Avoidant Personality Disorder (AVPD) is a common disorder that is related to an immense amount of distress, impairment, and disability. It is characterized as a chronic disorder that begins at an early age and has a life-long impact.
AVPD is under-recognized and not many studies are available despite being a chronic disorder. Also, not much is known about the most effective treatment of AVPD.
Thus, the motivation of research on Avoidant Personality Disorder has its own share of peaks and troughs. This is because there are concerns regarding the difficulty to distinguish it from other disorders. These disorders include Social Anxiety Disorder (SAD), Schizoid Personality Disorder, and Dependent Personality Disorder.
Difference Between AVPD and Social Anxiety Disorder
Further, both AVPD and Social Anxiety Disorder comprise social fears resulting in avoidant behavior, distress, and disability. The current standard supports the “severity-continuum hypothesis” as per which AVPD is considered as a severe variant of Social Anxiety Disorder.
However, there exist a small number of studies proposing the contrary and clinical experience suggesting that AVPD is a distinct disorder.
As per studies, support is found for an alternative to the “severity-continuum hypothesis”. This alternative suggests that both SAD and AVPD share a common focus on interpersonal concerns. However, they are sufficiently distinct from each other that explains retaining them as separate diagnostic categories.
Recent research suggests self-concept, avoidant behavior, early attachments, and attachment styles are the factors that distinguish AVPD from SAD.
Also, there has been a focus on early parenting experiences, temperament, and cognitive processing to understand the phenomena of AVPD.
What is Avoidant Personality Disorder (AVPD)?
As per American Psychological Association, AVPD is a personality disorder. The following are its characteristics:
- Hypersensitivity to criticism and rejection
- A desire for uncritical acceptance
- Social withdrawal in spite of a desire for affection and acceptance
- Low self-esteem
Such a pattern is long-established and severe enough to result in objective distress. In addition to this, it severely impairs one’s ability to work and maintain relationships.
Both the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV-PR) and DSM-V include Avoidance Disorder.
DSM is nothing but a publication issued by the American Psychiatric Association (APA) for the classification of mental disorders. Further, it uses standard criteria and a common language to describe and classify mental disorders.
Theodore Millon was the first to describe the Avoidant Personality Style in 1969. He came up with a Theory of Personality Development based on learned coping patterns. This theory is the Biosocial-Learning Theory.
This theory was based on the grounds that human behavior aims towards achieving positive reinforcement and avoiding punishment. Social learning is not the only factor that determines habitual behavioral responses.
However, many authors today identify the importance of behavioral factors. This is because they consider the dimension of activity or inhibition as an important biobehavioral part of personality.
AVPD As Active Detachment From Others and Hypersensitivity To Others
Millon further claimed that personality differences in individuals occur due to a number of factors. These were as follows:
- Whether individuals were more preoccupied with deriving pleasure or avoiding pain (pleasure-pain)
- If they saw to obtain or avoid these reinforcements majorly within themselves or via others (self-other)
- Whether individuals behaved in an active or passive manner to evoke or avoid any reinforcements (active-passive)
In addition to this, Millon also defined the dimension of ‘self-other as
- Dependent, that is, such individuals, depend on others for pleasure and security or to ward off pain.
- Independent or self-reliant
Likewise, with the ‘pleasure-pain’ dimension, he saw some individuals as detached and relatively unable to experience pleasure. Thus, in this dimension, he included a relative insensitivity to pain but also hypersensitivity.
Using these dimensions, Millon came up with a matrix from which he identified eight different personality types. This is how Millon described AVPD as a personality disorder that involves active detachment from others with hypersensitivity to the pain of rejection.
Thus, Millon identified the essence of Avoidant Personality Disorder as:
- Longing to relate to others
- Frustrated by essential self-doubt and a mistrust of others resulting in an active detached pattern of interpersonal interaction. In other words, actively withdrawing from or avoiding social interaction because of anticipated humiliation or rejection.
- Oversensitivity to social stimuli and hyperactivity to the moods and feelings of others. This takes place especially when there is a critical evaluation or a rejection coming in such a person’s way.
Meaning Of Confrontational
As per APA, a confrontational Method is an approach that targets to alter behavior in people by aggressively urging them to accept their weaknesses and failures. The encounter groups use such methods although in a less aggressive way. They use it in order to increase awareness and change behavior.ts
However, research studies have not supported the effectiveness of confrontational approaches used by therapists.
Socially Inept Definition
Avoidance Disorder constitutes feelings of inadequacy, extreme social inhibition, and sensitivity to negative criticism and rejection.
