Thursday, February 09, 2006

And then you put your arms around me and we tumble to the ground and then you say:

Avoidant personality disorder:
A personality disorder characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and extreme sensitivity. People with avoidant personality disorder often consider themselves to be socially inept or personally unappealing, and avoid social interaction for fear of being ridiculed or humiliated.
Avoidant personality disorder usually is first noticed in early adulthood, and is associated with rejection by parent or peers during childhood. Whether the rejection is due to the extreme interpersonal monitoring attributed to people with the disorder is still an open question.

The DSM-IV-TR, a widely used manual for diagnosing mental disorders, defines avoidant personality disorder as a "pervasive pattern of social inhibition, feelings of inadequacy, beginning by early adulthood and present in a variety of contexts, as indicated by some of the following:

1. avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
2. views self as socially inept, personally unappealing, or inferior to others.
3. is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
4. is unwilling to get involved with people unless certain of being liked
5. is preoccupied with being criticized or rejected in social situations

They are so preoccupied with monitoring themselves and others that producing fluent speech is difficult.

Research suggests that people with avoidant personality disorder, in common with social phobics, excessively monitor their own internal reactions when they are involved in social interaction. The extreme tension created by this monitoring may account for the taciturnity of many people with avoidant personality disorder. Avoidant personality disorder is reported to be especially prevalent in people with anxiety disorders, although estimates of comorbidity vary widely due to differences in (among others) diagnostic instruments. Research suggests that approximately 10-50% of the people who have a panic disorder with agoraphobia have APD, as well as about 20-40% of the people who have a social phobia.

Natural course of the disorder

People with avoidant personality disorder often experience vicious cycles of withdrawal. This reinforces the avoidant's fear of rejection and encourages further withdrawal. Another common development is the appearance of so-called "second-line defenses" in order to deal with the anxiety that the avoidance creates (ibid.). Examples of such defenses are a denial of the fear of rejection, or a replacement of their fear of rejection with a defensive insensitivity. The latter mechanism is called "hardening".