There are people who might avoid social interaction due to the fact that they are very sensitive to rejection and shy. The diagnosis for such people is Avoidant Personality Disorder or Anxious Personality Disorder.
People diagnosed with Avoidant Personality Disorder will describe themselves lonely, anxious, unappealing or socially inept. They usually avoid social interaction because they think they might be humiliated, ridiculed or rejected.
Avoidant Personality Disorder is a controversial disorder and skeptics think it might just a different conceptualization of generalized social phobia. The two disorders have similar causes, treatment, underlying personality features and course. But in order to clarify this controversy more data and more research is needed.
The research done recently suggests people with avoidant personality disorder show more severe symptoms than those with social phobia. Therefore they came to the conclusion that a two factor solution could be a better idea.
So, though they are pretty similar there is a good reason to have two different disorders.
The symptoms of Avoidant Personality Disorder include:
- Extreme anxiety or shyness in social situations
- Severely low self-esteem
- Hypersensitivity to criticism or rejection
- Volitional social isolation
- Lonely self-perception
- Trouble with occupational functioning
- Extremely self-conscious
- Self-critical regarding personal problem related to others
- Agoraphobia (in cases of extreme avoidant personality disorder)
- Using fantasy to escape painful thoughts
- Avoid physical contact
Causes of avoidant personality disorder are not clearly known or understood yet. It might actually be a combination of different factors that cause avoidant personality disorder including psychological, social and genetic factors.
When it comes to genetic factors it might be about inherited temperamental factors. Therefore some people might have a genetic predisposition to avoidant personality disorder. Group rejection and emotional neglect during childhood were also linked with Avoidant Personality Disorder.
Theodore Millon, a well-known psychologist found out that most patients with a personality disorder present a mixture of symptoms and usually there’s a major type disorder mixed with a secondary disorder or more.
He pinpointed four different subtypes of avoidant personality disorder.
Phobic (includes features of dependent personality disorder)
It is different from the basic avoidant personality because people with this subtype tend to invest their trust in a relationship and when it’s lost they continuously dread the loss of it. Usually people affected by this subtype are trapped between the possibility of abandonment and the desire to have a relationship.
Hypersensitive (includes features of paranoid personality disorder)
A person with hypersensitive avoidant personality disorder will experience mistrustfulness, paranoid and fear but to a lower rate than a person with paranoid personality disorder. Usually they are perceived as “high-strung” or petulant.
Usually the people affected by this subtype tend to attribute the dysfunctional features of their personality disorder to conspiracies conducted by mischievous characters around them.
Conflicted (includes features of passive-aggressive personality disorder)
People with this subtype tend to idealize people around them but they are able to turn back and might want to hurt others in retaliation when they feel they were under-appreciated.
To sum it up they have ambivalent and conflicting feeling about themselves and others. Their low self-esteem and pacific side is active during period of minimal stress. When they are put under stress they turn their pacifism into impulsive hostility.
Self-deserting (includes features of depressive personality disorder)
The self-deserting type of avoidant tends to combine the self-devaluation found in the depressive and the social retreat of the avoidant.
To avoid the discomfort of social relations they tend to immerse in a surrogate fantasy world. When the fantasy becomes less effective they tend to focus on the anguish of the past and the misery in their life until they cannot tolerate being themselves anymore and will try to withdraw from conscious awareness. Then they will become spectators that observe their own transformation from outside.
According to ICD – 10 in order to be diagnosed with avoidant personality disorder a patient should meet at least four of the following 6 criteria:
- Pervasive and persistent feelings of apprehension and tension
- Obsessive preoccupation with being rejected or criticized in social situations
- Unwilling to be involved with people unless they are sure they will be liked
- Restricted lifestyle because of the need to feel physically secure
- Belief that one might be inferior to others, inept or personally unappealing
- Avoid occupational or social activities that involve notable interpersonal contact, due to the fear of rejection, criticism and disapproval
According to DSM 5, people should meet 4 of the 7 criteria listed:
- Avoid social or professional activities that involve interpersonal contact because they fear disapproval, rejection or criticism
- Avoid to be involved with people except when they are sure of acceptance
- Restrained intimate relationships because of fears of ridicule or shame
- Obsessed with fears of rejection or criticism in social situations
- Constrained, shy in new social situation because of feeling of inadequacy
- Considers self socially inept, inferior to others or personally unappealing
- Unusually reluctant to engage in new activities due to fear of embarrassment
Anyway, people should seek the specialist help pf a trained therapist instead of using the DSM or ICD to diagnose themselves or others.
The treatment of avoidant personality disorder involves cognitive therapy, group therapy, social skills training or even drug therapy sometimes.