Avoidant personalty disorder: CRINGES (4 criteria).
C: Certainty (of being liked required before willing to get involved with others)
R: Rejection (or criticism) preoccupies one's thoughts in social situations
I: Intimate relationships (restraint in intimate relationships due to fear of being samed)
N: New interpersonal relationships (is inhibited in)
G: Gets around occupational activity (involing significant interpersonal contact)
E Embarrassment (potential) prevents new activity or taking personal risks
S: Self viewed as unappealing, inept, or inferior





AVOIDANT PERSONALITY DISORDER (APD)


For a number of years there was little distinction between the avoidant personality disorder and the schizoid or dependent personality disorders. However with the modifications included in DSM-IV, the three are now sufficiently differentiated.

Essentially, avoidant patients long for close interpersonal relationships, but fear humiliation, rejection, and embarrassment, and so avoid and distance themselves from others. Schizoid patients have little need or desire for close interpersonal relationships, and so avoid and distance themselves from others. Dependent patients are clinging and submissive because of their excessive need for attachment.

Essentially then, avoidant patients withdraw because of fears of humiliation, embarrassment, and rejection.

This disorder has a relatively low prevalence in the general population (estimated to be between .5 and 1 per cent. In clinical settings, the disorder has been noted in 10 per cent of outpatients. The reason for this discrepancy is that the presence of a personality disorder increases the likelihood (to some degree) of suffering from other psychiatric problems (particularly with APD, depression and anxiety).

Avoidant Personality Disorder can be recognized by the following behavioral and interpersonal style, thinking or cognitive style, and emotional or affective style.

Social withdrawal, shyness, distrustfulness, and aloofness characterize Avoidant patients behavioral style. Their behavior and speech are controlled, and they appear to be apprehensive and awkward. Interpersonally, they are sensitive to rejection. Even though they strongly desire closeness to others, they keep their distance and require unconditional approval before they are willing to "open up" to others. They tend to "test" others to see who can be trusted to like them.

The cognitive style of avoidants can be described as perceptually vigilant. This means that they scan the environment for clues to potential threats or acceptance. Their thoughts are often distracted by their hypersensitivity. They have low self-esteem because of their devaluation of their accomplishments and the overemphasis of their shortcomings.

Their affective or emotional style is marked by a shy and apprehensive quality. Because unconditional acceptance is relatively rare, they routinely experience sadness, loneliness, and tenseness. When more distressed, they will describe feelings of emptiness and depersonalization.

It should be noted that many more people have avoidant styles as opposed to having the personality disorder. The major difference has to do with how seriously an individual's functioning in everyday life is affected. The avoidant personality can be thought of as spanning a continuum from healthy to pathological. The avoidant style is at the healthy end, while the avoidant personality disorder lies at the unhealthy end.

DSM-IV Criteria for Avoidant Personality Disorder (301.82)*

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 settings
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 might prove embarrassing.
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). American Psychiatric Association

The most common syndromes seen with APD include agoraphobia, social phobia (some clinicians see APD as possibly a generalized form of social phobia), generalized anxiety disorder, dysthymia (an emotion of depression), major depressive disorder (the syndrome with all the associated signs and symptoms), hypochondriasis, conversion disorder, dissociative disorder, and schizophrenia.

It is now believed that avoidant personality disorder patients are excellent candidates for treatment (as opposed to some of the other personality disorders - this is probably due to the healthy desire and longing for close relationships). Various psychotherapeutic approaches can be successful, depending on the patients goals, preferences, and psychological mindedness, and the clinician's expertise.

Generally, the goal of therapy is to increase the patients self-esteem and confidence in relationship to others, and to desensitize the individual to the criticism of others. One must beware of the clinician that is overprotective of the patient and holds up progress - this sustains the poor view of self that the patient has come to treatment to remedy. The other clinician to beware is the one who forces the patient to face new situations prematurely, without proper preparation, and who then criticizes the patient for not being "brave" enough.

