Avoidant Personality Disorder diagnosed 2022

[Sanjuro21]

Hello over here,back in 2020,after a difficult situation i passed into workplace during covid restrictions,social anxiety,pressure,negative gossip and more,i failed to continue,i cracked due to many psychological and emotional stress,i retired from the job,but from next few weeks i got into an emotional hell,i couldn't sleep well,i was crying,i felt so weak,so rejected.Even if i found new job after 2 months in a more reliable company,for next 1.5 year i was taking meds efexor 75mg,doing psychotherapy and finally after many sessions,doctor diagnosed me with AVPD.☹️🥺

This disorder as many others,have no specific cure or treatment as there are not known the causes of it,i've tried supportive therapy,i;ve tried schema therapy some months,but didn't worked for me to ease the symptoms.😓 I'm dissapointed cause this disorder has ruined my whole social life.

My current situation is,i don't have friendships,never had from early childhood,i don't have relationships with girls/women never,no sex life at all,i hate my job but i'm trapped cause i can't find anything else,i still live with parents and they are not supportive at all and they are to critical up on me,i'm not going vacations as i don't have nobody to go with,i'm complete alone out there,may i have 1-2 friends.

 

[Daniel E.]

Welcome, Sanjuro!

It was a psychologist who diagnosed you as having avoidant personality disorder? Are you still seeing this therapist or psychologist? Do you see a psychiatrist who can confirm the diagnosis?**

Regarding your job, what stresses you the most? How have you been coping with your work issues? Does your local government (or other non-profit agency) have a job center that assists with job matching?

Personally, before I was married at the age of 35, I went on a few vacations or trips by myself. And I enjoyed it, especially since I am an introvert and didn't have to compromise about the itinerary. I would also go out to eat by myself. At the restaurants I go to now, I have noticed there are a number of retirees, especially men, who eat by themselves.

In any case, for your anxiety and relationship and work issues, I would look at the neurodiversity movement as one source of hope (for thriving, not just surviving). That's what I try to do anyway with my OCD/anxiety and occasional depression. So by not judging one's personality or behaviors, it is easier to accept one's current limitations and use one's strengths more effectively. And even with developmental disorders like autism, one can eventually find one's "tribe" and even see one's limitations as opportunities:

https://www.thepuzzledlife.net
Mental health symptoms often arise in those who have never found their fit...Counseling alone is not going to work with someone who has never found their 'fit', their 'tribe', and the optimal environments for their way of being.

Even if you like your therapist, you may need to consider changing therapists at some point -- to a therapist with an approach or personality that works better for you. Some therapies like CBT may eventually blame the client/person (using terms such as "resistance"), which is not conducive to self-acceptance. Perhaps you had a similar experience with schema therapy?

Another, additional option is group therapy or therapist-moderated peer support, which is increasingly provided online. I have also benefited from group-based exercise/yoga classes. Even small doses of socialization can be helpful, such as chatting with cashiers:

Social Challenge: Three Micro-Connections a Day

If you want to grow your connections, look at your micro-connections each day to improve your social confidence each day.

carolinemaguireauthor.com

As you say, there is no cure for most mental disorders. It's largely a matter of adjustment or coping, such as habituating to life itself, taking one day at a time, becoming more familiar with one's different moods, increasing a feeling of belonging/connection, and learning what works for you. As one gets older, acceptance of oneself and the human condition tends to increase anyway.

**Unfortunately, some psychologists and psychiatrists (unconsciously) use less common diagnoses as an excuse as to why they can't help a client more effectively.

 

[Daniel E.]

It is very common to have depression along with one's anxiety or other issues. We have all been there -- feeling hopeless and even suicidal since life seems too hard or painful. Feeling tired of the same old problems. Or things in life seem more like punishments rather than rewarding challenges or opportunities.

So with depression (or hopelessness or joylessness), if you did not love your job before, you would hate it now. It takes more effort to do things, especially if things often feel pointless or meaningless. But even when depression improves (since it tends to be cyclical), one's anxiety may increase. So it's very hard to deal with these things without support.

For affording individual therapy, one option is seeing a student therapist. Another option is finding a therapist that provides a sliding-scale fee. Community-based (non-profit or government-funded) mental health clinics are just one way to find sliding-scale therapists.

For anxiety or stress in general, there are also mindfulness or meditation groups, including in your beautiful country.

