9c0c94111754ce23700ac9229baecc40.pdf
Transcript
Avoidant Personality Disorder “A defining feature of avoidant personality disorder is the conflict of longing for intimacy versus the fear of vulnerability that naturally ensues in a close relationship with another” - Millon Avoidant Personality Disorder Avoidant Personality Disorder It’s going to b...
Avoidant Personality Disorder “A defining feature of avoidant personality disorder is the conflict of longing for intimacy versus the fear of vulnerability that naturally ensues in a close relationship with another” - Millon Avoidant Personality Disorder Avoidant Personality Disorder It’s going to be easy to see these traits in yourself and those around you… – Students in class who seem to earnestly desire participation in discussions Say little to nothing Seem awkward and self-conscious on those rare occasions when they speak a few words – Someone at a party who shows up early and stays late… But spends most of the time anchored to the corner of the room Waits for someone to approach him/her to make conversation – If you are the one who approaches, you’ll notice immediate discomfort upon even the most pleasant conversation Avoidant Personality Disorder This person may have one or two trusted friends – Perhaps a spouse or partner, or even a sole family member – Few others pass their strict tests of uncritical support and acceptance to gain access to their private circles This person is not content with this secret, isolated way of life – Pain from loneliness and seclusion hurts them to the core of their existence – They’d rather be alone than make themselves vulnerable to the “inevitable” social humiliation – Rather than experience the awkwardness of nakedly putting themselves on display, they take their silent, lonely pain and make themselves invisible Invisible away from the “harsh, but deserved criticism from others” Avoidant Personality Disorder This person may resist any life change that may bring them into the public eye – Includes occupational promotions and other life rewards This person may wish deeply for love, genuine intimacy, and greater life enjoyment or satisfaction – Their souls are seen as so disgraced that they must withdraw into a private world of shame At least there they can be left alone with their inadequacies Case Example: Allison Allison is a 22-year-old undergraduate at a local community college. She is clearly shy and uncomfortable in the clinical interview, but nevertheless complains of panic attacks so immobilizing that her contact with the outside world is limited to a bare minimum. With a new semester starting, she does not know if she will be able to attend classes. The pattern is always the same. Suddenly she notices her heart quicken, then she begins to sweat as the fear of an attack grows, then her heart begins to race faster an faster and she is overtaken by panic. Case Example: Allison There is little joy in Allison’s life. She tries to work each day, takes care of necessary errands, and shops for food every few weeks. Generally, she lets things accumulate and then tries to do them all at once, to get it over with. In the past, she occasionally enjoyed volunteer work at a botanical garden, but has never held a real job. When asked about her social life, she has difficulty naming friends. “My fear,” she states, “is that others won’t like me if they really find out about the real me.” Although her words are deeply felt, she never makes eye contact with the interviewer. She concedes that although others may be capable of succeeding in the world, she desperately wants to be left alone. Even when she is just sitting in class, she has difficulty believing that others who are laughing are not making fun of her. Case Example: Allison Allison’s history goes far toward making sense of her symptoms. She has been reminded many times that her birth was an accident, something unpleasant that her mother and father “had to go through.” She cannot recall a time when she felt loved by her parents. “Not that they were neglectful,” she quickly points out, “but I always felt like a burden to them.” Life at home was without warmth or joy, with much time spent fantasizing alone in her room, something she still does today. Worse, her parents, themselves highly successful, had high expectations for her but were often excessively critical, even of the smallest mistakes. Because of her shyness, she had to endure hours of merciless teasing from the other children, apparently the origin of a crippling self-consciousness that has followed her ever since. Unable to defend herself, she withdrew socially, as if to become smaller and less noticeable to others. Case Example: Allison When asked about relationships, Allison refers to her only boyfriend, when she was a high school senior, “Even then,” she reflects, “I was afraid to be myself or voice any kind of opinion of my own. I was afraid he would dump me.” When asked about marriage, Allison admits she has dreams of being accepted unconditionally, but doubts that it will ever happen. Instead, she prefers to be alone, “where it’s safe, where no one can see your faults, much less judge your or criticize you for them.” “If you keep with what you know,” she says, “you at least