Avoidant personality

A disorder characterized by the avoidance of both social situations and close interpersonal relationships due to an excessive fear of rejection by others.

Causes and symptoms

The cause of avoidant personality disorder is not clearly defined, and may be influenced by a combination of social, genetic, and biological factors. Avoidant personality traits typically appear in childhood , with the appearance of excessive shyness and fear of new people and situations. However, these characteristics are also developmentally appropriate emotions for children, and do not necessarily mean that a pattern of avoidant personality disorder will continue into adulthood. When shyness, unfounded fear of rejection, hypersensitivity to criticism, and a pattern of social avoidance persists and intensifies through adolescence and young adulthood, avoidant personality disorder is often indicated. Between0.5% and 1.0% of the general population suffers from avoidant personality disorder.

Diagnosis

Many individuals experience avoidant personality characteristics at one point or another in their lives. The occasional feelings of self-doubt and fear in new and unfamiliar social or personal relationships is not unusual, nor is it unhealthy, as these situations may cause feelings of inadequacy and social avoidance in even the most self-confident individuals. Avoidant personality traits only emerge as a disorder when they begin to have a long-term, negative impact on the individual, cause functional impairment by significantly altering lifestyle and impacting quality of life, and trigger feelings of distress for the individual.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the standard diagnostic reference for mental health professionals in the United States, states that at least four of the following criteria (or symptoms) must be present in an individual for a diagnosis of avoidant personality disorder:

• The avoidance of occupational or school activities that involve significant interpersonal contact due to an unreasonable or excessive fear of rejection or criticism.
• An unwillingness to enter into an interpersonal relationship unless there are assurances of acceptance.
• Restraint in interpersonal situations because of an unreasonable fear of being ridiculed.
• Preoccupation with criticism and the possibility of rejection in social situations.
• Inhibition with others in interpersonal relationships due to feelings of inadequacy.
• Self-perception of social inadequacy and inferiority to others.
• Reluctance to participate in new activities or take any personal risks because of a perceived risk of embarrassment.

Avoidant personality disorder can occur in conjunction with other social phobias, mood and anxiety disorders, and personality disorders . Diagnosis may be complicated by the fact that avoidant personality disorder can either be the cause or result of other mood and anxiety disorders. For example, individuals who suffer from major depressive disorder may begin to withdraw from social situations and experience feelings of worthlessness, symptoms that are also prominent features of avoidant personality disorder. On the other hand, the insecurity and isolation that are symptoms of avoidant personality disorder can naturally trigger feelings of depression .

Treatment

Cognitive therapy may be helpful in treating individuals with avoidant personality disorder. This therapy assumes that the patient's faulty thinking is causing the personality disorder, and therefore focuses on changing distorted cognitive patterns by examining the validity of the assumptions behind them. If a patient feels he is inferior to his peers, unlikable, and socially unacceptable, a cognitive therapist would test the reality of these assumptions by asking the patient to name friends and family who enjoy his company, or to describe past social encounters that were fulfilling to him. By showing the patient that others value his company and that social situations can be enjoyable, the irrationality of his social fears and insecurities are exposed. This process is known as cognitive restructuring.

Paula Ford-Martin

Further Reading

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 4th ed. Washington, DC: American Psychiatric Press, Inc., 1994.

Further Information

National Mental Health Association. 1021 Prince Street, Alexandria, VA, USA. 22314-2971, fax: (703)684-5968, (703)684-7722, (800)969-NMHA. Email: infoctr@nmha.org. http://www.nmha.org.