Since you live in a different part of the world, I don't know what is available locally. But online groups based in the US, Canada, UK, etc. often meet with Zoom (video). They are often affordable and sometimes free or donation-based. These groups can also be better than individual therapy for making one feel less uniquely alone. There are online Zoom groups for anxiety, depression, loneliness or other relationship issues, social anxiety, and many more situations.

The Zoom group I went to for OCD was operated by Pay What You Can Peer Support, which is based in Canada and includes groups for depression, anxiety, relationship issues, etc. Also see: Social Anxiety Support Groups

For self-help or between therapy sessions, journaling is often recommended. Writing down anything that is on your mind or doing a gratitude journal -- like what went well that day, even little things like if you enjoyed your breakfast or lunch or a cup of coffee. A mood journal of just keeping track of one's mood can also help.

Any of these things, including psychoeducation, can help with building hope.

Regarding the many different therapies, I like solution-focused the most. It makes the most sense to me, but other therapies help fill in the gaps, depending on the issue. For depression, I also like behavioral therapy, namely behavioral activation.

Solution-focused therapy is both cognitive and behavioral (like CBT and mindfulness-based approaches like DBT and ACT). Many therapists do solution-focused stuff already in their own lives, but they don't call it solution-focused. Like just doing one thing different, like just spending more time outdoors. Focusing on what went right (or how one coped) instead of what went wrong. Assuming you are always growing as a person, even if you don't see big changes yet.

Most of the popular therapies now, such as CBT and DBT, include both cognitive and behavioral approaches. Behavioral approaches may seem relatively basic compared to cognitive therapies. But by changing one's behavior, one's thoughts and perspectives may change. Similarly, cognitive approaches can lead to behavior change (such as by increasing self-efficacy and self-acceptance).

Psychodynamic and psychoanalytical therapies are more like "old school" therapy and are not popular now. I did some psychodynamic therapy. For me, it was good for self-acceptance, exploring things, and feeling less alone. But any good therapist can provide similar results regardless of the therapy used. A leader in the field of psychoanalysis is Michael Eigen, and someone who influenced the field greatly was Karen Horney with her theory of neurosis.

You probably know more about schema therapy than I do. My understanding is that it is not popular as a primary therapy. I have never tried it, but I have read about it. Like all therapies and treatments (and even physical exercise), it works partly by increasing cognitive flexibility. Personally, I did not like the self-help book I read about schema therapy. Too many parts of it seemed judgmental or opinionated.

Exposure therapy is a behavior therapy and is a gold-standard treatment for anxiety. It's a behavior therapy that is very well researched and is more of a direct approach. A common example: Fear snakes? Well, first, you will think about snakes and eventually you will be in the same room with one. Eventually, after spending enough time with snakes, you will no longer fear snakes (or at least fear them less).

The problem is getting people to do exposure therapy since one is facing one's fears, more or less head on. That's why other therapies that are cognitive or mindfulness-based are almost always used with it.

Albert Ellis, a founder of CBT, used exposure therapy to find a girlfriend. He would just go up to any woman and start chatting with them. Eventually, he was no longer anxious around women.

For depression, the behavior therapy that is used is called behavioral activation. Some examples of behavioral activation are exercising more, going out to see a movie, or even the smallest things like making a cup of coffee.

With such behavior therapies, they are practically guaranteed to reduce symptoms (sooner or later). A big issue is getting one to do "opposite action" -- doing behaviors that are the opposite of what one feels like doing. And the other problem is people getting depressed or putting themselves down for not doing more. So relatively small changes and goals are usually best. In other words, "baby steps" and "it's a marathon, not a race."

There is also client-centered therapy, which is a humanistic (holistic) therapy incorporated by most therapists to some degree but is not mainstream anymore as a primary therapy. With client-centered therapy (more in theory than practice), the therapist asks more questions than most therapists do and provides lots of empathy/validation/acceptance. The therapist tries to know the client rather than change the client. And this increases the client's self-acceptance, indirectly leading to behavior change. One can do self-help in this area by watching Youtube videos by the late Carl Rogers or reading quotes from his book On Becoming A Person.

As far as effectiveness, no therapy is necessarily better than another one (for motivating behavior change or increasing self-acceptance, frustration tolerance, cognitive flexibility, interpersonal effectiveness, and other measures of mental health). Most therapists combine various approaches. In numerous studies, the effectiveness of a therapy has more to do with how you relate to the therapist. I haven't read much research about group therapy, but I assume the same is true for group therapy and even self-help -- it has more to do with the personalities involved working well together to form a helpful "tribe."