People with AVPD view themselves as socially inept, inferior, or unappealing relative to others. Socially inept means a person who lacks in skill or the ability to cope with a social set-up.
Such individuals typically suffer from social anxiety, Avoidance Personality Disorder, and have too little social experience.
Thus, you may be socially inept if you:
- Feel nervous socializing with people. Further, you feel like ending conversations around people who are strangers to you instantly.
- Undergo a feeling that people avoid you.
- Often go into regret mode after saying things to people.
- Typically do not understand what to say next and there is a wired silence.
- Seem offensive to people when you joke with them.
A Love Avoidant is a person who typically keeps away from showing his love for his or her partner. In other words, such an individual engages in emotional distancing or emotional unavailability.
This is because the very idea of depending on others gives him distress, anxiety, and discomfort. Such people certainly want to be in a relationship, but experience fear of getting overwhelmed or astray.
Let’s understand the signs that will help you in recognizing the Love Avoidant.
Signs of a Love Avoidant Persons
- Initially appear to be pleasing and attentive but now become cold and distant
- Set obstacles intentionally to avoid being emotionally available to their partner or spouse
- Lack emotional initimacy because they fear being authentic of themselves or vulnerable. This is because they think that being authentic and vulnerable or open about their feelings may create dependency of their partner on them.
- Prioritize other things over relationships like working long hours, spending more time with friends, or getting addicted to someone or something, etc.
- Lack the ability to talk about their feelings as they do not open about both the positive and the negative feelings they go through.
Avoidant Personality Disorder Symptoms
A. Significant Impairments in Personality Functioning Indicated By
1. Impairments in Self-Functioning (a or b):
This includes low self-esteem associated with self-appraisal, socially inept, personally unappealing, or inferior. Such individuals also have excessive feelings of shame or inadequacy.
It includes unrealistic standards for behavior associated with reluctance to pursue goals, take personal risks, or engage in new activities that involve interpersonal contact.
2. Impairments in Interpersonal-Functioning (a or b):
This includes preoccupation with and sensitivity to criticism or rejection. Such sensitivity is associated with distorted interference of others’ perspectives as negative.
It involves reluctance to get involved with people until the patient is certain of being liked. It also includes diminished mutuality within intimate relationships because of the fear of being shamed or ridiculed.
B. Pathological Personality Traits in the Following Areas
1. Detachment Which is Characterized By (a or b):
This includes individuals reserved in social situations and avoiding social contact and activity. It also includes them not initiating social contact.
2. Intimacy Avoidance
Such individuals avoid close or romantic relationships, interpersonal attachments, and intimate sexual relationships.
These individuals also lack enjoyment from, engagement in, or energy for various experiences of life. Further, it also includes lacking the capacity to feel pleasure or take interest in things.
2. Negative Affectivity is Characterized By
The individual experiences intense feelings of nervousness, tenseness, or panic often in reaction to social situations. Further, he worries about the negative effects of past unpleasant experiences and future negative possibilities. Also, he feels apprehensive, fearful, or threatened by uncertainty. Finally, he has fears of embarrassment.
C. Stability and Consistency in Impairment in Personality Functioning and Traits
It is important to note that impairments in personality functioning and an individual’s personality expression are comparatively stable. That is, these are stable over a period of time and also consistent across different situations.
D. Impairment in Personality and Trait Expression Not Considered a Standard For Development
AVPD includes impairments in personality functioning and one’s personality trait expression. Such impairments are not considered normative or evaluative standards for an individual’s developmental stage or socio-cultural environment.
E. Impairment in Personality and Trait Expression Not Only Due to Effects of a Substance or a Medical Condition
Avoidance Disorder includes impairments in personality functioning and one’s personality trait expression. Such impairments are not only due to the physiological effects of substances like a drug or medicine. Or a general medical condition like trauma or a severe headache.
