Avoidant Personality Disorder is a psychiatric condition characterized by extreme anxiety and hypersensitivity in social situations.
The DSM-V categorizes it among other nine personality disorders. Patients with personality disorders exhibit rigid and unhealthy ways of thinking and behaving that make it difficult for them to interact with others and their environment. Consequently, patients struggle to maintain relationships and may perform poorly at work or school.
The DMS-V groups personality disorders in three clusters. AVPD belongs in Cluster C, which is characterized by pervasive anxiety.
What Is Avoidant Personality Disorder (AVPD)?
As a Cluster C personality disorder, AVPD causes fear and nervousness primarily in social situations. The intense negative feelings of inadequacy and self-consciousness cause people with this personality disorder to avoid interacting with others. These feelings and behaviors cause limitations in many areas of their lives.
Approximately 2.4% of people in the United States suffer from AVPD, and it appears to affect men and women in equal measure.
While it may seem like average shyness, the difference between a healthy personality trait and a personality disorder is the level of disruption it causes in a person’s life.
A shy person might not readily engage in some social situations like large parties or jobs that require them to interact with a high number of people every day. However, they can perform satisfactorily at work or school and engage in other social situations that make them more comfortable, as small gatherings with intimate friends and family in more quire settings. Shyness does not disrupt their daily life and does not cause intense feelings of fear and anxiety.
Contrarily, someone with AVPD experiences a level of disruption in their daily life. They are more ready to avoid social situations not out of preference but to relieve the powerful negative feelings arising from interacting with other people. In reality, they crave social connections, but it’s extremely difficult for them to establish them.
Like other personality disorders, AVPD usually begins manifesting in adolescence or early adulthood. While it might be observed in children, it isn’t diagnosed in children under 18 years of age.
Often, changes in a patient’s life during their teenage years and early adulthood, such as moving away from home or getting their first job, can aggravate symptoms or make them more apparent.
Symptoms
For a person with AVPD, the fear of rejection or ridicule from others is so overpowering that they choose to avoid social situations altogether. This avoidance becomes a pattern of behavior, with different degrees of severity.
Other traits found in people with AVPD are:
Social inhibition keeps them from trying anything new or taking risks
Awkwardness, shyness, self-consciousness in social situations
An intense fear of criticism, rejection, or disapproval
Strong anxiety in social situations stemming from their fear of rejection or ridicule
Low self-esteem and self-confidence
Few, if any, friendships and close relationships
Aggrandizes problems and obstacles
Feelings of inferiority and inadequacy
Causes
The exact cause of AVPD is still unknown. However, medical professionals agree it stems from a combination of environmental and genetic factors.
Some patients may be genetically susceptible to developing a personality disorder like AVPD. This predisposition means that AVPD may run in families. Sometimes, life experiences and other external factors act as a trigger or a contributing factor.
In particular, childhood experiences often play a crucial role in developing personality disorders as adults. Situations such as rejection by parents or friends can affect the patient’s self-esteem, which in some people may contribute to developing AVPD in the future.
Risk factors
Because the exact cause of AVPD is not known, it’s difficult to pinpoint specific risk factors.
However, medical experts have observed a few common traits among people who develop AVPD.
Among these factors are:
A history of shyness as a child, although not all shy children grow up to present AVPD
An unstable or abusive family situation
Bullying or rejection from peers as a child
A previous diagnosis of a conduct disorder in childhood
Diagnosis
Anyone suspecting they may have Avoidant Personality Disorder needs to be evaluated by a mental health professional to confirm a diagnosis.
During the consultation, the provider may perform a physical exam and consult the patient’s medical history. The doctor or mental health provider needs to have a thorough understanding of the patient’s past and current health conditions to ensure a physical illness isn’t causing the symptoms.
They will also carry out a psychiatric evaluation. The physician may ask questions about your behavior, thoughts, and feelings to narrow down a diagnosis.
