Is it AvPD, or Social Anxiety?

I feel like I'm defective socially. Not inept per se, more like painfully restrained.

I wasn't always this way. As a young child I was outgoing with and liked by my peers, but by the 3rd grade, I was about the least popular kid at school. When choosing teams for kickball, they would pick the mentally retarded kids before they picked me. It seemed I could do or say nothing right, and the only way I could defend myself from my classmates' constant tormenting was to keep my mouth shut and hide. This went on for about seven years, and I suppose it is expected that these experiences might leave me somewhat socially scarred.

Now I am 25. I am intelligent and generally successful, and acquaintances sometimes randomly approach me to tell me how much they admire things about me, yet I have never had a boyfriend, and I have never been kissed. I have a lot of friendly acquaintances and a few closer friends, but I feel like I don't really trust them. I feel an emotional separation from them like I can't throw my heart into the relationship entirely. I'll tell people sensitive things about me, but it comes out as nothing more than facts, when I feel that there ought to be some deeper meaning there. I also struggle greatly to make new friends. I can hold a pleasant conversation with someone, but inside I'm absolutely dying to run away because I feel like their interest is insincere or like I'm bound to screw it up somehow. It's very uncomfortable.

Group situations are very difficult for me. Events like mixers are particularly painful, and unless a very active effort is made to include me, or unless I feel like I have one of my better friends to cling to, I usually get anxious and overwhelmed (and possibly burst into tears) and leave. I really really really want to be able to mingle and have a good time like everyone else, but I just can't do it. I'm afraid I'll say something dumb or at least awkward. I don't even bother going to dances any more or attempting to dance because I can't bear the thought that someone might be laughing at my appearance (body image issues...) or my incompetence. Same applies for other activities where I don't feel skilled.

I flamed out of a music performance major partially because of undiagnosed ADD which prevented me from practicing for hours at a time, and partially because the constant evaluation and criticism of my playing was almost more than I could bear. I'm now pursuing a career as a Physician Assistant, but the evaluations of my faculty and preceptors terrify me. More than once, I have burst into tears when being graded after a practical exam. I think the career would be an okay fit for me, except I fear that patients or supervising physicians will reject me or berate me, despite my best efforts. It's bound to happen.

However, despite my great inhibitions, I'm not sure if, at the core, I really feel that I am inadequate or inferior as a person. Although I tend to be extremely self-critical, on the whole I actually do think that I am worthy of being liked (usually), but that there is some crippling barrier that prevents me from having and experiencing the meaningful relationships that I deeply desire. It has to be my fault. I always feel this insurmountable wall that ultimately keeps me separate. Protected, but pathetically alone. I can't tell you how much I want to know what it's like to love and be loved in a romantic relationship, or to have a best friend who I can talk to and hang out with and feel completely at ease, without fear of judgment or scrutiny. Pardon the use of the term, but I feel like a relationship retard.

I mentioned the avoidant personality disorder idea to a prior therapist, and he quickly shot it down without really exploring the issue. In my mind, there is obviously a problem here - the fundamental issue of wanting meaningful relationships, but feeling incapable of attaining them. The desire for positive social and other interactions, but being sabotaged by fears of judgment or rejection. Great reluctance to try new, potentially embarrassing things for fear of getting laughed at. The inability to tolerate appropriate criticism. I mean, is this normal? Is it really normal for a 25-year-old to be not only a virgin, but to have never had a boyfriend and never been kissed?

I guess I don't know what to make of myself. It sounds a lot like AvPD to me... is that what it sounds like to you, or is this just social anxiety? Does it even matter what it really is? I just know I don't want to live this way, if it can be helped.

If others reading this have had similar struggles and found effective help, what did you do? CBT? Self-help? I feel like there is an entire dimension to life that I have never experienced. Help me get there. Please.

Thank you in advance.

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Personality disorder is a complex business and not at all straightforward to diagnose, especially in oneself because it is difficult to be objective. You may just be suffering from social phobia or anxiety or there may be a combination of issues. Avoidant personality disorder can occur in conjunction with other social phobias, mood and anxiety disorders, and personality disorders. The diagnosis may be complicated by the fact that avoidant personality disorder may be either the cause or result of other mood and anxiety disorders.
Lots of people have avoidant traits, but it doesn't necessarily mean they have a diagnosable disorder and you really need to request a professional assessment in relation to discussing with a clinician what it is that you would like to change, if you do want to change.
Whether it is avoidant personality or social anxiety disorder, the best and only thing to do about it, along with psychotherapy (and CBT is best for me but everyone is different ), is to slowly and gradually put yourself into social situations, even if only briefly
and in my opinion u should start build your self esteem ...
hope it helps ...