Avoidant Personality Disorder Test
|Avoidant Personality Disorder Test (AVPD)|
|1.||It’s always difficult for me to try out new things or take risks because I might embarrass myself yet again.||Not Me||It Describes Me Somewhat||Definitely Me|
|2.||I wish I had more friends, but I find the thought of opening myself up to new people very frightening.||It’s Not Me||Describes Me Somewhat||It’s Definitely Me|
|3.||One of my very worst fears is being shamed or ridiculed in front of others.||Not Me||It Describes Me Somewhat||Definitely Me|
|4.||I find it hard to talk about my feelings because the other person might make fun of them.||It’s Not Me||Describes Me Somewhat||It’s Definitely Me|
|5.||Then, I try to avoid public spaces or social gatherings out of fear that someone might criticize me.||Not Me||It Describes Me Somewhat||Definitely Me|
|6.||People often tell me I’m way too harsh on myself.||It’s Not Me||Describes Me Somewhat||It’s Definitely Me|
|7.||I withdraw when someone is clearly romantically interested in me, even though on the inside, it is what I really long for.||Not Me||It Describes Me Somewhat||Definitely Me|
|8.||Others probably think I’m awkward, ugly, and/or stupid.||It’s Not Me||Describes Me Somewhat||It’s Definitely Me|
|9.||I am often intensely upset by critical remarks that just don’t seem to bother most people.||Not Me||It Describes Me Somewhat||Definitely Me|
|10.||In a group, I’m afraid to speak up about my ideas or complaints, because other people might ridicule, ignore, or criticize them.||It’s Not Me||Describes Me Somewhat||It’s Definitely Me|
Take this test at idrlabs.com and check for AVPD.
The Avoidant Personality Disorder Treatment
I. Pharmacological Treatment
When it comes to Personality Disorders, there is no approved drug treatment currently. Still, professionals use it off-label in practice for pharmacological treatment.
Typically, pharmacological treatment in personality disorders targets to stabilize disorder symptoms in patients. The medical professionals undertake such treatment to facilitate psychosocial interventions and psychotherapy.
One can apply the same concept to Avoidance Disorder. However, pharmacological treatment of AVPD as the primary or the chief diagnosis with no other comorbidities has not been very well-researched.
The World Federation of Societies of Biological Psychiatry (WFSBP) formulated guidelines and published the same for the treatment of personality disorders.
Many researchers suggest that Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) like Venlaflaxine may be effective in dealing with the biological treatment of AVPD.
II. Psychological Treatment Options For AVPD
Many psychological treatments are in the testing phase to come up with relevant treatments for AVPD.
Some of the psychological treatments tested for treating AVPD in various studies are as follows:
1. Psychodynamic Therapies
Psychodynamic Therapy is a global therapy that focuses on the overall perspective of the patient. This is different from problem-based therapies like CBT. Where Psychodynamic Therapy concentrates on exploring the patient’s urges, desires, and deep-rooted needs. CBT on the other hand targets to reduce or completely eliminate the symptoms of a specific disorder.
Thus, psychodynamic therapy focuses on improving the patient’s self-awareness and making him understand his thoughts, feelings, and beliefs with regard to his past.
So, various psychodynamic interventions have been tested and were deemed to be possibly effective when treating a host of psychiatric disorders.
Since psychodynamic treatments do not target precise diagnosis given their nature, such approaches may act as a limitation when used alone for treating AVPD.
That is why it is suggested to unify psychodynamic treatments. This is to check for the efficiency of the psychodynamic treatment of anxiety disorders including AVPD.
Various options have been suggested by authors for the psychodynamic treatment of AVPD. These include family therapy, brief psychodynamic therapy, etc.
2. Psychological Treatments
The authors have suggested various psychological treatments for AVPD. For instance, as per a research study, patients under the research study were put on 10-week cognitive-behavioral group therapy.
It was evident that the treatment provided better results than non-treatment for patients with AVPD. Some of the techniques used included group discussion, establishing specific goals within the group, clarifying problems and goals, etc. The intent was to identify fears underlying the avoidant pattern, enhancing awareness, and shifting the attention from fear to action.
Likewise, graduated exposure and training of interpersonal skills were also used along with concentrating on intimate relationships.
Similarly, there was a study of the AVPD patients who were randomized to 20-week psychodynamic and cognitive treatment. Patients in the cognitive group showed better results relative to the ones in the psychodynamic group.
However, the benefits of both treatments were maintained even after six months. Likewise, as per another study, brief cognitive therapy too was considered efficient for the treatment of AVPD.
However, the conclusions of this study couldn’t be recognized as the sample contained only two subjects.
Further, there are a few Randomized Controlled Trials (RCTs) that have been published by now on psychodynamically oriented psychotherapies for anxiety disorders.
The available evidence points out that psychodynamically oriented psychotherapies are effective in treating anxiety disorders as a whole.
Research studies have been undertaken where both psychodynamic and cognitive psychotherapies have been used to treat social anxiety, Cluster-C personality disorder, and other personality disorders.
These studies were conducted on patients where AVPD was not a primary diagnosis. It was suggested that both psychodynamic and cognitive treatments cannot be generalized to AVPD. But they are effective in treating this disorder.