Until fairly recently, most publications spoke only of psychotherapeutic interventions, and only a few spoke of pharmacological treatments. Some of the problem is that many patients fear medications and their side effects just as they do any other new experience. Nevertheless, recent data indicates that some aspects of extreme social anxiety may be highly drug responsive. Since APD overlaps greatly with generalized social phobia (which is very responsive to MAOIs - a type of antidepressant). There are many documented cases of the successful treatment of APD with MAOIs (such as Parnate, Marplan, and Nardil). The use of Nardil (phenelzine) often shows improvement in specific fears and in confidence and assertiveness in social settings. The best medication intervention should be accompanied by psychotherapeutic methods appropriate to the individual patient. Medications alone will not give the kind of lasting improvement that combined treatment can provide. It is important to remember that medications are not always indicated in every case and that other considerations (such as general physical health, dietary restrictions, etc) matter in determining the need for, and possible efficacy, of medications. Psychotherapy alone works best with the higher functioning APDs, but combined treatment (psychotherapy and medications) seems to provide the best results for moderate and more severely disordered patients.

goodnight, i don't think i've ever read the official diagnosis as stated.  i find that the APD gets triggered, rather than a constant, although once triggered it can last for many many months.  there are times when i feel a little more at ease and can go out into controlled settings (still having strong symptoms, but more like social anxiety).  i'm glad to see a post in here about this little known disorder.  i had been posting under the anxiety room because i didn't realize this was here.

i have tried many different cocktails of medications to no avail.  some which are suppossed to help have actually made it much worse.  therapy doesn't help much either.  i feel helpless when its bad and that the only thing i can do is wait it out at home in my chair (months and months at a time).  my therapist makes me come in to her office though.

Picasso
I'm sure that there will be some meds that might help, I've tried Olanzapine (Zyprexa), Seroquel and finally Risperidone.   The first med made me eat too much, the second I was too sedated and the third is fine.

I can assure you that therapy can help.  I know I've changed over the last 13 months at a Therapeutic Community, its just that talking therapies can take an awful long time and any change is so minute that you maybe can't see the benefits.  However, you may find that folk you haven't seen for a while might notice the change in you.

I don't have APD (at least I think not) but I have been dx with having a Personality Disorder.   Talking therapies are or can be good for these, however, it doesn't always suit everyone.

Perhaps Group Therapy might be better for you! just an idea.

Eileen

shuddering at the idea of group therapy.  
they made me go sometimes when i was inpatient (for anorexia).  it was so hard.  many of the groups i would be forced to go to and then become so overwhelmed i would just cry.  one time, i bolted and the people chased me down which made the fears a zillion times worse.  they let me go back to the main floor but i had to be supervised.  i hate groups.  i feel extremely intimidated.   :blues: it is the absolute worst feeling in the world.  especially the drama or relaxation ones.  eventually i was able to sit through the PTSD one (they forced me to), and right towards the end, was able to speak in it.  

i haven't heard of any of the medications you referred to.  i've been on a bunch of different ones, but most of the time i'm frightened of the medicines.  (that's something i found extremely surprising to read in the original post! i had no idea there was a connection).  i refuse to take many of them, but right now am in agreement with my pysch on zoloft, buspar, heavy klonepin, and ambian.  its suppossed to keep me calm.  lately i've been in my chair for the last month, but am slowly starting to come back around.  my therapist has been challenging me to go on short walks in the sunlight and to not wear clothing that is black or tent-styled.  

What is Risperidone???  

i think APD is much like social anxiety.  that's what i thought i had for years until i heard the diagnosis from my therapist and pysch.  i'm not sure what the real differences are.  i just know what i go through.  sometimes i'm a super slow speaker or cannot speak at all in public, and then sometimes i get so nervous i speak like a half-witted giddy child (that's my interpretation).  most of the time, i am cumbersomely slow, but i do notice that it changes depending on i don't know what.   : its frustrating because i can't always explain myself clearly when i have to talk to people so i just then start sounding like i'm pyscho, so i stop talking mid sentence.  i wish i could talk normal to people but i get so nervous i'm afraid i'll start crying.  

is it really a personality disorder?
what is a personality disorder?  is it genetic?  or from abuse?

personality disorders are a result of childhood experiences, abuse (sexual, physical or emotional) mainly.   Its what makes our personality and that is how we learn to experience the world and our reactions to it.

