Avoidant Personality Disorder

Avoidant Personality Disorder
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Personality disorders are conditions that are considered to cause patterns of abnormal behavior in person. A person suffering from the personality disorder is recognized through distressing symptoms that are ranging. However, avoidant personality disorder is common and most frequent personality disorder that is considered as a mental illness that affect interactions and maintaining interpersonal relationships. In addition, this particular personality disorder is characterized by isolative interpersonal behaviors whereby a person suffering from ADP endures a pattern of feelings that encompass extreme social inhibition, inadequacy and sensitivity to negative sensitivity and rejection. In addition, it results in significant impairment in social and occupational factors; therefore, an individual suffering from ADP tends to possess an experience that affects their self-esteem through several factors such as humiliation, degradation and rejection (American Psychiatric Association, 2015). Furthermore, this research paper focuses on an epidemiology study of avoidant personality disorder based on characteristics exhibited by individuals who are diagnosed.
Etiology
Research study reports that the causes of the avoidant personality disorder are yet to be revealed. However, most of the researchers suggest that the ADP is likely influenced by genetic, social and biological factors.

In further analysis, a social factor basically depicts how a person interacts with his/her family, friends and other children during his/her early childhood development. In addition, social factors correlate with psychological factors that portray the personality, temperament of an individual based on their environment and learned coping skills to deal with stress. Evidence shows that most people who are diagnosed with ADP have endured traumatic childhood experiences involving unstable attachment, criticism and rejection from their parents. Naturally, children need parental love and attachment with their parents but when subjected to ridicule, criticism and rejection they eventually develop a psychological shell that enables them to create a shield of resistance from further parental discrimination that is characterized by ridicule, criticism and rejection. Moreover, the harsh emotional experiences normally make the child yearn for parental attachment, but, unfortunately, they lack the skills and ability to maintain the as they grow up. Some of the characteristics of the avoidant personality disorder are hard to notice since they occur with a person’s experience. Consequently, other personality disorders may occur with the avoidant personality disorder (Heimberg, 1996). Some of this condition that commonly occurs frequently in with avoidant personality disorder include sociophobia disorder, dependent personality disorder and borderline personality disorders (Heimberg, 1996). According to Rattew, 2015, he states that some major symptoms of avoidant personality disorder are commonly shared among the personality disorders mentioned since they are similar in nature. In particular, the generalized sociophobia disorder can be confused with personality disorder since it is a condition whereby a person experiences anxiety and self-consciousness mainly in social circumstances. In addition, research shows that some of the genes associated with sociophobia are related with avoidant personality disorder whereby in sociophobia the amygdala is hypothesized with its connections. Evidence shows that an adult with sociophobia disorder is associated with the dysregulation of the brain’s system (Rattew, 2015).
Prevalence/incidence
In general, according to DSM-5(diagnostic and statistical manual of mental disorders) research, it reports that the prevalence of avoidant personality disorders in the adult population is estimated to range between 2.1-14% (Rattew, 2015). However, the rate of 3.6% is reported among adults who are receiving outpatient psychiatry treatment. According to a study conducted, the rate of young adults between men and woman who are diagnosed with ADP was 1.4 % and 2.5% respectively. In addition, research estimates indicate that the rate of ADP is equal among both men and females but is not usually diagnosed in individuals who are below the age of 18 years. However, most patients report to have developed the condition during early childhood and, as a result, many report to continue experiencing the same condition throughout their life. (Rattew, 2015)
Mortality/morbidity
In most cases, the individuals who are diagnosed with avoidant personality disorder normally portray some various characteristics. For instance, they refuse to attend school and perform poorly and this characteristic mainly occurs among children since they may experience significant sociophobia. Many individuals with severe social anxiety may conduct problems and expose oppositional behavior hence they refuse in participating in social activities and, as a result, they may not withstand a social situation due to panic or behavioral outburst (Rattew, 2013). Furthermore, they normally have a poor relation problem; they often refuse social invitations and normally have few friends in their social cycle. Also, these patients diagnosed with avoidant personality disorder, hardly show participation in social and nonsocial activities such as athletics, extracurricular activities and hobbies in comparison with patients diagnose with other personality disorders. Basically, they will normally avoid activities that involve too many social interactions and as a result, they may engage themselves in alcohol and drug abuse that would lead to unbearable consequences of depression. (Rattew, 2015)
Comorbidity
This is an aspect that normally involves finding the simultaneously presence of two or more psychiatric diagnoses in the same individual. However, it may feature the presence of two imperfect pathologies and imperfect diagnostic categories. Avoidant personality disorder and social order possess similar characteristics whereby an individual exhibits fear or avoidance of social situations and fear of possible rejection, criticism or humiliation (Herbert, 1992). Furthermore, the social situations are more circumscribed in social phobia unlike in avoidant personality disorder. Research further reports that between the avoidant personality disorder and generalized social phobia, there is a likelihood of considerable diagnostic overlap as the social aspect is associated with anxiety. (Sansilow, 2012)
Symptoms of avoidant personality disorder (Rogge, 2014)
Avoidance of occupational activities
Few friends
Reluctant in interaction with other people
Holding back intimate relationships
Avoid taking personal risks and involving in new activities
Show shyness in social situations
Get provoked when criticized or disapproved
Belief of socially inept
Possess one directional vision whereby they may ignore priorities and focus on a single concern
Normally exaggerate potential difficulties
Avoid public speaking in social situation or when forced to participate
Aggressive behavior
Self-victimization and self-loathing
Dreadful of abandonment
Mostly affected by depression and mood swings
Hyper-vigilant
Diagnosing avoidant personality disorder
However, for a person to be meeting the diagnostic threshold, he/she must exhibit at least four of the following criteria (Rogge, 2014). Since most individuals may show or experience characteristics of avoidant personality disorder at some point in their lives, this specific criterion would help health professions in determining whether an individual has the disorder or not. In addition, the diagnostic and statistical manual of mental disorders emphasize on individual exhibiting at least four of the criteria in order to accurately diagnose avoidant personality disorder.
Moreover, the criteria are:
Avoid participation of social and nonsocial activities involving significant close social interactions, due to fears of ridicule, humiliation and rejection.
Normally have a perception that is related to regarding themselves inferior compared to others
Avoid taking personal risks or reluctant in participating in new activities
Usually preoccupied with fears that are related to believing they will receive criticism or rejection
Avoids new interpersonal relationships
Hold back or turn down intimate relationships
Reluctant in interacting with people unless on condition of a specific acceptance
However, these criteria are related to the morbidity factors that are mentioned above. (Sansilow, 2009)
Treatment of avoidant personality disorder
Historically, individual therapy is one among the techniques used in treating of avoidant personality disorder. However, research reports that this type of therapy may be difficult to be implemented for an avoidant patient due to relationship hindrance with the therapist that is extended due to the characteristics of maladaptive behavior and thoughts of interpersonal relationships that an avoidant possess. Most likely, patients diagnosed with ADP tend to reject the help offered by the therapist because they doubt their authenticity and fear being rejected by them. Furthermore, mild criticism normally affects people with ADP, therefore, the therapist should take great care to avoid any situation that may seem judgmental to this patients. The therapist should provide accurate empathy and warm support to the diagnosed patients in order to lay a foundation of building trust. In addition, the establishment of trust would act as testing ground for coping skills through the facilitation therapeutic relationship (Sansilow, 2012).
Cognitive behavioral therapy is another treatment technique that modifies the distorted thoughts processes by facilitating encouragement to a diagnosed ADP patient that helps them in identifying and overcoming the fear of rejections and possible criticism. This technique has been proven to be effective and reliable in treating patients diagnosed with avoidant personality disorder. However, this technique involves the process of cognitive restructuring that normally helps in dealing with the overwhelming anxiety characteristic of patients diagnosed with avoidant personality disorder. Also, this technique involves identifying the false misconceptions related to the social situations that are associated with negative cognitions. In general, the process involves three stages that are; identifying the misconceptions, evaluation of accuracy and recognition of possible alternatives that can help in delivering the solutions. (Sansilow, 2012)
Consequently, there are two categories under which the behavioral therapy strategies falls. These categories include; graduated exposures and skills training. However, graduated exposures enable exposure therapy to help an individual in overcoming fear and change their behavior. Exposure therapy typically involves enabling individuals suffering from avoidant personality disorder to learn relaxation techniques and applying them in gradually particularly in higher-risk situations regardless of whether in therapy or not. On the other hand, the social skills techniques will gradually help to reconstruct interpersonal deficit characteristic that a patient diagnosed ADP may exhibit. Implementation of this technique will help those diagnosed individuals who are characterized by poor social skills to build positive social skills that will improve reactions towards others. (Sansilow, 2012)
Conclusion
The research study develops an insight of the attributed diagnoses that enables to organize patterns of etiology, the prevalence of the diagnosis, morbidity, comorbidity, symptoms and treatments. This study regarding individuals suffering from the avoidant personality disorder is useful as a diagnostic construct. It enables us to identify easily persons affected by this diagnosis and, therefore, appropriate treatment would be enacted to them.

