Avoident Personality Disorder.

Oh this makes so much sense to me! As I was reading it my stomach was churning. It explains so much! I am so shamed based I basically avoid living!

Hi Mouse,
I relate to this too...... basically it's a bummer to deal with

PM if you want.... if not I totally understand........

Where did you read about this, Mouse? I'd like to read it too.

Avoidant Personality Disorder
----------------------------------------------------------------------

Avoidant personality disorder (APD) ís considered to be an active-
detached personality pattern, meaning that avoidants purposefully
avoid people due to fears of humiliation & rejection. It ís thought
to be a pathological syndromal extension of the "normal inhibited"
personality, which ís characterized by a watchful behavioral
appearance, shy interpersonal conduct, a preoccupied cognitive style,
uneasy affective expression & a lonely self-perception ( Millon &
Everly ). According to this view, the avoidant pattern seems to range
ín varying degrees along a symptomological continuum from mild to
extreme. In mild cases, a person may be said to be normally shy,
whereas extreme cases indicate personality disorder.

APD vs. Generalized Social Phobia:

The symptoms of APD overlap with those of generalized social phobia.
Widiger (1992) reviewed 3 studies (Holt; Herbert; Turner et al.
[1992]) which demonstrated that GSP & APD are based on the same
underlying pathology & differ primarily ín the severity of social
anxiety & social functioning, with APD being the more severe
disorder. The evidence that most people diagnosed with APD will also
meet the diagnostic criteria for GSP, but people with GSP do not
necessarily have APD supports this view.

DSM Criteria:

The DSM-IV describes APD as:
A pervasive pattern of social inhibition, feelings of inadequacy &
hypersensitivity to negative evaluation, beginning by early adulthood
& present ín a variety of contexts, as indicated by 4 (or more) of
the following:

avoids occupational activities that involve significant interpersonal
contact because of fears of criticism, disapproval or rejection
ís 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
ís preoccupied with being criticized or rejected ín social situations
ís inhibited ín new interpersonal situations because of feelings of
inadequacy views self as socially inept, personally unappealing or
inferior to others
ís unusually reluctant to take personal risks or to engage ín any new
activities because they may prove embarrassing.

How does APD manifest itself?
The usual onset for APD ís early adulthood, with an equal prevalence
rate among women & men (APA). According to one study however,
(Greenberg & Stravynski, 1985) most of the people being referred for
professional help for social dysfunction, considered to be the same
disorder as APD by Marks (1987), were single men. One suggested
hypothesis for this finding ís that society expects men to be the
initiators ín romantic relationships. Therefore, when they do not
form relationships, ít ís seen as more of a problem than women who do
not initiate relationships but are not expected to ín any case
(Marks). Millon & Everly have suggested 6 dimensions onto which the
symptoms of APD can be mapped.

Behavioral Appearance:

Avoidants do exhibit the stereotypical traits of shyness, timidity &
withdrawing behavior. To those who know them well, the avoidants'
mistrust of others may also be apparent as an almost constant
wariness. However, Kantor (1993) argues that behavioral hostility ís
also typical of those suffering with APD. Avoidants may use their
shyness as a way to hurt others by preventing them from becoming
close. Alternatively, they will demonstrate their hostility ín a more
overt manner by insulting people who attempt to be friendly, for
example. This reaction may be because they are identifying their
aggressor & "deal with feared rejection by becoming rejecting
themselves." These expressions of hostility could be seen as
defensive fight responses. To protect themselves from being rejected,
they reject others first. This ís maladaptive because the avoidants
will tend to reject many people who would never have rejected them ín
the first place.

In terms of appearance, íf ít ís affected at all by APD, ít will tend
to be affected ín one of 3 ways. 1st, avoidants may put considerable
time & effort into making themselves attractive to others. The idea
behind this ís, at least they will be liked for their looks, íf not
for themselves. 2nd, they may consciously, or unconsciously, ensure
that their appearance drives others away. This provides them with
some control over their lives. Rather than waiting helplessly to be
rejected, they ensure rejection from the start by their own actions.
3rd, ín the case of avoidants who are suffering from PTSD, for
example, they may dress ín the style of the era when the trauma
occurred. This form of dress ís an indication that they are living ín
the past.

Speech ís may also be affected ín APD. Avoidants may be quite silent.
As Jerome Kagan explains, "For a rabbit, freezing on a lawn ís a sign
of fear. I believe that speechlessness ís a similar diagnostic sign
for us… There's a circuit ín the brain that controls our vocal cords
& becoming quiet can be one sign of fear." (Galvin, 1992). When they
do speak, avoidants may use frequent pauses & speak slowly (Millon &
Everly). This ís contrary to what we read regarding social phobia,
where pauses ín speech tended to be avoided because they were thought
to be a sign of lack of knowledge. Avoidants may also be
overtalkative, possibly due to an adrenic discharge or a false
belief, such as continuously talking will prevent death. For
avoidants who try to put people off with their behavior, insults or
social faux pas are commonly used as a way to assure rejection
(Kantor). While this does essentially realize their worst fear, ít
does again give avoidants some control over how others react to them.

