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MedCircle
7 Signs of Avoidant Personality Disorder
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Understanding the diagnostic process for a personality disorder is difficult, but Dr. Romany makes it simple. In this episode, she explains how the path to a diagnosis should and should not look and walks through the seven criteria used to diagnose avoidant personality disorder. Alright, Dr. Romany, what goes into diagnosing somebody with avoidant personality disorder? You know, Kyle, as with all personality disorders, it's not just sort of like a quick and easy kind of a process.
Many times when we come to the diagnosis of a personality disorder, it can require multiple interactions with a client to hear about how they're doing in various areas of their life, with their friendships, in their family, with a partner at work or at school, because personality disorders tend to be pervasive. So this is just somebody who doesn't want to do a sales talk, but they're doing well in those other areas. It takes time to get all that information. So at the core of it, in order to figure this out, we need a series of clinical interviews, or at least to start treatment with someone.
If a person with avoidant personality disorder came into treatment, they may very well come into treatment because they feel lonely and they feel frustrated and not being able to connect to other people, that might be what brings them in. So when they're brought in with that kind of a presenting issue, we're going to think about a lot of things. Is this person socially anxious? Is this person depressed? What's going on here? And then we'll dig deeper. And once we see the pervasiveness of it, it might take us even a few weeks, maybe even a few months to land on this summit squarely.
We'll also look at, for example, how do they perceive how other people view them? Is this more about being anxious or is this really about feeling inadequate and that people will reject them? People who are socially anxious are just more reacting to the physiological reactions they're having at that time. And yeah, they do worry about screwing up, if you will. But for the person who is experiencing avoidant personality disorder, it really is. It's the fear of rejection, the fear of criticism, the hypersensitivity. The themes are a little bit different. So it's a really nuanced kind of a path. And I have to tell you, I've worked with clients for maybe the first six weeks.
I thought, he's socially anxious. And about week eight or nine, I'm like, no, this might actually be more pervasive than that. And it'll show me how much more severe and consistent it is. And then I might do a little bit more work once I realize it's avoidant personality on sort of unscrambling those fears and focusing on it more as a pervasive pattern than as an anxiety disorder. I would imagine that most people come in for depression. Depression is probably one of the primary leading causes of why people ever get into mental health treatment.
But I have to tell you, there's also a lot of stuff of life that get people in relationship problems, dating problems, but a lot of it's relationship problems. And that's a lot of what brings people over the threshold of my office. Problems in a marriage, problems with a parent, problems with an adult child, something like that. And that we can break it down from there. So sometimes people will even come in with an entirely different kind of an issue and then we'll end up coming in a back door on this one. So it really takes a lot of interviewing, time.
Sometimes people do psychological testing or assessment and they'll give them a series of tests and those tests will give insight into these patterns. And that's almost like a faster way to that end goal. But no matter what, you still need to spend time with a client to understand them holistically. So what's the criteria in the DSM for avoidant personality disorder? So again, it's this pervasive pattern of sort of fear of rejection and social inadequacy characterized by sort of being socially inhibited. The first and so much so that it creates a sense of social and occupational impairment that it gets in the way of work, it gets in the way of life.
So the first criteria is that these are people who avoid occupational activities that have a lot of interpersonal interaction because of they're afraid of basically screwing up and looking foolish or making a mistake or criticism. And so you can see how that could hold someone back in a job. It's a pretty rare job where you never have to have contact with other people. And in some industries, it's a requirement. So they'll go out of their way to avoid that, including doing things like avoiding promotions, avoiding transfers, avoiding sort of forward motion in their career, which can hurt them in many ways, lower income, growth in their job, job security, but they'll go out of their way to avoid that.
The second is that they're not willing to get involved with other people unless they're sure that they'll be accepted. Now when you think about that, when do we ever have that kind of assurance? There's almost something childlike about that, right? And what happens then is because you rarely get that reassurance, they're not very likely to enter into close personal relationships. And this is where I also say there's a danger to that because sometimes it's easy for someone to manipulate them or trick them or toy with them because they can find someone who may accept them because they're trying to get something from them, money or something else like that.
And so in those cases, the person almost feels like it's a guarantee, come into our cult place and you can come be with us and we all love you. You can see with that vulnerability is everyone's liking them no matter what. You can see how it's really a setup for falling into some dangerous and expensive situations of people who actually don't have their best interests at heart and could be very emotionally manipulative or abusive. People with this pattern also show restraint or hold back within intimate relationships because they're afraid they'll be shamed by their partner or ridiculed by their partner. So what that means is they're reluctant to share about themselves.
They're reluctant to share their vulnerabilities, their intimate thoughts or feelings because they're afraid that, for example, let's say they shared a romantic or sexual fantasy that their partner would make fun of them or actually downright shame them. And so that fear means that they almost feel like they're, and some people could interpret it as almost like they're being aloof, they're being cold, they're being distant, they're being overly shy. But they're doing that because of their fear of being shamed. The fourth is continuing with that preoccupation. They're preoccupied of being criticized in social situations.
