Avoidant Personality Disorder

Avoidant Personality Disorder

Avoidant personality disorder is characterized by feelings of extreme social inhibition, inadequacy, and sensitivity to negative criticism and rejection. Yet the symptoms involve more than simply being shy or socially awkward. Avoidant personality disorder causes significant problems that affect the ability to interact with others and maintain relationships in day-to-day life.

Features

 

The essential feature of avoidant personality disorder is a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation that begins by early adulthood and is present in a variety of contexts.

1.     avoid work activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection

2.     avoid making new friends unless they are certain they will be liked and accepted without criticism

3.     act with restraint, have difficulty talking about themselves, and withhold intimate feelings for fear of being exposed, ridiculed, or shamed

4.     As they are preoccupied with being criticized or rejected in social situations, they may have a markedly low threshold for detecting such reactions

5.     are inhibited in new interpersonal situations because they feel inadequate and have low self-esteem

6.     believe themselves to be socially inept, personally unappealing, or inferior to others

7.     They are unusually reluctant to take personal risks or to engage in any new activities because these may prove embarrassing

Symptoms and Diagnosis

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.

Treatment

As with other personality disorders, a mental health professional will design a treatment plan that is appropriate for you. Avoidant personality disorder treatments vary, but they will likely include talk therapy. If a co-existing condition, such as depression or anxiety disorder, is also diagnosed, appropriate medications may also be used.

Borderline Personality Disorder

Borderline Personality Disorder

Borderline personality disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts.

Symptoms

1.     Frantic efforts to avoid real or imagined abandonment

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

4. Impulsivity in at least two areas that are potentially self-damaging

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

6. Affective instability due to a marked reactivity of mood

7. Chronic feelings of emptiness.

8. Inappropriate, intense anger or difficulty controlling anger

9. Transient, stress-related paranoid ideation or severe dissociative symptoms

Features

1.     Individuals with borderline personality disorder make frantic efforts to avoid real or imagined abandonment

2.     Individuals with borderline personality disorder have a pattern of unstable and intense relationships

3.     There may be an identity disturbance characterized by markedly and persistently unstable self-image or sense of self

4.     Individuals with borderline personality disorder display impulsivity in at least two areas that are potentially self-damaging

5.     Individuals with this disorder display recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

6.     Individuals with borderline personality disorder may display affective instability that is due to a marked reactivity of mood

7.     Individuals with borderline personality disorder may be troubled by chronic feelings of emptiness

8.     Individuals with this disorder frequently express inappropriate, intense anger or have difficulty controlling their anger

Treatment

Psychological treatments (talking therapies) are the best way to treat BPD. These treatments usually involve talking with a health professional one-to-one, or sometimes attending special groups. Medication is not recommended as a person’s main treatment for BPD.

Case Study on Social Anxiety

Jack, 28 years old, 10 years in the RAAF as an electronics technician

I reckon I was OK until high school. It was there that I started to get really anxious if I had to do a presentation to the class. I’d worry about it for days and the night before I couldn't sleep. When it came to the presentation, I’d be sweating, blushing, my mouth would go dry…it was like torture. It felt like everyone in the class was laughing at me. Other social situations were really difficult too. Going to parties, chatting up girls… I just　couldn't　do it. I’d stick close to one or two mates, let them do the talking, and just tag along. I've been pretty much the same ever since. When I was doing my tech training in the air force, I’d sit at the back of the class hoping no-one would notice me. If there was any chance I’d have to talk in front of the class, I’d call in sick or make some lame excuse. If it was a party, I’d get blind drunk first (and usually end up making a real dick of myself). I was OK if it was only a couple of mates, but with people I didn't know or large groups, I was cactus. I knew it was stupid and irrational, but that just made it worse. Why couldn't I just pull myself together and be confident like my mates?

Taking action

I was missing out on so much. My career was being affected – I should be a flight sergeant by now, but I never pushed myself forward. My social life was crap, and as for girlfriends… well, that seemed impossible. In the end I decided to bite the bullet. I couldn't face seeing anyone in uniform, so I found a GP in town and made an appointment. I was dead scared when the time came, but I forced myself to go in. The doctor was a woman about the same age as my Mum – I think that made it easier. She asked lots of questions like, did I avoid doing things because of being embarrassed, and did I worry a lot about what people thought of me? Of course, I said yes to all those and she told me I had "social anxiety" or "social phobia". It was a relief to know that it had a name and I wasn't the only person who had these problems. In fact, the doc said it was quite common, which made me feel a bit better. She also said there was a clinic at the university where they treated that kind of thing.
Well, long story short I rolled up to this clinic and they told me that I would go into a treatment group… a group for God’s sake. Didn't they understand that was my worst fear? But when I got there it was nowhere near as bad as I’d expected. Of course, I was terrified before I walked in, but all the others in the group had exactly the same problems as me and I knew they were finding it as hard as me to be there. We had to introduce ourselves and once I’d said something (and the world didn't end!) I felt like maybe I could do this group thing after all. We met every week for 12 weeks. We learnt about social anxiety and what causes it. We learnt ways to calm down physically, like relaxation and breathing. We discovered what a big impact our "self-talk" has on how we feel (I was telling myself how horrible this would be and how I’d look like a complete idiot, so I don’t know why I was surprised when I got anxious). The hardest – but I reckon the most important – part of treatment was the practical stuff. We had pretend meetings and parties, we went out to shopping centres and had to talk to strangers, we had to give talks… all those things I hated. But the more I did – combined with the other stuff we learnt – the easier it got.
Now? Well, I’m not exactly Mr Confident, but I’m a hell of a lot better and I don’t avoid things anymore. Sure, I still get anxious if I have to give a talk, but everyone does. I don’t put myself down. And I’ve met a girl… it’s early days, but we get on really well. I feel like my life is beginning to turn around.

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