This patient had, in the emerging phase, confined herself to activities that had little inherent interpersonal context—dull, lonely things like watching television supine on the couch, or self-destructive lonely things like excessive drinking and/or taking drugs. In contrast, in the merging phase, she had met and married a man after knowing him for only a few days, then, shifting once again after another few days, claimed that she and he were incompatible and filed for divorce.
A patient, after breaking up a relationship with a lover over his wearing a designer belt (as part of an attack skillfully geared to put the blame on him for his pseudosophistication instead of on her for her unrelatedness), thought twice and called the lover constantly, begged him to give her one more chance, and added, as often as she could, “I really like designer belts and, most of all, the people who wear them.” Her life ultimately deteriorated into shifting from the two-bedroom apartment with unloving roommates to the lonely studio apartment with the loving cat, then back again; placing personals ads on the Internet but constructing them in a way that assured they were geared to get few to no responses because they were too noncommittal to be consonant with their stated purpose; and frantically cruising singles bars, functions, and resorts, but drinking heavily to the point that she got too drunk to function effectively, then, after sobering up and staying home alone for months on end, starting to think, “I miss my social life,” and returning to her old ways of heavy drinking and frantically seeking “Mr. Right, right now.”
A patient told me of how a borderline man alternately seduced and abandoned her, keeping her involved in his charade by taking advantage of how her loving neediness rendered her too helpless emotionally to deal effectively and definitively with his alternate merging and emerging:
Here is a cross section of my conversations with Oscar:
Oscar avoided me through his not matching his action to his words and lofty promises. Our conversations went something like this:
O: I can’t live without you. This life here in Paris holds nothing for me. It is a life where [sobbing] no one even caresses me.
F: If you can’t live without me, how come you ditched me when I went to Paris to see you?
O: Because I don’t mean I need you for a week or two weeks, I need you for all of my life and forever.
F: A person that loves that much would have at least helped me when I telephoned, confused and panicked about what train to take to make my appointment with you—but you, working in your office at the train station, said you didn’t know, and had to hang up.
O: Well, if that is how you feel, I respect your feelings. I never try to force anyone to think differently than they do, that would be disrespectful and everyone is a sacred creature of God.
F: I don’t know which part of you to believe, the one who cries because he loves and wants to be with me, or the one who is never there and seems to have no urgency at all to see me.
O: Oscar is not a liar [he often referred to himself in the third person]. He is not a liar because when he was five years old his grandmother gave him a lesson he never forgot. When he tried to steal a candy when they were out shopping she slapped his hand, humiliating him, and made him bring it back. He has never lied again since.
Also, his emotions were phony. When he would cry, it would be with intense drama, but only for about five seconds, and then he would laugh or start a different conversation. It was more an obligatory wailing with a time limit.
Also, I am still not over the fact that he would never return my grandmother’s tablecloth. My grandmother had made it by hand (she used to do cut work when she came to this country). He inherited an apartment from his mother and said it was to be for us. I had brought the tablecloth and 12 napkins over for what was to be our place together, but we never got there because he told me the workmen were fixing it up and he was allergic to dust so we shouldn’t go. The next time I went to France, he told me he had rented the apartment out because I wasn’t clear enough about when I would move in with him. So I asked him for the tablecloth back. He said he still had it and treasured it because he treasured everything I gave him, but he would give it back to me, but he never did, although it meant a lot to me and nothing to him. Once I got really upset and he told me he had sent it and it was on its way. When I opened the envelope he sent me (yes he actually sent me an envelope!) there was one thin, worn cloth napkin (not my grandmother’s) with a hole in the middle. I asked if this was supposed to be a joke, and he started crying, saying he couldn’t do anything right, and please forgive him, God made him imperfectly.
Also, every time we got together, after passionate e-mail exchanges in the year in between, saying how when we met we were going to plan our future together—he would find a way to hedge. Here were some of his excuses about not making plans:
• I wasn’t prepared to talk about this. You take me off guard. You jumped in too strongly and didn’t wait for me to bring up the subject.
• My son Sacha is still under 18. I need to protect him from my wife, Josette, who is crazy, and I’m afraid of what she might do to him.
• My brother-in-law is gay so if I leave my son now, he may have too much of an influence on him.
• Your being upset with me made me too upset to talk with you about a plan.
Sometimes when I was with him I felt only hope that we would be together forever. Sometimes instead I felt only despair that we would always be apart. Just as I couldn’t live without him, I couldn’t live with him. As far as he was concerned, it seems as if he could, and did, live very well either way: one minute with, and the next minute without, me.
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CHAPTER 7
omor
bidity
Comorbidity with other personality disorders distorts the “pure” clinical picture of avoidant personality disorder (AvPD). For example, Millon describes an “avoidant-passive-aggressive mixed personality,”1 which adds a dimension of annoyance with, to the anxious withdrawal from, others.
Comorbidity alters the treatment approach to AvPD, and it does so in at least two ways. First, the therapist must treat all the disorders that constitute the final picture. Thus, while nonparanoid avoidants need to focus on, expose themselves to, and immerse themselves in relationships so that they can connect with others without becoming unduly anxious, paranoid avoidants need to start not with exposing themselves to relationships in the real world, but with rethinking their suspicious ideas about the real world to which they will hopefully soon be exposing themselves. Second, comorbidity determines the nature of and increases the number of resistances that crop up to impede therapeutic progress. Thus avoidants who also, in paranoid fashion, wonder, “What did he mean by that?” tend to be reluctant to think and act less avoidant just on the therapist’s say-so. Avoidants who are also depressed tend to resist therapy because they view the therapist’s exhortations to do something as a criticism that they didn’t already do it. Avoidants who are also masochistic tend to resist therapy because they respond to getting better by feeling worse. Avoidants who are also obsessive-compulsive tend to resist therapy because as stubborn individuals, they respond to therapeutic exhortations by taking one step backward—to “rethink,” really undo, every step they just took forward.
COMORBID AVPD AND PARANOIA
Here the classic AvPD fire of sensitivity to the possibility of criticism, humiliation, and rejection is fueled by suspicion of what others might be thinking and up to. Such suspicion originates in large measure in a lack of basic trust resulting from projection, where “I dislike myself ” becomes “you feel antagonistic toward me and so must be out to get me.” These avoidants primarily withdraw because they become wrongly convinced that others dislike or even hate them, as they view a cancellation of a date due to sudden illness as a personal rejection; an ogling look from a stranger not as a come-on, but as a hostile stare; an offer of friendship or love as sexual harassment; an attempt to matchmake as trying to humiliate them for being so desperate that they need to be fixed up; and the best-intentioned advice, including that from a concerned therapist, as criticism for prior wrongdoing and/or as an attempt to control them for the personal gain of the advisor.