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According to the DSM IV, an avoidant personality
disorder is a continuous pattern of social isolation, inhibition,
feelings of inadequacy, and hypersensitivity to negative evaluation.
This disorder usually begins in childhood, with severe shyness and
isolation. These individuals avoid work, school, most interpersonal
contacts because they are excessively fearful of criticism, disapproval
and rejection. Should they reach a level of job promotion, they
reject these. They need excessive support and nurturance from others.
They are able to establish some intimate relationships. However,
they need unconditional love consistently offered, and usually have
extreme difficulty talking about themselves because they area fearful
of being exposed or ridiculed. These individuals are extremely shy,
very inhibited, and have excessive doubts about social competence.
They avoid strangers at all costs. They rarely take risks, and they
exaggerate potential dangers to the ultimate degree. General laypeople
describe them as being very shy, quiet and isolated. According to
the DSM IV, a true, full-blown avoidant personality disorder is
rare, and the prevalence in the population is about 0.5-1%. These
individuals usually encounter quite a bit of sympathy and empathy
from others. They are usually compliant, and good employees.
It is not uncommon for these individuals to be referred by their
spouses. Sometimes the issue is brought forth indirectly in marital
therapy.
Treatment of Avoidant Personality Disorder
Initiating trust and engaging them in therapy is fairly easy initially.
They are very compliant and usually willing to openly engage in
conversation, although they will avoid talking about themselves,
as it makes them grossly uncomfortable. Once a diagnosis is made
and a trusting relationship established, focus on particular issues
can begin, and therapy SLOWLY advances.
Behavior modification is of some help. As indicated above, a slow
transition is helpful, very similar to the treatment of phobias.
Desensitization techniques have proven to be quite helpful, taking
small steps forward. Very similar to treating of a social phobia,
the avoidant personality disorder may be taken out of the office
setting and into perhaps a store to make a purchase, or even asking
a bystander for directions, targeting areas of concern for the patient.
Obviously a decision to leave the safety of the office setting must
be discussed prior to going out, and it may be 3-4 months down the
road in therapy before the patient is ready for a trip such as this.
Again, if there is attendant anxiety, medication can be helpful.
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