don’t have to worry about embarrassing yourself.” Avoidant Personality Disorder Avoidant Personality Disorder – 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: Avoidant Personality Disorder (1) Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection – Imagined nightmares of defective performance can lead to job suffering In some cases, patients may quit or remain in positions with little challenge Avoidant Personality Disorder (2) Is unwilling to get involved with people unless certain of being liked – Must be absolutely sure of being liked, which is extremely difficult to accomplish – Often has an abiding faith in their own defectiveness Results in an ability to bring shame on herself simply by existing Most of us are insecure about something – These people’s insecurities constitute their perceived reality – Thickness of outer shell doesn’t make it less fragile Avoidant Personality Disorder (3) Shows restraint within intimate relationships because of the fear of being shamed or ridiculed – Even when hypersensitivity is overcome long enough to let someone in, imagined inadequacies result in a fear to be oneself – When in a relationship the following become very difficult Revealing the true self Sharing secrets Telling partners about actual likes and dislikes – If someone does like the person, it’s only because they had the wisdom to never show their true self Avoidant Personality Disorder (4) Is preoccupied with being criticized or rejected in social situations – Wherever they go, they feel people always have expectations of them Fear – Criticism and rejection – Simply disappointing others – Rejection doesn’t need to be actually voiced to summon fears Just the idea that they are being privately judged is enough to warrant disengagement Avoidant Personality Disorder (5) Is inhibited in new interpersonal situations because of feelings of inadequacy – Fears of inadequacy make them shrink back Allows them to feel smaller and less noticeable than others – The key is limiting exposure By revealing little about themselves, they leave little to be attacked – Narcissistic and Histrionic personalities surge forward in social situations Avoidants inhibit themselves and withdraw – Avoidants must Always be aware of others Be sure that others are never aware of them Avoidant Personality Disorder (6) Views self as socially inept, personally unappealing, or inferior to others – Make it difficult to achieve potential in life – Reluctant to risk pushing boundaries Avoidant Personality Disorder (7) Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing – This results in stagnation Avoidant personalities refuse to take risks that might leave them open to public view Can be highly creative in the privacy of their apartment or become superheroes in their own fantasy lives – In the real world, they believe it best not to attempt anything that might bring attention to themselves Cognitive Conceptualization Core Beliefs – Long standing dysfunctional beliefs that interfere with social functioning – As children, they may have had a significant person (parent, teacher, sibling, peer) who was highly critical and rejecting of them Schemas – – – – – “I’m inadequate” “I’m defective” “I’m unlikeable” “I’m different” “I don’t fit it” Also develop negative beliefs about other people – “People don’t care about me” – “People will reject me” Cognitive Conceptualization Cognitive Conceptualization Underlying Assumptions – Not all children with critical or rejecting significant others become avoidant Avoidant personalities hold underlying assumptions – “If this person treats me so badly, then I must be a bad person” – “If I don’t have friends then I must be different or defective” – “If my parents don’t like me, how could anyone?” Cognitive Conceptualization Fear of Rejection – Avoidants make the error of assuming that others will react to them in the same negative fashion as the critical significant others did Continually fear that others will find them lacking and reject them They fear that they will not be able to bear the dysphoria that they believe will arise from the rejection – As a result, they avoid social situations and relationships This is done in order to avoid the pain they expect to feel when someone inevitably (in their judgment) rejects them Cognitive Conceptualization Fear of Rejection – This prediction of rejection causes dysphoria which itself is extremely painful – The prospect of rejection is even more painful because the avoidant person views others’ negative reactions as justified Rejection is interpreted in a very personal manner Cognitive Conceptualization Fear of Rejection – Rejection is perceived as being caused solely by personal deficiencies “He rejected me because I’m inadequate” “If she thinks I’m unintelligent (unattractive, etc.), it must be true” These attributions are – Generated by negative self-beliefs – Reinforce dysfunctional beliefs Cognitive Conceptualization Self-Criticism – Avoidant patients experience a string of self-critical automatic thoughts Happen in social situations as well as anticipated encounters Thoughts are rarely evaluated, but produce dysphoria – – – – – – “I’m unattractive” “I’m boring” “I’m stupid” “I’m a loser” “I’m pathetic” “I don’t fit in”