Interpersonal Conduct:
Avoidants often test others to determine whether or not they are
being sincere ín their friendliness. Because they may frequently see
rejection where ít does not exist, people will tend to fail these
tests & then later be avoided because they may reject or humiliate
those with APD (Millon & Everly). They will, therefore, frequently
have difficulty beginning & maintaining relationships (Kantor),
partly because they have difficulty trusting others & thus, are very
reluctant to share their feelings or allow themselves to be
vulnerable. As a protective measure against the humiliation &
rejection, they may become avoidant of others.
On the other hand, avoidants may form relationships, even making an
effort to meet new people. However, these people are kept at a
distance. Therefore, this group of avoidants ís avoiding intimacy,
rather than avoiding people altogether.

Cognitive Style:

Avoidants excessively monitor the situation to the extent that they
are trying to process so much information, they are no longer paying
sufficient attention to the interaction itself (Millon & Everly). The
literature on social phobia suggests that the phobics are unable to
follow the interaction because they are so focussed on their internal
reactions. However, the research on avoidant personality disorder
also emphasizes that the avoidants are engaged ín external monitoring
of the other person's reactions as well. This additional processing
of information could contribute to the increased severity of APD over
social phobia. The excessive monitoring by avoidants, combined with a
hypersensitivity to rejection makes their perception of rejection
almost inevitable.
Their dysfunctional thought processes may also include fear of being
vulnerable, because ít makes ít easier to get hurt or humiliated.
They may also be perfectionists & reject anyone who does not live up
to their impossible standards. This may again be a case of rejecting
someone before they are rejected themselves. Another possibility ís
that they are degrading the other person so that íf they are rejected
they will find ít less painful because they didn't like the person
anyway. Some people believe that relationships are just too much work
& aren't worth the effort. Rationalization may also be present ín
this belief with the idea that ít ís not because they are unable to
form relationships that they don't have any, ít ís that they do not
want to waste their time on relationships. Some avoidants even
believe that they must avoid intimacy because "giving love to others
reduces the energy they have available for themselves & that they
need for their vital life processes," (Kantor).

Affective Expression:

People with APD may exhibit little affect due to the fear that
showing their emotions will make them vulnerable to rejection or
humiliation (Kantor; Millon & Everly). To observers, avoidants may
appear tense & anxious (Millon & Everly).

Self-perception:

Avoidants tend to have low self-esteem & believe that they are
unworthy of being ín successful relationships. They are also very
self-conscious, frequently lonely & see their accomplishments as
being of little or no worth (Millon & Everly).

Primary Defense Mechanism:

To cope with their unhappiness, people with APD often escape into
fantasy which ís "a `safe' medium ín which to discharge affection,
aggression or other impulses that would otherwise be inappropriate,
uncomfortable or impossible to achieve ín reality," (Millon &
Everly). Avoidants will tend to read, watch TV or daydream to escape
from reality.

Etiology & Development:

>From an evolutionary point of view, the "fight-or-flight" dichotomy
suggests that both hostility & avoidance are naturally occurring
responses to fear. Both are thought to be based on anxiety evoked by
the presence of a feared stimulus object or situation. However,
avoidance can co-vary with fear, vary inversely or vary independently
(Rachman & Hodgson, 1974). Therefore, avoidance behavior seems to be
more complex than ís accountable for by the simple presence of fear
or anxiety. What appear to be purposeful hostile reactions to others,
for example, may be indicative of highly complex psychological
processes.

It ís commonly believed that biological factors, including heredity &
prenatal maternal factors, set the foundation for personality &
personality disorders, while environmental factors shape the form of
their expression (Millon & Everly). In the case of avoidant
personality disorder, the evidence of major biogenic influences ín
íts etiology & development ís speculative & weak (Millon & Everly).
However, there ís some evidence that a timid temperament ín infancy
may predispose individuals to developing APD later ín life (Kaplan &
Sadock, 1991). While shyness appears to indicate underactivity, Kagan
believes that this inherited tendency to be shy ís actually the
result of overstimulation or an excess of incoming information. Timid
individuals cannot cope with the excess of information & so withdraw
from the situation as a self-protective measure. The inability to
cope with this information overload may be due to a low autonomic
arousal threshold (Venebles, 1968). The same mechanism may also be
responsible for the avoidant's hypervigilence. However, ít ís
generally believed that these biological substrates exist within the
avoidant personality as a biological foundation for the emergence of
the disorder itself & that full development of APD ís likely due to
significant environmental influences (Millon & Everly).

