Avoidant personality disorder
(The psychiatry bible)
Avoidant personality disorder
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:
- avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
- is 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
- is preoccupied with being criticized or rejected in social situations
- is inhibited in new interpersonal situations because of feelings of inadequacy
- views self as socially inept, personally unappealing, or inferior to others
- is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.
Sensible Psychology Definition
Low self esteem
Feeling so negatively about yourself and so worried about what others might think of you that you avoid situations where you might ‘fail’ or might be judged badly.
May arise from wanting to be or seem ‘perfect’, or from a sense of inferiority and social inadequacy.
Avoiding what we fear
‘Avoidant personality disorder’ is a curious label. We all tend to avoid what scares us. It’s natural, isn’t it? A cat that has been maltreated in the past may fear being around humans. The cat doesn’t have ‘avoidant personality disorder’ so much as a natural (and potentially quite useful) fear of what has caused it harm in the past.
The ‘avoidant’ part of anxiety is simply a possible side effect of fear – not a structural component of the fear itself.
A case in point – Looking for relationship
A woman came to see me who had been told by a psychiatrist that her chronic problems with establishing relationships were due to ‘avoidant personality disorder’. She was in a state of despair.
“If it’s my personality, I am stuck with it, right?” she said hopelessly.I pointed out that she wasn’t born feeling self conscious, or worried what people might think of her, or anxious that she was going to fail. So this pattern of avoidance could not be a fundamental part of her identity, of who she really ‘is’. But it could be a way of responding to difficult situations that she had learned along the way. “And what can be learned can also be unlearned.”
The only reason she was ‘avoidant’ was because anxiety was causing her pain, and it’s natural to want to avoid that. “In fact,” I told her, “there really would be something wrong with you if you didn’t naturally feel you wanted to avoid things that make you anxious!”
She was hugely relieved to discover that there’s nothing ‘weird’ about wanting to avoid anxiety-inducing situations or relationships. On the contrary.
This did not mean that she did not have a problem. She really wanted to have a relationship, but her fears made her hold back from fully engaging in one. She needed to learn a new way of dealing with those fears and relaxing with the idea of getting close to someone.
So I taught her how to hypnotically rehearse meeting people, speaking out at work and going to social events until it started to feel normal and natural again before she actually went out and changed her behaviour.
Her comment when it was all over was: “Well, if I did have avoidant personality disorder, then I must have changed my personality!”
However, a person tagged with an ‘avoidant personality disorder’ label may also be caught in a kind of vicious behavioural cycle that we need to deal with.
We avoid what we fear and fear what we avoid – it’s a feedback loop
In nature, for survival purposes, we avoid that which may harm us. But how do you know what is going to harm you? You have to learn through experience. That seems simple enough, but a complicating factor is that your unconscious mind learns what to fear not only from what happens to you, but also from what you do – from your own behaviour.
So fear can actually be ‘switched off’ around situations that you seek out – even if that situation is intrinsically very dangerous, such as defusing a bomb, or putting your head in a lion’s mouth as part of a circus act.
It’s as if your unconscious concludes: “This can’t be dangerous, or he/she wouldn’t be doing this. So I might as well not waste energy generating anxiety!”
So what seemed terrifying at first comes to feel pretty commonplace because you are actively seeking it out.
The reverse is also true. If you avoid something determinedly enough, even if it really isn’t that dangerous, your unconscious mind, trying to be helpful, will build up the fear of the thing you are avoiding even more, as if it has concluded: “Wow! This must be really life-threatening or he/she wouldn’t be trying so hard to avoid it. I better increase the fear level just to make sure he/she really won’t go into that situation!”
In this way we avoid what we fear, but also fear what we avoid.
The longer a person is off work with ‘stress’ the harder it can feel to go back to work because of this fear/avoidance cycle. Avoidance may seem to solve the problem but it actually aggravates it. And, of course, an avoidant person’s avoidance patterns may stop them from seeking romantic intimacy, going to social gatherings or taking up work opportunities, thereby preventing themselves becoming fulfilled.
People prone to avoiding the opportunities that come their way, or who have wrongly tagged non-threatening or mildly threatening situations as ‘dangerous’ need, of course, to stop being avoidant.
One ‘safe’ way to overcome avoidance is to experience what you’d been avoiding in your mind. This allows your unconscious mind to practise feeling relaxed about it before you do it for real.
This was the approach used with the woman in the case study above.
Treatment for avoidant personality disorder
Avoidance problems are often treated with Cognitive Behavioural Therapy (CBT) – which focuses on helping people examine what they think and do with a view to changing their unhealthy habits of mind and behaviour – or another form of psychotherapy. As anxiety is a major factor in avoidance behaviour, anti-anxiety and/or antidepressant medication may be prescribed (see Drugs and medications ).
The sensible psychology approach
It is not ‘pathological’ to avoid something you fear.
At the same time, avoidance itself, through a natural feedback mechanism in the brain, increases the fear of what is being avoided.
Teaching people to relax deeply while strongly imagining themselves voluntarily entering those situations can have profoundly therapeutic effects, alongside social skills training if needed.
Effective therapy for avoidance anxieties will focus on how to
- calm down anxiety through deep relaxation
- hypnotically rehearse entering into the very situations that were previously being avoided – this gives the brain a chance to ‘re-tag’ situations once perceived as threatening to ones that are now perceived as comfortable, and even enjoyable
- rehearse specific social skills such as ‘what to say’ in social situations
- switch off negative use of the imagination (aka worrying what others might or might not think of you) in order to feel free to be more spontaneous.
We have also observed that as people become more confident about successfully handling and even enjoying previously avoided situations, their levels of self esteem naturally improve as a by-product.
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