As long as people aren't asking me if i'm all right, i am alright.

I don't have the answers, I just feel the same way. It seems like there's no one to talk to that understands, so I just start babbling to anyone. I know that's not good, but I can't seem to stop, it's like being hungry or desparate. My family puts me down, my husband just watches TV, my son doesn't call, few friends but they take call waiting from people they see everyday and say they'll call back but don't.........on and on. Sound familiar?

Is having trouble making friends a symptom of bipolar, never having been taught how to, or some other kind of disorder? Do we worry about rejection more than others? Do they feel like bipols are like chameleons and they don't want to get close because they don't know if we are goofing around with them?

Lots of questions, I know. But, as you can see, I'm trying to figure it out also. I'm going to school and my grades are great, teachers are great, people think I'm sensitive and sincere, but no one seems to have the time to be there when I need them.

If you figure out the answer or a method of solving this issue, let me know. I'm pulling for you.

Wambat

I had forgotten this post. Since I wrote it, the bipolar diagnosis has been brushed aside, and I've started seeing a new therapist. I tried telling her how frustrating/painful this social anxiety (or whatever it is) is for me, and rather than explore the issue, she seems to just want me to learn to be content with "that's just the way I am." The thing is, it's not who I am inside. Having been hypomanic before and knowing what it's like to be outgoing and have friends and actually enjoy parties, I can never, EVER be content in the wallflower role. I have tasted of the way that so many others live life more fully, and I cannot be satisfied with just a fragment of what I know is possible. I want to know what's holding me back, and I want to overcome it! From what the therapist has said, I suspect that she has similar social inhibitions, but instead of trying for more, she has chosen to be content with it... so why should my goals be any different?

I'm not sure that we're the best fit. I feel strongly about my goals, especially in this respect, and I don't think we're "on the same page." So, instead of coming to my level or explaining why her goals differ from mine, she accuses me of being difficult by "shooting down" all of her attempts to help me. *sigh* I don't want to switch therapists again, but if we can't agree on what we ought to be working towards, then we're wasting our time.

Wambat - I babble to anyone and everyone, too... why do you think I ended up on PsychCentral?? :P I definitely having trouble with selecting the appropriate audience for my thoughts sometimes. However, I don't usually feel that I'm reaching out to others... I live alone and I'm fairly content by myself except when I'm in a social situation or realizing how pathetic it is that I'm nearing 26 and have never had a boyfriend or anything.

Although I'm not officially bipolar any more, I still have my moods, and I think that can make it harder for a person to make and keep friends. Harder to make friends because who wants to be friends with someone who is depressed?, and harder to keep friends because a person who befriends you while you're 'up' may not be able to handle you while you're down.

I KNOW I worry about rejection more than many people. I'm very sensitive to criticism, and I think that's part of what makes social situations hard for me. I worry that my conversation attempts will be awkward, and that I'll be a downer. I don't dance because I'm so self-conscious and because I worry that people will laugh at me. So what do I do? I withdraw. I stand at the side and watch, desperately wishing that I could be involved... laughing, talking, dancing, and enjoying myself like everyone else. I get so anxious and saddened by my perceived inability to participate that I become upset. I can't tell you how many times I've left a social gathering in tears because of this.

Anyway, I'm pulling for you too. I'm glad to know I'm not the only one... I just wish I had more understanding/support from my therapist. It would mean a lot to me to feel like I had her as a strong ally, and that through her, I have some concrete hope of overcoming this. For now, it seems I'm still flying solo.

(((Medicated))) Thanks so much for this thread. Both of your posts reflect exactly how I feel & the things that I do. I understand so well what you are going through & how desperately you want things that everyone has the right to have but we "can't". It's sooo painful. I'm going to print out what you wrote & take it to my T when I finally find one! I visited this forum for that very reason, too; not knowing if my problems are due to extreme social phobia or if I have Avoidant PD. I avoid everything in life.
You wrote that your T said that you are "shooting down" her attempts to help you, & now she told you to be content with being alone. And you wrote that you really don't want to find another T, which leads me to believe that you've had this problem with a few. Do you think you are fighting getting better b/c you are scared? If that's the case, she's probably aware of it, which may be why she told you to just be content with being alone. Maybe you can approach this with her & try to work on it. However, if you truly believe that she doesn't "get" how unhappy you are, I suggest that you find a different T.
Best of luck. You can PM me anytime. Please let me know how things go.

