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

Self-protective strategies of Person with AvPD (Alden)

Stages of Interpersonal Intimacy and important considerations when client is advancing through stages (Alden)

Types of Avoidance entailed in AvPD (Taylor et al)

Primary Concerns in social situations of Client with AvPD (Hoffman)

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

Instead of symptoms just with stressor (ex. Social Anxiety, “cyclic” element, panic attack due to presentation. AvPD is CONSTANT!), less insight with AVpd, trauma/neglect appear to contribute to etiology of AVpd