Some might say that you could have a predisposition to a PD especially as it tends (or can do) run in families.  

as this poem by Philip Larkin says

This Be The Verse

They f**k you up, your mum and dad.
 They may not mean to, but they do.
They fill you with the faults they had
 And add some extra, just for you.

But they were f**ked up in their turn
 By fools in old-style hats and coats,
Who half the time were soppy-stern
 And half at one another's throats.

Man hands on misery to man.
 It deepens like a coastal shelf.
Get out as early as you can,
 And don't have any kids yourself.

that does sound a lot like me
avoidant...
many points in the descriptions fit me.




that could almost have come from me.
me too, shuddering...
and my inpatient's experience with groups was not too well either. (depression; and backache problem, well and they said they could treat depression and ptsd as well)

Picasso may i ask how was your ptsd group? what did you do there, talk about experiences, or about how to cope with the symptoms, or like exercises? was it also about mindfulness (don't know if this is the right word) or with imagination or such?
what made the difference for you, that you could speak there in the end? or compared to the other kinds of groups?



that's like a perfect description of what happens with me too sometimes.

and often i feel like the words just get stuck somewhere in my throat, or somewhere halfway between my thoughts and my trying to express something, and i speak lower and lower till the words somehow fail me. :(

have a look in the medications room or thread.

Risperidone is an atypical antipsychotic.

i'm wondering whether it has always to do with childhood abuse, when you get a PD. or can it also come from "adult experience"?

hmmm... maybe there must be like a PD disposition that comes from childhood experiences to make one cope badly with things that happen later?

yes mynah I'd agreee with that.  PDs usually are formed and emerge by adolescene, late teens.  In fact they say that a diagnoses of PD can't usually be made till the person is an adult.  So perhaps its late teens, early twenties that it is evident.   Our experiences as children will affect how we deal with things as adults.  Thats a given, with anybody, diagnosed with a PD or not.    Look at famous folk in the public eye and how they behave when they are grown up - Prince Harry comes to mind - look at how he dealt with that reporters.   Mmmm a tad over the top there I believe.  But then he might well have a PD, mother had mental health problems, father absent a lot, parents divorced (messily), what kind of adult behaviour has he seen in his life?

firelizardee, i feel what i had wanted to write here was not really under the topic of APD anymore... so i wrote my reply in a new thread:
PTSD and/or PD ??
i hope it's okay this way?

of course it is, you donn't need to ask before starting new threads.   In fact its good that you recognised that it needed a new topic.

Eileen

I've been diagnosed with Borderline traits, although APD traits are there as well, although they've gotten better with age and experience.  I'm still reluctant to try new things, but have learned to force myself.  Once there, I'm okay with talking.  I'd rather talk with new people who don't know me than in a group of people who do know me.  But my life is definitely impacted by fear of making mistakes, fear of what people think of me and I'm definitely over-vigilent and not very trusting of people around me, like co-workers.

This has been a problem since very young childhood, so I think a lot of it is a combination of genetics, being a very sensitive person, and then being raised by an alcoholic mother with no dad around for the most part, and he was both mean and supportive, so that was confusing.  I think my mom has and grandmother had some sort of personality disorder.  All four of us kids is messed up to some degree.  

I don't think this is a curable condition, but it can be made better, especially when started early.  I started therapy in my early 20's after I'd left home, and it sure taught me the difference between the "reality" I thought my family was, and what the world was really about.  I still don't understand the way the "real" world works and maybe never will, but it definitely helps to have a therapist show patients the possibilities and where our ideas are distorted.

I wish the US had therapy communities.  That would be helpful to so many people who instead have to go it alone in therapy.

 WBH

The US does have Therapeutic Communities.  The idea came from a British guy but the AMericans do use it.

There is a Therapeutic Communities of America which do TC's for folk recovering from substance abuse.  Do a search on the internet and you'll find info about it and related TCs.  

