Avoidant personality disorder

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Not to be confused with antisocial personality disorder. (Clinically, the term
"antisocial" denotes a disregard for society's norms and rules, not social
inhibition.)

Anxious [avoidant] personality disorder

Classification and external resources

ICD-10 F60.6

ICD-9 301.82

MedlinePlus 000940

eMedicine ped/189

MeSH D010554

Personality
disorders

Cluster A (odd)

Paranoid · Schizoid
Schizotypal

Cluster B (dramatic)

Antisocial · Borderline
 Histrionic · Narcissistic

Cluster C (anxious)

Avoidant · Dependent
Obsessive-compulsive

Not specified

Depressive
Passive–aggressive
Sadistic · Self-defeating

v•d•e

Avoidant personality disorder (AvPD)[1] (or anxious personality disorder)[2] is

a personality disorder recognized in the DSM-IV TR handbook in a person over the
age of eighteen years as characterized by a pervasive pattern of social inhibition,
feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance
of social interaction.
People with AvPD often consider themselves to be socially inept or personally
unappealing, and avoid social interaction for fear of being ridiculed, humiliated,
rejected, or disliked.
AvPD is usually first noticed in early adulthood, and is associated with perceived or
actual rejection by parents or peers during childhood. Whether the feeling of rejection
is due to the extreme interpersonal monitoring attributed to people with the disorder is
still disputed.

Contents
• 1 Signs and symptoms
• 2 Causes
• 3 Diagnosis
○ 3.1 World Health Organization
○ 3.2 Millon's subtypes
○ 3.3 Differential diagnosis
• 4 Treatment
 • 5 Epidemiology
• 6 History
• 7 See also
• 8 References

[edit] Signs and symptoms

People with AvPD are preoccupied with their own shortcomings and form
relationships with others only if they believe they will not be rejected. Loss and
rejection are so painful that these individuals will choose to be lonely rather than risk
trying to connect with others.
• Hypersensitivity to criticism or rejection
• Self-imposed social isolation
• Extreme shyness or anxiety in social situations, though feels a strong desire for
close relationships[3]
• Avoids physical contact because it has been associated with an unpleasant or
painful stimulus
• Avoids interpersonal relationships
• Feelings of inadequacy
• Severe low self-esteem
• Self-loathing
• Mistrust of others
• Emotional distancing related to intimacy
• Highly self-conscious
• Self-critical about their problems relating to others
• Problems in occupational functioning
• Lonely self-perception, although others may find the relationship with them
meaningful
• Feeling inferior to others
• In some more extreme cases — agoraphobia
• Utilizes fantasy as a form of escapism and to interrupt painful thoughts[4]