Environmental Factors

Parental Rejection:
An important environmental factor ín the development of avoidant
personality disorder ís parental rejection (Kantor; Millon & Everly).
Although normal, healthy infants may encounter varying degrees of
parental rejection, the amount of rejection seems to be particularly
intense &/or frequent for people who subsequently develop APD.
Frequent or intense rejections crush children's natural energy &
optimism, leaving instead attitudes of self-deprecation & feelings of
social isolation. Rejection by parents appears to be particularly
devastating because ít may be interpreted as a direct contradiction
to the commonly held edict of unconditional love & acceptance of
offspring by their parents. The rejected child asks, "if my parents
won't accept me, who will?", yet some children learn that their
parents do not accept them, thus the question ís always present &
every person the avoidant interacts with will be put to the test.

Although avoidance ín children does not appear to be necessarily
linked to APD ín adulthood, ít appears that particular kinds of
rejection by parents can alter the attitude & behavior of children ín
a way that disposes them to develop the disorder more easily later ín
life. For example, Kantor suggests that íf a child's expression of
positive emotion ís met with remoteness, criticism or punishment, he
might learn to spare himself anguish by keeping positive feelings to
himself. Perhaps such a child might abandon positive feelings
altogether. There ís little doubt that this would jeopardize later
adult relationships.

Likewise, íf a child's negative feelings are rejected, for example,
íf she ís repeatedly told "it's bad to feel angry", she might forego
otherwise workable relationships ín order to avoid not only the
intermittent feelings of dissatisfaction or anger that are an
inevitable part of practically all close relationships, but also her
ambivalence toward negative feelings ín general.

Furthermore, parental rejection may indicate some underlying parental
fear, which the child unconsciously imitates. In such a case, the
child may learn not only to fear rejection from others, but also to
believe that the world ís a fearful place.

Peer Rejection:

A 2nd environmental factor implicated ín the emergence of APD ís
rejection by peer groups. If a child leaves a hostile or rejecting
situation & encounters positive reinforcing experiences outside of
the home, early rejection by parents need not result ín self-
deprecating attitudes. However, íf parental or familial (including
siblings) rejection ís compounded by rejection from a peer group, the
prognosis points heavily toward a personality disorder.
Repeated social interactions expose an individual to potential
rejection over a sustained period of time. Such rejection, íf ít
occurs, can wear down the individual's sense of self-competence &
self-esteem. Following humiliation & rejection by peers, individuals
then begin to criticize themselves. Feelings of loneliness &
isolation are made worse because of harsh self-judgments & increasing
feelings of personal inferiority & self-worthlessness contribute to
withdrawing behavior. Rejection by their peers seems to validate the
rejection by their parents. When children cannot turn to their
parents, their peers, or even themselves for gratification or
validation, they retreat. Avoidant personality may be the result.

Other Factors:

In addition to rejection by parents & peers, ít ís speculated that
several other factors can play more & less significant roles ín the
development & persistence of APD. For example, children who are
infantalized by their parents may have difficulty relating to people
outside of the family. As adults they may be regressive & dependent
ín relationships. Avoidance may also be recommended by parents,
peers, teachers, entertainers, religious leaders & the media as
protection against the evils of the world. Unresolved rivalry with
siblings has been suspected of inducing transferential jealous
competition among individuals, leading to avoidant behavior. Also,
sexual feelings, for example Freud's (1950) "incest taboo", may
unconsciously lead to avoidance of close relationships with parents &
later with potential partners. It has been noted that sometimes
avoidants isolate themselves ín order to manage strong ambivalent or
negative feelings toward sex (Kantor). In psychopathic proportions,
avoidance may lead to a purposive distancing ín order to enhance
sexual fantasies (Shapiro, 1981). In some cases, a more poignant
expression of sexual disgust may be expressed as love revulsion, a
condition ín which the avoidant has learned to "love" isolation, not
because ít ís a real preference but because ít ís a defense against a
forbidden desire to be with others (Kantor). Finally, transference
can lead to avoidant behavior when an individual distances herself
from people who remind her of something or someone she disliked or
feared ín the past — often parents, but also others outside of the
family.

