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Avoidant Personality Disorder

Avoidant personality disorder is extreme sensitivity to rejection. So people with this sensitivity stay away from relationships, not because they donít want relationships but because they are so frightened of rejection when they get into them. Usually they will only enter into relationships when they are guaranteed of uncritical acceptance. Avoidant people usually lack self confidence. They attempt to bolster their self confidence by seeking unusually supportive companions. They are usually afraid to speak up. They are afraid to be in the limelight and afraid to be in positions of authority. They are very likely to interpret clinicians comments as critical and so treatment of these individuals is going to be quite delicate. The major defense of avoidant personality disorder is avoidance. Some people would argue that this is not a personality type per se but really a defense mechanism. However, the DSM IV tells us that itís a personality type avoidant personality disorder, avoident personality disorder

In terms of the diagnosis, the criteria basically involve a pervasive pattern of social discomfort, fear of negative evaluation and easily hurt by criticism, has no close friends, avoids social or occupational activities, reticent in

In terms of etiology, the causes of avoidant personality are really unknown. One of the promising avenues of research is in the area of temperament and shyness. Again, Jerome Kagan has done a lot of work on the inheritability of shyness and this genetic or inheritable component of temperament may underlie avoidant personality disorder for many of these patients. There is no information on the prevalence of this disorder in the population or the sex ratio or familial patterns. Many patients who meet these diagnostic criteria meet another set of criteria as

The course and prognosis are largely unknown partly because this is a fairly recently defined disorder.

In terms of differential diagnosis, youíve already heard that it is important to differentiate the avoidant personality disorder from schizoid personality disorder, although that differential may be difficult. Essentially schizoids claim not to want any relationships and avoidant people claim to want them but to be frightened of them. Another important differential is between avoidant personality disorder and phobias of all kinds, because as you know people who are agoraphobic, people who have simple phobias, social phobias, will have the same avoidant mechanisms. However, often these mechanisms are quite isolated. These are people who donít need the same kind of uncritical acceptance. These are not people who are as sensitive to perceived criticism as people with avoidant personality disorder. So the phobias are much more

In terms of treatment, psychotherapy is the treatment of choice but itís quite difficult because people are so sensitive to rejection. But therapy can help people ease the harshness of their own self-criticism and see the ways that they project their self-criticism onto other people and they then expect their relationships to be fraught with pain. Cognitive therapy can be useful in helping people to uncover these underlying false assumptions about themselves and the world. Group therapy can demonstrate to avoidant individuals, if they allow themselves into group, can be very effective in showing avoidant individuals the effect of their hypersensitivity on

The benzodiazepines have been used to treat anxiety in avoidant personality disorder but there really isnít a long-term role for these and there hasnít been another class of medication that has been used productively with avoidant personality disorder.

Dependent personality disorder is essentially again one of those disorders that some people would argue is simply a trait. But people with dependent personality disorder structure their lives so that other people will take responsibility for their welfare. So they will try not to function on their own but to seek out bosses, lovers, and friends who will tell them what to do and allow them to be passive. They avoid making decisions, including intimacy, socially, what job to take, even what to wear. The dependent person will put up with a great deal in relationships in order to avoid having to function autonomously. For example, the wife who puts up with verbal and physical abuse by her husband, or vice-versa, because that person feels incapable of functioning without the spouse. Obviously there are many other reasons for remaining in abusive relationships and so most people do not have dependent personality disorders necessarily who are in abusive relationships. But that is one mechanism by which abuse is sustained and

Predominant defenses are projection, for example, projection of responsibility, of capability, of avoidance and turning against the self.

The diagnostic criteria emphasizes a pervasive pattern of dependent and submissive behavior. In terms of the etiology, most theorists write about the roots of this kind of extreme dependency as coming from childhood experiences. One hypothesis is that parents can foster this kind of dependence by giving the children the implicit or explicit message that any independent behavior is bad and will lead to abandonment. Also by essentially giving the child the sense that his or her judgment is not valid and that the only person who knows whatís right for the child is the parent. Dominant and submissive personality traits may be genetically inherited so there is some research going on that suggests that submissiveness and dependence may have some genetic