3. Schema Therapy
Schema Therapy is used for the treatment of Avoidant Personality Disorder. It’s an integrative approach based on the principles of CBT.
However, it expands to include concepts from other psychotherapies. Schema Therapy helps an individual to alter well-established self-defeating life patterns with the help of cognitive, behavioral, and emotion-focused techniques.
Further, Schema Therapy concentrates on therapeutic relationships, improving the daily functioning of an individual beyond therapy.
Also, it obtains insights from an individual’s early life experiences that resulted in the development of defective schemas to bring about change.
Schema Therapy involves four main concepts. Patients learn about these concepts. These include:
i. Maladaptive Schemas
There are 18 schemas that are maladaptive in nature. These form during childhood and are self-defeating. Further, they represent patterns that keep repeating throughout our lives.
ii. Schema Domains
We see the events of our lives and distort them so as to validate our schemas. These schemas are grouped into five categories or five broad schema domains including:
- Disconnection and rejection
- Impaired autonomy and performance
- Impaired Limits
- Excessive responsibility and standards
- Over vigilance and inhibition
iii. Coping Styles
These refer to the ways individuals make use of to adapt to harmful childhood experiences. For instance, some individuals may give up on their schemas and act as if such schemas are true.
Whereas, others figure out ways to run away from pain. And still, others fight back or overcompensate.
Now, you must understand that these are the ways you have learned as a child to cope with your pain. Thus, it becomes natural to you to continue using such maladaptive coping strategies as an adult.
iv. Schema Modes
Schema Modes are nothing but are time-to-time emotional states and coping reactions that we experience. These maladaptive schema modes get stimulated by events that we are over-sensitive to.
Thus many of the schema modes either lead us to overreact or under-react to given moments or situations. This leads us to behaving in a manner that may both hurt us as well as others.
Social Anxiety Disorder Vs Avoidant Personality Disorder
Both Social Anxiety disorder and AVPD are related to significant distress, impairment, and disability. Further, high levels of the associated distress, depressions, and suicidal thoughts in these disorders impact the community at large.
There is an overlap between Social Anxiety Disorder and AVPD. However, there exist studies and clinical experience which suggest that AVPD is a distinct disorder. Further, it is so far widely under research.
No doubt AVPD and Social Anxiety Disorder share a focus on interpersonal concerns. Yet, there is clinical experience justifying that both are sufficiently distinct. Further, they must be retained as separate diagnostic categories.
The following table shows the key factors that differentiate Social Anxiety Disorder vs Avoidant Personality Disorder.
i. Social Anxiety Disorder
Social Anxiety Disorder, also called Social Phobia, is a common condition and is found in 3% to 8% of the population. Further, it starts at an early age, typically in the teenage years, and has a chronic course.
As per the US Epidemiological Catchment Area (ECA) study, it was found that social phobia is a disorder with the lowest treatment needs being met at only 7.9% of the group.
AVPD is relatively less prevalent and is typically found in 2% of the population. Much like social phobia, it too is chronic and emerges early in life with regards to its onset
2. Better Researched Disorder
i. Social Anxiety Disorder
Social Phobia is studied better relative to AVPD. For instance, it is observed that individuals with Social Phobia have an immense burden of the disease.
This burden is even greater than the one faced in chronic conditions like heart disease and diabetes.
Further, individuals with Social Phobia are unable to achieve their highest occupational potential. Further, they have fewer chances of being in long-term intimate relationships, and typically have less optimal quality of life.
Also, only a few people with social phobia seek treatment. In addition to this, of those who do, very few receive evidence-based treatment.
AVPD or Avoidance Disorder remains poorly researched with its treatment needs yet to be established. This is why there is no data to indicate the percentage of needs unmet in such a condition.
One can say that the treatment needs met in AVPD are close to negligible. This is said based on the severity of the burden of this disease, the impairment associated with AVPD, and avoidance that is so important to this condition.
3. Symptomatic Difference
i. Social Anxiety Disorder
The following are the DSM-V criteria for Social Anxiety Disorder or Social Phobia. This will help in understanding the symptomatic differences between SAD and AVPD.
1. Fear of Possible Scrutiny By Others
This is characterized by fear or anxiety about one or more social situations in which a particular individual is exposed to possible scrutiny by others. For instance, social interactions like having a meeting with unfamiliar people, being observed while eating or drinking, and performing in front of others like giving a speech or a presentation.