The Self-perpetuating Cycle of APD:

Avoidants have limited contact with others when they use avoidance to
protect themselves from being rejected. People notice the withdrawing
behavior of the avoidant individual which leads either to a
reciprocal avoidance by the observer or ridicule of the avoidant by
those observing his hermit-like behavior. As Millon & Everly point
out, often people who appear weak or timid attract the attention of
those who enjoy belittling others. A cycle of withdrawal, ridicule or
rejection, further withdrawal & so on, perpetuates the avoidant
personality disorder.
The avoidant ís painfully alert to the minutest signals of rejection
from others. Unfortunately, being hypersensitive to rejection often
lowers avoidants' ability to correctly perceive what ís & what ís not
rejection. They may imagine rejection where none exists or view a
minor & partial rejection as one that ís major & complete. They feel
that every rejection follows from a thoughtful evaluation of their
real worth when they know that people who reject others sometimes do
so because they have problems of their own (act reflexively &
transferentially rather than thoughtfully & realistically) (Kantor).
The strategy they have adopted to protect themselves backfires & the
fears associated with the negative view of themselves seems to be
confirmed. As the pattern repeats itself & the problem magnifies, the
avoidant finds him or herself ín a world of self-fulfilling prophecy.

Furthermore, as avoidants withdraw more & more from social
situations, they are left with an increasing amount of time to
reflect upon their sorrowful state. Like an unrequited love affair,
avoidants' desire for interpersonal relationships peaks & most often
the conclusion they reach ís that they are not only incapable of
improving their attractiveness or likeability to others, but that
they do not even deserve acceptance. This fosters more avoidance &
alienation (Millon & Everly).

Finally, we cannot overlook the importance of operant conditioning ín
the perpetuation of avoidant personality disorder. The avoidant
desires social affiliation yet ís fearful of rejection & humiliation.
The pattern of avoidant, seclusive, aloof & hypersensitive behavior
that characterizes the disorder ís negatively reinforcing to the
individual. That ís, through avoidant behaviors, these individuals
can reduce the probability that they will be rejected or humiliated.
Thus the behavior ís reinforced & the disorder ís made more severe
(Millon & Everly).

Treatment:
Avoidance reduction ís typically an action-oriented approach to
handling the causes, complications & consequences of APD. It borrows
from the active techniques found ín other psychotherapies. For
example, "total push", from behavior therapy, forces avoidants to
face social interactions for longer periods of time; supportive
therapy gives encouragement ("you can do it"), positive feedback
("you are good enough to succeed") & reassurance ("you can handle the
anxiety"); family therapy tries to convince the smothering family to
stop infantilizing the individual; & pharmacological therapy advises
administering anti-depressant medication to help allleviate the
avoidant's anxiety. Generally, avoidants are encouraged to "do"
rather than contemplate, to engage themselves ín fearful situations
as a means of overcoming their fear.
In summary, those with APD are extremely sensitive toward & fearful
of, rejection by others. Their reaction to this fear may be a flight
response, ín the case of avoidance, but may also be a fight response,
ín the case of hostility. While genetics may predispose individuals
to developing this disorder, ít ís thought that the environment or
more specifically, early failed relationships are the pivotal cause
of the development of APD. Through their own dysfunctional thoughts &
behaviors, avoidants inadvertently perpetuate their suffering. Active
behavioral therapies are recommended & sometimes medication ís
administered.

_________________



Avoidant personality disorder (AvPD) is considered to be an active-detached personality pattern, meaning that avoidants purposefully avoid people due to fears of humiliation and rejection. It is thought to be a pathological syndromal extension of the "normal inhibited" personality, which is characterized by a watchful behavioural appearance, shy interpersonal conduct, a preoccupied cognitive style, uneasy affective expression, and a lonely self-perception (Millon & Everly, 1985). According to this view, the avoidant pattern seems to range in varying degrees along a symptomological continuum from mild to extreme. In mild cases, a person may be said to be normally shy, whereas extreme cases indicate personality disorder.

The pattern of avoidant, seclusive, aloof & hypersensitive behavior that characterizes the disorder ís negatively reinforcing to the individual. That ís, through avoidant behaviors, these individuals can reduce the probability that they will be rejected or humiliated. Thus the behavior ís reinforced & the disorder ís made more severe (Millon & Everly).

See: http://www.geocities.com/ptypes/avoidantpd.html

Essential Feature

The essential feature of the avoidant personality disorder is a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation (DSM-IV, 1994, p. 662).

See: http://www.toad.net/~arcturus/dd/avoid.htm

The DSM-IV describes APD as:
A pervasive pattern of social inhibition, feelings of inadequacy &
hypersensitivity to negative evaluation, beginning by early adulthood
& present ín a variety of contexts, as indicated by 4 (or more) of
the following:

avoids occupational activities that involve significant interpersonal
contact because of fears of criticism, disapproval or rejection
ís 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
ís preoccupied with being criticized or rejected ín social situations
ís inhibited ín new interpersonal situations because of feelings of
inadequacy views self as socially inept, personally unappealing or
inferior to others
ís unusually reluctant to take personal risks or to engage ín any new
activities because they may prove embarrassing.