I would imagine they'd also do TC type treatment for PDs.  In fact someone who is a member here at DF is going through treatment at a TC type group.  But I forget who it is. Sorry.  

Eileen

I want to add this reply because I'm so shocked by it myself at the difference between where I was two years ago and where I am now with the social avoidance.  

I'm trying new things:  I'm learning to ride a motorcycle (actually, I haven't graduated up to the motorcycle....I'm still on the moped and as my confidence builds, then I'm getting a Rebel (I hope)).  

I'm teaching on a regular basis.  I teach classes on jewelry making.  

From the teaching, I've learned that when I'm in social situations that I must speak in, I can switch into "teacher" mode.  ITS NOT DID.  Its just letting myself speak in the voice of confidence and authority that I use in my teaching.  

Today I'm starting a 4 day art show with my agent and another artist.  I will have to be with the public everyday talking about my art for the next 4 days, from 10 in the am to 8 in the pm.  I will have to close my own sales sometimes (I've always had my agent or galleries do all of my business and all I did was stay in my studio in my pajamas).  

I'm a bit afraid, but I know that once I get out there, I'll just do it.  When I feel myself getting overwhelmed, I'll back down.  I'm taking my knitting with me (Yes, I knit! ) and so I can avoid people by appearing as though I'm busy (one of my specialty avoidant techniques), but I will not use that as a way to avoid people all together.  

My entire team has been amazed at the progress I've made this year on the APD.  All those little steps I felt I could barely take a few years ago have added up to some real progress.  I'm still frightened AND WOULD RATHER stay home and avoid - - but that does nothing for me or my career.  I'm definitely looking forward to being home at night, and then finally on Monday.  

Ugh.  this is going to be hard and long.....but its doable!

i'd like to wish you luck picasso, hope it will go well for you
and a safe return back home.
rachel

picasso I hope it all goes well also.  I sometimes find myself 'acting' confident and not shy but its not really how I feel.  I do remember a friend telling me years ago that I looked and sounded so confident that she was amazed when I told her how I actually felt.  We hide it so well don't we.

Eileen

Well, I've definitely got that. 100%. No one ever even tried to figure it out or label it for me. Great. APD, eh? Yep... tick another one off for me.

This is me too, 100%, I've just discovered. Doc is shifting treatment accordingly next visit. I've been complaining of depression (which I was, before Wellbutrin), and what I called social anxiety in keeping me from going back to work, for which he prescribed prozac and said it would be activating to that end (3 weeks in, so far no help with anxiety at all), but AvPD fits me like my own skin. I never knew there was a name for why I've had NO life in my 31 years, why I've spent most of them alone in a room unable to hold down a job for longer than a few months or a year, why I quit everything and fear everything and analyze everything (especially people, including myself) to the point of exhaustion.

It's shocking to read it all in one summation of a disorder, I never suspected a personality disorder, no one ever told me I wasn't 'normal', I've had a few close friends that said I even had "great" personality, very humorous. Even though I knew I wasn't normal in all the other ways, like relating with the opposite sex, and feeling like a ghost as a kid, I didn't know why, didn't know why I had so much difficulty, for example, just answering simple questions like "hi, how are you?"

I'm in learning mode right now, seeking out information about it, and hopefully learn some new things to cope better being around people, and have a better life than the pain I've experienced to date would suggest for the future. I want more than what I've been limited to having, so I'm starting on this journey.

TO DF -

I just registered today. I happened to see this topic and wondered if it could really be what I thought it was. I have been going through an extremely strange kind of "phase" that, to date, has lasted about 3 1/2 years, and even though I think I have it figured out, I always lose my clarity about what is causing it. But all of the symptoms above are exactly what I display. I have never really heard of this particular disorder before. And, not to be flip, but I truly can't imagine anyone not needing to be sure they are liked before getting involved with someone. That is not normal? Hmmm.... I definitely worry sometimes i am becoming agoraphobic because I have gotten to where I only leave the house for work and to get food. I am not afraid to - I just cannot think of any reason to go outside. This is EXTREMELY unlike me before this "phase" started. Other symptoms are sleeping ALL DAY, absolutely no feelings, no NOTHING. I rarely even cry although it seems like I should be crying - I just have almost no emotion. I have lost all my friends. I don't want to do anything I used to love. I don't even take care of myself. Rare showers, clothes are dirty, apartment is filthy-again, not ANYTHING THE WAY I USED TO BE. I won't go to anything social. I haven't dated for years. Can anyone shed more light or personal experiences?

