Martin Kantor - The Essential Guide to Overcoming Avoidant Personality Disorder

The Essential Guide to Overcoming Avoidant Personality Disorder

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The Essential Guide to Overcoming Avoidant Personality Disorder

MARTIN KANTOR, MD

Q PRAEGER

AN IMPRINT OF ABC-CLIO, LLC Santa Barbara, California Denver, Colorado Oxford, England

Copyright 2010 by Martin Kantor, MD

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, except for the inclusion of brief quotations in a review, without prior permission in writing from the publisher.

Library of Congress Cataloging-in-Publication Data

Kantor, Martin.

The essential guide to overcoming avoidant personality disorder / Martin Kantor. p. cm.

Includes bibliographical references and index.

ISBN 978-0-313-37752-5 (hard copy : alk. paper) ISBN 978-0-313-37753-2 (ebook) 1. Avoidant personality disorder. I. Title.

RC569.5.A93K36 2010 616.85'82dc22 2009044857

ISBN: 978-0-313-37752-5 EISBN: 978-0-313-37753-2

14 13 12 11 10 1 2 3 4 5

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To M.E.C.

Hello Martin. For many years I am spiraling deeper into isolation and only yesterday I read about Avoidant PD and discovered I fit on all counts. I am not sure what to do about it. I am scared to talk to people and my memory is weak.

letter to the author

reface

Sufferers from avoidant personality disorder (AvPD) fear forming and maintaining relationships because of ongoing, engaging, deep, pervasive, multilayered interpersonal anxiety. This anxiety causes them to have difficulty meeting, connecting with, getting close to, and staying involved with other people. According to Oldham and Morris, the disorder occurs in fully 10 percent of patients of outpatient mental health clinics,

I believe that even these disquieting statistics underestimate the extent of the problem, with this disorder far more widespread than most patients believe and clinicians acknowledge. This is because avoidants themselves overlook AvPD because they dont know it exists, or they downplay AvPD because they believe that having social anxiety is somehow shameful. And their therapists, equally misinformed about, or reluctant to recognize, the disorder, dismiss their suffering as normal shyness, reticence, unfriendliness, cliquishness, or as just part of growing up; or, spotting the disorder, they tell their patients that the problem is insignificant or condone it as acceptable, justified, and even romantic. They then offer reassurances that all is well and say that no therapy is necessary, or if it is necessary, it should be for something else entirely.

On their part, researchers often miss the diagnosis because they fold AvPD into borderline personality disorder (BPD). They fail to distinguish the characteristic chronic distancing patterns of AvPD from those of BPD, which consist of a more acute cyclic, intermittent approach-avoidance shifting. Unlike in AvPD, where the distancing is dynamically, if not clinically, resolute, in BPD, overly close intense relationships characteristic of the object hunger-merging phase of the borderline condition are in turn fitfully undone by an equally intense object satiation-emerging phase. As a result, we see the typical borderline tendency to alternate rapidly between overvaluation of and love for, and undervaluation of and disdain for, other peoplethe all too familiar come here, go away, I love you.

More often still, and with even more tragic results, is the widespread proclivity of researchers to subsume the diagnosis of AvPD under the rubric of social phobia and then to report exclusively on social phobia, virtually ignoring AvPD. Thus the PDM, or Psychodynamic Diagnostic Manual, refers to AvPD as phobic (avoidant) personality disorder. In some ways, avoidants do resemble social phobics, and some therapists believe that they can effectively treat AvPD as if it were a compendium of social phobias, expecting the former to disappear when the latter are relieved. But to my way of thinking, the two disorders differ significantly diagnostically and therapeutically, in large measure because they differ structurally. For avoidants, unlike social phobics, are not terrified by specific, discreet, easily identifiable, well-delineated trivial prompts such as having to speak in public, use a public rest room, eat and swallow while being observed, or enter a crowded room where there is a party going on. Instead, they are troubled by a panoply of mostly negative personality traits that have more of an existential than a situational implication. Thus they suffer not from a fear of writing a check in public but from a fear of getting close to others and committing themselves to one someone special. Clearly, to me, while the dynamics of the two disorders overlap, each takes a unique form , with social phobia being a symptom disorder and AvPD being a personality disorder , and with the former being a modified, encapsulated, delimited version of the latter. Thus, though sufferers of both disorders are struggling emotionally with a fear of criticism and humiliation, the one, the social phobic, displays the fear as a need to avoid using a public rest room to urinate, whereas the other, the individual with AvPD, displays it as a global need to avoid not only restrooms, but also all rooms with people in them, making the avoidant individual reluctant to enter into life and to do all the things that happy people living normally ordinarily do.

This is a crossover text meant for two audiences. The first is for therapists hoping to properly identify and thoroughly fathom AvPD in preparation for developing a dedicated treatment approach to helping their patients cope with, or fully overcome, its ravages. The second is for sufferers from AvPD hoping to free themselves from their painful shyness and self-destructive distancing so that they may emerge from the dark shadows of isolation and loneliness into the bright light of warm, close, satisfying, loving, lasting relationships. Thus this book can be read in two ways: it is a guide for therapists developing a psychotherapeutic technique suitable for effectively treating AvPD and a manual for sufferers hoping to develop a self-help approach to profitably modify their lives and change their lifestyles, as they come to subdue their irrational fears and newly and more successfully cope with their overwhelming, life-sapping, happiness-destroying interpersonal anxiety.

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PART ONE

AND CAUSATION

-<3^3

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In this chapter, I focus on classic avoidant personality disorder (AvPD), a disorder whose individuals, as Fenichel noted in 1945, suffer from social inhibitions consisting of a general shyness [that may lead to withdrawal] from any social contact [because] they anticipate possible criticisms. I start with a summary of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV ) criteria for AvPD, then add a summary of criteria formulated by Francis and Wi-diger, Benjamin, Horney, me, and the American Psychological Association Help Center.