Avoidant personality disorder Health Article

Definition

Avoidant personality disorder is one of several personality disorderslisted in the newest edition of the standard reference guide to mental disorders Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM-IV-TR. It is characterized by marked avoidance of both social situations and close interpersonal relationships due to an excessive fear of rejection by others. Persons with this disorder exhibit feelings of inadequacy, low self-esteem, and mistrust toward others.

Description

People who are diagnosed with avoidant personality disorder desire to be in relationships with others but lack the skills and confidence that are necessary in social interactions. In order to protect themselves from anticipated criticism or ridicule, they withdraw from other people. This avoidance of interaction tends to isolate them from meaningful relationships, and serves to reinforce their nervousness and awkwardness in social situations.

The behavior of people with avoidant personality disorder is characterized by social withdrawal, shyness, distrustfulness, and emotional distance. These people tend to be very cautious when they speak, and they convey a general impression of awkwardness in their manner. Most are highly self-conscious and self-critical about their problems relating to others.

Causes

The cause of avoidant personality disorder is not clearly defined, and may be influenced by a combination of social, genetic, and biological factors. Avoidant personality traits typically appear in childhood, with signs of excessive shyness and fear when the child confronts new people and situations. These characteristics are also developmentally appropriate emotions for children, however, and do not necessarily mean that a pattern of avoidant personality disorder will continue into adulthood. When shyness, unfounded fear of rejection, hypersensitivity to criticism, and a pattern of social avoidance persist and intensify through adolescence and young adulthood, a diagnosisof avoidant personality disorder is often indicated.

Many persons diagnosed with avoidant personality disorder have had painful early experiences of chronic parental criticism and rejection. The need to bond with the rejecting parents makes the avoidant person hungry for relationships but their longing gradually develops into a defensive shell of self-protection against repeated parental criticisms. Ridicule or rejection by peers further reinforces the young person's pattern of social withdrawal and contributes to their fear of social contact.

Symptoms

DSM-IV-TRspecifies seven diagnostic criteria for avoidant personality disorder:

• The person avoids occupational activities that require significant interpersonal contact. Job interviews or pro motions may be turned down because the person's own perceptions of his or her abilities do not match the job description.
• The person is reluctant to participate in social involvement without clear assurance that they will be accept ed. People with this disorder assume other people are not safe to trust until proven otherwise. Others must offer repeated support and encouragement in order to persuade them to participate in a social event.
• The person fears being shamed or ridiculed in close relationships. As a result, people with this disorder become overly alert to behavioral cues that may indicate disapproval or rejection. They will flee a situation in which they believe that others might turn against them.
• The person is preoccupied with being criticized or rejected. Much mental and physical energy is spent brooding about and avoiding situations perceived as "dangerous."
• The person is inhibited in unfamiliar social situations due to feelings of inadequacy. Low self-esteem undermines their confidence in meeting and conversing with new acquaintances.
• The person regards him- or herself as socially inept. This self-disparagement is especially apparent when the person must make social contacts with strangers. People with avoidant personality disorder perceive themselves as unappealing or inferior to others.
• The person is reluctant to take social risks, in order to avoid possible humiliation. Avoidant people seek interactions that promise the greatest amount of acceptance while minimizing the likelihood of embarrassment or rejection. They might go to a school dance, for example, but remain in one corner chatting with close friends rather than going out on the dance floor with someone they do not know well.

Demographics

Avoidant personality disorder appears to be as frequent in males as in females. It affects between 0.5% and 1.0% of adults in the general North American population, but it has been diagnosed in approximately 10% of clinical outpatients.