A pervasive
pattern of social inhibition, feelings of inadequacy, and hypersensitivity
to negative evaluation, beginning by early adulthood and present
in a variety of contexts, as indicated by four (or more) of
the following:
Avoids occupational activities that involve significant interpersonal
contact, because of fears of criticism, disapproval, or rejection.
Is unwilling to get involved with people unless certain of
being liked.
Shows restraint within intimate relationships because of the
fear of being shamed or ridiculed.
Is preoccupied
with being criticized or rejected in social situations.
Is inhibited in new interpersonal situations because of feelings
of inadequacy.
Views self as socially inept, personally unappealing, or inferior
to others.
Is unusually reluctant to take personal risks or to engage
in any new activities because they may prove embarrassing.
DSM-IV
Code: 301.82
Associated
Features:
Depressed
Mood
Anxious or Fearful or Dependent
Personality
Differential
Diagnosis:
Some disorders have similar or even overlapping symptoms. The
clinician, therefore, in his diagnostic attempt has to differentiate
against the following disorders which need to be ruled out to
establish a precise diagnosis.
Social
Phobia, Generalized Type
Panic Disorder With
Agoraphobia
Dependent
Personality Disorder
Schizoid Personality
Disorder
Schizotypal
Personality Disorder
Paranoid Personality
Disorder
Personality
Change Due to a General Medical Condition
Symptoms
that may develop in association with chronic
substance use.
Cause:
There is
no clear cause for avoidant personality disorder; some theories
suggest that it is a function of how one is brought up, but
biological factors are likely as well. This disorder is fairly
uncommon and there is little information about occurrence by
gender or about family pattern.
Treatment:
Counseling
and Psychotherapy [ See
Therapy Section ]:
As with most personality disorders, the treatment of choice
is psychotherapy. While individual therapy is usually the preferred
modality, group therapy can be useful if the client can agree
to attend enough sessions. Because of the basic components of
this disorder, though, it is often difficult to have the individual
attend group therapy early on in the therapeutic process. It
is a modality to consider as the patient approaches termination
of individual treatment, if additional therapy seems necessary
and beneficial to the client.
Pharmacotherapy
[ See
Psychopharmacology Section ] :
As with
all personality disorders, medications should only be prescribed
for specific and acute Axis I diagnoses or problems suffered
by the individual. Anti-anxiety agents and antidepressants should
be prescribed only when there is a clear Axis I diagnosis in
conjunction with the personality disorder. Physicians should
resist the temptation to overprescribe to someone with this
disorder, because they often present with complaints of anxiety
in social situations or a feeling of disconnectedness with their
feelings. The anxiety in this instance is clearly situationally-related
and medication may actually interfere with effective psychotherapeutic
treatment.
Self-Help
[ See Self-Help
Section ]:
There are
not any self-help support groups or communities that we are
aware of that would be conducive to someone suffering from this
disorder. Such approaches would likely not be very effective
because a person with this disorder is likely to avoid attending
such sessions, due to increased anxiety and difficulty interacting
socially.
