Avoidant personality disorder: a person who fears rejection

Avoidant personality disorder is one type of personality disorders, characterized by obvious avoidance for social situations as well as not forming any close interpersonal relationships. This is because of these people have an excessive fear for rejections by others. Persons with this disorder exhibit feelings of inadequacy, low self-esteem, and mistrust toward others.

Description

People who are diagnosed with avoidant personality disorder desire to be in relationships with others but lack the skills and confidence that are necessary in social interactions. They fear criticism, and in order to protect themselves from anticipated criticisms or ridicules, they have tendency of being withdrawn from people. Such avoidance of interactions has a propensity to isolate patients from any kind of forming of meaningful relationships, and which in turn also serves to reinforce their nervousness and facing of awkwardness in the social situations.

The behavior of individuals having avoidant personality disorder is characterized by:

• Social withdrawal
• Shyness
• Distrustfulness
• Emotional distance
• Tends to be very cautious while they speak
• Convey general impression of awkwardness in their own manner
• Most people are highly self-conscious/ self-critical about their having of problems in relating to others.

Causes of Avoidant Personality Disorder

The causes of avoidant personality disorder have not been clearly defined, but are influenced by combinations of:

• Social factors
• Genetic factors
• Biological factors

Avoidant personality- traits usually appear in childhood, which can be observed in signs of excessive shyness and feeling of fear when child confronts with new people and even in new situations. The above traits are also developmental appropriated emotions for any children, however, and don’t automatically mean that pattern of the avoidant personality disorder shall continue into the adulthood.

If shyness, tenuous fear of rejections, hypersensitivity to criticisms, and patterns of social avoidance is persisting and also intensify in the course of adolescence and in young adulthood, a diagnosis is of avoidant personality disorder is indicated.

The causes that are correlated with persons diagnosed with the avoidant personality disorder are that person has experienced painful early occurrence of chronic parental criticisms and rejections. The initial need of bonding with rejecting parents in turns makes avoidant individual hungry for relationship but this longing gradually then develops into defensive shell for self-protection against the repeated and chronic parental criticisms. Also it’s been observed when there is ridicule/rejection by the peers; it further reinforces person’s patterns of social withdrawal as well as it contributes in their fears of social contacting.

Symptoms of Avoidant Personality disorder

DSM-IV-TR has specified seven diagnostic-criteria:

• The individual avoids occupations and activities requiring major interpersonal contact. Example Job interviews/ promotions cay be turned down, coz the individual’s own perceptions of abilities don’t match job description.
• The person is disinclined to participating in social involvement without some clear assurance them being accepted.
• People with disorder assume that other people are not to be trusted or safe until they have proven otherwise. They need repeated supports and encouragements in order to convince them in participating in social events.
• The person often fears of being shamed/ridiculed in close-relationships. Because of this they are so overly alert to any behavioral cues that may be indicating any disapproval or rejections. They tend to flee from situations in which they think that others may turn against them.
• The person is so preoccupied in thoughts of being criticized or even rejected, that much of its physical and mental energy gets spend in brooding about it and rather in avoiding those situations which according to them are perceived as “dangerous.”
• The person is self-conscious in the unfamiliar social situations because of feelings of inadequacy.
• Low self-esteem undermines individual’s confidence: in meetings and while conversing with any new acquaintances.
• The individual regards him/ herself as socially inept. The self-disparagement is apparent when individual needs to make social contacts with any of strangers.
• Perceive themselves as unattractive/ unappealing or unlikable/ inferior in front of others.
• The person is very reluctant in taking any social risks; this is done in order of avoiding possible humiliations. Avoidant people tend to seek interactions which have promising of greatest guarantee of being accepted while they ensure in minimizing likelihood of any kind of embarrassment or any rejection.

Treatments for Avoidant Personality disorder

The basic goal of treating individual with avoidant personality disorder is improving its self-esteem as well as confidence. Also improving the patient’s social skills will able him in his interactions. Its important that treatments help patient to become more resilient to any potential or even real criticisms made by others.

Psychodynamically oriented therapies: Supportive approach

• First the therapist empathizes with patient’s strong senses of shame as well his feeling of inadequacy which will help therapist create a relationship with patient of trust.
• Therapy mostly moves slowly: Reasons being that patients are mistrustful of others; and treatment probing into their emotional-state quickly results in protective withdrawal by patient.
• A patient discusses his situations once he feels trust is established and rather feels safer.
• With help of therapies he is able to draw imperative connections between deeply felt feelings of shame and as how they behavior in social situations.
• There in with help of therapist, they try and overcome these shortcomings in them.

Cognitive-behavioral therapy

• Cognitive-behavioral therapy or CBT approach assumes there is patterns of faulty thinking which underlie personality disorder, and therefore CBT focuses on bringing a change in patterns of distorted cognitive by examining validity of assumptions behind it. If patient feels inferior complex with his peers, unlikable/un attractive/socially unacceptable etc, cognitive therapist would test this assumptions against reality.
• Therapist will ask the patient first to name those family members and friends who enjoy their company, or describe any past social encounters which were fulfilling according to then.
• This will show patient that even others value and like his company as well as social situations are enjoyable also
• In CBT therapist exposes patient’s irrationality of social fears and all insecurities. The process is called as “cognitive restructuring.”

Medications

• Monoamine oxidase inhibitors (MAOIs): proved to be useful for helping patients having avoidant personality disorder in controlling symptoms like social unease and has shown experience of initial success.
• The patients on MAOI’s medications avoid foods which contains a substance called as tyramine found in:

Cheese, red wines, liver, vermouth, sherry, beans with broad pods, sauerkraut, meat extracts and soy sauce

Group therapy and Family and marital therapy

• Group therapy: Provides patients of avoidant personality disorder with some social experiences, which will expose them social interactions which will give them feedback from others which is safe, and in controlled environment.
• However, patient may be reluctant for entering any group therapy because of his fear of social rejections.
• But empathetic environment in social group settings helps each member to overcome social anxieties.
• Social skills training: incorporated along with group therapy helps in enhancing social awareness and the feedback.
• Family therapy: this is done for patient who wants help in breaking out of family pattern that has been reinforcing the avoidant behavior.
• Marital therapy: couple therapy includes attempts to break cycle of rejections, criticisms or ridicules that usually characterizes most of the avoidant marriages. Other strategies are also included for helping couple in developing constructive ways for relating to one another without any shame.

Preventions

As mentioned in causes that avoidant personality disorder has correlation with it being originating in patient’s family of origin, therefore for preventive measures for families that none of their children face this disorder and so that they live healthier, families need to do:

• Nurturing to their children
• Emotionally stimulating
• Expressive family environment

Such small steps taken so that children develop proper self-esteem and confidence will be able to prevent children from getting Avoidant Personality Disorder and live a healthy and good life.