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PART ONE
DESCRIPTION AND CAUSATION
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CHAPTER 1
Cl assic or Type I Avoidant Personality Disorder
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.”1 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.
DSM-IV CRITERIA
The essential DSM-IV2 criteria for AvPD are as follows:
1. Shyness, timidity, and withdrawal from relationships associated with the willing renunciation of autonomous strivings to avoid the friction and conflict associated with closeness and commitment. (The Quality Assurance Project refers specifically to “fear of commitment”3 and assigns it a central role in the dynamics of avoidance.)
2. A fear of criticism, humiliation, and rejection.
3. Feelings of inadequacy and low self-esteem.
4. Anxiety in new social situations.
5. Hypervigilance and self-consciousness.
6. Social awkwardness due to an off-putting fearful tense demeanor that, in turn, elicits ridicule and derision from others, which confirm self-doubts, leading to further awkwardness, causing others to pull back because they see avoidants not as “fearful of rejection by me,” but as “being rejecting of me.”
NON-DSM-IV CRITERIA
Frances and Widiger
Francis and Widiger go beyond the DSM-IV view of AvPD as the product of a sensitivity to and fear of interpersonal rejection in the form of criticism and humiliation by others to offer further reasons for social anxiety:
1. A fear of flooding and losing control of various impulses due to overstimulation, for example, the fear that forbidden, even revolting, romantic or hostile impulses are about to erupt— disturbing inner peace or even completely shattering internal equanimity.
2. An associated fear of experiencing “uncomfortable body sensations” such as tremulousness.
3. A fear of failure, accompanied by a paradoxical (masochistic) fear of success.4
Millon/Benjamin/Horney
These observers emphasize the generally downplayed role freefloating and reactive anger play in the distancing process. Millon describes an “avoidant-passive-aggressive mixed personality”5; Benjamin speaks of the avoidant’s tendency to become too readily “indignant”6; and Horney, according to Portnoy, notes that “the major possibilities of anxiety come to be [not only] rejection or disapproval by others [but also] hostile impulses from within the self.”7
Kantor
I propose the following as basic criteria:
1. Self-criticism due to self-condemnation by a harsh, unforgiving, shaming conscience, causing one to become guilty over legitimate desires and ordinary (but to the avoidant extraordinarily shameful), interpersonal foibles.
2. Annoyance with others over the most trivial things, for example, “every time he dries himself he uses a new towel, running up my laundry bill, and that in a recession!”
3. A masochistic desire to be hurt by suffering relationally.
4. A fear that acceptance and closeness will interfere with doing the “me” things avoidants really want to do and thoroughly enjoy doing like a man’s watching the TV shows he likes or a woman’s becoming fully emancipated both personally and professionally.
5. A fear of acceptance and closeness due to a fear that these will “swallow avoidants up whole,” leading to a loss of boundaries and a compromised identity due to becoming overly dependent on, and subject to the full control of, others.
6. Relational idealism consisting of a disdain for relationships that appear to be imperfect, originating in excessive expectations of oneself and others, associated with excessive pridefulness and a hypermorality that too narrowly defines what is and what is not “biblically” correct and so relationally permissible.
7. A fear of depletion due to a fear of letting go with others to the point of significantly dissipating one’s life energy.
8. The excessive use of relational defenses. (The Psychodynamic Diagnostic Manual, or PDM, lists, in addition to the defense of phobic withdrawal/avoidance the defenses of symbolization, displacement, projection, and rationalization.8)
9. Covalent characterological features, including histrionic (oe-dipal) rivalry that buries the potential for closeness, intimacy, and commitment under competitive struggles with others—as Gabbard notes, “entailing an aggressive demand for complete attention . . . associated with a wish to scare away or kill off all rivals . . . [with the competitiveness] interwoven with a sense of shame”9; obsessive fretting about the correctness and propriety of one’s interpersonal actions—with obsessive overworry about the consequences of making even minor relational mistakes associated with a hypermorality that leads to viewing one’s ordinary humanity, including, or especially, one’s acceptable sexuality, as shameful and sinful; paranoid suspiciousness about the negative things others are, or might be, thinking; depressive alarmism and pessimism that nothing will ever work out as hoped and planned for and the worrisome fear that if all is not already lost, it soon will be; excessive “don’t make waves” passivity, accompanied by a paradoxical fear of passivity and so a need to be on constant alert and continuously active to assure always being in complete control of everything about one’s relationships; extreme dependence possibly leading to a codependent relationship with one person to avoid having to relate to any and all others; narcissism characterized by constant pulse taking, for example, “how you make me feel,” that implies an unempathic lack of concern about “how I make you feel”; neophilia—a need for newness associated with easy boredom with the old; and neophobia—a fear of newness, leading to a need for sameness, creating a fear of change and progress.
10. Fear of being different from equally avoidant peers, as if being different from them means defying them, and so becoming a nonavoidant pariah in what is perceived to be, and ultimately too often actually is, one’s avoidant society.
The American Psychological Association Help Center
1. Canceling social events at the last moment.
2. Avoiding situations that provide positive social interaction.