In the case of children, this anxiety may be seen in peer settings and not just in interactions with adults. The child has the fear that if he or she acts in a particular way or shows anxiety symptoms, he will be taken negatively by others.
For example, he may be humiliated, embarrassed, or rejected by others. Or his behavior may offend his peers.
2. Fear From Social Events
In such individuals, the social situations always evoke fear or anxiety. In the case of children, such anxiety or fear can be expressed through crying, freezing, clinging, tantrums, shrinking, or failing to speak in social situations.
3. Actual Threat
Such anxiety of fear is not in proportion to the actual threat that the social situation presents.
Individuals having SAD either avoid social events or live with intense fear or anxiety.
This fear, anxiety, and social avoidance results in clinically important distress or impairment in social, occupational, or other important aspects of day-to-day function.
The fear, anxiety, or social avoidance is continuously present and lasts for six months.
Typically, the necessary features of a personality disorder are impairments in personality functioning both self and interpersonal. In addition to this, one needs to have pathological personal traits to be said to be having a personality disorder.
Accordingly, the following criteria should be met to diagnose Avoidant Personality Disorder.
i. Social Phobia
I. Genetic Factors
There are a lot of studies that indicate an important role of genetic factors when it comes to social phobia. As per studies, genetic factors contribute 30% to 60% of the variance in Social Phobia.
However, it is highly possible that a major part of this reflects one or more common genetic risk factors for anxiety and depression. That is, comparatively, a small component of these numbers is specific to social fears.
Further, the genetic component plays a major role in neuroticism. Whereas introversion may not be the result of a genetic risk factor. Rather, some specific risk component may give birth to introversion.
II. Temperamental Factors
In addition to this, temperamental factors like trait anxiety, harm avoidance, and behavioral inhibition emerge to be associated with anxiety disorders including social phobia.
Today, one of the temperamental factors that showcase the highest interest is called “behavioral inhibition to the unfamiliar”. As per studies, Behavioral Inhibition (BI) is identified in infancy. But, it displays itself differently and is activated by different situations at different stages.
For example, some of the earliest triggers for BI include noise. This is where the infant reacts to noise with a surprising response. Likewise, a few years later, BI shows itself by withdrawal from the situation. For example, the child clinging or going closer to the mother when the trigger is a stranger.
Similarly, physiological indicators of such sympathetic arousal have also been seen in children high with Behavioral Inhibition.
While some children may come out of these reactions, there is evidence that children with extreme levels of BI or disinhibition showcase such reactions persistently. That is, they are not able to get rid of such reactions.
Further, such reactions have a connection with psychological problems faced later in life. These include conduct disorders and externalizing in the disinhibited children and anxiety disorders in the inhabited ones.
Additionally, studies suggest that BI is likely to have physical and social fear components. The social fear components may be more persistent and closely related to social phobia later.
On the other hand, physical fear components explain wider associations of BI with other anxiety disorders.
III. Environmental Factors
Environmental Factors have also been suggested to be relevant to diagnose a social phobia. Anxiety Disorders are said to have a connection with anxious attachment and overcontrolling parenting style in general.
However, studies suggest that these play a very limited role accounting for only about 4% of the variance in childhood anxiety. The important point to note here is that Environmental Factors like parenting style is a possible factor of differentiating Social Phobia from AVPD.
However, parenting style may have much greater relevance when it comes to AVPD.
I. Quality and Nature of Parental Relationships
As you know, the psychoanalytic theory that Freud proposed suggests that personality development is critically influenced by childhood experience.
Likewise, various aetiological theories of AVPD are based on factors that operate in early childhood. The most important of all is the child’s relationship with his principal caregivers.
Researchers have given importance to criticism and rejection in the child’s relationship with his parents. However, they have given lesser importance to unavailability and absence.
Many studies also focus on both feared and actual separations from the caregivers. In this, attachment theory is the most common model that researchers cite. This is put forward to explain how such childhood experiences lead to the host of symptoms that have been described as AVPD.
There are other researchers who have simply measured the rate of such experiences without calling on any attachment model.
II. Attachment Theory
One of the prominent aetiological factors of AVPD is the attachment theory. As mentioned above, important features of AVPD include:
- Pre-occupation by rejection and/or humiliation by others
- A personal belief of ineptness and inferiority, and
- Immense avoidance of interpersonal interaction
Now, some of the features of AVPD are common to Social Phobia. Therefore, researchers suggest that the attachment style can be a factor that distinguishes AVPD from SP.
In other words, attachment style is possibly relevant in establishing and maintaining treatment for AVPD. Disturbances of attachment have been highlighted in the causal theories of AVPD.