 

[Sanjuro21]

For this specific personality disorder,which therapy you would suggest as better approach of the issues such as extreme shyness,low self esteem,lack of self confidence,inferiority,sensitivity over negative criticism and gossip,self acceptance,fear of failure,AVPD has many symptoms to resolve and work,so is not easy case even for an experienced therapist to use combination of therapies to succeed a good improvement.

 

[Daniel E.]

Some information resources are listed here:

Diagnosed with Avoidant Personality Disorder

I have been diagnosed with AvPD. I am not trying to start anything here, I actually came into this thread to see if there were any other people on here that were DIAGNOSED with it as well. I know everyone has issues and seeks out answers but please go to a Dr. if you think you have a mental...

forum.psychlinks.ca

I have also tagged all previous discussions about AvPD so that they are easier to find:

avpd

As you may know, there is a lot of overlap between avoidant personality disorder and social anxiety disorder. So much so, that the differences are arguably theoretical or negligible. Similarly for borderline personality disorder, some argue that a better term for BPD would be emotional regulation disorder -- no personality disorder required.

Even with the more common diagnosis of social anxiety disorder, there is some controversy as there are lots of cultural and technological factors. For example, there is an entire subset of the Japanese population called hikokomori that suffered from social exclusion due to problems in the economy and other societal factors. In my own experience with psychiatrists and psychologists, they generally ignore such external factors in favor of individual pathology (as both professions profit from the latter).

In any case, for any disorder, I would use a solution-focused approach, for therapy or self-help. Most therapists incorporate similar techniques to some degree.

For example, one solution-focused technique is "Keep doing what works." You are already doing things that help you as a human being. So you try to notice (and write down) all the things that you are already doing that helps your mental health, your physical health, your ability to cope, or your personal growth. Then, you just do more of one (or some) of those things.

Another solution-focused technique is "Do one thing different."

These things are simple, but a lot of people in recovery find that these small, simple things do add up eventually to a whole new lifestyle. And this is not to dismiss your difficulties. I have lived through hell with OCD, and I know you have been through hell with AvPD and are still going through it.

Another thing that helps me is focusing on my strengths, such as curiosity.

There is a well-researched quiz for finding your strengths:

Know Your Strengths

The VIA Survey of Character Strengths is a free self-assessment that takes 10 minutes and provides a wealth of information to help you understand your best qualities. VIA Reports provide personalized, in-depth analysis of your free results, including...

forum.psychlinks.ca

The important thing to avoid is thinking you are too different or that your problems are too unique or too complicated. I did that for over a decade! We are not our problems or any disorder. We are not even our personality. In other words, each person is more than the sum of their parts. And the opposite of mindfulness is overidentification.

Most people would be better off over-identifying with their strengths rather than with their problems -- since almost every mind tends to focus on the negative. These negative tendencies only increase with a mental disorder like anxiety or depression.

 

[Daniel E.]

On Quora, my psychologist therapist there has this advice:

My avoidant personality disorder is ruining my life. Does anyone with AVPD have tips for forming relationships and just living a normal l...

Answer by David McPhee, Ph.D., Ph.D. Psychology, University of Minnesota - Twin Cities (1994)

qr.ae

So you are already doing relatively well in that you are able to work with people, though you do not like doing so much of the time (at least at your current job).

Is there anything now that at least sometimes helps you be more comfortable, confident, or satisfied at work? Are some days better than others?

In the past, did you have a job that you liked fairly well? If you could have any job in the world, what would it be?

 

[Sanjuro21]

I know and read this doctor from quora,i think the obstacles so far for me,are first that i hate/dislike my job subject and even if i tried last 2-3 years to escape and find something more joyful,suitable for me,second is due to the low salary,i cannot financially leave my parents house and live independent with my own rules and decisions without having 24/7 some eyes to watch me,i need my own personal time and house.

Third,the sensitivity of criticism,the wondering how always the others around may see me,the negative gossip,the extreme shyness,the fear to say something due to fear to redicule,the self acceptance.There are many symptoms to resolve,is just not the anxiery or depression.

 

[Daniel E.]

