Are You Burying Your Head in the Sand?

Do you have difficulty putting yourself out there to connect with other people or experience the world? Have people used the terms shy, timid, and homebody to describe you? Does leaving your living place feel unbearable and overwhelming, making it easier to stay home alone? If so, let’s look deeper into what Avoidant Personality Disorder is to see if it’s time to reach out for support. Personality disorders, in general, can often go misdiagnosed or be underreported, leaving many without the professional support that is needed. It is even more specific to Avoidant Personality Disorder (AvPD) as the avoidant nature of the diagnosis leads to a lack of people seeking treatment, leaving it as the least commonly diagnosed personality disorder and, therefore, the most unresearched. Less than 1.2% of the general population has been diagnosed with this disorder. The objective of this blog will be to describe the symptoms and characteristics of Avoidant Personality Disorder and when/how to reach out for help to engage in treatment.

Characteristics of Avoidant Personality Disorder:

Avoidant Personality Disorder (AvPD) is a cluster C personality disorder. Cluster C constitutes personality disorders associated with anxiety. Other cluster C diagnoses are Obsessive Compulsive Personality Disorder (OCPD) and Dependent Personality Disorders (DPD). A personality disorder, in general, is defined as a person experiencing a pattern of thinking, feeling, and behaving that is highly rigid to the point where it makes their behavior inappropriate to themselves and others. AvPD is prevalent in all genders and backgrounds equally. Core characteristics and traits for people with this diagnosis are timidity, shyness, and a lack of perceived self-resilience. They may appear skittish or fragile, view themselves as inferior, and perceive the world/others as dangerous and scary. As indicated by the name, these perceived fears cause a pattern of avoidance when navigating the world.

At the core of this diagnosis are feelings of inadequacy and intense sensitivity to feedback or evaluation of any kind. There may also be an overwhelming fear of rejection, which may cause a person to avoid any activity or relationship that may open themselves up to these risks. It includes almost all interpersonal interactions and activities that may cause embarrassment, especially anything that may result in risk-taking. There will be a refusal of all activities or connections unless there is the utmost confidence that they will be liked and treated kindly in a safe manner.

Daily, this would make everyday tasks or conversations for someone with AvPD very challenging. Someone may find answering a phone call or scheduling a doctor’s appointment to be an impossible task. The avoidance would be even further exacerbated if there was a risk of confrontation or conflict due to any situation. People with AvPD may find themselves self-isolating from family, friends, school, or work commitments and find it incredibly challenging to leave their house. The thought of trying to make new relationships causes intense anxiety and leads to patterns of loneliness.

Differentiation from other diagnosis:

Since AvPD is not a commonly discussed or diagnosed disorder, it’s essential to differentiate AvPD from other diagnoses, especially those that are driven by anxieties and fears. The most common diagnoses to differentiate are Social Anxiety disorder(SAD) and Schizoid Personality disorder (SPD). Of course, there are often situations where someone may be experiencing multiple co-occurring diagnoses with AvPD, most commonly Generalized Anxiety Disorder (GAD) or other major concerns like self-esteem issues.

Although AvPD and SAD both share common characteristics of avoidance in response to anxious emotions or a fear of a negative outcome, the main qualifying difference is that SAD is specific to an isolated social situation or environment, and there is a general desire to challenge these anxieties and make connections. Whereas with AvPD, it is invasive of all aspects of life, from talking to a coworker to going to the grocery store. In both situations, there is a desire for connection in intimacy, but the fear and anxieties prevent this from happening. Someone seeking treatment for social anxiety disorder would view the therapy process, although potentially uncomfortable, as trying to assist in improving their social situation. Whereas with AvPD, they would presume that the therapist is there to either reassure their concerns or risk endangering them altogether, not help them. It would be much harder for someone with AvPD to see a way out of their circumstance or reach out for support in the first place.

While symptoms of  SPD and AvPD typically lead to avoiding social interaction and situations altogether, SPD is done so with a genuine disinterest in social situations and a lack of desire to have relationships, whereas AvPD is driven by anxiety and fear. People with SPD would be indifferent to care about what other people thought about them, while someone with AvPD would be incredibly sensitive to it. The major difference here is the passive vs active desire to avoid social situations.

Treatment of Avoidant Personality Disorder and when to reach out:

The most common evidence-based form of treatment is psychotherapy in the form of Cognitive Behavioral Therapy (CBT) and psychodynamic theory. CBT can help people with AvPD identify the thought patterns that lead to their anxieties and social deficiencies and eventually challenge them. It is also incredibly important to be sensitive to feelings of shame and engage in treatment plans that will focus on building self-esteem and mastery, as a majority of the symptoms are held up by defense structures rooted in low self-esteem. Some of this work may be explored using psychodynamic therapies to get to the unconscious thoughts and core beliefs that are created by past experiences, which inform the same and low self-esteem.

Reinforcing a support system and including those individuals in the treatment plan is also incredibly important. This may include group therapies or family therapy so that the individual is aware that there are people who they can rely on and who are willing to help them navigate this process.

From a pharmaceutical standpoint, there is no known proven medication that can treat AvPD; however, like many other personality disorders, there can be success in trying to treat the individual symptoms of the diagnosis. As an anxiety-related personality disorder, there may be success in medication similar to other anxiety disorders, and this should be discussed with a psychiatrist as part of the treatment plan.

If the symptoms and experiences described in this blog resonate with you, it may be time to reach out to a mental health professional to start the therapeutic process. Engaging with a mental health clinician with whom you are open to developing a therapeutic relationship can be significant, as that will be the backbone of your work. Reaching out for help may be the opposite thing that you want to do given the avoidant nature of the symptoms you are experiencing, but identifying that thought process is the first step, and recognizing that support may help ease the symptoms instead of solidifying the rigid emotions and behavior of the personality disorder.

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