When people think of the different types of psychiatric/psychological disorders or use the term mental illness, they often think in terms of someone developing a disorder at a specific point in their life following a relatively normal period of functioning. For example, someone may develop major depressive disorder after a number of difficult experiences with their relationships, or someone may develop an alcohol use disorder after being relatively functional and only a social drinker for a period of time. However, not all of the psychological/psychiatric disorders recognized by the American Psychiatric Association (APA) have identifiable onsets or are considered to be temporary conditions or reactions to certain aspects of living.
Personality disorders are considered to consist of longstanding behaviors and feelings that are in contrast to what society expects from people in terms of their behavior and their responses to the behavior of other people. Behaviors associated with all 10 of the recognized personality disorders are believed to first be expressed in an individual early in their development: either during childhood, adolescence, or young adulthood. These behaviors and reactions are inflexible (do not change in most instances), persistent (occur in a variety of different situations), and typically in contrast to cultural and societal expectations of appropriate behavior in similar situations. For the most part then, individuals who are diagnosed with personality disorders are acting and behaving in accordance with what they perceive as being appropriate, whereas most other individuals in their lives view the actions of these people quite differently. This results in individuals with personality disorders perceiving that everyone else has issues and they are acting appropriately.
Avoidant Personality Disorder
APA currently recognizes 10 different personality disorders in its current edition of the Diagnostic and Statistical Manual of Mental Disorders (the current edition is the DSM-5). Despite quite a bit of controversy and discussion regarding issues with the personality disorders and their diagnostic criteria, the clinical presentation of these disorders as depicted by APA has not changed in several decades. APA had promised to reconceptualize the category for the DSM-5; however, this did not happen in 2013 when the DSM-5 was released. The diagnostic criteria for personality disorders have remained relatively unchanged since the DSM-IV was released in 1994.
All of the different personality disorders have several related diagnostic criteria that define them. APA has grouped the 10 different personality disorders into three specific categories or clusters based on the major feature that the cluster presents. Avoidant personality disorder is classified in the cluster that primarily exhibits anxious or fearful types of behavior: Cluster C personality disorders.
The formal diagnosis of avoidant personality disorder is based on the presence of four out of a possible seven different diagnostic criteria or symptoms. Only an individual who consistently displays four or more of these symptoms could receive a diagnosis of avoidant personality disorder. While the formal diagnostic criteria will not be presented here, a basic description of the diagnostic criteria for avoidant personality disorder follows.
- The overall presentation of individuals with avoidant personality disorder is one where there is a very persistent pattern of being hypersensitive to criticism (real criticism or perceiving that one will be criticized). These individuals believe that they will be negatively evaluated by others in nearly every context and therefore shun any type of interpersonal contact with people, except for people who are well known to them, such as first-degree relatives.
- Individuals with avoidant personality disorder will not get involved with other people, socialize with others, or attend social events unless they are fully convinced that they will not be negatively evaluated by others. The result is that they remain relatively isolated and have very few friends or contacts outside of close family members.
- Individuals with avoidant personality disorder do not attempt to try to engage in new experiences or step outside of extremely familiar routines and boundaries.
- These people tend to have negative views about themselves and their abilities, and may believe themselves to be unappealing to others or even inferior to others. As a result, they will often interpret even benign comments or comments not directed at them as being critical statements.
- They are often perceived as dependent by their close relatives and unwilling to engage in nearly any form of personal autonomy.
- The behaviors displayed by these individuals lead to severe distress or difficulties in the individual’s functioning, such as in their occupation, school performance, personal relationships, etc.
Avoidant personality disorder is much more serious than mere shyness or even other psychological disorders such as social phobia. Shyness is typically a type of characterological trait that will subside when a person becomes familiar with others. Social phobia represents a more circumscribed situation where an individual is extremely fearful of engaging in certain social activities, such as public speaking or eating in public, but not as pervasive and as longstanding as a personality disorder (although there is quite a bit of overlap in the diagnosis of social phobia and avoidant personality disorder). The manifestation of avoidant personality disorder begins early in the person’s life, is extremely resistant to change, and is quite pervasive in all aspects of the person’s life (meaning that they rarely develop more than a few contacts and most of these are close family members).
In order for a formal diagnosis of avoidant personality disorder, the person must fulfill the aforementioned diagnostic criteria, and the individual’s behavior cannot be better explained by another psychological or psychiatric disorder (e.g., social phobia), a medical condition (e.g., a head injury or a developmental disorder), or the use of drugs or medications. In addition, some evidence must be presented that the individual’s behaviors are longstanding and have been observed since adolescence or early adulthood.
Other Descriptive Information about Avoidant Personality Disorder
There are no identified causes for any of the personality disorders. There is most likely an interaction between a strong genetic component and environmental experiences that produce the types of behaviors observed in individuals with all personality disorders. The prevalence in the general population of avoidant personality disorder is reported at 2.4 percent.
Researchers who attempt to understand the subjective experiences of individuals with psychiatric or psychological disorders have identified some of the pervasive cognitions in these individuals. For those with avoidant personality disorder, it is important to understand various specifics about the disorder.
- People with the disorder innately, and often not consciously, avoid processing and even recognizing information that is in conflict with their general viewpoint of the world and themselves. These individuals tend to focus only on information that confirms or is consistent with what they expect to happen or with what they already believe. Information that is in conflict with their viewpoints is often ignored or discounted. For example, if someone with avoidant personality disorder is introduced to a new person who is friendly and complements them, they often will interpret the actions of the other individual as being somehow negative or condescending, and may interpret the compliments as sarcastic remarks.
- In conjunction with the above explanation, people with avoidant personality disorder make a lot of internal self-statements that are absolute in nature and not contingent. For example, self-statements like, “People always view me as inferior,” tend to fuel their perception of the world and their tendency to selectively abstract information that conforms to their belief. Because their beliefs are so ingrained, they engage in self-fulfilling prophecies, such that they act in ways to elicit their own expectations of others.
- The thought processes associated with avoidant personality disorders often involve catastrophizing any interpersonal interaction such that the individual believes that any situation where they are in the presence of or interacting with others will result in a worst-case scenario. There is no middle ground for them.