The ICD-10 (1994, p. 232) has a personality disorder called the anxious (avoidant) personality disorder characterized by feelings of tension, apprehension, insecurity and inferiority. These individuals wish to be liked and accepted but experience hypersensitivity to rejection and criticism. Personal attachments are restricted. People with the anxious personality disorder have a tendency to avoid activities by a habitual exaggeration of the potential dangers or risks involved. They believe that they are socially inept, personally unappealing and inferior.

Millon & Davis (1996, pp. 253-256) call AvPD the withdrawn pattern. These are individuals who are oversensitive to social stimuli and are hyperreactive to the moods and feelings of others. Individuals with AvPD are chronically overreactive and hyperalert, with affective disharmony, cognitive interference, and interpersonal distrust. They are disposed toward the more severe schizophrenic disorders. Historically, this pattern has been described as being preoccupied with security and strained in associating with people.

Everly (Retzlaff, ed., 1995, pp. 25-3 states that the most severe pathology found in AvPD is in the area of self-image. In AvPD there is the failure of the core personality to adapt in a competent manner to interpersonal adversity -- presumably both past and present. Stone (1993, p. 355) also sees the key traits of AvPD as social reticence and avoidance of interpersonal activities. These individuals are easily hurt by criticism and fear showing their anxiety in public. They would like to be close to others and to live up to their potential, but are afraid of being hurt, rejected, and unsuccessful (Beck, 1990, p. 43).

There is overlap between AvPD and social phobia, generalized type (DSM-IV, 1994, pp. 663-664). The essential feature of social phobia (social anxiety disorder) is a marked and persistent fear of social or performance situations that may provoke embarrassment. Most often, the social or performance situation is avoided though it may be endured with dread. The avoidance, fear or anxious anticipation must interfere significantly with daily routine, occupational functioning, or social life or cause significant personal distress (DSM-IV, 1994, p. 411). Sutherland & Frances (Gabbard & Atkinson, eds., 1996, p. 991) suggest that AvPD and social phobia are constructs that differ only in the severity of dysfunction. Frances, et.al. (1995, p. 376) propose the possibility that they are two different constructs for the same condition. Benjamin (1993, p. 294) notes that the interpersonal patterns for generalized social phobia are very similar to AvPD; both groups avoid social contact and restrain themselves because of fear of humiliation or rejection. She proposes that social phobia is diagnosed if symptoms of pervasive anxiety or panic are present. Millon and Martinez (Livesley, ed., 1995, p. 222) believe that the avoidant personality is essentially a problem of relating to people while social phobia is largely a problem of performing in situations. Stone (1993, pp. 355-356) suggests that social phobia, agoraphobia, and OCD often have an underlying AvPD.

It is common for persons with AvPD to have comorbidity with other personality disorders. AvPD is most often diagnosed with DPD, BPD, PPD, SPD, or StPD (DSM-IV, 1994, p. 663). Frances, et.al (1995, p. 376) note the considerable overlap between AvPD and DPD. These two personality disorders share interpersonal insecurity, low self-esteem, and a strong desire for interpersonal relationships. Benjamin (1993, p.301) describes the desperate attempts to avoid being alone that may be seen in DPD as an exclusionary indicator for AvPD.

AvPD is found equally in males and females (DSM-IV, 1994, p. 663).

Self-Image

Individuals with AvPD are preoccupied by the unpleasant and perplexing personal definition they hold of themselves as defective, unable to fit in with others, being unlikable, and being inadequate. This self-image usually results from childhood rejection by significant others such as parents, siblings, or peers. These individuals then believe that others throughout their lives will react to them in a similar fashion. They are often unable to recognize their own admirable qualities that make them both likable and desirable (Will, Retzlaff, ed., 1995, p. 97). Rather, they see themselves as socially inept and inferior. They believe that they are personally unappealing and interpersonally inadequate. They describe themselves as ill at ease, anxious, and sad. They are lonely; they feel unwanted and isolated. Individuals with AvPD are introspective and self-conscious. They usually refer to themselves with contempt (Millon & Davis, 1996, p. 263).

For individuals with AvPD, their deflated self-image references their entire being. Nothing about them escapes their own self-derision (Millon & Davis, 1996, p. 264). Doubts about their social competence and personal appeal become especially severe in the presence of strangers (DSM-IV, 1994, p. 662).

View of Others

Individuals with AvPD view the world as unfriendly, cold, and humiliating (Millon & Davis, 1996, p, 265). People are seen as potentially critical, uninterested, and demeaning (Beck, 1990, pp. 43-44); they will probably cause shame and embarrassment for individuals with AvPD. As a result, people with AvPD experience social pananxiety and are awkward and uncomfortable with people (Millon & Davis, 1996, p. 261). However, they are caught in an intense approach-avoidance conflict; they believe that close relationships would be rewarding but are so anxious around people that their only solace or comfort comes in avoiding most interpersonal contact (Donat, Retzlaff, ed., 1995, p. 49).

