Avoidant Personality Disorder.. What is it? video


In avoidant personality disorder, those affected always feel insecure, inferior, tense, and worried. At the same time, they constantly crave affection and to be accepted by others.

They suffer from constant self-doubt and are overly sensitive to criticism and rejection. Therefore, they often avoid certain situations and activities . They only form close relationships with other people if they are sure they will be accepted.

Unlike most other personality disorders, those who suffer from their behavior often perceive it as a problem.

What is avoidant personality disorder?

Avoidant or avoidant personality disorder (AVPD) is a relatively common disorder that is associated with significant distress, disability, and disability. It is a chronic disorder with an early age of onset and a lifelong impact. However, it is little recognized and little studied.

Avoidant Personality Disorder (AVPD), as conceptualized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is characterized by largely avoiding social interaction driven by fear of rejection and feelings of rejection. personal insufficiency.

Differences with insecure personality

People with an insecure personality style, which can resemble an avoidant personality disorder but less pronounced, are self-critical and tend to be cautious and reserved.

They are sensitive to criticism and rejection and tend to change their own expectations and ideas when other people have different attitudes. Because those affected do not stand out, are trustworthy and try to avoid conflict, they are often recognized by other people.

What are the typical symptoms of an avoidant personality disorder?

According to the DSM, those affected have a deep pattern of social inhibition and a constant feeling of inadequacy and are hypersensitive to negative criticism. At least four of the following criteria must be met:

  • Out of fear of criticism, disapproval or rejection, those affected avoid professional activities that involve closer interpersonal contacts.
  • Unwillingness to get involved with people unless they are sure they will be approved.
  • They are afraid of being embarrassed or ridiculed, they are even averse to intimate relationships.
  • They are deeply affected by the fear of being criticized or rejected in social situations.
  • Due to feelings of their own inadequacy, they become inhibited in new interpersonal situations.
  • They consider themselves socially inappropriate, unattractive, and inferior to other people.
  • They avoid personal risks and new activities because they could be embarrassing.

Differences with social phobia

An avoidant personality disorder resembles social phobia in many ways. However, the main difference is that the symptoms in this case are deeper, last longer and are more likely to be experienced by those affected as part of their personality. The fears are related to a wide variety of social situations, and his self-esteem is very low.

On the other hand, with social phobia, there are fears in some specific situations (for example, fear of speaking in public, insecurity towards strangers). Furthermore, a social phobia can only develop later in life, is less experienced as part of one's own personality, and is often fully treated through therapy.

How common is an avoidant personality disorder?

The frequency with which avoidant personality disorder occurs is around one to two percent of the population. Men and women are probably affected just as often.

Depression or anxiety disorders often occur at the same time as this disorder. In addition, it can also occur frequently together with dependent or borderline personality disorder.

What are the possible causes of avoidant personality disorder?

As with the other personality disorders, an interplay of biological, psychological, and environmental factors is taken into account . Studies suggest that genetically affected people tend to feel restless, tense, nervous, and easily vulnerable. If there are additional negative psychological or social influences, this can promote the development of the disorder.

Psychoanalysis and behavior therapy look at causes in childhood

From the perspective of psychoanalysis, pejorative behavior on the part of parents or a tendency to ridicule their children contributes to the development of the disorder . This behavior means that those affected are constantly undervalued, do not develop self-esteem and tend to have negative and self-critical thoughts.

Cognitive behavioral therapy also sees a cause of the problem in the fact that those affected repeatedly experienced rejection and criticism in their childhood. As a result, they have developed a negative self-image and negative thought patterns about themselves.

For fear of devaluation, from now on they avoid friendships and many types of social contacts. As a result, they develop few social skills, feel inadequate in many situations, and withdraw more and more over time.

Avoidant Personality Disorder Treatment

Understanding attachment difficulties in AVPD seems especially relevant to treatment, and the literature suggests that many of the CBT ( Cognitive Behavioral Therapy Techniques) strategies used for social anxiety disorder may also be helpful. It can also be helpful to focus on self-concept, experiential avoidance, and maladaptive schemas.

Psychotherapeutic approaches

Avoidant personality disorder is primarily treated with psychotherapy, and this can often help those affected. Because many suffer and are aware of their behavior, they are often willing to begin therapy on their own and work to overcome it.

The methods used in therapy are similar to those used to treat social phobia and other anxiety disorders. However, in the case of an avoidant personality disorder, long-term psychotherapy is often necessary to achieve sufficient changes.

Possible problems in psychotherapy and possible solutions

A problem in therapy may be that the patient fears that he or she will not really be liked and accepted or will be rejected by the therapist. Therefore, they often begin to avoid therapy sessions or suspend therapy altogether. Therefore, it is important to establish a good therapeutic relationship in which the therapist behaves in an appreciative, sensitive and supportive way.

It is often more difficult for those with this disorder than for patients with social phobia to take therapeutic measures or initiate changes. They have long expressed fears and doubts about themselves and may not dare to participate in certain methods of therapy.

Therefore, therapy should be carried out in small steps and patients should have enough time to decide on a therapy measure themselves.

Therapy based on deep and psychoanalytic psychology

In the case of an avoidant personality disorder, both long-term psychoanalytic therapy and short-term deep psychological therapy can be used .

It is considered useful if the therapy focuses on the "transference" between the therapist and the patient, that is, if the relationship between the therapist and the patient is used to discover and change typical problems and uncertainties in relationships. Furthermore, the biographical developmental conditions of the disorder can also be processed in the course of therapy.

Cognitive behavioral therapy

Cognitive behavioral therapy is considered the most effective therapeutic approach in treating the disorder. At the beginning of therapy, the patient is first informed about the causes, typical symptoms, and consequences of social fears and self-uncertainty, which is also known as psychoeducation.

An important part of therapy is social skills training. It can strengthen patients' self-confidence and teach them skills that help them cope with different social situations. Specific instructions, behavioral exercises and role-playing games with video feedback are often used for this.

Working through unfavorable thought patterns can help change people's negative views of themselves and their environment.

In doing so, they learn to challenge general negative views (for example, "I can't" or "I'm not attractive" ) and to replace them with more positive and differentiated views. The therapy also works to change the typical everyday problems of the patient.

Patients can also learn to change the physical symptoms of their fear and insecurity , such as sweating or flushing. In paradoxical intervention, they must closely monitor these symptoms and intentionally provoke or increase them further.

In most cases, this leads to habituation and a decrease in anxiety. A confrontation with different situations of anxiety can also help reduce it.

If those affected already feel much more secure and have acquired new social skills, they can be encouraged later in therapy to think about longer-term goals in their lives and ways to achieve them.

Group therapy

In group therapy, patients can practice managing social situations with like-minded people . So social skills training can be done well in a group.

The behavior of other group participants can serve as a model in which patients can learn new behaviors (eg, safer behavior).

In the group they can share their experiences, support each other, and learn to deal with other people's comments and give themselves feedback (for example, praise or constructive criticism).

Psychotropic drug therapy

In some cases, anxiolytic antidepressants are used to accompany psychotherapy. They can help reduce patient anxiety and discomfort. However, the drug alone cannot achieve long-term improvements.

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