The goal of the examination is to assess aspects of the patient’s personality such as their perception of themselves and the world around them, their attitude and behaviors toward others, and impulse control.
Because symptoms may overlap with those of other personality disorders or mental health conditions, getting a diagnosis isn’t always straightforward.
Differential diagnosis
In particular, AVPD may overlap with the following conditions:
Schizoid personality disorder. As another Cluster C personality disorder, it also presents social isolation and anxiety. The difference lies in the cause of isolation. While people with AVPD often crave close relationships, the powerful fear of rejection and ridicule makes them avoid interacting with others. In contrast, people with schizoid personality disorder isolate themselves from others because they are not interested in others.
Social anxiety disorder. At its core, social phobia and AVPD share the avoidance of social situations because of a fear of ridicule or rejection. The differences are subtle, which makes it difficult to distinguish between the two. One key difference is which situations cause fear and anxiety. People with social phobia often fear that an action they perform will make others reject them. In contrast, people with AVPD avoid socializing because they believe there is something inherently wrong with them that will make people automatically reject them. For example, a person with social phobia might avoid a job interview out of fear of saying the wrong thing. Someone with AVPD may do so because they believe they are not intelligent enough to do the job.
Complications
AVPD may cause major disruptions in the patient’s work, school, and relationships. It makes it difficult for them to build a strong support network, making it hard for them to receive emotional support and care.
For this reason, one complication of AVPD is the use of drugs or alcohol to cope with the symptoms.
Some patients may use substances to help them in social situations. For example, by drinking alcohol excessively to be more outgoing at a party. Over time, using substances as aids for social interaction may result in substance abuse and addiction.
Fear of social situations can severely hinder the patient’s performance at work or school. They may struggle to go to class or the office. Over time, it may be an obstacle to complete their studies or get a job.
Treatment
Because the cause of AVPD is still unknown, it’s not possible to prevent its onset. However, the sooner the symptoms are treated, the better the outcome for the patient.
If during a physical exam the physician doesn’t find a physical condition that explains the symptoms, they will refer the patient to a mental health professional.
Depending on the person’s situation and severity of the symptoms, psychiatrists, psychologists, nurses, and social workers may be involved in the treatment to ensure all the patient’s needs are met. For example, someone with more severe symptoms may need support to gain the social and occupational skills to find and maintain a steady job.
The primary treatment for AVPD is psychotherapy. The goal of psychotherapy is to change the person’s maladaptive patterns of thoughts and behaviors and replace them with healthy ones.
Therapy helps people overcome fears, reduce or eliminate unhealthy behaviors, and develop healthy coping skills. While therapy is carried out most often in individual sessions, some persons might benefit from group sessions with other patients or with friends and family.
Sometimes medication may be used alongside therapy. There are no specific medications for AVPD, but some may help ease symptoms. The most common medications involved in treating AVPD symptoms include anti-depressants, anti-anxiety medication, and mood stabilizers. Only a medical doctor can prescribe medication.
People who present severe symptoms and cannot take care of themselves may need to be admitted to a hospital for psychiatric treatment.
Following the treatment is vital to manage AVPD and reduce symptoms.
We are the same as every living thing – in that our environment shapes us. In fact it will shape us to the extent that we either grow to our full wonderful potential or we can fade and die.
An analogy that makes it plain to understand how vital our environment is to us is to realize how we care for plants in our garden. We know it is essential to have the correct soil, to keep the soil in the best conditions possible by ensuring it has enough water and nutrients, that the plant has sufficient sunshine and doesn’t get too hot or cold.
We know that if we neglect any of these, the plant will wilt and if left uncared for it would eventually at some point die. The environment we live in is just as vital to our wellbeing.
This means not only our home, but also the community and even country we live in. Our environment needs to be a sanctuary and provide what we need to grow and thrive.
Mental, emotional, spiritual and physical
Human beings are social creatures. We were made that way, as part of our survival as originally we didn’t have so much to protect us as many animals do, such as long sharp fangs or pointed claws.