So as a result, for example, they won't offer up an opinion, right? They won't share, even if they have an opinion about something, they'll hold back on that because that, as you can imagine, especially in this day and age of so much polarization, that they'd be so afraid that somebody would make fun of them for having that opinion. So they'll show not only in an intimate relationship, but in any social situation, that fear of being rejected or criticized has them holding back, sharing really anything that meaningful for fear of that rejection. The fifth criterion for this disorder is that they feel inhibited when they're in a new interpersonal relationship because they feel inadequate.
So that could be a new friendship, that could be a new colleague, it could be a new partner. But because they feel so inadequate, they feel less than, they very much hold back or feel very, very awkward. And they'll often sort of put down what it is they do for a living. I've worked with many clients like they have the most interesting job, but sometimes they're sort of like they're, they're quirky or they're off the grid and they're almost ashamed of it. And they'll be like, I don't want to tell anyone what I do for a living because they're going to make fun of me.
And if that happens even once, that can inhibit them for many, many years after that. So that's always their fear. So they won't even go there. And it's hard because you can't curate how the world is going to react to someone. But because they feel so inadequate, they, especially when they meet new people, they really, really hold back. Criterion six is that people with avoidant personality disorder, they judge themselves. They consider themselves to be socially inept and less socially skilled than other people. So that's literally their identity when they go in. So they go, don't ask me or don't have me talk to them. I'm the wrong person. They'll always assume everybody's more socially skilled.
In many ways, that's a cognitive distortion, but it feels very, very real to them. And what that means then, once again, they're socially inhibited. They take no risks. They miss a lot of opportunities. And because of that, it keeps reinforcing their identity as being socially inept. When they just that this is largely happening up here for them and they rarely get to sort of test themselves, if you will, socially. Finally, people with avoidant personality disorder are very reluctant to take any kind of risk to try something new, especially in front of other people because they're afraid they'll embarrass themselves. So let me tell you this right now.
A person with avoidant personality disorder is never going to do karaoke. OK, that's the kind of thing. They'll never be the person who will jump up on stage, be a volunteer, even step up at their brother's wedding. That would be very upsetting because they're so afraid of embarrassing themselves. And again, there's even this interesting phenomenon where they're also afraid that they're going to embarrass other people who are being embarrassed by watching their awkwardness. Does that make sense? It does. It's almost like this reciprocal sort of a thing. So because they'll never take any risks, they miss a lot of life.
You know, like they won't they might be afraid, for example, there's like a cool pond to jump in off of a rock. They won't do that because they're afraid they'll jump in the wrong way. They might be inhibited to try something on vacation or try a new activity or anything like that. So they miss so much life and they look at it almost like longingly. But because they're so afraid of being embarrassed, they won't try something new. They miss. They miss so much opportunity for growth, curiosity, meeting new people, advancement at work. But that fear of embarrassment overrides all of that sort of wanting to do it.
The reason it's important for viewers to know what the criteria is in the DSM, which is the manual professionals use to do these diagnoses, is because that is what you're going to keep in the back of your mind as you are putting someone through this diagnostic process. Now as you put someone through this or when someone goes through this process with a professional, are there things that they should look out for that would be a red flag of, whoa, this professional is not doing their job, whether that's quick to diagnose them with anything or something like that? I think that that quick to diagnose is something I would struggle with.
And the problem is nowadays there's sometimes a quick to diagnose because various agencies expect a diagnosis. That's what people want. They need it, they want it, the insurance, call it what you will. That's a problem. And psychiatric diagnosis is not like diagnosing anemia where you stick a needle in someone's arm, you take some blood, you run an assay, you're like, oh, you've got anemia. This is a very nuanced art and it's something that morphs over time. A person who initially may look socially anxious over time, we learn, is avoidant personality. Then we come to learn that they're drinking a lot and they're drinking a lot to manage.
You know what I'm saying? And so it's something that blossoms over time. And I think there needs to be a real respect for that process. So somebody says, I can take care of that for you in three sessions. Yeah, no. And so I think the quick cure-alls that I have some magical way, a magic bullet, a magic pill, if you will, to make all of this go away. I think people should be leery of that. I wish we did. Me too. I absolutely wish there was some mantra I could give somebody and say, say this 10 times and you are good to go. It's not like that.
While I've seen extraordinary growth for many clients in therapy, not just with me, but with many of my colleagues who are clinicians, this is sometimes not only a slow, it can be a slow process, but it's an arduous process. I mean, it's a commitment on both sides of the therapist and the client. So I think anyone is like, we can deal with this in just a few sessions. I've got a magical manual that will make this go away, a very quick diagnosis.
And more than anything, because the way we come to diagnosis is an evolving process, somebody who gets so stuck, like, no, you have this, no, you have this, as more information comes in about where a person's at, that's also important too. And I'm going to be frank with you, I don't talk with my clients in terms of their diagnosis. I don't like that. I don't want it to be, hi, Kyle, my whatever you are, my anxious person. We'll talk about it in general terms. I'd rather talk about avoidant personality disorder and not use those three words. I'd rather call it things like, you know, your fear in such situations.