Most people tend to cope in short-term ways that create more problems. DBT validates these unideal coping mechanisms as understandable, while helping people to realize that these short-term coping mechanisms are not effective for long-term goals.

In other words, your attempts to avoid what you fear (such as criticism, gossip, and ridicule) may be what limits you the most:

If You Don't Want It, You've Got It | Association for Contextual Behavioral Science

contextualscience.org

Maybe your problems are not the problem. Usually, it’s your solution, if your solution is making attempts to eliminate, reduce, or avoid pain.

I’m not saying that we should want pain, but avoiding it isn’t really working, is it? Learning to accept pain is a scary thing for most of us. We’re wired to resist it and pull away from it. But just see what happens when you gently open up to it instead. Mindfulness helps us let go of resistance and open up to the present moment, with all that it holds, with acceptance.

But this is why I like solution-focused therapy. It doesn't play the blame game (like CBT or ACT sometimes can by using the term "resistance," as in the article above that is from an ACT perspective).

And one of the good things about DBT is that it helps teach skills for dealing with strong emotions like feelings of rejection:

Why dialectical behavior therapy is so effective for multiple disorders

Why dialectical behavior therapy is so effective for multiple disorders by MATTHEW MCKAY, PHD Dialectical behavior therapy (DBT), with its four key skills (mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness), was originally developed to treat Axis II borderline...

forum.psychlinks.ca

A pattern of over-intense emotional response, whether learned or hardwired, can be replaced with more effective coping skills. These skills are both specific (see the four DBT skills above) and highly learnable.

The Four Skill Modules | DBT Skills Group of NJ

DBT Skills Group of NJ is designed to help people with anger, episodic depression, irritability or anxiety, intense or chaotic relationships, impulsivity, stress and feelings of emptiness.

dbtskillsgroupnj.com

Core Mindfulness Skills
Mindfulness skills in DBT come from the eastern spiritual traditions. These skills help members focus on the present and attend to what is happening in the here and now in a calm way. It helps people slow down and focus on doing what is needed to care for oneself in the moment. Members learn the value of wise mind instead of succumbing to intense emotions and acting in a destructive way.

Distress Tolerance Skills
Distress tolerance helps people get through difficult times when emotions are running high. It teaches people to soothe themselves in healthy ways when they are feeling upset rather than becoming overwhelmed by emotions or hiding from them. This allows individuals to make wise decisions about whether and how to take action, rather than falling into the intense, desperate and often-destructive emotional reactions. Crisis survival skills are also taught so that one does not engage in problematic behaviors and ultimately make the situation worse. Reality Acceptance Skills focus on helping people fully accept reality and provide a guideline for responding to painful aspects of life.

Interpersonal Effectiveness Skills
Interpersonal effectiveness skills involve helping people understand what their needs are in their relationships and helps develop effective ways of dealing with others in order to get one’s wants or needs met in a healthy way. This involves respecting the self and others, listening and communicating effectively, dealing with difficult people, repairing relationships and being able to say no.

Emotion Regulation Skills
The DBT emotion regulation skills help people understand their emotions. It teaches people to decrease the intensity of their feelings and helps them ride out strong emotions without acting on them. It provides education about the function of emotions and how to not be swamped by them.

 

[Daniel E.]

What Is Radical Openness? (RO DBT)

https://www.newharbinger.com/9781626259287/radically-open-dialectical-behavior-therapy/ (2018) Based on over twenty years of research, radically open dialectical behavior therapy (RO DBT) is a breakthrough, transdiagnostic approach for helping people suffering from extremely difficult-to-treat...

forum.psychlinks.ca

"RO DBT is an invaluable resource for treating an array of disorders that center around overcontrol and a lack of social connectedness—such as anorexia nervosa, chronic depression, postpartum depression, treatment-resistant anxiety disorders, autism spectrum disorders, as well as personality disorders such as avoidant, dependent, obsessive-compulsive, and paranoid personality disorder."

From 2016:

A Review of Characteristics and Treatments of the Avoidant Personality Disorder. Could the DBT be an Option?

Avoidant personality disorder (APD) is a frequent disorder whose prevalence has been reported to be as high as 10% in mental clinic outpatients. There is an open debate on whether APD is to be considered a different disorder compared to social phobia (SP), or they are different quantitative...

clinmedjournals.org

Psychological interventions may also be used for the treatment of APD but there is not enough evidence in literature to sustain that a treatment is preferable to another one. A limited number of published evidence investigated the effects of cognitive psychotherapy on samples of APD patients, where APD was the main diagnosis [53-55].