I don't think you are in the wrong at all. I never had a girlfriend until I was 26 and I know a male friend who is 40 and still a virgin. I think you need a better therapist. And perhaps a better Doctor? Peace.

Medicated,

I can relate to the things you describe. I was first diagnosed with severe social phobia and major depressive disorder when I was 22. I've been in therapy for nearly 3 years now and am making progress albeit rather slowly. At a certain point I asked my therapist what was 'really' wrong with me (my feeling was that my behavioural patterns were too pervasive to be captured by the social anxiety diagnosis). At this point he brought up AvPD and this seems to represent my symptoms more fully. I think I have some other quirks too - after all diagnostic criteria are necessarily reductive and simplistic. People are inherently more complex than that diagnostic manual.

Diagnoses can be dangerous things - if you get a 'bad' or 'inappropriate' label it can stick with you for a long time and affect self-esteem. I imagine personality disorders are notoriously difficult to diagnose and it is a rough business. From what I've read, the distinction between social phobia and AvPD is that AvPD is more pervasive and social phobia is often isolated to particular types of situations (such as performance anxiety for specific tasks). AvPD is more a set of behaviours and beliefs in relation to social functioning, such as those things you describe about yourself. You have a strong desire to function socially and be popular but you feel enormous anxiety in social situations. This conflict and the feelings of distrust are, in my opinion, at the heart of AvPD.

I'm sorry you had such an awful experience at school. This is traumatic and horrifying for a young child and I'm sure this has profoundly affected you - I'm sorry you had to go through this experience. I hated school and found it very difficult to fit in. By the end of my school career I mostly stayed at home. My home situation was abusive but the security of hiding away in my bedroom was far more attractive than the tremendous shame and vulnerability I felt sitting alone eating lunch at school or being surrounded by the other students in the common room. My biggest problem is lack of trust and low self-esteem. I consider myself to be inept socially and expect people to think negatively of me and to see the worst in me. Do I find myself bad to the core? Sometimes I do, sometimes I feel utter contempt for myself, when I'm feeling my worst but this is balanced by a belief in my own goodness. At times I feel an extraordinary feeling of injustice and self-pity for my experiences.

Remember that AvPD is a 'rare' condition (by rare I mean there are not that many people diagnosed with it - this could just be that many people who have it don't seek out help because the idea of doing that is too distressing). What it does mean is that therapists and psychiatrists might first look at other diagnoses before coming to this one. I think it takes a good professional who really knows you well to hit the nail on the head.

As for treatment. I'm fairing much better since I started therapy. I've definitely improved but I'm still a long way to living life free of problems (and maybe it's idealistic to think that that will ever be the case). I've been doing psychoanalytic psychotherapy (something like toned down psychoanalysis crossed with psychodynamic therapy) for nearly 3 years. I've been able to form a fairly trusting relationship with my therapist - but the problems with constant distrust make therapy difficult and slow. Realistically, I'm going to be in long-term therapy. I'm considering trying group therapy - ('considering' is quite a way off from 'doing' so we'll see) - I can imagine this can be a useful thing if you can tolerate it.

One last thing... you are 26... you have your whole life ahead of you to find a lovely guy. Don't beat yourself up about not having had an intimate relationship and don't try to force it. It really isn't so uncommon for guys or girls to be mid-20s or even much older before they find the right person (and just think of all the people who have had countless turbulent flings and are no closer to forming a close genuine relationship).

Onzi

After reading this post, I can relate 100% to you. Especially in group situations, I feel so completely awkward, like I'm naked in the room. It's so tough to try and be outgoing and make friends. I've always struggled with forming friendships; my parents would always tell me that "friends are second, your family is what matters." Having this influence my entire life, and the fact my parents have no friends, I struggled to get close to friends. I only have a few close friends, and of those, I don't really feel safe or trust a single one of them to fully open myself up in a friendship with them. I have had a few boyfriends, but none of them lasted. I don't think you're missing much, only heartbreak. One of my close friends is 23, and she also has never had a boyfriend, and is still a virgin, so you are not alone at all. There are a ton of people just like you and me.

Hello, Medicated. In my view, what your new therapist told you is akin to "just get over it." I would have a hard time connecting to someone who so cavalierly dismisses your concerns.

My thought is this. Make copies of your posts here for you and your therapist to discuss at your next session. If you are not satisfied that the therapist is willing to help you achieve what you want from your life, I would find someone else to see.

Somewhat tangentially, have you considered taking dancing lessons? There are ways to practice social skills you feel awkward about.

