Personality Disorders 102: Avoidant PD

Today, we move on to the Cluster C personality disorders. These are otherwise known as the anxious or fearful cluster, as anxiety is a major part of the illnesses in this cluster. This week’s topic is Avoidant Personality Disorder.

People who shied away from most social contact, and didn’t really get involved with people or activities, were first picked up on by Bleuler (a Swiss psychiatrist who was the first person to study schizophrenia), in 1911, and linked with schizophrenic symptoms. Ten years later, Kretchsmer separated the two and declared the avoidant symptoms a separate diagnosis.

The DSM describes AvPD as : a widespread pattern of inhibition around people, feeling inadequate and being very sensitive to being evaluated negatively, since early adulthood and occurring in a range of situations. In addition, four of seven specific criteria should be met, which are:

  • Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
  • Is unwilling to get involved with people unless certain of being liked
  • Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
  • Is preoccupied with being criticized or rejected in social situations.
  • Is inhibited in new interpersonal situations because of feelings of inadequacy
  • Views self as socially inept, personally unappealing, or inferior to others
  • Is unusually reluctant to take personal risk or to engage in any new activities because they may prove embarrassing

AVPD is strongly linked to anxiety, and is present in 45% of people diagnosed with Generalised Anxiety Disorder (GAD). Approximately 2.3% of people in America (data is patchy for other countries) have been diagnosed with AVPD. While more people may fit the criteria, they are unlikely to be noticed due to not getting into trouble.Often, symptoms which happen as a result, such as depression over their condition, or the anxiety that causes the AVPD symptoms, will be identified and treated without acknowledging the actual AVPD symptoms.

My media example of AVPD is Shinji Ikari, from the anime Neon Genesis Evangelion. The series is about teenagers forced to take on the role of combat pilots, controlling semi-sentient robots called EVAs, but goes beyond this to also be very psychological and focused on the effects of fighting on the characters.

While the typical anime hero is loud, brash, confident to a fault and very focused on others, Shinji is a deconstruction of this personality: he is described as “shrinking from human contact”, has incredibly low self-worth, and expects to be seen negatively.

The causes of AvPD are not fully decided, but it is thought that upbringing plays a part, with bullying and peer group rejection often found in the histories of people with AvPD.

Social skills/awareness training, and sometimes Group therapy, can be used in order to get the person with AvPD to realise which social behaviours are useful and which are a result of their anxiety, and to gain practice in socialising. Only co-occurring symptoms such as depression and anxiety are medicated.

Psychological Criticisms of AVPD

The symptoms of AVPD appear similar to the symptoms of Social Anxiety Disorder (otherwise known as Social Phobia), as both include extreme shyness, social withdrawal, and feeling socially inept, among other things.  The main difference between the two is their prevalence; SP is found in about 7% of Americans in any given year.

It’s not clear whether AvPD and SP are separate disorders,  or whether AVPD could a more severe form of SP. AVPD, in theory, could be the result of social phobia affecting a person’s life enough that they also meet the general personality disorder criteria. However, this would be difficult to study in more detail, due to the difficulties in obtaining information and data from people with SP or AVPD.

Critics of psychiatry often claim that SP, and sometimes AVPD, are simply the medicalisation of shyness and introversion- that people are labelled “impaired” purely because they are different. While there are elements of truth in this, this ignores the negative effects of AVPD in terms of potential…. while someone with AVPD is unlikely to ever end up in a psychiatric unit or a prison, they are also unlikely to reach their full potential as they will believe themselves too inept to ever reach it. The main difficultly with treating and finding AVPD is often simply that people with it tend to “slip through the cracks” of the diagnostic system.

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