Avoidence Symptoms

Mark Dombeck, Ph.D. Updated: Oct 25th 2005

This disorder is characterized by a long-standing and complex pattern of feelings of inadequacy, extreme sensitivity to what other people think about them, and social inhibition. It typically manifests itself by early adulthood and includes a majority of the following symptoms:

    * 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 risks or to engage in any new activities because they may prove embarrassing

Avoidence Treatment

Cynthia Levin, Psy.D. Updated: Oct 25th 2005

Personality disorders are typically some of the most challenging mental disorders to treat, since they are, by definition, an integral part of what defines an individual and their self-perceptions. Treatment most often focuses on increasing coping skills and interpersonal relationship skills through psychotherapy.

Psychotherapy

As with most personality disorders, the treatment of choice is psychotherapy. While individual therapy is usually the preferred modality, group therapy can be useful if the client can agree to attend enough sessions. Because of the basic components of this disorder, though, it is often difficult to have the individual attend group therapy early on in the therapeutic process. It is a modality to consider as the patient approaches termination of individual treatment, if additional therapy seems necessary and beneficial to the client.

Individuals who suffer from this disorder typically have poor self-esteem and issues surrounding any type of social interactions. They often see only the negative in life and have difficulty in looking at situations and interactions in an objective manner. This can also interfere with their self-report when they present for an initial evaluation, which can lead to important life history and medical information being missed (because the patient deems it and him or herself too unimportant to bother). It is necessary to take a more detailed evaluation than usual, while doing so in a relatively unobtrusive fashion. The clinician should be sensitive to nonverbal cues of the client during this session, to evaluate when information is being withheld. This is essential to making a differential diagnosis with similar-looking but vitally different disorders, such as someone who suffers from schizoid or borderline personality disorder. As with other personality disorders, the individual is not likely to present him or herself to therapy unless something has gone wrong in their life with which their dysfunctional personality style cannot adequately cope. As with other personality disorders, psychotherapy is usually most effective when it is relatively short-term and oriented toward finding solutions to specific life problems. While self-esteem issues will undoubtedly present themselves in treatment, serious self-enhancement is unlikely. The negative self-valuation is a life-long, pervasive cognition not conducive to regular methods of increasing one's self-esteem. As with all therapy, a solid therapeutic relationship founded with good rapport and listening to the client is important to the therapist's effectiveness. The therapeutic relationship in itself is used as a place where the client learns how to feel comfortable and safe in other social relationships. Forming initial rapport is likely to be more difficult with someone who has this disorder, since early termination is often an issue. Once rapport is formed, though, therapy is usually quite stable, unless issues are brought up that are extremely difficult for the client to deal with. Therefore, care should be used by the clinician in exploring new material during the session.

Termination of therapy is an important issue as well because a successful ending to therapy and the therapeutic relationship reinforces the possibility of new relationships.

Medications

As with all personality disorders medications should only be prescribed for specific and acute Axis I diagnoses or problems suffered by the individual. Anti-anxiety agents and antidepressants should be prescribed only when there is a clear Axis I diagnosis in conjunction with the personality disorder. Physicians should resist the temptation to over-prescribe to someone with this disorder, because they often present with complaints of anxiety in social situations or a feeling of disconnectedness with their feelings. The anxiety in this instance is clearly situationally related and medication may actually interfere with effective psychotherapeutic treatment.

Self-Help

There are not any self-help support groups or communities that we are aware of that would be conducive to someone suffering from this disorder. Such approaches would likely not be very effective because a person with this disorder is likely to avoid attending such sessions, due to increased anxiety and difficulty interacting socially.

However, learning relaxation and stress management techniques, especially stress inoculation techniques would be helpful for someone with Avoidant personality disorder. By learning relaxation and other stress reducing tools, the person is more able to cope during times of stress and manage one's own anxiety levels.

References:
Portions are from Internet Mental Health, by Phillip W. Long, M.D.