Avoidant Personality Disorder

[David Baxter PhD]

By the way, I took an online test about "Avoidant personality disorder" and scored way over the threshold to meet the criteria. But who the hell is going to give a ---- about me?

As I have said many times, these online tests are not a diagnosis. At best, they are very broad screening tests with as much chance of leading you down the wrong path as the right path.

You can use online tests as entertainment. For anything else, see a qualified professional.

 

[Roy H.]

Would you recommend I bring this up with a therapist, or a psychiatrist?


Also, is this "Avoidant Personality Disorder" just another made-up contrived "Anthropophobia" label, that may or may not really have any substance?


There doesn't seem to be a ton of information or interest in it. What is it...2.4% people have "it"?

 

[David Baxter PhD]

Would you recommend I bring this up with a therapist, or a psychiatrist?

A psychologist or a psychiatrist.

Also, is this "Avoidant Personality Disorder" just another made-up contrived "Anthropophobia" label, that may or may not really have any substance?

It's real. It is included in the "Cluster C" group of personality disorders in DSM5.

See Cluster C and Avoidant Personality Disorder DSM-5 301.82 (F60.6) - Therapedia

There doesn't seem to be a ton of information or interest in it. What is it...2.4% people have "it"?

From Avoidant Personality Disorder DSM-5 301.82 (F60.6) - Therapedia:

Prevalence
The DSM-5 reports that APD affects approximately 2.4 percent of the population (American Psychiatric Association, 2013). Among patients in outpatient psychiatric clinics, there is between 10% and 20% of that population affected by APD.

But the fact that is relatively rare doesn't make it "not real" or "trivial". The prevalence of schizophrenia is the general population is even lower but that is a very real and very debilitating disease.

From NIMH » Schizophrenia

Prevalence of Schizophrenia
Precise prevalence estimates of schizophrenia are difficult to obtain due to clinical and methodological factors such as the complexity of schizophrenia diagnosis, its overlap with other disorders, and varying methods for determining diagnoses. Given these complexities, schizophrenia and other psychotic disorders are often combined in prevalence estimation studies. A summary of currently available data is presented here.

Across studies that use household-based survey samples, clinical diagnostic interviews, and medical records, estimates of the prevalence of schizophrenia and related psychotic disorders in the U.S. range between 0.25% and 0.64%.

Estimates of the international prevalence of schizophrenia among non-institutionalized persons is 0.33% to 0.75%.

 

[Roy H.]

A psychologist or a psychiatrist.



It's real. It is included in the "Cluster C" group of personality disorders in DSM5.

See Cluster C and Avoidant Personality Disorder DSM-5 301.82 (F60.6) - Therapedia



From Avoidant Personality Disorder DSM-5 301.82 (F60.6) - Therapedia:



But the fact that is relatively rare doesn't make it "not real" or "trivial". The prevalence of schizophrenia is the general population is even lower but that is a very real and very debilitating disease.

From NIMH » Schizophrenia

This is a little off topic but since we're talking about it I will ask: Is "avoidant personality disorder" a form of schizophrenia?

 

[forgetmenot]

I don't think avoidance personality disorder is a form of schizophrenia . It may be someone with schizophrenia will have trust issues or delusional thoughts that keep them from wanting to be with people but no is is not a form of schizophrenia. It is a diagnosis all of its own i think just my thoughts i am not a doctor.

 

[Daniel E.]

Also, I found this in Wikipedia:

Avoidant personality disorder is reported to be especially prevalent in people with anxiety disorders, although estimates of comorbidity vary widely due to differences in (among others) diagnostic instruments. Research suggests that approximately 10–50% of people who have panic disorder with agoraphobia have avoidant personality disorder, as well as about 20–40% of people who have social anxiety disorder. In addition to this, avoidant personality disorder is more prevalent in persons who have comorbid social anxiety disorder and generalised anxiety disorder than in those who have only one of the aforementioned conditions.

Some studies report prevalence rates of up to 45% among people with generalized anxiety disorder and up to 56% of those with obsessive-compulsive disorder. Posttraumatic stress disorder is also commonly comorbid with avoidant personality disorder.

Avoidants are prone to self-loathing and, in certain cases, self-harm. In particular, avoidants who have comorbid PTSD have the highest rates of engagement in self-harming behavior, outweighing even those with borderline personality disorder (with or without PTSD). Substance use disorders are also common in individuals with AvPD—particularly in regards to alcohol, benzodiazepines and heroin—and may significantly affect a patient's prognosis. Earlier theorists proposed a personality disorder with a combination of features from borderline personality disorder and avoidant personality disorder, called "avoidant-borderline mixed personality" (AvPD/BPD)…


There is also an overlap between avoidant and schizoid personality traits (see schizoid avoidant behavior) and AvPD may have a relationship to the schizophrenia spectrum...


