Avoidant Personality Disorder

Avoidant personality disorder belongs to Cluster C, which includes dependent personality disorder and obsessive-compulsive personality disorder. These disorders are characterized by fear and anxiety. People with avoidant personality disorder with a chronic tendency have extremely low self-esteem, fear of being rejected by others, and fear of negative judgments by others. Because of this, they prefer to be alone over the risk of rejection they will experience. Eventually, people with this disorder experience limitations in social interaction. In Korea, about 10-20% of the total population has various personality disorders. About 1% of them have a severe personality disorder. Unfortunately, there are no accurate statistics on how many people have an avoidant personality disorder. In general, it is said that about 0.5% to 1% of the general population has an avoidant personality disorder. In particular, 50% of people diagnosed with panic disorder with agoraphobia and about 40% of people diagnosed with social phobia or social anxiety disorder have an avoidant personality disorder. An avoidant personality disorder is known to affect both men and women equally. A combination of genetic and environmental factors is said to influence the development of the disorder.

 

Criteria for Diagnosis of Avoidant Personality Disorder by DSM-5:

Diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) of the American Psychiatric Association

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative

evaluation, beginning by early adulthood and present in a variety of contexts, as indicated

by four (or more) of the following:

1. Avoids occupational activities that involve significant interpersonal contact because of

fears of criticism, disapproval, or rejection.

2. Is unwilling to get involved with people unless certain of being liked.

3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.

4. Is preoccupied with being criticized or rejected in social situations.

5. Is inhibited in new interpersonal situations because of feelings of inadequacy.

6. Views self as socially inept, personally unappealing, or inferior to others.

7. Is unusually reluctant to take personal risks or to engage in any new activities because

they may prove embarrassing.

 

Symptoms of Avoidant Personality Disorder:

This disorder is usually diagnosed in adults 18 years of age or older. As with other disorders, symptoms of avoidant personality disorder can be found already in childhood, and in some cases, symptoms can be found in children younger than 2 years of age. Therefore, they often begin to cause discomfort in adolescence or early adulthood. Shyness, social isolation, and avoidance of strangers and new places are recurrent behaviors that begin in childhood and develop into typical patterns as they age. In other words, when the symptoms of avoidant personality disorder do not disappear easily over time and are continuously maintained, this disorder can be diagnosed. Therefore, this disorder is not diagnosed in persons younger than 18 years of age. People with this disorder find it awkward and difficult to stand in front of others, and they tend to be extremely sensitive and afraid of criticism or approval from others. They may have a strong fear of rejection by others and may tend to avoid social interactions altogether. People with avoidant personality disorder choose isolation over the risk of being rejected by others because their fear of rejection by others is so strong.

Identifying avoidant personality disorder and social anxiety disorder is not the correct way to understand avoidant personality disorder. Avoidant Personality Disorder refers to experiencing anxiety in all areas of an individual's broader life, including social anxiety disorder. Therefore, it is common for people with an avoidant personality disorder to be exposed to social anxiety disorder, obsessive-compulsive personality disorder, and depression, and other anxiety disorders.

 

Causes of Avoidant Personality Disorder:

The exact cause of avoidant personality disorder is unknown. Studies have shown that childhood life circumstances, in general, have a significant impact on the development of this disorder. In other words, children who are to be diagnosed with avoidant personality disorder as adults show symptoms similar to those of avoidant personality disorder in their interactions with their parents from an early age. Children who were abused or neglected by their parents when they were young are also more likely to be diagnosed with avoidant personality disorder when they grow up. In particular, it is said that adopted children are exposed to this disorder at a double rate.

In particular, it is known that personality disorders are heavily influenced by genetics. According to the results of a family and twin study, the heritability of avoidant personality disorder is 28%, a dependent personality disorder is 57%, and the heritability of obsessive-compulsive personality disorder is 77%. Introversion and COMT gene mutations are also known as genetic risk factors for avoidant personality disorder.

Treatment of Avoidant Personality Disorder:

Because people with avoidant personality disorder have deep-rooted negative thinking and behavior patterns that have been around for many years, it is difficult to easily treat the symptoms. However, they understand the severe pain of this disorder and tend to want the relationship to develop. Therefore, they participate positively in psychotherapy. Psychotherapy may be considered primarily for the treatment of avoidant personality disorder, and it is considered to be more successful than drug treatment. Cognitive-behavioral therapy is particularly helpful for people with this disorder, focusing on helping them overcome fears, change their thinking processes and behaviors, and better cope with social situations. However, to alleviate the side effects of this disorder that may occur as a result of loneliness, medications may be considered to help them cope with their fear of rejection and their sensitivity to rejection. In other words, if certain symptoms such as depression or anxiety occur, medication can be considered to treat them. For the best results, psychotherapy and drug treatment should be combined, and it can be said that the effect is greater when the participation and support of family members is added.

 

As a counselor, I have never met a client who visited a counseling center with an only avoidant personality disorder. In general, it is common to find the tendency of avoidant personality disorder during conversations with clients who complain of social phobia, anxiety, and depression. The important characteristic they show is the self-defense mechanism they express. Many, if not all, negatively describe the people or circumstances they have a relationship with for a variety of reasons. And based on this, they often claim the justification of not wanting to have a relationship with them. In the end, it can be said that their typical appearance is low self-esteem and strong self-respect. Perhaps it can be said that they choose this method as a means of living. However, in many cases, I find myself with low self-esteem and too high self-respect in my daily life. This is because I can get out of that situation without getting hurt. I discover my own crude way to hide the shame or frustration that I feel. To a certain extent, asserting self-respect is one of the ways to protect me. However, if it goes up too much, I think it's a narcissistic personality disorder, and if it goes down too much, it's an avoidant personality disorder. And in this passage, I think that a mature image that can naturally accept, acknowledge, and express our own strengths and weaknesses is the direction we should aim for.