Individuals with AvPD tend to respond to low-level criticism with intense hurt. To make matters worse, they become so socially apprehensive that neutral events may well be interpreted as evidence of disdain or ridicule by others (Donat, Retzlaff, ed., 1995, p. 49). They come to expect that attention from others will be degrading or rejecting. They assume that no matter what they say or do, others will find fault with them (DSM-IV, 1994, p. 662).

Even memories for individuals with AvPD are comprised of intense, conflict-ridden, problematic early relationships. They must avoid the wounds inside of them at the same time they are avoiding the external distress of contact with others. The external environment brings no peace and comfort and their painful thoughts do not allow them to find solace within themselves (Millon & Davis, 1996, pp. 263-264).

Relationships

Individuals with AvPD are "lonely loners." They would like to be involved in relationships but cannot tolerate the feelings they get around other people. They feel unacceptable, incapable of being loved, and unable to change. Because they retreat from others in anticipation of rejection, they lead socially impoverished lives. They have immature and unrealistic expectations of relationships; they believe that they can have no imperfections if they are to be accepted and loved. Interpersonally, they are ill at ease, awkward and tense. They experience unremitting self-consciousness, self-contempt and anger toward others (Oldham, 1990, pp. 188-193).

Individuals with AvPD will develop intimacy with people who are experienced as safe. Nevertheless, they will often engage in triangular marital or quasi-marital relationships which provide intimacy while maintaining interpersonal distance. These individuals like to foster secret liaisons as a "fall-back" position in case the key relationship does not work out (Benjamin, 1983, pp. 307-308). As sexual partners and parents, people with AvPD appear self-involved and uncaring (Kantor, 1992, p. 109) as they preserve distance from others through defensive restraint and withdrawal. Even so, these individuals long for affection and fantasize about idealized relationships (DSM-IV, 1994, p. 663).

Issues With Authority

Individuals with AvPD are unlikely to provoke or resist authority. At least at a behavioral level, they are inclined to be compliant and cooperative. However, whether the authority figures are service providers or law enforcement officers, people with AvPD are not forthcoming and resist self-disclosure. Exposure means, for these individuals, ridicule, shame, and censure. They will not willingly give away the information that they believe will result in such painful experiences.

AvPD Behavior

Individuals with AvPD behave in a fretful, restive manner. They overreact to innocuous experiences but maintain control over their physical behaviors and expression of emotions. Their speech is hesitant and constrained. They appear to have fragmented thought sequences and their conversation is laced with confused digressions. They are timid and uneasy (Millon & Davis, 1996, p. 261).

Kantor (1992, pp. 36-41) notes that individuals with AvPD, as with all of the personality disorders, have a tendency to live in the past or in fantasy -- they receive too little input from the here and now. This diminished ability to pay attention results in mild memory disturbances and a characteristic immaturity. These individuals are distracted by their own extraordinary sensitivity to subtleties of tone and feeling; they are hyperalert to the meaning of emotive communication. Their thought processes are interfered with by flooding of irrelevant environmental details (Millon & Davis, 1996, p. 263).

Individuals with AvPD behave in a stiff, shy, and apprehensive manner that is disquieting to others. The very rejection they fear may be the direct result of other people becoming impatient and uncomfortable with their unremitting tension and inability to accept that they can be a part of interaction without special guarantees of safety. In fact, people with AvPD, overtly or covertly, are seeking others to take the interpersonal risks for them; they are not able to be responsible for their own well-being socially and become a burden on the nurturing and care-taking capacity of those around them. For those who experience severe avoidant symptoms, no amount of protectiveness or gentleness can ease their fear; they will withdraw without explanation and leave behind a general bewilderment about what went wrong.

Affective Issues

Shame is one of the central AvPD affective experiences. Shame and self-exposure are intimately connected -- which leads to withdrawal from interpersonal connection to avoid experiencing shame (Sutherland & Frances, Gabbard & Atkinson, eds, 1996, p. 993). These individuals are anguished. They describe their emotions as a constant and confusing undercurrent of tension, sadness, and anger. Sometimes this relentless pain results in a general state of numbness. They posses few social skills and personal attributes that can lead them to the pleasures and comforts of life. They must attempt to avoid pain, to need nothing, to depend on no one, and to deny desire. They try to turn away from their awareness of their unlovability and unattractiveness (Millon & Davis, 1996, p. 265).

Feeling capacity is normal for individuals with AvPD; it is their affective expression that is limited. Insight is present but superficial and not useful; it is seldom used for change (Kantor, 1992, p. 108). Their main affect is dysphoria, a combination of anxiety and sadness (Beck, 1990, p. 44). They are apprehensive, lonely, and tense (Sperry & Carlson, 1993, p. 332); they can experience feelings of emptiness, depersonalization (Sperry, 1995, p. 36), and excessive self-consciousness. Occasionally, individuals with AvPD lose control and explode with rage (Benjamin, 1983, p. 297).