Likewise we don’t have fur to keep us warm. Then there is the fact that human babies are born far more underdeveloped than almost all animals.
For the first 12 months a human baby is totally dependent on the adults around it for food, shelter and warmth as we can’t even walk for usually around nine to 12 months old. Yet, most baby animals can walk within days and sometimes hours.
A human brain doubles in size in the first year. So it’s growing rapidly – and the environment around it will influence how it develops.
Negative consequences on our cells of being in a frequent or continual state of alert at real or perceived dangers has been scientifically proven. Stem-cell biologist and author Dr Bruce Lipton has explained how the trillions of cells in our body are either growing and maintaining our health or in a defensive mode when they cannot grow as they should.
Being in a damaging environment like this means we’re more likely to become ill – that can be in a mental, emotional or physical sense. Increasingly, experts such as Dr Lipton and physician, author and trauma expert Dr Gabor Maté are stating how mental, emotional, spiritual and physical aspects of us are all inextricably linked.
Disconnection is a major part of all mental health problems. Frequently, people who are suffering from such as addiction, anxiety or depression will feel alone and disconnected from other people.
So the world around us and the people in it are vital to our wellbeing. We need to feel connected.
No main is an island
Renowned psychologist Carl Jung (1875–1961) used another plant analogy that explains this so well. Talking about a plant’s rhizome, which is its stem that is continuously growing underground, he said: “Life has always seemed to me like a plant that lives on its rhizome. Its true life is invisible, hidden in the rhizome.
“The part that appears above ground lasts only a single summer. Then it withers away – an ephemeral apparition. When we think of the unending growth and decay of life and civilizations, we cannot escape the impression of absolute nullity.
“Yet I have never lost a sense of something that lives and endures underneath the eternal flux. What we see is the blossom, which passes. The rhizome remains.”
So underneath the soil there are roots, there’s the soil, there are nutrients in the soil, and vital things for the life of the plant happen in the soil when it rains. Then above and around the plant there’s the air and oxygen, the sunshine, the rain, night and day…
If the plant ignored all of these other parts of it, and relied solely on itself, it would soon wither and die. It can be said that’s the same with us if we ignore connections around us.
The war on drugs
Portugal’s decriminalization and changed policy on illegal drugs in the past decade proves this point. Instead of spending money on the “war on drugs”, the country – that had one of the highest number of drug users in Europe – started to spend that money on rehabilitation and to allow users to integrate in society again.
For instance, a group of three people who’d been carpenters until their drug use had put them out of action, were encouraged – with financial help – to start up a small carpentry company to do their work around their community. This gave them a connection again.
There’s a strong point here that for many addicts the connection they have with their drug replaces any other connection. It becomes their number one and sometimes only “relationship”.
Within a few years of this new policy Portugal saw a huge improvement. For example, Portugal’s drug death toll plummeted to three per million compared to the European average of more than 17 per million.
People need people
It’s also one of the reasons the Twelve Steps group meetings and regular one-one-one therapy both work so well. There’s connection between people – and what they think and feel.
Sometimes when people have grown up in an environment, their home and/or community where there was little positive and loving connection, therapy might be the first time they have ever felt validated and valued as a person. Feeling unloved as they may have in this way leads to all sorts of emotional and mental health problems.
Of course, if the environment someone has grown up in – or it could be they presently live – is one where abuse and aggression is commonplace, it is bound to have negative consequences.
So while a great deal of recovery is about working on inner feelings and beliefs, the external environment has to be considered as it certainly plays a major part in someone’s wellbeing.
Today while there are more ways of connecting than ever before, there is actually less real connection. Communities were stronger in the past and all generations of a family used to live closer to each other.
In general, people had more time for each other even including those in their household. There was more connection.
It is like if we took a piece of coal from a glowing fire… on its own without the warmth of the fire the piece of coal would soon go out. People need other people: we need connection and relationships.
