Avoidant Personality Disorder Historical Developments

Although the term avoidant personality was first used by Millon, several clinical theorists throughout the twentieth century have referred to related personality constructs. Jung, in his 1936 paper on psychological typology, described the "introvert" as having a distinct dislike of society, appearing awkward and inhibited and having feelings of inferiority. He stated that the introvert "has an everlasting fear of making a fool of himself...he is overcritical, pessimistic and worried...never feels accepted." This type of person can have warm relations with other people "only when safety is guaranteed...and consequently the number of friends and acquaintances is very restricted".

Later, Horney described the "interpersonally avoidant" person as one who experiences "intolerable strain" in associating with other people and asserted that "solitude becomes primarily a means of avoiding it". She referred to the general tendency of these persons to "suppress all feeling, even to deny its existence" and also to "never become so attached to anybody or anything so that he [or she] or it become indispensable...but to have nothing matter much".

In her landmark book published in 1950, Neurosis and Human Growth, Horney also described the cognitive stance of the avoidant person:

On little or no provocation he feels that others look down on him, do not take him seriously, do not care for his company, and, in fact, dislike him. His self contempt...makes him...profoundly uncertain about the attitudes of others toward him. Being unable to accept himself as he is, he cannot possibly believe that others, knowing him with all his shortcomings, can accept him in a friendly or appreciative spirit.

Millon's social learning theory of avoidant personality disorder is consistent with psychodynamic object relations theories. He described the "active detached" pattern as representing "fear and mistrust of others." This results in patients' efforts to maintain a "constant vigil lest their impulses and longing for affection result in a repetition of the pain and anguish they have experienced with others previously." He further explained that "they actively withdraw in order to protect themselves. They have the desire to relate, but they have learned it is best to deny these feelings and to keep an interpersonal distance".