Results point into the direction of the efficacy of the treatment compared to non treatment at all. Due the high efficacy of DBT in the treatment of borderline personality disorder, it has been suggested that the same technique, together with some specific modifications that more precisely tailor the core of APD, may be used. This modified DBT treatment has been proposed by Lynch and colleagues [96], and it is based on the assumption that over-control may be a relevant strategy that subjects with APD developed in order to balance their inner psychological balance. Further research is mandatory to investigate the efficacy of this modified DBT model on APD.

 

[Daniel E.]

Shyness, Introversion, Sensitivity, Social Anxiety ? What?s the Difference?

Shyness, Introversion, Sensitivity ? What's the Difference? By Douglas Eby May 4, 2010 Shyness and introversion may seem to be the same in some ways, at least on the surface. They can overlap, and we may have both traits ? but they are not the same thing. And they are not the same as the trait...

forum.psychlinks.ca

 

[Sanjuro21]

How much time need a proper therapy to deliver improvement,if we suppose that the person does 3-4 visits per month?

 

[Daniel E.]

For mental health in general, they have done waiting list studies where some people improved (to some degree) even before the first therapy session, such as if they were reading a self-help book.

Don’t Give Up If Getting Over Social Anxiety Takes Time

New research finds that "sudden gains" during the treatment of social anxiety doesn't predict long-term outcomes.

www.psychologytoday.com

"Every individual has their own timeline to improve and if you put in the energy regularly, you will eventually see benefits. Much of treatment for social anxiety includes daily and weekly practice of skills and homework, including putting oneself in stressful situations, like public speaking or talking to new people at parties."

 

[Sanjuro21]

As i have said before,my job is into mall as guard with lot of people,when there is crowded people around over here and there,if have to take rensposibillity for anything such as to give directions,to put a limit,to speak loudly,i see my self lacking and suffer from social anxiety,fear of failure,fear of do the wrong choice/thing,i crack under pressure to keep control and be calm.

 

[Daniel E.]

The goal of life is not symptom reduction (or just symptom reduction).

So part of therapy and self-help is bringing back the vitality of life:

“Patients coming for consultation complain about headaches, sexual disturbances, inhibitions in work, or other symptoms; as a rule, they do not complain about having lost touch with the core of their psychic existence.”

“For the analyst it is a source of never-ending astonishment how comparatively well a person can function with the core of himself not participating.”

― Karen Horney (1885-1952)

 

[Sanjuro21]

I have phobias and emotional fears,DSM5 disorders are not treatable,they need long term therapies that in most cases cost is not affordable.

 

[Daniel E.]

Everything you mention is treatable. Treatment or recovery can mean a lot of things. Some aspects of the self heal or recover faster than others. Feeling even 10 percent better can lead to more changes.

With or without therapy, you will get better -- as long as you don't give up on yourself. Therapy helps speed up the process and helps you to become your own therapist. And group therapy -- online or in person -- is a more affordable option. There are also self-help books on avoidant personality disorder, but they are not as popular as the self-help books on social anxiety disorder (like this one and this one).

Most people who benefit from therapy are "stuck" in some way. Life seems like an endless series of obstacles, but the reality is more hopeful:

"These mountains that you are carrying, you were only supposed to climb.” - Najwa Zebian

"Real obstacles don't take you in circles. They can be overcome. Invented ones are like a maze." ~ Barbara Sher

"Verbal knowing rests atop non-verbal knowing so completely that an illusion is created that all knowledge is verbal." ~ Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change

A big issue with avoidant personality disorder is that one is "shutting out the sun" -- avoiding both the ups and downs of interpersonal relationships. Though there are rare exceptions, for the vast majority of people, including introverts, the quality of interpersonal relationships is a big factor in one's happiness or well-being. This is why, traditionally, interpersonal therapy was the therapy of choice for depression.

But since with avoidant personality disorder, as with social anxiety disorder, there is a strong preference to avoid rejection, uncertainty, etc., it is quite understandable that, over time, one will have less and less social interest. A goal of therapy is to reverse this process in some ways so that one has a sufficient amount of socialization and interpersonal harmony.

Similarly with depression, no one is born depressed. Depression requires a certain way of viewing the world and acting in it -- as a survival strategy of sorts that eventually backfires or overcompensates.