Finally, one of my therapists told me I was a social retard. I was rather pathetic, but I have learned some things. Now I believe I am at least an advanced wallflower.

Good luck.

I guess I don't know what to make of myself. It sounds a lot like AvPD to me... is that what it sounds like to you, or is this just social anxiety? Does it even matter what it really is? I just know I don't want to live this way, if it can be helped.

If others reading this have had similar struggles and found effective help, what did you do? CBT? Self-help? I feel like there is an entire dimension to life that I have never experienced. Help me get there. Please.

Thank you in advance.[/quote]

Hi! You ask whether your condition is AvPD or "just" social anxiety. First, I really don't think that your word "just" applies to social anxiety disorder. It's really painful, really affects your life and is just not like the common cold or a mild headache. As you can see for yourself by doing a search, the articles over the past twenty years seem to say that AvPD and social anxiety disorder are pretty much the same thing, with AvPD being "perhaps" (emphasize that "perhaps,") more intense than social anxiety disorder. There are also many articles out there comparing the effectiveness of psychodynamic therapy with CBT as far as AvPD and social anxiety are concerned. I can't remember whether there was a clear winner. You'd have to check out those articles yourself. Of course, most of those articles have to be paid for so you may have to concentrate on the free abstracts. Take care!

I have been diagnosed with Generalized Anxiety Disorder and Avoidance Anxiety Disorder. I can understand my disorder. I know where it comes from, but I cannot find out how to fix or control it. I hate what has happened to treatment of mental health here in Canada. I can only find counselling if I am admitted into hospital, or if I pay out of my own pocket (which I cannot afford). I am living in this state of anxiety but cannot find the solutions. I now tend to question every action I choose to take (or not take, in case of avoidance) as if I am the sole cause for all of my problems. I seem to be in this circular hell of constantly making the same poor decisions or repeating actions that cause me to fail at certain life issues. How do I pull myself out of this nightmare?

For myself, my AvPD has traits unique to my other disorders. Procrastination, which makes CBT near useless (for me). Exposure, no matter how steady, makes things worse not better so its harder to go back. The 'avoidance' seems weaved throughout my whole life, Every aspect of it. All related to fear of course. Councelling helps 'unload'. Psychotherapy may well 'unblock' what keeps it going. Example, I was abused when young and allways felt dirty and odd- talking through it gave me a different viewpoint on it and now I never think of it. That never directly helped my AvPD but its one less burden. I would imagine also that most AvPD sufferers are or end up depressed whether its associated or not- Its hard being lonely. I would also imagine there is a high rate of addiction amongst AvPD sufferers too, but thats more an 'educated' guess. Addiction fills the emptyness that we feel from being alone so much. DEFINITELY join a local Social Anxiety self-help group if ur lucky to have one near you. Whether you can keep up with the meetings is down to you. I cant. Not at the mo.
AND MEDICATION 'DOES' WORK- VERY WELL! You'll need a specialist though who's willing not to give up as you wont get what you need from a GP (unless ur a lucky sod who responds to an SSRI ). Nardil (phenelzine) is a drug that brung me back to life- for a while. I now take clonazepam, isocarboxazid with trimipramine just added. Things were 'sort of' manageable 'till a feww months back when depression hit me from nowhere. Back in Nov'09 I asked a girl out and we had a 5 month relationship. Thats right, 'I' did the asking lol.
What keeps me going in my lowest moments is remembering what I HAVE done. All by myself. I should be proud of myself but the conflict inside negates all that.
Hope I've said something worthwhile.
Good luck!

I have been officially diagnosed with Avoidant Personality Disorder. I have similar anxieties as you do Medicated, but in my case, I avoid things even when they look up or positive. It is not simply a social issue, which it is partly, but it is also things like avoiding to complete things. I avoided my convocation when I graduated university. I avoid interviews or even applying for them due to a practice called self-fulfilling prophecy. In order to avoid rejection, I don't even apply for the job. To avoid social discomfort, I don't bother going to happy events. To avoid failure, I didn't even do an exam once. I most likely would have gotten somewhere in the 70s, but I still avoided the stress of the writing. This is avoidance anxiety.

I am also suffering from anxiety attacks related to such issues where I cannot avoid them. Yes, I also feel very nervous and shy in scoial settings, and I tend to become a wallflower in events where I wish I could be the hit of the party. I just can't seem to get past the stress. So some of the traits are similar.

Personality is formed in early childhood and is unchanging like a computerchip. It remains the same during the rest of your adult life. In neurological terms your brain reacts differently to certain situations because of genetics or circumstances in early childhood it has been programmed to react in this different way.

