessions with her?

Thank you for your excellent posting. You are most insightful and express yourself so well. My instant identification with your described symptoms and, thus, my attraction to someone like me is obvious considering that this is my 3rd effort at a reply, my previously lengthy and "eloquent" [gag] responses having gotten me booted twice now. Better shorten it down, I guess. Your success with work is a good opportunity for forced social interaction, as is making pleasant comments to fellow sufferers in the grocery check out line. Maybe you could expand on this.

Unless there has been a misunderstanding [can you become comfortable with asking your therapist for clarification?], your therapist seems to be saying,"Kindly keep paying me, but just accept the symptoms that brought you here." You know better. You have been better and you can return there. Is it possible that she was trying to say "accept yourself" [not your symptoms] The following are just ideas. You have received many excellent responses from those more knowledgeable than me. As light as my response might be, I feel desperately for your pain, which is so like my own.

Is a med change needed?

As you are walking about "paste on" a smile, just enough to look pleasant, but not so much that you appear to be listening to voices. Look at people occasionally. Typically they will smile back

The body dysmorphic symptoms you mention probably mean that you are very much more attracive to others than you are to yourself. Just to keep your anxiety in this area at minimum, however, try to be at essentially your best in terms of cleanliness and grooming when you go out. It's easy not to care when you're depressed.

Forgetting about what others might be thinking for a sec, pretend to be invisible, and take a good hard look at others. How many are really having a good time? The answer is not many, unless they are drunk or drenched in endorphins from dancing the night away. The humongous response to your posting shows you how many of us are helping you prop up that wall, albeit in other locations. That's why forums such as this excellent one, and chat rooms in general, are so popular. Social anxiety is a form of internal torture, and it is on the rise. This forum seems to be a forerunner as a safe place. Please keep posting. You already have friends here. If you persevere with making friends here, those friendships grow easily. It is an important solution for the socially shy.

Forgetting about what others are thinking for just one more sec, try to imagine why types of problems those around you have at home. If they are one of those "idealized" folk, with spouse and kids, they have PROBLEMS at home." I promise you.

"Having a boyfriend" was important to me for a long time, too, but you have managed to avoid the pitfalls i fell into in addressing my social anxiety - drugs, alcohol and "settling" for bottom-of-barrell types. CON-GRAT-U-LA-TIONS!!

Make it a point to add a sentence or two to the forced interaction you have on the job. Concentrate on the problems others might be having rather than what they might be thinking. [I'm not SAYING I can DO any of these things]. And keep on posting. Chances are excellent that you will get to know many people here; that you will keep up contacts with some of those; that you will get an occasional phone #; that you will make many friends and learn to talk again. You have a friend here. billieJ

Wow! I never knew I there was such a personality disorder. This is me to a T. The only people I really talk to are those in my household. I had an opportunity to make a friend down the road a few months ago, but she was getting too friendly & I started to panic. Eventually this caused a fight between me & my boyfriend & he went down the road to tell her not to call or come over. I have lots of friends I enjoy talking to on FB, but no real close friends anymore. I fear it & I really enjoy the isolation of my home. I'm lonely, but I tell myself that my boyfriend, my three sons & my 2 cats are more than I can handle. I also scored high on paranoia, which makes it even harder to make friends. I find myself wondering what their "true" motives are. It's so hard to trust others. I sometimes fantasize about going out and cry over what I am missing, but I really enjoy being home as much as possible.

I am sorry for anyone who lives with this disorder. For me its completely excruciating. Trying to find a way to make it through the holidays. Day by day. But the pain of the avpd is profound. I got up the nerve today to actually read about it. I was diagnosed almost 2 years ago. I was shocked. Everything fit me. It was the perfect description of me. Just have to get through the holidays. I cannot post here at pc much. Its part of the Avpd. I do not feel safe posting. I thik the definition of hell is being so totally alone. Sorry for the depressing rant. I hope it will be allright to post that at pc. Good luck to you all. You deserve all thats good

[quote=christa;1665310]I have had AvPD most of my life. the difference between having a social phobia and Avpd relate to the degree of how well you are able to function. When I see these blogs about people who claim to have AvPD I am skeptical, because I have always thought I was the only person with this disorder. Maybe not.

[quote=christa;1665333]I am glad you joined the Psych Central community Christa. And also glad that you feel comfortable enough to post. I was originally diagnosed as having AvPD in 1981 by a psychotherapist. And then again in 2010 by a pcychiatrist who knew nothing of the first dx 19 years prior. They are correct in their dx. I am a member of two moderated AvPD message boards. So you are not alone at all. Many people do have this "disorder". But I sure do understand the feeling of being alone in it. Yes.
Again, I am glad you are here. You arent alone.

Medicated, I think your T knows what she's doing. I think you should try for as long as you want to see if you're happy to be alone. Try it. See it. And then move on after what you found out.

I tell myself I am happy doing stuff alone like reading, writing, and drawing. I won't mind being single for the rest of my life, but I think I would be happier if I was married to a woman.

More about me: I was diagnosed with AvPD about 5-6 years ago. I am much better now. Speaking of never never had a mate. I am a male who will be 37 this year and never been kissed. About the last sentence, I am a little bit scared of sharing that. But I decided to just go ahead. I don't want to be AvPD or be anxious. Who cares!! Right?

Medicated, I'm really sorry your therapist is not being understanding. That would be really hard. I am diagnosed with Avoidant Personality Disorder, but I'm often unsure if I really have it. I do have a hard time with criticism and I don't like really big social situations. I can't make small talk, but part of that is due to being autistic. Anxiety is a terribly difficult thing to deal with on a daily basis. It really wears you down... And I'm sure you can find a good romantic partner. Some people it just takes longer than others and you aren't that old to begin with. I wish you well.

Whatever it is: Social Anxiety or Avoidant Perosnality Trait/Disorder, It sounds like you and I have a very great deal of similar experience in life. I want to thank you for so articulately and understandably expressing your issues. I try to explain to doctors and therapists, and I feel like they are not quite "getting it." Reading your post sounded so like my life experiences that I am kind of impressed that this disorder seems to cause pretty much the same problems in those who have it. In my case, it was fourth grade when alienation from classmates really kicked in. My struggles have been strikingly similar to your own. Since you are training to be a P.A., get a copy of the DSM IV or the new DSM V and read for yourself the criteria for personality disorders. You are a smart, and reflective person. Don't assume that the therapist you saw is necessarily better than you might be at finding the diagnosis that is the closest fit. Then, at least you can put a name to this affliction. Also, bear in mind that the system of categorization in the DSM editions is very much a "work in progress." I haven't found one-on-one therapy to be very helpful for my experience with severe social anxiety/avoidant behavior. Nor have I found drugs to be all that helpful. Group participation, I find more uselful. I now believe that sharing with persons who have this disorder might be very worthwhile.