According to the WHO and the American Psychiatric Association, patients with avoidant personality disorder exhibit 7 characteristics,in terms of the patient’s behavior:
- Avoids activities involving interpersonal contact for fear of rejection in its various forms.
- He/she does not relate deeply with people for the same reason.
- This fear affects intimate relationships.
- The possibility of social rejection is a frequent concern, even if the person is usually alone.
- If he/she meets new people, he/she tends to feel inferior.
- Self-perception is that of being uninteresting and incapable of relating to others.
- Apart from social relationships, he/she does not get involved in new activities in case they compromise him/her.
As in other personality disorders, biological factors are involved. These factors are still in the initial phase of study, although it seems that the noradrenergic system is involved.
On the other hand, psychosocial factors also play a role, including expectations of devaluation and/or rejection in childhood and intense fear of the possibility of separation from parents (even for a short time, even minutes). It is more common in immigrants who have to adapt to a new culture.
Personality disorder by avoidance develops in adolescence and early youth, which is when the character is formed. In cases in which there is a brain injury, consumption of toxic substances, continuous severe depression or post-traumatic stress, the previous personality may be transformed and this disorder may appear at a later age.
Treatment
It consists mainly of psychotherapy, either cognitive-behavioral, interpersonal, psychodynamic (based on psychoanalysis but with some differences, psychodrama in individual form, etc.).
It should begin in individual format, but as it is basic that the patient can adapt in social relationships, it is important to continue with group psychotherapy.
Medication is given if anxious or depressive symptoms appear, being useful antidepressants, anxiolytics and, if necessary, hypnotics; although it is important to clarify that drugs do not modify the essence of the way of being; this objective is exclusive of psychotherapy.
Prognosis
As psychotherapy is the essential treatment, research to determine the prognosis is more difficult than in disorders in which medication is the basis of treatment. It is therefore risky to give percentages, although if we compare avoidant personality disorder with severe personality disorders (borderline, paranoid, etc.), the prognosis in this case is better.