Etiology and Development of Avoidant Personality Disorder

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From an evolutionary point of view, the “fight-or-flight” dichotomy suggests that both hostility and avoidance are naturally occurring responses to fear. Both are thought to be based on anxiety evoked by the presence of a feared stimulus object or situation. However, avoidance can co-vary with fear, vary inversely or vary independently (Rachman and Hodgson, 1974). Therefore, avoidance behavior seems to be more complex than is accountable for by the simple presence of fear or anxiety. What appear to be purposeful hostile reactions to others, for example, may be indicative of highly complex psychological processes.

It is commonly believed that biological factors, including heredity and prenatal maternal factors, set the foundation for personality and personality disorders, while environmental factors shape the form of their expression (Millon and Everly). In the case of avoidant personality disorder, the evidence of major biogenic influences in its etiology and development is speculative and weak (Millon and Everly). However, there is some evidence that a timid temperament in infancy may predispose individuals to developing of Avoidant Personality Disorder (APD) later in life (Kaplan and Sadock, 1991). While shyness appears to indicate underactivity, Kagan believes that this inherited tendency to be shy is actually the result of overstimulation or an excess of incoming information. Timid individuals cannot cope with the excess of information and so withdraw from the situation as a self-protective measure. The inability to cope with this information overload may be due to a low autonomic arousal threshold (Venebles, 1968). The same mechanism may also be responsible for the avoidant’s hypervigilence. However, it is generally believed that these biological substrates exist within the avoidant personality as a biological foundation for the emergence of the disorder itself and that full development of APD is likely due to significant environmental influences (Millon and Everly).

Environmental Factors Leading to Avoidant Personality Disorder

1. Parental Rejection
   An important environmental factor in the development of avoidant personality disorder is parental rejection (Kantor; Millon and Everly). Although normal, healthy infants may encounter varying degrees of parental rejection, the amount of rejection seems to be particularly intense and/or frequent for people who subsequently develop APD. Frequent or intense rejections crush children’s natural energy and optimism, leaving instead attitudes of self-deprecation and feelings of social isolation. Rejection by parents appears to be particularly devastating because it may be interpreted as a direct contradiction to the commonly held edict of unconditional love and acceptance of offspring by their parents. The rejected child asks, “if my parents won’t accept me, who will?”, yet some children learn that their parents do not accept them, thus the question is always present and every person the avoidant interacts with will be put to the test.
   
   Although avoidance in children does not appear to be necessarily linked to APD in adulthood, it appears that particular kinds of rejection by parents can alter the attitude and behavior of children in a way that disposes them to develop the disorder more easily later in life. For example, Kantor suggests that if a child’s expression of positive emotion is met with remoteness, criticism or punishment, he might learn to spare himself anguish by keeping positive feelings to himself. Perhaps such a child might abandon positive feelings altogether. There is little doubt that this would jeopardize later adult relationships.
   
   Likewise, if a child’s negative feelings are rejected, for example, if she is repeatedly told “it’s bad to feel angry”, she might forego otherwise workable relationships in order to avoid not only the intermittent feelings of dissatisfaction or anger that are an inevitable part of practically all close relationships, but also her ambivalence toward negative feelings in general.
   
   Furthermore, parental rejection may indicate some underlying parental fear, which the child unconsciously imitates. In such a case, the child may learn not only to fear rejection from others, but also to believe that the world is a fearful place.
2. Peer Rejection
   A 2nd environmental factor implicated in the emergence of APD is rejection by peer groups. If a child leaves a hostile or rejecting situation and encounters positive reinforcing experiences outside of the home, early rejection by parents need not result in self-deprecating attitudes. However, if parental or familial (including siblings) rejection is compounded by rejection from a peer group, the prognosis points heavily toward a personality disorder.
   
   Repeated social interactions expose an individual to potential rejection over a sustained period of time. Such rejection, if it occurs, can wear down the individual’s sense of self-competence and self-esteem. Following humiliation and rejection by peers, individuals then begin to criticize themselves. Feelings of loneliness and isolation are made worse because of harsh self-judgments and increasing feelings of personal inferiority and self-worthlessness contribute to withdrawing behavior. Rejection by their peers seems to validate the rejection by their parents. When children cannot turn to their parents, their peers, or even themselves for gratification or validation, they retreat. Avoidant personality may be the result.
3. Other Factors
   In addition to rejection by parents and peers, it is speculated that several other factors can play more and less significant roles in the development and persistence of APD. For example, children who are infantalized by their parents may have difficulty relating to people outside of the family. As adults they may be regressive and dependent in relationships. Avoidance may also be recommended by parents, peers, teachers, entertainers, religious leaders and the media as protection against the evils of the world. Unresolved rivalry with siblings has been suspected of inducing transferential jealous competition among individuals, leading to avoidant behavior. Also, sexual feelings, for example Freud’s (1950) “incest taboo”, may unconsciously lead to avoidance of close relationships with parents and later with potential partners. It has been noted that sometimes avoidants isolate themselves in order to manage strong ambivalent or negative feelings toward sex (Kantor). In psychopathic proportions, avoidance may lead to a purposive distancing in order to enhance sexual fantasies (Shapiro, 1981). In some cases, a more poignant expression of sexual disgust may be expressed as love revulsion, a condition in which the avoidant has learned to “love” isolation, not because it is a real preference but because it is a defense against a forbidden desire to be with others (Kantor). Finally, transference can lead to avoidant behavior when an individual distances herself from people who remind her of something or someone she disliked or feared in the past — often parents, but also others outside of the family.

continue: The Self-Perpetuating Cycle of Avoidant Personality Disorder

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Reviewed: 04/2006