Defensive Structure

Individuals with AvPD utilize fantasy to interrupt their painful thoughts. They seek to muddle their emotions because diffuse disharmony is more tolerable than the sharp pain and anguish of being themselves. They also depend on fantasy for some measure of need gratification. Other AvPD defenses include avoidance and escape. Their paramount goal is to protect themselves from real or imagined psychic pain. Fantasy and escape are all that is left because they cannot gain comfort from themselves or from others (Millon & Davis, 1996, pp. 264-265).

Dorr (Retzlaff, ed., 1995, p. 196) also notes that individuals with AvPD can deal with their emotions only through avoidance, escape, and fantasy. When faced with unanticipated stress, they have few internal strengths available to them to manage the situation. Energy is misdirected to avoid rather than to adapt. While these individuals seek isolation out of fear of humiliation or rejection, they desire relationships and connection. That leaves them with fantasy as their primary defense; here, the use of fantasy can be seen as a variant of the general defense of denial (Kubacki & Smith, Retzlaff, ed., 1995, p. 167).

Individuals with AvPD take rejection as an indication of personal deficiencies; they engage in a string of automatic self-critical thoughts that are extraordinarily painful. The resultant AvPD social avoidance is readily apparent. What is less obvious is the concurrent cognitive and emotional avoidance. Their dysphoria is so painful that they use activities and addictions to distract them from negative thoughts and feelings as well. They engage in wishful thinking, e.g. one day the perfect relationship or job will come along; one day they will be confident and have many friends. The patterns of cognitive, emotional, and behavioral avoidance are reinforced by a reduction in sadness and become ingrained and automatic (Beck, 1990, pp. 257-265). Meanwhile, individuals with AvPD lower their reality-based expectations and stay clear of involvement with real people (Beck & Freeman, 1990, pp. 43-44).

See: http://www.toad.net/~arcturus/dd/avoid.htm

Medication Issues

It is recommended, for personality disordered individuals, to medicate target symptoms rather than the personality disorder itself. AvPD is quite vulnerable to the target symptom of dysphoria which is usually accompanied by mood instability, low energy, leaden fatigue, and depression. Also associated with dysphoria is a craving for chocolate and for the use of stimulants, e.g., cocaine. Many dysphoric individuals will respond to standard antidepressant medications (Ellison & Adler, Adler, ed., 1990, p. 53). Global improvement for individuals with AvPD may be possible in response to tranylcypromine, phenelzine, or fluoxetine. (Ellison & Adler, Adler, ed., 1990, p. 47)

Treatment Goals

For individuals with AvPD, the goal of treatment is to increase self-esteem, increase confidence in interpersonal relationships, and to de-sensitize their reaction to criticism (Sperry, 1995, p. 44). Treatment should be directed toward reinforcing a self-concept of competency. These individuals can learn to balance caution with action and to develop a tolerance for failure (Dorr, Retzlaff, ed., 1995, pp. 196-197).

Millon (Millon & Davis, 1996, pp. 281-282) believes that the ultimate aim of therapeutic intervention is to counter the tendency for individuals with AvPD to perpetuate a pattern of social withdrawal, perceptual hypervigilance, and intentional cognitive interference. He does note, however, that these individuals often have a poor prognosis. Their habits and attitudes are pervasive and ingrained, as with all the personality disorder patterns. They are rarely in a supportive environment that could assist them to change their behavior. They are also inclined, in treatment, to reveal only that which will not cause the service provider or other group members to think ill of them.

As with all of the personality disorders, individuals with AvPD cannot become their own personality and temperamental opposite. While they may, in fact, fantasize about becoming an outgoing, confident extrovert, the development of a more functional version of their basic personality traits can lead to a substantial improvement in the subjective experience of the quality of their lives. Oldham (1990, pp. 173-182) suggests that the more functional personality style of the avoidant personality disorder is the "sensitive personality style." These individuals are comfortable with the familiar, stay close to family and a limited number of friends, care what others think about them, are cautious and deliberate in dealing with others, and maintain a courteous, polite interpersonal reserve. Within their own homes and with friends, they are warm, giving, open and creative. The implication is that these individuals can develop rewarding relationships and live with interpersonal connectedness while not pressuring themselves to be excessively outgoing. They do not have to be extroverted to avoid isolation.