“Psychiatrist” derives from the Greek words psukhe meaning “soul” and iatros meaning “healer”. So “psychiatrist” actually means – and originally meant when it was first used around 170 years ago – “soul healer”.
Yet so much of 21st Century mental health treatment focusses only on the mind. Could it be that one of the reasons rates of what are known today as mental health problems have increased so dramatically is because we ignore the spiritual aspect of being a person?
As renowned motivational speaker and one of the world’s bestselling self-help authors Dr Wayne Dyer put it: “We are not human beings in search of a spiritual experience. We are spiritual beings immersed in a human experience.”
Since the Industrial Revolution started in Europe in the 18th Century, the Western world has put increasingly less emphasis on spirituality. Nations and their people look to the material world as a reason for living and the way to happiness.
But striving for material gain has led to much more pressure and stress in life. Now, for instance, it is a necessity that both partners work full-time whereas until relatively recently that was not the case.
Power of Connection
In a recent talk entitled The Power of Connection, physician, trauma expert and author Dr Gabor Maté said: “There are mental illnesses that develop originally really as compensations against stress and trauma.
“Now we have the GDP, the Gross Domestic Product. This is how we measure success. It’s how much wealth.
“In a materialistic society, we measure success by the possession or the control or the production of matter, of materials. It’s materials that matter.
“But is that really the true measure of a human society? Well, it’s one measure.
“But is it a true measure of a successful society? Can a society be called successful because it produces, controls or owns more matter than some other society?
“An equally important measure, at least as important measure of a society and culture, is to what degree does it meet human needs? How well does it promote healthy human development and to what degree and ways does it undermine it?”
Maté talks about disconnection caused by our modern Western system playing a major part in both physical and mental illnesses. Connection with others can be seen as a spiritual aspect of the human condition.
Feeling disconnected from others is a major part of many mental health illnesses, including conditions such as addiction and depression. We live in a world today that despite us being more connected than ever before through technology, there is often less actual connection.
A large part of recovery is about restoring connection. That is to other people – but also for the person seeking help to reconnect with their true selves.
Spiritual matters
In the past century, science has also risen as a more powerful force of reasoning than spirituality. The fact is proof of something is easier to believe if we can see it.
But spiritual matters often cannot be directly seen. Although spiritual people will say the consequence and effect of spiritual things can be seen everywhere.
They might liken it to television signals. Nobody can see the movie traveling from its source but you can see it on your television screen.
Many people connect spirituality to religion. But there are also many who are not part of any religious group who live spiritual lives.
In fact in the Alcoholic Anonymous “Big Book” chapter entitled “We Agnostics” it is all about this and says: “Something like half of us thought we were atheists or agnostics.” This was written in the 1930s when church-going and a spiritual life was much more the norm than it is now.
So AA membership today – estimated to be more than two million people worldwide – is likely to have an even larger percentage who identify as atheists or agnostics when they start the Twelve Steps recovery program.
Step Twelve of this program says: “Having had a spiritual awakening as the result of these steps…” Therefore, the point of the Twelve Steps is to have a “spiritual awakening” – this is what has been shown for more than 80 years now to help people formerly considered by most doctors and psychiatrists to be hopeless cases.
That is not just those addicted to alcohol, but also to drugs and people with behavioral addictions too. Such a “spiritual awakening” has been seen to work for those identifying as atheists as well as for those who identify with one of the world’s religions.
Esteemed psychologist Carl Jung played a forceful part in the formation of AA. It was one of his clients – business executive Rowland Hazard – who was told by Jung that his only chance of beating an addiction to alcohol was a “spiritual or religious experience – in short, a genuine conversion”.
This filtered back to a New York stockbroker called Bill Wilson who was battling his own alcoholism. Wilson went on to become one of AA’s co-founders.
Shakespeare on disease and divinity
We can also look further back to great literature to see that a spiritual solution was seen as the cure for what today are mostly seen as mental health problems.