Many authors have claimed adverse early experiences with parents like criticism or rejection as one of the contributing factors for AVPD.
It is likely that an attachment style, at least in part, may be one of the factors that mediate the causal effects of these childhood adversities.
The fear of rejection in AVPDcomes with underlying negative self-beliefs. This includes one having a self-view of being intrinsically inferior or unappealing.
Low self-esteem may be related to the motivation of avoiding the pain of rejection. It is also possible that self-concept typically is significantly more fragile in AVPD than SP.
This also includes evoking dysfunctional defense strategies leading to distress and disability Thus, attachment difficulties may play a role in having such a fragile self-concept. As a result, it makes attachment style is a factor that causes AVPD.
Attachment Style and AVPD
Maintaining intimate relationships is an important drive for humans. Further, it acts as an important factor in one’s growth, personal happiness, and satisfaction.
Therefore, any hurdle in the way of the formation of such intimate relationships is of immense personal and clinical importance.
Attachment Theory was developed by John Bowlby as a Theory of Personality Development. This theory describes the internalization of a child’s interactions with their principal caregivers.
Such interactions provide children an example of relational and emotional experiences in adulthood. In most basic terms, attachment is described in terms of security vs insecurity.
People who are secure have witnessed a good caregiver and have successfully internalized this experience. This results in a secure, emotionally stable self that has the potential to develop balanced and secured intimate relationships.
Insecure attachment on the other hand may come about when caregivers fail in a variety of ways. This includes their inability to provide a safe, secure, predictable, emotional, and physical environment.
Such an experience makes it necessary for the individual to develop a variety of coping strategies with such relationships.
Further, such strategies when carried forward in adulthood lead to less secure and more problematic relationships.
As per studies, four patterns of attachment have been described. These are explained in the following section.
1. Secure Attachment
Secure Attachment is the ideal attachment style as a part of the attachment theory. As its name suggests, individuals who display Secure Attachment form secure relationships and enjoy stable and loyal connections specifically in their intimate relationships.
The confidence and sense of security have a direct connection with the security and confidence they experience as children with their caregivers.
As children, these individuals may show initial distress when their principal caregiver leaves. However, they are able to calm themselves as they are aware that the caregivers will come back.
They get such confidence based on repetitive demonstrations by parents of being supportive, caring, and responsive to the needs of their child. Such security makes the child unravel the world independently, make social connections with others, and practice self-reliance.
Traits of a Secure Attachment include:
- High self-esteem
- Increased independence
- Ability to easily form social connections with others.
Such traits get carried into adulthood thus leading to trusting and stable relationships.
2. Anxious-Preoccupied Attachment
This is the opposite of secure attachment. Adults with such an attachment style display contrasting behaviors.
As children, they demand a higher level of intimacy and security from their parents. However, as adults, they adopt possessive behaviors that make their partners go away from them.
These attachment styles are seen in individuals who suffer abusive experiences as children. The parents of such children are unpredictable in their behavior, cannot be trusted, and fail to provide security.
The child becomes distressed when the primary caregiver goes away. But, the child is confused when the caregiver comes back.
In other words, the child cannot examine the world independently and is scared of strangers. People with such attachment styles are anxious and have a low self-concept. They experience decreased anxiousness when their partner is next to them. But become anxious when the partner goes away.
They are preoccupied with searching for a secure bond to a degree that they become extremely dependent on their partners. Further, they are doubtful about themselves and showcase a high degree of impulsiveness.
Thus, adults with such an attachment style want fantasy bonds. They do not see themselves as equal to their partners. Further, they always want their partners to save them, solve their problems, and become the fillers of their emotional gap.
3. Dismissive-Avoidant Attachment Style
Dismissive Avoidant is another insecure attachment style. This type of attachment results in unhealthy and disappointing relationships.
It is because Dismissive Avoidant people have high self-worth, give importance to independence, and do not prioritize forming close or intimate relationships.
Now, you may typically see these traits in good light but, the dismissive-avoidant style is maladaptive. This is because such individuals are not assertive about their feelings, drive relationships away, are defensive, and keep themselves away from basic human needs.
Again, such an attachment style comes from a childhood where people exhibit self-confidence and do not desire close relationships.
As per research, parents of Dismissive Avoidant children are distant, hold back affection, and are not responsive to the emotional needs of their children.
Further, Dismissive Avoidant individuals typically get high professional success. Also, traits of independence are self-sufficiency are preferred or admired as against flawed traits of codependency.