It may be that you would benefit from some additional "doses" of socialization on a daily or weekly basis, some adjustments with your assumptions or expectations about yourself and others, or just doing more of what is already working for you.

This is not to say you need to be a social butterfly or anything else that is not in your nature. Personally, I socialize more online than offline, with the exception of talking to my spouse, small talk at places of business, and visiting some family members. It may not be an ideal situation, but I find the conversations more meaningful to me this way. That's part of the reason I am here and enjoy forums. Socializing online (at dating sites) is also how I met my spouse. A related thread at Nebulous' forum: Is it hard making friends as an adult?

 

[Sanjuro21]

I tried two therapies,for almost 2 years in a row,with a small break of some months,none of them delivered any kind of help to me.I struggle to socialize online more,i have no social media accounts and i hate to give info to others such as uploading pics or doing stories.

I hate my job and can't find other subject i can have some joy and satisfaction,i don't have personal life in general.

 

[Daniel E.]

It is hard to be happy if your nervous system is mostly in "survival mode." It can feel like most of your life is just waiting for something bad to happen.

Is going to the gym a hobby for you? That can help a lot with anxiety and even socialization since a gym is a social environment -- even without talking to others.

It is, unfortunately, often an expensive process to find the right therapist. Some therapists are much better than others, including when it comes to "fit" or matching with one's personality. Many people give up due to financial concerns if they are not lucky enough to have insurance that pays for therapy.

With or without therapy, finding your "tribe" -- the kind of people that you get along with -- is probably your best bet in the long term, as well as developing a daily or weekly routine of small pleasures or various interests. You don't have to be friends or even acquaintances with people to benefit from socializing with others in some small ways. Just being around certain people or social environments can help. Like going to the library, gym, or a cafe.

As I have mentioned before, mindfulness is another way people are doing self-help, and there are meditation groups as well. The way I like to think of mindfulness is that it is like giving your mind/brain a short break, like a few moments of vacation. On vacation, one is the same person and yet different -- lighter, not as serious. There are also guided meditations on the apps like Calm.

The goal with mindfulness and self-help in general is to thrive (rather than to continue to exist in just "survival mode.") Like being more alive/present without taking negative thoughts at face value. The Stoics like the Greek philosopher Zeno talked about this -- warning people not to take impressions as truth.

A common phrase in self-help is to take "baby steps." A similar saying by Zeno: “Well-being is realized by small steps, but is truly no small thing.”

 

[Sanjuro21]

Everyone needs a "quick fix",but personality disorders doesn't have one,cause doctors,psychiatrists,psychologists don't know the causes of a disorder,so they just suggesting different therapies that suppose will help.In my case,it took me 1-1,5 year to just starting slowly recovering from this emotional hell,with efexor as meditation,with supportive psychotherapy,when i realised that doctor cannot help me anymore so i stopped,then i continued schema therapy with a clinical psychologist,i had read before that this not so known therapy,could help for my disorder,psychologist told me that if you want this to work,it needs to give at least 1 year time and at least 3-4 visits per month,so therapy to give results,after 6 months,i retired cause i had lost my job for some month and i was tired and dissapointed i couldn't find what therapy will give me solution.Cost was expensive,i had to pay for every visit 50€* 4 visits per month=200€,when my salary was just basic such as 600€.

 

[Daniel E.]

One way I like to make sense of the chronicity of mental health disorders: There is no cure for the human condition. One will always have negative thoughts or an inner critic. But things slowly get better over time.

Even people who can easily afford therapy for many years are often still struggling at times, even decades later with their mental health disorder(s). Therapists themselves are known to be "wounded healers."

The celebrity Howie Mandel often discusses his OCD (which is the condition I have), and he also has ADHD. After many years of treatment, he still often feels like he is in a "nightmare." He continues to take meds and do therapy. But, according to him, the best thing is living in the present moment by staying busy or distracted. And exercising is one way he stays distracted.

So even without a personality disorder, one may be dealing with a very long-term situation. And, on the other hand, there are people with personality disorders, such as borderline personality disorder, who are relatively symptom-free later on. So you never really know what the future holds (in a good way). This is why it is best to expect a surprise (Shift from Worry to Wonder) or be more open to experience. People can rise to almost any occasion, which is why there are so many people in history who did amazing things despite depression, autism, etc.