A phobia is an emotion. When I got diagnosed with avoidant pd, I could - in retrospect - understand a lot of my childhood memories a lot better. Why I was like that and that as a kid, etc. Not only traumatic memories, but memories wherein I was different from others. Same goes for my youth and early adulthood. The traits have always been there.

I think a phobia is much more an emotion than a pattern that is present in almost everything you do. A sociophobic experiences a violent panic attack, an intense emotion that takes over when you are faced with social interaction. It's a strong emotion that is restricted in time however. It comes and goes (usually when the situation is over). A personality disorder is more like a behaviour pattern based on personality (I would almost use the word lifestyle but it seems out of place as disorders are most of the time crippling your lifestyle more than helping it).

I want to prevent people from interpreting me as one is more severe than the other. I'm sure both are very unpleasant. But I think they are seperate things.

How do we learn to deal with these fears and anxieties? I just got a new geenral physician but I don't think we will see eye to eye on my health issues. Docs are hard to get here also so I can't just seek out another one. This doesn't halp with my tendencies to avoid things I am not comfortable with. I might avoid him all to often. I will have to speak to community and social services to see if I can seek counselling through them.

I'm in Canada too. Maybe we could brainstorm, I know a few resources country wide and by province.

Avoidant vs Anxiety. Well, I had an idea yesterday. I want to be less socially anxious. So I started making a list of EVERY single thing that I avoid, relationships, people, furniture I should replace, situations I miss out on, conflicts that I avoid. I made the other column of "why" this is something that makes me anxious enough to avoid it. ALL the reasons.

I'm still working on it, but I thought if I can see it on paper, and realize WHY these things are bothersome, I may be able to figure out ways to conquer them. Some things will be necessary to avoid, some will have to wait till later, but I always felt once you know WHY you can figure out "Why not?" a lot easier.

PS... I know what you mean about psychologists. Psychiatrists will only see you for a longer amount of time if you are in a hospital. If you see them in office, it's ten or fifteen minutes usually once a year or less.

The last psychologist I went to cost $150 an hour. I'm on disability, and it will cover my prescriptions, but it won't cover my psychologist so that maybe I could get OFF my prescriptions.

Hi everyone,

New here, so adding my thoughts. I'm both social phobic and AvPD. I know I'm both because I definitely have panic attacks, worrying, replaying everything in my head, and all the other phobia goodies, but I also avoid situations much of the time, procrastinate like crazy, don't ever take the initiative with people, etc., all of which I think goes more with avoidance.

Also, to Medicated, I'm 26 and I was a virgin until less than a year ago.

When I was a kid, I wasn't bullied. Mostly I was ignored, because I usually chose to sit in the back or the corner or avoid the game or whatever. The only time I was noticed was for academics, since I was one of the smartest kids in most of the schools I've gone to. (Is that bragging? It's fact, so I don't see it as bragging. I hate myself but I also think I'm smarter than most people. I can't explain it.) I wasn't a hand-rasier, obviously, but if I was called on (and didn't have my selective mutism going at the time) I would always give the right answer and the other kids knew I was smart and would ask me to explain class stuff to them. They didn't want anything else to do with me though, and I don't think I really thought much about it. I watched TV alot and listened to music and to the radio, and I don't think I really cared about "friends." In junior high, we had enforced recess in the schoolyard, and I brought a tennis ball every day and walked the perimeter of the yard bouncing it by myself. I did know that people were looking at me, but I think I tried to tune it out. By high school, I could do some form of small talk and even had people who would eat lunch with me or work with me in class, but I never got invited anywhere or became close to anyone. Same with college. In law school, I tried talking to people my first year, and nothing came of it, so after that I sort of stopped trying as hard, especially since I also had other anxieties and avoidances regarding academics, future employment, etc.

I've been with the same therapist for 15 years. I like her, she seems to understand a lot of my problems, but I still don't have any friends and I don't have a boyfriend anymore and I don't know if she thinks that can change or not. My psychiatrist (who absent-mindedly gives out loads of pills) is retiring this month, so I may have to find a new one for my drug supply, but I just take klonopin. Sometimes several times a day. Yum yum.

ty so much for sharing this.

All I can say in a nutshell is this:

I too remember a time when I was outgoing and loved people.

Deep down I still am.

But fear was put in me somehow---don't really recall when.

Now I am too afraid to interact in any way.

I relate to that struggle---wanting so badly to reach out and be part of and simply being so restrained that I simply can't do it.

ty again,

Billi