In Shakespeare’s tragedy Macbeth, Lady Macbeth is agitated, anxious, unable to eat, rest or sleep. She is irritable, restless and discontent.
Macbeth sends for a doctor to cure his wife. When the doctor arrives he swiftly recognizes the source of Lady Macbeth’s problem.
He says: This disease is beyond my practice… More needs she the divine than the physician.
So the debate about mental health illness and spiritual sickness is ongoing. Although there are many people who are today regarded as having important knowledge – such as Carl Jung, Gabor Maté and Wayne Dyer among many others – who talk about a spiritual solution at least being a part of the answer to many of today’s mental health problems.
Many people with an addiction seem to fall into a relentless battle where they stop because they know they have to stop. But then they cannot stay stopped.
In fact this is so well known in recovery communities there’s the phrase: stopping is easy; it’s staying stopped that’s the difficult part.
So someone may do this repeatedly for years. They stop and then after a certain period – that could even be of several months or more – they find that almost as if against their own will they have started again.
It’s disheartening, frustrating and causes great anguish, despair and sometimes anger. Not only for the person trying to quit, but also for all those around them.
Some people eventually just give up on giving up. But there is always a way to stay stopped.
If you consider the amount of people in recovery from an addiction, there are millions of people in the world today who are living proof. This is true for alcoholism and drug addiction as well as for behavioral addictions such as shopping, sex, gambling and work.
Thankfully, there are proven methods that can help anyone to stay stopped from any addiction.
Keep it in the day
One of the first phrases that people in recovery groups and/or therapy may well hear is “keep it in the day”. It’s also said that quitting an addiction should be taken “one day at a time”.
This breaks it down and makes it seem much less daunting. You don’t have to think about giving up forever – just for this one day.
But then repeat this, one day at a time (often abbreviated to “odaat”). There are people with, for instance, 40 years sobriety from alcohol addiction – who still take it just one day at time.
Sometimes if a day seems too long, break that down. So, make it for one hour or even one minute at a time: that is, “just for the next hour/minute I won’t drink or use or do my addictive behavior…” Then keep repeating this.
Avoid tempting places and behaviors
There’s a famous soccer player in England called Paul Merson with a well documented struggle with drink who said: “If you keep walking past the barbers, eventually you’ll get a haircut.”
Although humorous, it makes a serious point. Many people quit such as an alcohol addiction, but still go to bars…
The word “temptation” derives from a Latin word temptare meaning “handle, test, try”. So putting yourself in the place or places where you used “do” the addiction means you are giving yourself a test.
One day you might not pass the test. Then you are back under the power of the addiction.
It’s the same if your addiction was, say, shopping. If you go to the shops or start browsing online, there could be problems ahead once again.
Stick with the winners!
This is similar to avoiding places – but is directed towards people. Those people we often drank with or got drugs from or gambled with – and so on.
If you really want to stay stopped from an addiction, certainly in the beginning and for some time at the start it’s best to avoid these people. Just as is the case for most people with avoiding certain places, this is not likely to be forever.
But just until you know in your heart that you can handle the test of being in these places and among these people again. Although when many people in recovery reach this point they realize they don’t actually want to go to those places again or be with those people.
There’s a phrase frequently heard in addiction recovery circles that is “stick with the winners”. It may sound harsh, but really is just to get you considering who you’re keeping company with at any given time.
We also need to look out for people who cause us to have strong emotions or who trigger us. This could include family, friends or colleagues.
It would be best to avoid these people in most instances. But if that’s impossible, such as with some family members, at least be aware that you need to keep alert.
Also perhaps do some mental and emotional preparation before you see them – such as meditate or read something that inspires you to stay stopped from your addiction. As well, try your best to limit the time you spend with anyone like this.
Watch out for social media
Many people who are addicted to something will find they get triggered when they have negative emotions. They seek to change the way they feel – and turn to something they have found achieves that, albeit in a short-lived way that’s always detrimental in the long-term.