Accordingly, it is important that treatment goals address realistic expectations for change, including confrontation of fantasies that cannot be realized and should not be part of the treatment plan. For example, one single, AvPD male client, a carpenter in his early thirties, was somewhat like Elvis Presley in his fantasies. He longed to have a Cadillac convertible, wore his hair long and slicked back, and dressed in tight blue jeans, silk shirts, and gold jewelry. Part of his fantasy was having a relationship with a beautiful, tall, blond, slender young female who would affirm his own desirability. In the meantime, a female friend that he was quite fond of but who was short, brunette, heavy, and not particularly attractive was quite interested in him. This individual was not, at the time he was in treatment, willing to release his fantasies of who he was not so that he could enjoy who he was. He described himself as lonely, frustrated, and sad. His feelings related to the longing in his fantasy version of himself. He was unable to accept and appreciate what was available to him that would allow him to be considerably less lonely.

See: http://www.toad.net/~arcturus/dd/avoid.htm

I've never been officially diagnosed with APD, but a lot of it fits my personality. There's quite a bit of overlap between APD and social anxiety. APD is considered to be more severe, but SAD is considered to be a disability but APD is not because it is in the category of personality disorders.

Thank you ((((((((((Mouse)))))))))))

I hope you are ok!

That is a lot of good information. Did you scan it or type it by hand?

(((((((((((Mouse)))))))))))))

Avoidant Personality Disorder=Silence

Mouse,i do the same thing. At last i figured out what i had since i was 9 years old. That's why i'm having flashes of my childhood all the time and they are confusing me.That's why i'm afraid to be.I know how you are feeling.I just say to you to be strong,like i do.You have the support of all of us.Its hard to live with this s**t.

I was recently diagnosed with social anxiety,
and according to my therapist,
the only reason i wasnt diagnosed with Avoidant Personality Disorder is because i'm under 18.

That sounds like me. I have only been Dxed with Major Depressive Disorder, single episode but my T talks about social anxiety a lot. I found myself relating to the mistreatment in childhood stuff from parents and fellow classmates. I probably don't have it because I do share things with T that I think she might not like although it is hard for me. I had to read it aloud to her because I WANT or maybe I NEED her to like me. Please, like me T. My teacher had a case study of someone with Avoidant Personality Disorder and this person sounded like me. CREEPY-if you ask me.

For awhile I have wondered if there might be something else wrong with me.I have Bipolar I with panic attacks.This morning I decided to look for myself.This really hit home.When people ask me why can't you work I usually tell them the trueth I don't like people.But after I have said it is sounds harsh and I am ashamed that I said it .So much of the veiws and pionts fit me that it caused me to have a panic attack.So I had to stop reading.But I just wanted to let you know that I appreciate you bringing this to our attention.I think that I have APD.

I have always wondered it there was more wrong with than Bipolar1 with panics.I can't work,it is hard for me to go in stores.It drives me crazy.I want to know if they are thinking bad thing about me and why. When people ask why I don't work I am honest and tell them I don't like people.I love everyone but I don't like being around people.I never understood until I read this now I understand. It was so scary tha I had a panic attack and had to stop reading.But I just wanted to let you know that this really helped me and I am going to ask my Dr.

This really hit home.I think I may have this. I can't believe how close to me this sounds.Its scary!!!!

Cherryblossom, do you feel like you really don't have much need to be around people and don't enjoy having people around much, or is it more like you wish that you could be more social, but you are afraid of rejection? Do you relate to either of those?

Some time I don't care to be around people,but there is more time when I want to be with people.I am afraid of people thing that I am stupid or anything.I am VERY afraid of judgement,rejection.Thats why I just stay at home.

(((((((cherry)))))))) are you working with a T on these issues. It has helped me.

(((((((((((((((( cherry ))))))))))))))))

wow,,, lots of writing.... it kinda fits my personality i think,,,, but then i see things that arent there most of the time and am probably being silly....
take care all
self

Yes,Fuzzybear.I know I need help.I went to my doctor about it yesterday and he told me that he didn't think that I had APD.But I seriuosly do and I want help for It.I am tired of being scared of people.

Yes I went to my doctor yesterday.He don't think I have APD

I went to my doctor with this and he said trhat he thought that I didn't have this.But I think he is wrong.I want help for this where I can go around people without being panicy. I am so glad that you wrote about this.I never could understand until I read this.

Doctors really can't do much for personality disorders because doctors mostly work with medicines, and personality disorder treatment is more involved in learning new skills and changing the way you think about things. Doctors might not diagnose something that they aren't familiar with or prepared to treat. Could you try talking to a counselor or therapist?

Oh, and if you told them APD, that often stands for antisocial personality disorder, which you don't sound like you have - it's very different. Avoidant PD is AvPD. I'm not sure if you referred to it by initials or not. If you want help, you should be able to get help, and it is a significant problem if you can't enjoy being around people because of fear of rejection. It also can be treated if you are ready to put in enough effort and face your fears. I hope that you can find a professional who is able to support you in that.

Rap