“It is very possible to suffer silently with an intense fear of rejection, closeness or social situations but still soldier on, essentially unimpaired on the outside, but miserable on the inside.”
– Jonice Webb (2016)
Avoidant Personality Disorder (AvPD) is described in the DSM-5 as a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluations. However, this goes beyond the idea of being “shy” or “awkward.” Those with AvPD are hesitant to socialize with someone without the certainty that they will be liked. They rarely take personal risks due to a fear of humiliation and are often preoccupied with how others perceive them. People with AvPD crave intimate relationships, acceptance, and socialization.
Although they possess the desire to form connections with other people, they are afraid of being rejected and will withdraw from them as a coping mechanism. Within the relationships that they possess, they will avoid becoming too invested in order to protect themselves from the pain of being rejected and develop attachment anxiety (American Psychiatric Association, 2013). They will even decline therapy due to the possibility of becoming attached to their clinician (Eikenæs, Pedersen, & Wilberd, 2016). The broad range and severity of symptoms distinguished AvPD from other mental illnesses such as social anxiety disorder.
AvPD is considered to have one of the highest degrees of impairment in daily functioning out of the ten diagnosable personality disorders (Weinbrecht et al.,2016). People who possess AvPD are more likely to be less educated—and is the only personality disorder to be statistically associated with lower education—have a smaller support network, and develop high levels of interpersonal and psychiatric symptoms. It has been found to have levels of psychosocial impairment comparable to that of borderline personality disorder, which has been subjected to a high amount clinical research in recent year (Wilberg, 2009). AvPD is present in less than 6% of the general population, but AvPD patients make up almost 15% of psychiatric outpatients. Despite its prevalence and significance, AvPD is among the most misunderstood and under-researched mental illnesses (Zimmerman, 2005).
Trish Poce, who was diagnosed with AvPD, spoke on the show HealthyPlace Mental Health about how her disorder affected her life. She says “I didn’t realize I had a problem. I was just sure I was not able to be like other people around me. I was shy, awkward and felt as though I never really fit in.” Poce had grown up on army bases and moved frequently. When she would arrive at her new home, she would befriend someone. When she moved away, that friendship would end. Poce’s symptoms were ignored by her family due to their belief that she was just “troublesome.” As a result, she went undiagnosed for years. Her disorder affected her mentality and she began to spiral:
“Because I was so socially inept, I made many bad decisions about who was to be my mate. I always picked abusers. This is because, in some way, I was still trying to get the love my parents never gave me. I went through a bout of alcoholism until I ended up in the mental health system about 18 yrs ago, when I attempted my first suicide.”
Following this, psychiatrists diagnosed Poce with AvDP. For the first 10 years, Poce failed to respond to the numerous medications that were being prescribed to her and changed psychiatrists several times. However, she was eventually able to find a psychiatrist who explained the effects of her medication and helped her understand and cope with her internal conflict. He reduced her medications and guided her using dialectical behavior therapy, a cognitive-behavioral psychotherapy that aims to develop mindfulness, interpersonal abilities, distress tolerance, and emotion regulation. From that point, Poce was able to receive proper treatment and improve. She describes her healing process:
“It took 5 years, but I feel my heart has been healed. I am working on accepting the past as it was, I know I can’t change it. I am now in the process of letting the past go and releasing all the demons in my head. I am now ready to continue with the rest of my healing.
At this stage, I am still socially inept. I still fear new situations, mingling with people and I still call myself names. I have problems managing my time, accomplishing tasks I have set out. But I do feel like a whole person now and not some fragmented little church mouse. A butterfly. I have ended the chrysalis stage and now am opening my wings.”
It is difficult to see or notice if someone possesses a mental illness. The willingness to discuss and educate is key to greater awareness of lesser known or more hidden illnesses. Those with avoidant personality disorder are constantly in the shadow and struggle to form connections with people who could potentially help them. In a blog post written by clinical psychologist Dr. Jonice Webb, she had said “Of all of the personality disorders, Avoidant is probably one of the least studied and least talked about. I think that’s probably because avoidant folks are quiet. You shy away from the limelight. You stay out of trouble, you stay out of the way. You don’t make waves. So now, for a change, let’s talk about you.”
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Eikenæs, I., Pedersen, G., & Wilberg, T. (2016). Attachment styles in patients with avoidant personality disorder compared with social phobia. Psychology And Psychotherapy: Theory, Research And Practice, 89(3), 245-260. doi:10.1111/papt.12075
Webb PhD, J. (2016). Does Childhood Emotional Neglect Cause Avoidant Personality Disorder?. Psych Central. Retrieved from http://blogs.psychcentral.com/childhood-neglect/2016/10/does-childhood-emotional-neglect-cause-avoidant-personality-disorder/
Weinbrecht, A., Schulze, L., Boettcher, J., & Renneberg, B. (2016). Avoidant Personality Disorder: a Current Review. Current Psychiatry Reports, (3), 1. doi:10.1007/s11920-016-0665-6
Wilberg, T., Karterud, S., Pedersen, G., & Urnes, Ø. (2009). The impact of avoidant personality disorder on psychosocial impairment is substantial. Nordic Journal Of Psychiatry, 63(5), 390-396.
Zimmerman, M., Rothschild, L., & Chelminski, I. (2005). The prevalence of DSM-IV personality disorders in psychiatric outpatients.The American Journal Of Psychiatry, 162(10), 1911-1918. doi:10.1176/appi.ajp.162.10.1911