[edit] Causes
The cause of AvPD is not clearly defined, and may be influenced by a combination of
social, genetic, and psychological factors. The disorder may be related
to temperamental factors that are inherited.[5]Specifically, various anxiety disorders in
childhood and adolescence have been associated with a temperament characterized by
behavioral inhibition, including features of being shy, fearful, and withdrawn in new
situations.[6] These inherited characteristics may give an individual a genetic
predisposition towards AvPD.[7]
Many people diagnosed with AvPD have had painful early experiences of chronic
parental and/or peer-group criticism or rejection. The need to bond with the rejecting
parents or peers makes the person with AvPD hungry for relationships, but their
longing gradually develops into a defensive shell of self-protection against repeated
criticisms.[3]
[edit] Diagnosis
[edit] World Health Organization
The World Health Organization's ICD-10 lists avoidant personality disorder
as (F60.6) Anxious (avoidant) personality disorder.[2]
It is characterized by at least 3 of the following:
1. persistent and pervasive feelings of tension and apprehension;
2. belief that one is socially inept, personally unappealing, or inferior to
others;
3. excessive preoccupation with being criticized or rejected in social
situations;
4. unwillingness to become involved with people unless certain of being
liked;
5. restrictions in lifestyle because of need to have physical security;
6. avoidance of social or occupational activities that involve significant
interpersonal contact because of fear of criticism, disapproval, or
rejection.
Associated features may include hypersensitivity to rejection and criticism.
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also
satisfy a set of general personality disorder criteria.
[edit] Millon's subtypes
Psychologist Theodore Millon identified four subtypes of avoidant personality
disorder.[8][9] Any individual avoidant may exhibit none or one of the following:
• conflicted avoidant - including negativistic (passive-aggressive) features
The conflicted avoidant feels ambivalent towards themselves and others. They
can idealize those close to them but under stress they may feel under-
appreciated or misunderstood and wish to hurt others in revenge.[8] They may
be perceived as petulant or to be sulking.[8]
• hypersensitive avoidant - including paranoid features
 The hypersensitive avoidant experiences paranoia, mistrustfulness and fear, but
to a lesser extent than an individual with paranoid personality disorder.[8] They
may be perceived as petulant or "high-strung".[9]
• phobic avoidant - including dependent features
• self-deserting avoidant - including depressive features
[edit] Differential diagnosis
Research suggests that people with AvPD, in common with sufferers of chronic social
anxiety disorder (also called social phobia), excessively monitor their own internal
reactions when they are involved in social interaction. However, unlike social
phobics, people with AvPD may also excessively monitor the reactions of the people
with whom they are interacting.
The extreme tension created by this monitoring may account for the hesitant speech
and taciturnity of many people with AvPD; they are so preoccupied with monitoring
themselves and others that producing fluent speech is difficult.
AvPD 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 AvPD, as well as about 20–40% of people who have
social phobia (social anxiety disorder).
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.
[10]
Although it is not mentioned in the DSM-IV, earlier theorists have proposed a
personality disorder which has a combination of features from borderline personality
disorder and AvPD, called "avoidant-borderline mixed personality" (AvPD/BPD).[11]
[edit] Treatment
Treatment of AvPD can employ various techniques, such as social skills
training, cognitive therapy, exposure treatment to gradually increase social
contacts, group therapy for practising social skills, and sometimes drug therapy.[12] A
key issue in treatment is gaining and keeping the patient's trust, since people with
AvPD will often start to avoid treatment sessions if they distrust the therapist or fear
rejection. The primary purpose of both individual therapy and social skills group
training is for individuals with AvPD to begin challenging their exaggeratedly
negative beliefs about themselves.[13]
[edit] Epidemiology
According to the DSM-IV-TR, AvPD occurs in approximately 0.5% to 1% of the
general population.[14] It is seen in about 10% of psychiatric outpatients.[15]
[edit] History
The avoidant personality has been described in several sources as far back as the early
1900s, although it was not so named for some time. Swiss psychiatrist Eugen
Bleuler described patients who exhibited signs of AvPD in his 1911 work Dementia
Praecox: Or the Group of Schizophrenias.[16] Avoidant and schizoid patterns were
frequently confused or referred to synonymously until Kretschmer(1921),[17] in
providing the first relatively complete description, developed a distinction.
[edit] See also
• Attachment theory
• Hermit
• Highly sensitive person
• Hikikomori
• Inferiority complex
• Love-shyness
• Recluse
• Solitude
[edit] References
1. ^ Avoidant personality disorder - Diagnostic and Statistical Manual of Mental Disorders Fourth
edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)
2. ^ a b Avoidant personality disorder - International Statistical Classification of Diseases and Related
Health Problems 10th Revision (ICD-10)
3. ^ a b "Avoidant personality disorder". Avoidant personality disorder. Healthline Networks. 2003.
Retrieved 2006-02-26.
4. ^ Understanding Avoidant Personality Disorder, Real Mental Health, Inc.
5. ^ Rettew, David C.; Michael S Jellinek, Alicia C Doyle (March 4, 2008). "Avoidant Personality
Disorder". eMedicine. Retrieved January 26, 2010.
6. ^ "Avoidant Personality Disorder Causes, Frequency, Siblings and Mortality — Morbidity". Avoidant
Personality Disorder. Armenian Medical Network. 2006. Retrieved 2007-02-26.
7. ^ Lenzenweger, Mark F.; John F. Clarkin (2005). Major Theories of Personality Disorder. Guilford
Press. pp. 69. ISBN 1593851081.
8. ^ a b c d Millon, Theodore; Carrie M. Millon, Seth Grossman, Sarah Meagher, Rowena Ramnath
(2004). Personality Disorders in Modern Life. John Wiley and Sons. pp. 194. ISBN 0471237345.
9. ^ a b Millon, Theodore (2006). "Personality Subtypes Summary". The Official Website for Theodore
Millon, Ph.D., D.Sc.. DICANDRIEN, Inc. Retrieved January 23, 2010.
10. ^ Van Velzen, C. J. M. (2002). Social phobia and personality disorders: Comorbidity and treatment
issues. Groningen: University Library Groningen. (online version)
11. ^ Kantor, M. (1993, revised 2003). Distancing: A guide to avoidance and avoidant personality
disorder. Westport, Conn: Praeger Publishers.
12. ^ Comer, R. J. (1996). Fundamentals of abnormal psychology. Avoidant personality disorder, pp.428-
430. Third edition. New York: Worth.
 13. ^ Eckleberry, Sharon C. (2000-03-25). "Dual Diagnosis and the Avoidant Personality Disorder". The
Dual Diagnosis Pages: From Our Desk. Archived from the original on 2006-12-16. Retrieved 2007-
02-06.
14. ^ Webb, James T.; Amend, Edward R.; Webb, Nadia (2005). "Ideational and Anxiety
Disorders". Misdiagnosis and dual diagnoses of gifted children and adults: ADHD, bipolar, OCD,
Asperger's, depression, and other disorders. Great Potential Press, Inc. pp. 112. ISBN 0910707677.
15. ^ Internet Mental Health - avoidant personality disorder
16. ^ Millon, Theodore; Martinez, Alexandra (1995). "Avoidant Personality Disorder". in Livesley, W.
John. The DSM-IV Personality Disorders. Guilford Press. pp. 218. ISBN 0898622573.
17. ^ Kretschmer, Ernst (1921). Körperbau und Charakter. J. Springer.

Psychology portal

DSM personality disorders

Self-defeating (masochistic)

Cluster A (odd)Paranoid · Schizoid · Schizotypal

uster B (dramatic)Antisocial · Borderline · Histrionic · Narcissistic

Cluster C (anxious)Avoidant · Dependent · Obsessive-compulsive

nality disorder not otherwise specified

endix B (proposed)Depressive · Negativistic (passive-aggressive)

v•d•e
ICD-10 personality disorders

Schizotypal Schizotypal

Anankastic · Anxious (avoidant) · Dependent · Dissocial · Emotionally unstable · Histrion

Specific
OtherEccentric · Haltlose type · Immature · Narcissistic · Passive-aggressive · Psychoneur

Unspecified Unspecified

Mixed and
Mixed and other
other
Retrieved from "http://en.wikipedia.org/wiki/Avoidant_personality_disorder"
Categories: Personality disorders
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