There is controversy as to whether avoidant personality disorder (AvPD) is distinct from generalized social anxiety disorder. Both have similar diagnostic criteria and may share a similar causation, subjective experience, course, treatment and identical underlying personality features, such as shyness.

It is contended by some that they are merely different conceptualisations of the same disorder, where avoidant personality disorder may represent the more severe form. In particular, those with AvPD experience not only more severe social phobia symptoms, but are also more depressed and more functionally impaired than patients with generalized social phobia alone. But they show no differences in social skills or performance on an impromptu speech. Another difference is that social phobia is the fear of social circumstances whereas AvPD is better described as an aversion to intimacy in relationships.


Avoidant personality disorder - Wikipedia

 

[Daniel E.]

For a more general, cross-cultural perspective:

Estimates suggest that nearly half a million Japanese youth have become social recluses.

Hikikomori - Wikipedia

 

[Roy H.]

Also, I found this in Wikipedia:

I actually read that before you posted it (the Wiki link) and saw the correlation in that article, which is why I asked.

 

[Daniel E.]

I really liked the book Shutting Out the Sun: How Japan Created Its Own Lost Generation, though it's been years since I read it. There isn't any mention of schizophrenia or autism. The avoidant behaviors of the young people are mostly seen as from culturally-induced anxiety, including PTSD, as well as familial shame and ignorance.

 

[Roy H.]

I really liked the book Shutting Out the Sun: How Japan Created Its Own Lost Generation, though it's been years since I read it. There isn't any mention of schizophrenia or autism. The avoidant behaviors of the young people are mostly seen as from culturally-induced anxiety, including PTSD, as well as familial shame and ignorance.

I'm afraid to go outside when particular neighbors are out there - even though I like them and want to interact with them.


Going to work around people is painful every day for me - so much so I am thinking about giving up my job, even though I am okay with the job and want to keep it.


Family gatherings are horrific for me...I either am able to medicate with vodka or miss out entirely. I skipped my sister's wedding because I was mortified of seeing all the people and be barraged with staring eyes.


Are those flags, do you think, for APD?

 

[Daniel E.]

My understanding is that there is no red flag per se. Some of my former reclusive behavior still shocks me to this day -- and I just had run-of-the-mill social anxiety (along with OCD and depression).

And honestly, as long as the treatment is the same (e.g. cognitive behavior therapy), then I honestly don't think it matters too much.

I do think it's very important to continue to not give up on looking for affordable therapy. Even one session can inspire hope and provide perspective. I am seeing a therapist now who is an intern. She is great and only charges $25 a session.

In Minneapolis, there is even free therapy (as you probably know): Walk-In

 

[GaryQ]

[MENTION]Roy H[/MENTION],

Have you considered looking into exposure therapy and maybe simply convert all this energy on looking into "HOW" rather than trying to figure out "WHY"?

So many people never find the cause or reason for a specific phobia. Honestly I don't really need to know if watching the gigantic spider scene in the movie The Incredible Shrinking Man (1957) hidden around the corner while my parents were watching it on TV when I was like 3 years old was the trigger (really scared the living daylights out of me) or if I just have a natural plain old case of arachnophobia like so many others have. What will it change knowing why? Nothing at all because the fear is there regardless of whether the cause is known.

Now translate that to your own personal phobias. Theoretically it applies to any phobia.

There a probably a million great articles on Facing your fears since it's a proven and often very effective therapy that also has similar uses with OCD pronlems but this article is interesting because it explains the concept of exposure habituation about all things in general and how it applies to diminishing certain phobias. And the fun thing is this can be done without paying a psychologist or psychiatrist to do it although they might be better at developing an exposure plan.

Overcoming fear: The only way out is through

Good luck and I hope you can find a way to work on your struggle rather than needing to find a scientific name for it. I think you'll have a better chance of success going down this path than the one you are currently on (trying to figure out what it is or causes it, etc.)

 

[Roy H.]

I don't know, it just has always seemed like it was important for me to be able to define it more clearly I think.

 

[GaryQ]

Me too but I finally realized knowing is good but honestly hasn't helped me much with fixing any of my issues anxiety and phobia issues

 

[David Baxter PhD]

This is a little off topic but since we're talking about it I will ask: Is "avoidant personality disorder" a form of schizophrenia?