Social media, as well as being something to which many people get addicted, can also be a trigger. People look on Facebook, Twitter or suchlike and they feel angry due to some political opinion.
Or they feel extremely envious of someone’s house, car, latest holiday or that they have a loving partner (or so it seems). Then there’s that other person posting and boasting about their work achievements – and that leaves a feeling of being less than because self-esteem is already low.
Similarly, be aware that as well as social media, things such as the news, soap operas, song lyrics, movies and documentaries can all change the way we feel for the worse. As well, for some people watching sports can do this.
It’s not to say you necessarily need to stop these pastimes outright or forever. But if you know they lead to an addiction or even craving, perhaps they are best limited or totally avoided.
Gratitude
Develop what is known in recovery communities as “an attitude of gratitude”. It will help you focus on positives.
It’s a way of making sure negative feelings don’t get overwhelming. Gratitude lists – when you write down things you’re grateful for – are simple and wonderfully effective.
It’s important to write these regularly, such as just before you got to bed and then read them first thing in the morning. But of course they can be written any time to help chase away negative feelings.
Sometimes you may have to force yourself to write one, and this is especially beneficial when you really don’t feel like it. But they always work because such as anxiety and depression cannot exist while you are focusing on gratitude.
It is full of positive ways to live, one day at a time. This is for everyone, not just people who are addicted to something.
Live well – and say sorry
Following on from the Just For Today card is this: to live the mantra – how can I help others? See what you can give to the world.
Many people who are addicted take from the world, including such as from their work, other people, family and friends. This is not because they are bad people, but because they feel empty and consumed with pain – and are simply desperate to fill up their emptiness and block the pain.
But the best way to do this is quite the opposite of taking. Whenever we give, we gain.
So help others and always see what you can give to the stream of life. Be kind and generous.
This includes saying sorry as promptly as you can when you realize you’ve said or done something that might have caused harm. Never say “Sorry, but…” – just sincerely saying “Sorry” is best.
Alter attitudes
Many people who go to AA Meetings say AA could also stand for Altered Attitudes. This is because if you are stopping an addiction you need to learn to live a new way, where you change your responses and reactions to certain things that are a part of life.
It is necessary to work on self-esteem, self-love and self-confidence. This is an inside job.
Then when you feel stronger from the inside, outside things won’t have such a negative impact. Acceptance will come easier – and people feel calmer and more assured about life.
Meditation
Meditation has for centuries benefitted people around the world. There’s no one way to do it, but many people who are experts in it speak about seeking calm and stillness, of being an observer of the moment without any judgement.
It’s been proven to be especially beneficial as a way to start the day. If we begin the day calmly like this we will have more energy for dealing with anything that the day ahead might bring to us.
Meetings
Twelve Steps group meetings such as for Alcoholics Anonymous, Narcotics Anonymous or any of the many different types of Twelve Steps groups have proven now for more than 80 years to be of immense help to many people.
This is for people who once felt hopeless. There are many reasons why they are thought to be so beneficial – one of those being that a group of people together is stronger than a person alone.
Twelve Steps
Another reason why Twelve Steps group meetings are so beneficial to so many addicts is that they are often what leads to someone starting the Twelve Steps recovery program.
You don’t have to do the Twelve Steps if you attend any of these meetings, but it is one of the main reasons for them. Many people in Twelve Steps recovery compare the meetings to the physician’s waiting room and the Twelve Steps are the medication you’re given to get and stay well.
Therapy
Therapy is of course a hugely effective and proven way of quitting an addiction and staying stopped. A good therapist will offer methods to live well day by day and also look back at your life, such as at family history or help you deal with a trauma.
Here at Tikvah Lake Recovery we specialize in offering daily one-on-one therapy. In our experience this is by far the best sort of treatment.
We can also offer you an introduction to the Twelve Steps. We listen carefully to all of our guests and then personalize the treatment so that it works as swiftly as possible and gives the strongest and most enduring recovery possible.