They see intimacy as a weakness and use high self-esteem as a cover-up for the belief that he or she is not worthy of love and affection.
In romantic relationships, they seek less emotional intimacy, maintain emotional distance, and have the potentiality to shut off emotionally when their partners are under stress.
4. Fearful-Avoidant Attachment
It is an insecure attachment style where Fearful Avoidant adults show mixed feelings about relationships.
In other words, they are scared of close, intimate connections but at the same time fear rejection and abandonment.
Such adults may showcase anxious-avoidant behavior during childhood. Further, these individuals desire close relationships but lack self-confidence and high self-esteem. This is because they lack in some areas or are flawed in some way. As a result, other people go away from them.
Thus, people with Fearful Avoidant attachment lack self-confidence and carry a negative view of themselves. They think they do not deserve emotional closeness and that they have flaws resulting in rejection and betrayal.
Further, such people are even doubtful about their partners and predict that they will be hurt by their partners. As a result, they find it difficult to express their feelings, are emotionally detached, and find it difficult to give and receive care and affection.
Also, such adults are stuck between two contrasting beliefs. They understand the importance of emotionally close relationships and want such a bond. But, at the same time, they are scared of being hurt by their partners. Therefore, they run away from developing intimate relationships.
III. Cognitive Factors
It has been suggested that children with AVPD may use hypervigilance as a coping strategy with an inaccessible parent. Such hypervigilance can then generalize to other social situations.
Now, you must understand that this may not help much in differentiating social phobia from AVPD. This is because both the disorders showcase hypersensitivity to social triggers.
Many authors propose that continuous or repeated negative interactional experiences with parents may result in negative expectancies in the child. And this may lead the child to use avoidance as an important coping strategy.
From a cognitive perspective, this would represent a cognitive mediational factor that will strengthen avoidance as the coping strategy.
You must note that there is no point of difference that is indicated by this cognitive perspective between AVPD and SP. However, social phobia with its typical onset in adolescence is less likely to have an early pattern of social disturbance. This provides some point of difference between SP and AVPD.
ii. Anxiety-Avoidance Isolation
Likewise, Lafreniere suggested a cycle of anxiety-avoidance-isolation. As per this concept, there is a series of behavioral adaptations to a perceived failure to achieve the basic goal of social affiliation.
Thus, a child who repeatedly fails to accomplish social affiliation becomes anxious about social interaction and begins to avoid it resulting in social isolation.
The child’s failure to achieve social affiliation can be because of the principal caregiver who is inconsistent or high in negative affectivity. Such a behavioral pattern leads the child to greater emotional distress.
iii. Parental Rejection
In addition to this, Millon saw a reduction in self-esteem as an important factor that is an outcome of parental rejection or denigration. As per Millon, infants who encounter emotionally withdrawn parents during the sensory attachment stage may end up with feelings of insecurity and tension.
The Sensory Attachment Stage refers to the first 12 months of an infant’s life. Likewise, if the infants encounter denigration and ridicule during the sensorimotor-autonomy stage, it may severely impact their development of confidence and competence.
The Sensorimotor-Autonomy Stage refers to the period from 12 months to 6 years. Millon further suggested that patterns of social hesitancy and avoidance become evident in early childhood even before the child starts going to school.
IV. Impact of Childhood Experience On Personality Development
According to Stravinski, parents who used guilt and shame to control their child’s behavior may weaken the self-esteem of the child. He and his colleagues identified patients with DSM-III AVPD considered parents as following relative to the normal children.
- Less affectionate
- More rejecting
- Favoring other siblings
- Less tolerant
- Less encouraging of achievement
Thus, AVPD as per studies has been closely associated with a history of neglect. Further, a study in the non-clinical examples has also shown links between AVPD and early caregiver experiences.
Research done using an Early Maladaptive Schema (EMS) paradigm indicated association with maternal overprotection and family sociability. This was mediated in part by an EMS of belief in the need to crush personal needs, wants, and desires.
Such parental behavior was instigated to avoid any negative interpersonal consequences.
Similarly, there have been studies that suggest that children with higher levels of AVPD symptoms were more probable to report higher levels of:
- Childhood emotional abuse
- Sexual abuse
- Parental overprotection
- Lower care
- Childhood teasing
Temperamental factors are also suggested to be important contributors to AVPD. Accordingly, there are a host of theoretical models suggesting the same. These include Cloninger’s Biosocial Model, the Five-Factor Model, and model based on Behavioral Activation System (BAS), and Behavioral Inhibition System (BIS).