No.

 

[Daniel E.]

Shame and Avoidant Personality Disorder - Personality Disorders
Allan Schwartz, LCSW, Ph.D.

...The simple fact is that all of us, as members of the human species, have a need to belong. While most of us need to spend some time alone, too much aloneness results in depression. Even those with Avoidant Personality Disorder become depressed if they are alone too much of the time. The healthy need to feel accepted and to belong outweighs the wish to avoid.

In all of the cases of avoidant personality disorder I have treated the individuals were either married or in long term relationships. In addition, most were working or had been working until they were forced to resign as a result of overwhelming anxiety and severe depression. Most of the people I have treated were also extremely bright and had attained high levels of education and professional status. They ran into trouble quickly after they started their careers as a result of the demand put on them to be social in their job or profession. As a result of this trouble, they were forced to seek psychotherapy.

Of the cases of people with Avoidant Personality Disorder, those who were married also ran into difficulty with their spouses. The reasons for the marital difficulties had to do with the fact that the spouse with the personality disorder rarely wanted to go out and socialize. The unwillingness to be in social situations even included going to movies, restaurants, and having friends and family over for social visits.

Treatment

There are a variety of treatments available for Avoidant Personality Disorder. Medication can be useful in reducing anxiety and depression. Among the types of medications used are the anti depressants and/or the anti anxiety drugs. When these symptoms are reduced, individuals with this disorder often find it easier to make use of psychotherapy.

Cognitive-behavioral therapy is most useful with the social phobias and avoidant disorders because the emphasis is on changing thinking patterns as well as modifying behavior. The emphasis is on helping the patient face and become desensitized to the stimuli (social situations) that cause them the most trouble. Behavior modification includes learning the social skills necessary to function in society. Among the skills needed to be developed are: 1. making eye contact with people, 2. learning to greet people with a smile and rehearsing common verbal interactions between people, 3. learning how to be assertive in ways that are appropriate, 4. learning what to say or how to respond in a variety of social situations, and 5. learning and rehearsing how to carry on common everyday conversations with people.

Attending assertive training classes is something which can also be helpful for these individuals, as is group therapy, and learning the social skills necessary to function in society.

 

[Daniel E.]

The Best Ways to Overcome Eye Contact Anxiety

Eye contact anxiety can interfere with everyday social interactions. By the same token, the ability to maintain good eye contact is an important aspect of social interaction. People who look others in the eye are perceived as friendly and welcoming. However, many shy and socially anxious people have difficulty with this part of communication...

If you've not been diagnosed with an anxiety disorder but still find that eye contact makes you anxious, you can build your tolerance by engaging in increasing amounts of eye contact over time. Gradually, it should feel less uncomfortable as you do it more often.

Start small with people who make you feel less anxious, such as a good friend, and work your way up to more anxiety-provoking situations such as holding eye contact with your work supervisor...

A 2017 review published in Current Psychiatry Reports found that social anxiety is related to a mixture of being on guard and avoiding processing emotional social stimuli. This means that at a party, you might both be on the lookout for people who seem to be judging you, but also try to avoid situations in which you feel you are being judged. In addition, the review showed that socially anxious people tend to avoid maintaining eye contact. Again, this is likely due to the fear of being judged.

 

[Roy H.]

Me too but I finally realized knowing is good but honestly hasn't helped me much with fixing any of my issues anxiety and phobia issues

I've walked off jobs (that I actually liked) because of social pressure; I changed my major in college because I was afraid to do an internship for my preferred major; I never went out with my girlfriend back then and no doubt it had an adverse effect on our relationship (which I drank all the way through just to even have said relationship).


And there are countless other painful memories/experiences that have related to this "phobia" or whatever I've been suffering with now for my entire adult like, now 20 years and counting.


I just would like to have a specific label to put on it. Maybe at that point I can better address it before I give up entirely on my situation.

- - - Updated - - -

Shame and Avoidant Personality Disorder - Personality Disorders
Allan Schwartz, LCSW, Ph.D.

...The simple fact is that all of us, as members of the human species, have a need to belong. While most of us need to spend some time alone, too much aloneness results in depression. Even those with Avoidant Personality Disorder become depressed if they are alone too much of the time. The healthy need to feel accepted and to belong outweighs the wish to avoid.