Thank you so much!


sleepyme

Just seeing this post makes me glad I joined here. This describes me perfectly. I have never even heard of this before. The whole reason I joined was to have interpersonal contact with people who did not judge me, because they were having similar problems.

this is great information.

I have never been diagnosed with this, but I remember reading about avoidant personality disorder in high school psychology and thinking that the description sounded exactly like the way I behave. Especially the whole "testing" thing, which I think I do unconsciously, before I'm even fully aware of what I'm doing.

I do feel like, if I have avoidant personality disorder, it is probably closely allied with my social anxiety. They probably exacerbate each other. Or the social anxiety caused me to become avoidant? I don't know. I'm not sure if I even see the difference in how the two operate, at least in me.

Oh, just as a sidenote, I don't think I exhibit these behaviors as much as I used to.

Even when my anti-depressant doesn't work too well, it at the very least curbs some of the impulses mentioned here.

Angel:

Have you ever discussed the possibility of having APD with your doc?

Out of curiosity, what have you been diagnosed with? You mentioned taking ADs? What are you taking? If it's none of my business, just say, "Bean, it's none of your business." and I'll shut up.


-Bean

No, it's fine. I have been diagnosed with depression and social anxiety. I am currently taking Zoloft, 100 mg. I haven't talked about APD with any of my doctors. I'm thinking of changing therapists, and I also think that I need something different (either in terms of dosage or medication) with my antidepressants, because right now neither of them are working out too well.

Angel:

If your current meds are working, talk to your doc. Don't wait another day. You may be suffering when you don't have to. Tell your doc what is and isn't working, and how you've been feeling lately. Sometimes a dosage change is all it takes.

I took Zoloft about 10 years ago. At 1st it worked great. Then after 6 months or so, it went kaput. Just stopped working for me. My doc switched me over to a couple of meds that left me feeling either manic or like a zombie. The doc ran out of answers.

I found a new doc, who wanted me to try Zoloft again. I did, and experienced the same results. Worked great for 6 months, than nothing. This newer doc switched me over to Effexor. Over time, we added lithium and Wellbutrin. I do take other meds, but it's these 3 that have been Rxd for my anxiety and depression (I'm schizoaffective). I've been taking my current "cocktail" for 8 years now, with excellent results.

Why are you considering switching therapists? I've had many over the years, and must say that if you're not completely comfortable with your therapist, it's time to move on. Only a good relationship will allow for easy communication.

Please keep me posted on everything.


-Bean

I'm just really nervous about approaching the doctor about medication. The whole encounter seems so awkward to me. And I kind of don't want to be on multiple medications . . . it seems like so much.

I've only been seeing the therapist for a little over two months. I keep thinking that I need to give him more time. Besides, I'm never comfortable with anyone. Even with "best friends" I feel uncomfortable, nervous, and awkward. So I'm not sure that having a therapist with whom I'm comfortable is possible.

(((((Angel)))))

It's a difficult thing - becoming comfortable talking to others. I had a very hard time with it. At first, I had to force myself to be honest and open with my docs, esp my therapist. But I realized that I had no choice but to tackle the subject. If I wanted to get better, I had to start talking. Over time, it became easier and easier. Now I can freely discuss my illnesses, meds, etc with just about anyone.

It takes time to reach a certain comfort level. Sometimes it's easiest to write a letter. Hand your doc the note and the beginning of your session, letting it open the door for further discussion.

You really should talk to about meds. Some people (me) need meds as much as therapy. It's hard, I know. Just keep trying. It gets easier.

Remember, Angel, DF is here to support you as you trudge through these hard times.


-Bean