There is some evidence for the following factors to be relevant. These include:
- Personality rigidity
- High-harm avoidance
- Low novelty seeking
- An overactive Behavioral Inhibition system
Many authors suggest negative emotionality, behavioral inhibition, and shyness as critical factors for both Social Phobia and AVPD.
As per studies, AVPD relies mainly on the temperamental factor of anhedonic introversion. Whereas, Social Phobia relied heavily on internalizing factors.
Further, as per the biobehavioral factor of approach/avoidance, the avoidant child is low on social approach and high on social avoidance. In one of the studies, the avoidant children had higher scores on measures of depressive symptoms, negative effect, fear of negative evaluation. Further, they had lower scores for positive affect and wellbeing.
Similarly, temperament may also serve as a mediator of the outcome of negative experiences with principal caregivers in early childhood. As per a study, introverted patients with AVPD considered their parents as the ones responsible for shaming and guilt feelings in them and less tolerant.
VI. Genetic Factors
As per a study, there have been genetic influences on SP and AVPD over a period of time. Genetic influences on AVPD were seen to be stable over time. Whereas, genetic risk for Social Phobia varied.
Thus, many authors suggested that the environmental factors contribute to the co-occurrence of AVPD and SP. But, there are distinct factors responsible for Social Phobia and AVPD.
There is a well-established treatment for Social Phobia. The studies show the effectiveness of both Cognitive Behavioral Therapy (CBT) and Pharmacotherapy as a treatment for Social Phobia.
But you must remember that Social Phobia may have a lower pre-post impact compared to other anxiety disorders. However, without treatment, Social Phobia becomes chronic. This is evident in the low natural remission rates in Social Phobia.
Lastly, the chronicity and resistance to treatment of Social Phobia are personality features. These contribute to overlapping with AVPD.
Apart from the case reports available, there is not much research into the treatment of AVPD. Pharmacotherapy is not taken as an effective treatment for a Personality Disorder treatment in general. Also, there are no trials using pharmacotherapy to treat AVPD.
Similarly, there are few studies that suggest psychological treatment effective for treating AVPD. These treatments are as follows:
- Graded Exposure
- Social Skills Training
- Supportive-Expressive Psychotherapy
These treatments have been suggested to be helpful. However, the few studies suggesting these are often limited to Social Phobia with or without AVPD.
Despite some improvement, there were many patients who did not attain normative levels of functioning or showcased only little improvement.
Similarly, a group dynamic therapy program showed more functional improvement rather than a reduction in symptom distress.
Avoidant Personality Disorder Relationships
As discussed above under the DSM-V symptoms for AVPD, an avoidant personality avoids occupational activities involving interpersonal contact. This is because he or she fears criticism, disapproval, or rejection.
Likewise, if you see the other symptoms carefully, you will understand that these can have a severe impact both on the quality as well as the emotional intimacy in a romantic relationship.
This is because a truly intimate connection demands both the partners to be expressive about their feelings and thoughts and be open to showing vulnerability.
Since an avoidant personality holds back being expressive and vulnerable, many relationships stand to suffer. Therefore, if you are in a relationship with an avoidant personality, the experience with your partner is both demanding and emotionally exhausting.
This is because the avoidant personalities have developed a way of life that believes in self-reliance. That is, they are independent individuals who meet their own physical and emotional needs.
Thus, such an approach of being self-reliant makes them feel uneasy and irritated when their partners try to depend on them to meet their emotional needs.
Further, these personalities are reluctant to go through any emotion. Also, they are typically a little self-aware with regards to what emotions they are going through. That’s why the emotions of other people such as their partners are all the more confusing and irritating for Avoidant Personalities.
In other words, the avoidant personalities show resistance and do not want negative emotions. Be it their own emotions or someone else’s.
Outcomes of Negative Emotions Experienced by Anxious Avoidant Personality
When you force an avoidant personality to feel or accept negative emotions, they would typically go into withdrawal or isolation. Further, they would try their level best to detach themselves from their partner and the emotional experiences by:
- Keeping away from getting physically involved with their partner
- Not entering into deep conversations
- Keeping to themselves even when residing in the same apartment with their partner
- Holding back from making any commitments
- Not giving validation or responding to partner’s feelings
- Then, not expressing love
- Not saying I love you
- Ignoring the irritation their partner expresses towards them
Typically, those in a relationship with an avoidant personality find it really challenging to understand their partners. They always remain in a state of confusion in respect of what their avoidant partners need or want to say.
Also Read: Borderline Personality Disorder Test