What is Avoidant Personality Disorder?

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, and 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 are 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.

What are some causes of Avoidant Personality Disorder?

Direct cause and effect is unknown. We do know that variations of the diagnosis in less extreme cases can be caused by (PTSD) Post-Traumatic Stress Disorder. Life trauma, at a young age, with little to no support and few coping mechanisms can lead to avoidant behavior. This may not meet all the criteria for Avoidant Personality. There are those clinicians that firmly believe in an organic etiology. To date there is little know on this rare disorder.

What is the 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.