References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Rogge, T., & Kirkland, W. A. (2014). Avoidant personality disorder. The New York Times. Retrieved from http://www.nytimes.com/health/guides/disease/avoidant-personality-disorder/overview.html
Sanislow, C. A., Bartolini, E. E., & Zoloth, E. C. (2012). Avoidant personality disorder. In V. S. Ramachandran (Ed.), Encyclopedia of Human Behavior, 2nd Ed. (pp. 257-266). Academic Press: San Diego.
Heimberg, R. G. (1996). Social phobia, avoidant personality disorder and the multiaxial conceptualization of interpersonal anxiety. In P. M. Salkovskis (Ed.), Trends in cognitive and behavioural therapies (pp. 43-61). London: Wiley.
Sanislow, C. A., Little, T. D., Ansell, E. B., Grilo, C. M., Daversa, M., Markowitz, J. C.,… McGlashan, T. H. (2009). Ten-year stability and latent structure of the DSM-IV schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders. Journal of Abnormal Psychology 118: 507-519.
Rattew, D. C. (2015). Avoidant Personality Disorder. Retrieved from http://emedicine.medscape.com/article/913360-overview#showallRettew, D. C., Pataki, C., Jellinek, M. S., Doyle, A. C., Windle, M. L., & Sylvester, C. (2013). Avoidant personality disorder. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001936/