In all of the cases of avoidant personality disorder I have treated the individuals were either married or in long term relationships. In addition, most were working or had been working until they were forced to resign as a result of overwhelming anxiety and severe depression. Most of the people I have treated were also extremely bright and had attained high levels of education and professional status. They ran into trouble quickly after they started their careers as a result of the demand put on them to be social in their job or profession. As a result of this trouble, they were forced to seek psychotherapy.

Of the cases of people with Avoidant Personality Disorder, those who were married also ran into difficulty with their spouses. The reasons for the marital difficulties had to do with the fact that the spouse with the personality disorder rarely wanted to go out and socialize. The unwillingness to be in social situations even included going to movies, restaurants, and having friends and family over for social visits.

Treatment

There are a variety of treatments available for Avoidant Personality Disorder. Medication can be useful in reducing anxiety and depression. Among the types of medications used are the anti depressants and/or the anti anxiety drugs. When these symptoms are reduced, individuals with this disorder often find it easier to make use of psychotherapy.

Cognitive-behavioral therapy is most useful with the social phobias and avoidant disorders because the emphasis is on changing thinking patterns as well as modifying behavior. The emphasis is on helping the patient face and become desensitized to the stimuli (social situations) that cause them the most trouble. Behavior modification includes learning the social skills necessary to function in society. Among the skills needed to be developed are: 1. making eye contact with people, 2. learning to greet people with a smile and rehearsing common verbal interactions between people, 3. learning how to be assertive in ways that are appropriate, 4. learning what to say or how to respond in a variety of social situations, and 5. learning and rehearsing how to carry on common everyday conversations with people.

Attending assertive training classes is something which can also be helpful for these individuals, as is group therapy, and learning the social skills necessary to function in society.

I have an appointment scheduled with addiction-specializing therapist next Thurs, so I will bring this "APD" thing up with them and see what they have to say. I saw a shrink a couple weeks ago and he wanted me to start on Prozac but I am still just taking Neurontin.

- - - Updated - - -

The Best Ways to Overcome Eye Contact Anxiety

Eye contact anxiety can interfere with everyday social interactions. By the same token, the ability to maintain good eye contact is an important aspect of social interaction. People who look others in the eye are perceived as friendly and welcoming. However, many shy and socially anxious people have difficulty with this part of communication...

If you've not been diagnosed with an anxiety disorder but still find that eye contact makes you anxious, you can build your tolerance by engaging in increasing amounts of eye contact over time. Gradually, it should feel less uncomfortable as you do it more often.

Start small with people who make you feel less anxious, such as a good friend, and work your way up to more anxiety-provoking situations such as holding eye contact with your work supervisor...

A 2017 review published in Current Psychiatry Reports found that social anxiety is related to a mixture of being on guard and avoiding processing emotional social stimuli. This means that at a party, you might both be on the lookout for people who seem to be judging you, but also try to avoid situations in which you feel you are being judged. In addition, the review showed that socially anxious people tend to avoid maintaining eye contact. Again, this is likely due to the fear of being judged.

Regarding eye contact, I don't do anything around people anymore. At the job I am doing, I keep sun glasses on at all times. Even indoors. And when around any family or neighbors or any kind of people, I always have to have sun glasses on. Everyone thinks I'm NUTS!

As you can imagine, this is a serious problem. The eye contact thing...that might be more deep than just having this disorder or that disorder and i've brought it up in other threads around here as well.

But it's a very serious problem. I wish it wasn't and people wouldn't think I'm batsh-- crazy, but whether perceived or real, they think I'm very strange for wearing sunglasses all the time, indoors and out.

 

[GaryQ]

Wearing sunglasses when not needed is often associated with substance abusers and the need to try and avoid people noticing it since it’s real easy to see if someone is high by looking them in the eye.

Please don’t take this the wrong way, I’m no mental health expert but it almost sounds like the equivalent of hypochondria but instead of being physical health related it mental health related.

there could be so many possibilities and even overlapping issues that cause your problems. Regardless of the label given the treatment will be based on relieving and correcting the behavior. Contrary to physical problems where each different diagnosis is important and often requires a different treatment.

 

[Roy H.]

Wearing sunglasses when not needed is often associated with substance abusers and the need to try and avoid people noticing it since it’s real easy to see if someone is high by looking them in the eye.

Please don’t take this the wrong way, I’m no mental health expert but it almost sounds like the equivalent of hypochondria but instead of being physical health related it mental health related.

there could be so many possibilities and even overlapping issues that cause your problems. Regardless of the label given the treatment will be based on relieving and correcting the behavior. Contrary to physical problems where each different diagnosis is important and often requires a different treatment.

I'm not really following what you're trying to say here.