Session 12: Avoidant Personality Disorder

Essential Feature

pattern of S I, feelings of I, hypersensitivity to
N evaluation

social inhibition, inadequacy, negative

Prominent features:

A disharmony
Interpersonal D
O & hyper-reactive to moods of O
Social A
Self C
Diffuse, D quality

Affective, distrust, Oversensitive, others, anxiety, contempt, dreamy

SELF-IMAGE
Deflated & Unpleasant; U, I,
U

Unlikable, inadequate, undesirable

VIEW OF OTHERS:
Others: C, U, and D
World: U, C, H

Critical, uninterested, demeaning, unfriendly, cold, humiliating

RELATIONSHIPS:
Self-P oriented; “L loners”;
I and U expectations; Marked
by D, little initiation or R, secret
relationships on the side & rich relationship
fantasies; “Avoid pain, need nothing; depend on no one”

Protection, Lonely, Immature, unrealistic, distance, risks

ISSUES WITH AUTHORITY:
C and cooperative; withholding of
information and self-D

Compliant, disclosure

Behavior: 
Fretful, stiff & shy manner
Immaturity
Emotionally & physically controlled
O to innocuous experiences
P and/or F oriented
M disturbances
Reticence/P
Early exits or withdrawals

Overreactivity, Past, fantasy, Memory, passivity,

Affect:
Centrality of S
Trivial embarrassments = I
Tension, sadness & anger
Inclined toward P
Vulnerable to A & D

shame, intolerable, pessimism, Anxiety, Depression

Defenses:
A and F

Avoidance, Fantasy

SELF-CREATED WORLD (ALTERED REALITY)
D + P > genuine, interpersonal C

Distance, predictability, connection

Common beliefs:

“Maybe someday someone will L me enough that I will stop H myself”
“Other people are S, more self-confident and A than I am; it is all just plain E for them than me”
“ If I took a chance approached someone, and they rejected me, I couldn’t stand it”.

love, hating, stronger, acceptable, easier

Protective Factors for SAD:

Desire for relationships and B
(compliance in T)

belonging, treatment

Risk Factors for SAD:

Difficulties self-R and managing life
Gen’l Loss of M due to personality structure
Hunger for increased courage and interpersonal confidence
Inclination toward E as coping

regulating, maturation, esapism

Drugs of Choice
S & anti-A agents (for
hyperarousal & self-D thoughts)
Mild H (fantasy effects)
S/PCP (for strength, courage, vulnerability)

Sedatives, anxiety, depracatory, hallucinogens, Stimulants

Treatment Recommendations:

Kindness, patience, P regard
• Encourage R but in small increments that build on S
• T issues (“interpersonal Methadone”)
• C issues pertaining to
hypersensitivity and frailty (F, impatience, P)
• G Therapy/ AA membership With Support
• Weigh cost/benefit of M intervention
• S skills training, assertiveness training,
socialization experiences, drug refusal skills,
cognitive interventions, systematic desensitization

positive, risks, success, Transference, Countertransference, frustration, parental, Group, medication, Social, 

Avoid in Treatment:
• Underestimate AvPD H, I
and firmly held negative beliefs
• Pressure or overwhelm with large challenges
• Use confrontation or “T love” approaches
• Expect A without providing other means for managing life stress

helplessness, inattentiveness, tough, Abstinence

Difference between Social Anxiety & AvPD (lecture notes/Dr. Grande movie clip)

Instead of symptoms just with S (ex. Social Anxiety, “cyclic” element, panic attack due to presentation. AvPD is C!), less I with AVpd, T/N appear to contribute to etiology of AVpd

stressor, CONSTANT, insight, trauma, neglect