Avoidant Personality Disorder Introduction Causes Diagnostic Guidelines ICD-10 Criteria Diagnostic criteria (DSM-IV-TR) Differential Diagnosis Frequency Siblings Mortality / Morbidity Complications Prognosis Associated Features Relationships Employment Memory Historical Developments Review of Empirical Literature Studies Treatment Recommendations L Cognitive and Behavior Therapies L Psychodynamic Therapy L Interpersonal Therapy L Psychopharmacological Treatment L Group Therapy L Family Therapy L Medications Conclusions References

Avoidant Personality Disorder Complications, Prognosis, Associated Features and Relationships

Complications

• Social phobia
• Major depression
• Substance abuse
• Long-term difficulties in social and occupational functioning

Prognosis

• No long-term studies of children and adolescents with avoidant personality disorder are available.
• Social anxiety often precedes the onset of adolescent depression and alcohol abuse.
• Onset of social phobia in a child younger than 11 years can be associated with continued symptoms into adulthood.
• Examinations of adults with APD indicate that childhood lack of involvement with peers and failure to engage in structured activities may persist through adolescence and adulthood.
• Children aged 2 years described as being very fearful and withdrawn in new situations were found to have higher levels of social anxiety in adolescence.

Associated Features

• Depressed Mood
• Anxious/Fearful/Dependent Personality

Relationships

Individuals with AvPD are "lonely loners." They would like to be involved in relationships but cannot tolerate the feelings they get around other people. They feel unacceptable, incapable of being loved, and unable to change. Because they retreat from others in anticipation of rejection, they lead socially impoverished lives.

They have immature and unrealistic expectations of relationships; they believe that they can have no imperfections if they are to be accepted and loved. Interpersonally, they are ill at ease, awkward and tense. They experience unremitting self-consciousness, self-contempt and anger toward others (Oldham, 1990, pp. 188-193).

Individuals with AvPD will develop intimacy with people who are experienced as safe. Nevertheless, they will often engage in triangular marital or quasi-marital relationships which provide intimacy while maintaining interpersonal distance. These individuals like to foster secret liaisons as a "fall-back" position in case the key relationship does not work out (Benjamin, 1983, pp. 307-308). As sexual partners and parents, people with AvPD appear self-involved and uncaring (Kantor, 1992, p. 109) as they preserve distance from others through defensive restraint and withdrawal. Even so, these individuals long for affection and fantasize about idealized relationships (DSM-IV, 1994, p. 663).

Employment

Avoidant Personality Disorder does not generaly impact on an individuals intellectual or physical capacities. In 'safe' familiar situations they will generally demonstrate no symptoms.

Job seeking can be very challenging because it triggers the individuals basic concerns. The individual will often have a great deal of difficulty effectively presenting their skills and qualifications. They will be awkward and uncomfortable in a job interview. An employer could easily discount the individuals abilities because of the manner in which they present themselves.

In employment they may have a great deal of trouble in new or changing situations. They will have trouble with interpersonal relationships and public speaking. They will tend to be perfectionists but downplay their skills, abilities and accomplishments. They will have a great deal of difficulty with any job that requires them to "sell" or even present their work to a potential customer, or even other co-workers.

Since their standard practice is to avoid situations that elicit their anxiety, they may just not attend important meetings, or be unable to participate in team discussions because they cannot allow themselves to feel part of a team.

Memory

Avoidants often report having a poor memory particularly for peoples names.

An emerging literature has begun to document the cognitive consequences of emotion regulation. A process model of emotion suggests that expressive suppression (conscious efforts to inhibit overt emotion-expressive behavior), should reduce memory for emotional events. Results from recent studies have supported this.

Since people with APD are consistantly tense & anxious and exposed to emotion-eliciting situations but may exhibit little affect due to the fear that showing their emotions will make them vulnerable to rejection or humiliation (Kantor; Millon & Everly), it is likely that emotion-expressive suppression is an almost constant feature.

The literature on social phobia suggests that the phobics are unable to socialy interact because they are so focussed on their internal reactions. Research on avoidant personality disorder also emphasizes that avoidants are engaged in external monitoring of the other person's reactions as well.

The excessive monitoring by avoidants together with rigorous expressive suppression may use up a large portion of finite psychological resources resulting in a decrease of memory for the details of the unfolding emotion-eliciting situation.