3. Few or no friends.
4. Avoidance of activities that are otherwise pleasurable.
5. Passivity, pessimism, and low self-esteem.
6. Excessive computer use that is not social in nature and without face-to-face contact with others.10
I next offer a more detailed discussion of the some of the previously mentioned criteria.
DSM-IV CRITERIA
1. DSM-IV: Shyness, timidity, and withdrawal.11 Avoidants are shy, timid, introverted, withdrawn, socially inhibited individuals anxiously desirous of relating but conflicted about doing so due to a fear of getting close and committing to others.
Unlike schizoid individuals, who have a severely reduced capacity for relationships, avoidants can relate and are both unable and unwilling to relinquish relationships completely and definitively. As Sullivan suggests, the problem is that their “intimacy need[s] collide with the need for security”12 so that they feel frustrated and pull back as selfprotection becomes more urgent than self-fulfillment.
2. DSM-IV: Fear of criticism, humiliation, and rejection. Avoidants are fearful of what other people think partly based on hypersensitivity and a proneness to exaggerate the dangers of a negative evaluation. They avoid taking personal risks because they fear being exposed, ridiculed, and shamed, for example, for crying or blushing publicly. (As the Quality Assurance Project says, “an extreme interpersonal sensitivity to perceived rejection” and a tendency to interpret ordinary slightly negative human interactions as rejection leads avoidants to see “developing involvement with others as hazardous.”13)
A Case Example
An avoidant man, expecting too much from the world, overlooked how some rejection is simply part of life’s give and take, and instead, expecting life to always be fair, rewarding, and complete, became highly vulnerable to even minor signs of life’s inherent unfairness and imperfections. Regularly expecting relational successes, he would panic when they were not forthcoming, pull back, give up, and cry, “Never again.” Too, regularly expecting relational miracles, he would go to mingles events/singles resorts and share singles homes in country resorts, and surf the Internet for dates, thinking, “Tonight, I will connect for sure,” then, even though he knew intellectually and from experience that he could not count on connecting every night, he would let one night’s failure or one turndown become a commentary on how he was completely wasting his time because no one would ever love him. His motto soon became, “It’s better to have never loved at all than to have innocently loved, then been rejected for having done so.”
Sensitivity to rejection frequently results in defensive outbursts meant to destroy what could otherwise easily have been a viable relationship.
Case Examples
A patient stormed out of the house after telling his wife he was leaving her because one day, instead of being there to greet him when he came home from work, she had gone out to do some errands and forgot to leave a note saying where she was, “forcing me to come home to an empty house, causing me to feel ‘you left me and so you don’t love me,’ throwing me into a panic about having to stay home by myself for who knows how long, thinking, ‘I did something wrong, this is my comeuppance, and as a result I am always going to be completely alone, and in this, such a hostile, world.’ ”
A patient kept the same routine for months or years—eating in the same restaurant every night and ordering the same food and drinks night after night, meal after meal. He did that until one “fateful day” he changed restaurants on a slim, slightly paranoid pretext because he felt that his “waiter hustled me for drinks, and served me baked potatoes today that were smaller than the baked potatoes he served me yesterday.”
A music critic, preoccupied with “who is being mean to me, ” interpreted any opinion that differed from his own as putting him down in a critical way. When others corrected his mispronunciations, he thought that they were calling him stupid and uneducated for misspeaking. When people expressed any neediness at all to him, he interpreted that as their criticizing him for not giving them what they wanted. A globally anxious protective removal grew out of these negative misinterpretations and led to misunderstandings and arguments that became his reason to permanently rupture even relationships that had, until then, otherwise been going well.
3. DSM-IV: Feelings of inadequacy and low self-esteem. Avoidants feel inadequate; see themselves as socially inept, unappealing, or inferior; and assume that others view them the same way. Hence they have an undue need for certainty and security and, before they extend themselves to others, require that others pass stringent tests indicating that they will always act in an obviously supportive and nurturing manner. Avoidants also withdraw because they feel unworthy of being liked, making it unlikely that they will expect/ask others to like and accept them. (Avoidants can, however, be intimate when they know that assurance of uncritical acceptance is forthcoming.)
A Case Example
A gay patient withdrawing from a suitable partner as a form of self-apology said, “The new man in my life is a vice president of a large media company here in Chicago. The person that introduced us said he was just looking for an average guy, but I was concerned when he got into his Mercedes and all I have is an old Honda. In other words, he lives a much higher lifestyle than I do, and I am worried that I will not be able to keep up with him. He is also very good looking, and I am just average in looks and make a lot less than he does. But we seem to be hitting it off so far: no sex or anything like that—just enjoying each other’s company and I actually like him, to date anyway. I just work as a welder in a large construction company, but I am not after his money or anything. My friends say I am worrying about nothing. Still, I’m going to drop him because I would rather live poor and be happy than force myself on someone I feel I am unworthy of.”
4. DSM-IV: Anxiety in new social situations. Excessive security needs along with doubts about relational certainty in both personal and occupational contexts cause avoidants to become highly anxious in unfamiliar situations, as, for example, when attending large parties.
Although the DSM-IV emphasizes that many avoidants are most fearful of strange, unfamiliar surroundings, where they know nobody or are just meeting new people, some avoidants actually function best with strangers like waitresses, for they see them as safe because they are comfortably remote and predictably unavailable.
A Case Example
One timid avoidant, though shy with friends and family, was bold and forceful with waiters and coat check girls—for as strangers, they were unlikely to expect anything from him beyond the superficialities. He was able to feel positively about women he merely passed on the street, but with women he really liked and got to know, to use his own words, when he “got past first base” and was “in a position to score,” he “completely froze up.”
5. DSM-IV: Hypervigilance and self-consciousness. Avoidants always have one eye open to what others think. They tensely appraise others’ movements and expressions to see if others approve of what they are saying and doing, only to avoid others because they become convinced that others believe the avoidant has done, or is about to do, something wrong.
Their vigilance promotes an excessively rich fantasy life, as they frantically appraise the movements and expressions of others, conjuring up the bad things others might be thinking and doing from slim stuff, thence creating complex, fantasized, fearful scenarios, especially about being alone and its lonely consequences. They routinely have dreams about potential or actual social loss, for example, “I call you on your cell phone but no one answers, you were there in the room with me a minute ago, but now you have simply disappeared; and clearly you don’t want me anymore because you find me disgusting, which is why you are telling me to get out.”