301.82 Avoidant Personality Disorder

DSM-IV diagnostic criteria:

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

(1) avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection

(2) is unwilling to get involved with people unless certain of being liked

(3) shows restraint within intimate relationships because of the fear of being shamed or ridiculed

(4) is preoccupied with being criticized or rejected in social situations

(5) is inhibited in new interpersonal situations because of feelings of inadequacy

(6) views self as socially inept, personally unappealing, or inferior to others

(7) is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

None of the above apply to me, unless it is all totally unconscious.

I am actually more likely to take risks, including the risk of rejection, in order to find out accurate information or deal with an obsession I need to resolve, etc. I realize people may not like me, or may ridicule me, for example in relation to my website, and while I am not so thick-skinned that it is easy for me, as time has gone on, I have found it increasingly important to face such possibilities.

The issues I have with social functioning are related to the effects of long-term isolation, which was not originally brought on by avoidant behaviour - I asked for help with anxiety, depression, eating disorder, and the events that occurred from there resulted in the loss of social ties.

This is another diagnosis I would find ego-dystonic. The relationships I have formed in the last decade have all been about facing the kinds of risks that an avoidant personality would avoid. Also, while not feeling superior, I do not feel inferior to those I contact.

The truth is that I am likely to be rejected in many social situations because of my personal details. However, I am aware that I have a somewhat pleasing or non-threatening demeanor which some people may take to if given enough time, in spite of my personal details. But, if I think that in order to retain a person's good opinion I will have to repress my real attitudes or inclinations, I will not want to begin a friendship - I will find such possibilities empty.

Wikipedia: Differential diagnosis: associated and overlapping conditions

Research suggests that people with AvPD, in common with sufferers of chronic social anxiety disorder (also called social phobia), excessively monitor their own internal reactions when they are involved in social interaction. However, unlike social phobics, people with AvPD may also excessively monitor the reactions of the people with whom they are interacting.

The extreme tension created by this monitoring may account for the hesitant speech and taciturnity of many people with AvPD; they are so preoccupied with monitoring themselves and others that producing fluent speech is difficult.

The above is somewhat interesting, and may account for some of my 'difficulties' in speech. But what if the focus were put in a different place? Such that it is not considered 'excessive', but a special aptitude that I have developed which helps me to find relationships that have a potential to be more 'meaningful' to me than the norm? If you cannot shut out 'unpleasant' or conflicting info, you may be seen as dysfunctional, but what if it actually means that you are more aware or perceptive than the average person, and that if you can learn to deal with it you will have certain advantages over others? It is also a burden, in being aware of things that others are not.

It's important to note that I think that there are people who like me, and people who don't, and that this has often been a part of my history. I think many aspects of my personality and appearance meet with divided judgments. I don't think I avoid social contact because I feel I am socially inept or that I will be ridiculed, humiliated or rejected: I am willing to face all of those things if there is a kind of 'reward': the reward being personal interaction that feels non-superficial, or 'meaningful'.

I also do not like the term 'avoidant', as I think of myself as a person who makes the effort to confront issues and situations and conversations that most people cannot or will not. I will face fears that other people cannot, and a major one of these is fear of rejection. I would rather 'get it over with' than not know.

Wikipedia: A key issue in treatment is gaining and keeping the patient's trust, since people with AvPD will often start to avoid treatment sessions if they distrust the therapist or fear rejection. The primary purpose of both individual therapy and social skills group training is for individuals with AvPD to begin challenging their exaggeratedly negative beliefs about themselves.

Trust is a significant issue in therapy for me, but I think the bigger problem relates to my patterns with food and how they impact on my willingness to go to an appointment. The truth is, therapists do not like all of their patients, and there can be great differences in individual therapists themselves as to how they approach treatment. Not all patient/therapist combinations are good ones. At any time that I have had appointments, the day of the appointment is the focal point of my life, and an enormous pressure. Some of this pressure could be relieved if someone took me to therapy, at least in the beginning, but it cannot be denied that there are personal factors involved with whether a patient/therapist relationship will work. I don't think anyone should expect all such relationships to work out, and when a patient avoids a certain therapist, it might be worth considering that it was not a good fit, rather than a part of the patient's pathology.

However, my inability to go to therapy, or my outright quitting, has usually had to do with my assessment that the therapy was not going to be complex enough. I would waffle and sometimes take this upon myself because I was confused about it. I think that another key issue was support: in order to attend therapy I needed at least for a time someone to take me, and to talk to me about going regularly - in short, someone to take an interest in whether I went or not. I didn't avoid it, though, while thinking I was missing out on something beneficial. I think I was making an unconscious statement about the hopelessness of the situation.

I think sometimes that therapists or psychiatrists did judge me in negative ways. This was not my focus. My focus was whether I thought it was possible to have a complex enough relationship with a therapist or doctor to actually help my situation.

There was a long history of my family avoiding dealing with the issue of me not going out. There was avoidance, but I am not sure that the focus belongs on the avoidance, as much as the reasons behind not going out, the chain of events, behaviours and familial reactions leading up to and continuing afterward.

When I think of the term avoidant, what comes to mind relates to what most people think of as 'normal' human behaviour. Popular culture seems to reinforce the idea that human beings are inherently avoidant. Breaking up with someone is almost always portrayed as something that most characters put off and put off, people get their friends to send 'emergency calls' to help bail them out of bad dates, people aren't able to cancel a wedding until everyone is sitting down and waiting on the actual wedding day, people are reluctant to tell their friends their real opinions, people keep their secret feelings to themselves for years - it's like people will go to extreme lengths to avoid having a real discussion with others, and human life revolves around this necessity. Avoidant = unwilling or unable to face one's own feelings, or those of others. Unwilling to face discomfort, mess or ugliness. In some cases, it may be healthy to be able to distinguish priorities, such that energy isn't completely consumed by constant exposure to the intense and unpleasant aspects of life, but if avoidant behaviour is never challenged, or is in fact reinforced, how is that healthy?

I am not sure that 'avoidant personality disorder' is a good term to describe a condition in which those diagnosed with it seem to have very low self-esteem. It doesn't address the causes for the development of low self-esteem, but would seem to judge them for having it, partly by lumping them into an unappealing category.