How does Avoidant Personality Disorder (APD) manifest itself?

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The usual onset for APD is early adulthood, with an equal prevalence rate among women and men (APA). According to one study however, (Greenberg and Stravynski, 1985) most of the people being referred for professional help for social dysfunction, considered to be the same disorder as APD by Marks (1987), were single men. One suggested hypothesis for this finding is that society expects men to be the initiators in romantic relationships. Therefore, when they do not form relationships, it is seen as more of a problem than women who do not initiate relationships but are not expected to in any case (Marks). Millon and Everly have suggested 6 dimensions onto which the symptoms of APD can be mapped.

1. Behavioral Appearance
   Avoidants do exhibit the stereotypical traits of shyness, timidity and withdrawing behavior. To those who know them well, the avoidants’ mistrust of others may also be apparent as an almost constant wariness. However, Kantor (1993) argues that behavioral hostility is also typical of those suffering with APD. Avoidants may use their shyness as a way to hurt others by preventing them from becoming close. Alternatively, they will demonstrate their hostility in a more overt manner by insulting people who attempt to be friendly, for example. This reaction may be because they are identifying their aggressor and “deal with feared rejection by becoming rejecting themselves.” These expressions of hostility could be seen as defensive fight responses. To protect themselves from being rejected, they reject others first. This is maladaptive because the avoidants will tend to reject many people who would never have rejected them in the first place.
   
   In terms of appearance, if it is affected at all by APD, it will tend to be affected in one of 3 ways. 1st, avoidants may put considerable time and effort into making themselves attractive to others. The idea behind this is, at least they will be liked for their looks, if not for themselves. 2nd, they may consciously, or unconsciously, ensure that their appearance drives others away. This provides them with some control over their lives. Rather than waiting helplessly to be rejected, they ensure rejection from the start by their own actions. 3rd, in the case of avoidants who are suffering from PTSD, for example, they may dress in the style of the era when the trauma occurred. This form of dress is an indication that they are living in the past.
   
   Speech is may also be affected in APD. Avoidants may be quite silent. As Jerome Kagan explains, “For a rabbit, freezing on a lawn is a sign of fear. I believe that speechlessness is a similar diagnostic sign for us… There’s a circuit in the brain that controls our vocal cords and becoming quiet can be one sign of fear.” (Galvin, 1992). When they do speak, avoidants may use frequent pauses and speak slowly (Millon and Everly). This is contrary to what we read regarding social phobia, where pauses in speech tended to be avoided because they were thought to be a sign of lack of knowledge. Avoidants may also be overtalkative, possibly due to an adrenic discharge or a false belief, such as continuously talking will prevent death. For avoidants who try to put people off with their behavior, insults or social faux pas are commonly used as a way to assure rejection (Kantor). While this does essentially realize their worst fear, it does again give avoidants some control over how others react to them.
2. Interpersonal Conduct
   Avoidants often test others to determine whether or not they are being sincere in their friendliness. Because they may frequently see rejection where it does not exist, people will tend to fail these tests and then later be avoided because they may reject or humiliate those with APD (Millon and Everly). They will, therefore, frequently have difficulty beginning and maintaining relationships (Kantor), partly because they have difficulty trusting others and thus, are very reluctant to share their feelings or allow themselves to be vulnerable. As a protective measure against the humiliation and rejection, they may become avoidant of others.
   
   On the other hand, avoidants may form relationships, even making an effort to meet new people. However, these people are kept at a distance. Therefore, this group of avoidants is avoiding intimacy, rather than avoiding people altogether.
    
3. Cognitive Style
   Avoidants excessively monitor the situation to the extent that they are trying to process so much information, they are no longer paying sufficient attention to the interaction itself (Millon and Everly). The literature on social phobia suggests that the phobics are unable to follow the interaction because they are so focussed on their internal reactions. However, the research on avoidant personality disorder also emphasizes that the avoidants are engaged in external monitoring of the other person’s reactions as well. This additional processing of information could contribute to the increased severity of APD over social phobia. The excessive monitoring by avoidants, combined with a hypersensitivity to rejection makes their perception of rejection almost inevitable.
   
   Their dysfunctional thought processes may also include fear of being vulnerable, because it makes it easier to get hurt or humiliated. They may also be perfectionists and reject anyone who does not live up to their impossible standards. This may again be a case of rejecting someone before they are rejected themselves. Another possibility is that they are degrading the other person so that if they are rejected they will find it less painful because they didn’t like the person anyway. Some people believe that relationships are just too much work and aren’t worth the effort. Rationalization may also be present in this belief with the idea that it is not because they are unable to form relationships that they don’t have any, it is that they do not want to waste their time on relationships. Some avoidants even believe that they must avoid intimacy because “giving love to others reduces the energy they have available for themselves and that they need for their vital life processes,” (Kantor).
4. Affective Expression
   People with APD may exhibit little affect due to the fear that showing their emotions will make them vulnerable to rejection or humiliation (Kantor; Millon and Everly). To observers, avoidants may appear tense and anxious (Millon and Everly).
5. Self-perception
   Avoidants tend to have low self-esteem and believe that they are unworthy of being in successful relationships. They are also very self-conscious, frequently lonely and see their accomplishments as being of little or no worth (Millon and Everly).
6. Primary Defense Mechanism
   To cope with their unhappiness, people with APD often escape into fantasy which is “a ‘safe’ medium in which to discharge affection, aggression or other impulses that would otherwise be inappropriate, uncomfortable or impossible to achieve in reality,” (Millon and Everly). Avoidants will tend to read, watch TV or daydream to escape from reality.

continue: Development of Avoidant Personality Disorder

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Reviewed: 04/2006