And I keep coming back to that terminology. To me, diagnoses are shorthand. I get that. And I like to talk with my clients in terms of the ingredients, because it's the ingredients that are causing them the distress. And I think that's a much more meaningful conversation. Yes, I 100% am on board with that. Has anyone ever come into your office and said, hey, Dr. Rowany, thanks for seeing me. I have avoided personality. So nobody's even aware of that. I've had people come into my office and say, hi, I have narcissistic personality disorder or hi, I have borderline personality disorder.
Maybe they've seen other clinicians, but I've never in my career had someone walk into my office and say, this is what I have. Why? I think that, first of all, the name is strange, right? So they're thinking they're struggling with like, they get really anxious around people. So they think of it as an anxiety disorder. The idea of avoidant, the name wouldn't even make sense to them. And I think that a lot of times these people have been branded as socially awkward, ultra shy. Those kinds of words have been used. So they don't even think that this is sort of more of a consistent diagnostic pattern.
You got to remember, this is one of those patterns that's only recently getting a little more research interest, but it is not like patterns like borderline personality. They've gotten tons and tons of research put on them, mostly because it's a much more distressing disorder for people experiencing it. But avoidant personality is also very uncomfortable. So we're seeing more and more work on it for sure. What would you say in your experience is the typical age someone gets diagnosed with APD? I think with all personality disorders, and I hold to this, we do not really issue these diagnoses much before the age of 18. The personality is still developing through adolescence.
And I'm a bigger fan of even holding off to 21 to 25, because I think adolescence in our culture is now going all the way up to 25, frankly. And I don't even mean that tongue in cheek. I mean that seriously. I get that. We call it transitional adulthood, but it's just expanded adolescence. So I like to sort of see the personality sort of take shape before we sort of toss a label on it. But I think that we would start seeing these patterns onset in late adolescence, early adulthood in any systematic way.
However, these are people who have struggled with this pattern of fear, fear of rejection, fear of inadequacy, feeling socially inhibited probably through their entire childhood. So it's not like they're fine socially and then one day they hit 18 and all of a sudden it becomes more difficult for them socially. This pattern has been there. Just for fun, I come into your office and let's say it's been a few sessions. You start to think that I might have APD. What type of questions would I hear? Talk to me about your friends. Tell me about the people you spend time with. Find out about their dating life and dig deeper into their relationship.
How many relationships have they had? How long have they lasted? How did they meet? What are their relationships like within their family, their workplace? So I'd really do some digging around how all of their social relationships feel. What I think would then start to emerge is the same theme over and over again. I don't really have that many friends. They might either say I've never had a relationship or it's hard for me to get into a relationship. I don't really like dating. They may report intact familial relationships, but I wouldn't be surprised if we found out that their familial relationships were also fraught with anxiety given the origins of this pattern.
I would be looking to see if there's a consistency around the fears, the fears of inadequacy, all those fears cutting across all relationships. Once we got there, I would point that out. It's not like I'm trying to do some sort of voodoo magic. I'll say, do you see the consistency in this pattern? And they'll say, yeah. And I'm actually kind of aware of it. I never thought of it that way. Many times when we, it's almost like taking all the stuff out of someone's house and laying it in a pattern. Oh, I never knew I had 27 pairs of black shoes. That is a metaphor. Yes, that is so it. Oh my gosh. That's my takeaway.
That's so big. That's big on even a broader conversation of mental health and therapy. It's like going into your house and going, I didn't know I had three can openers. And we're unpacking it and laying it all out. So a good psychologist, a good therapist lays out all the information. And I actually draw out pictures for each of my clients or diagrams that help me sort of see patterns. And I have like all these weird ways I do it. It's really just for myself. But once I start seeing a pattern, then I go into the next session and I sort of sniff around it. And then I present, I say, look at this.
This is something I'm noticing. How does that feel? And they'll say, I don't agree with that. And then I respect that because we're not I'm not going to be right all the time. I'll be lucky if I was right 75% of the time and then say, OK, and then I'll work with them collaboratively. But many times when they have 27 pairs of black shoes, they'll say, shoot, I guess they were in all over the scattered all over the house. And so now that I'm seeing them here like this, that's really what it becomes. So we look for the pattern and we see that universality. And once they see that, then we can really start.
That's when we then start going back into childhood. You know, what where do you think this came from? And that's where we'll often get into the ideas of shame, how they were treated by peers. They may have even had a very, very humiliating first sexual experience. For example, they may have been shamed during a making out with a peer early on. Or, you know, it could even be in some cases that there was sexual abuse or unwanted sexual contact that could also push into this this area, feeling fearful around social interaction, especially if they were shamed for it, which some children are. And so any of those things can contribute to this.
So we go and listen, nobody's going to very few clients, I should say, are going to open with that. That's something you respectfully work into. And so and then we get that and we start helping them connect us because a lot of these people say, I'm just awkward. And then you can say, I don't think you're just awkward. Do you understand where this is coming from? And it's no longer about a leaf in a tree. You're showing them the roots, the trunk and the whole tree. And they'll say, so good. Oh, now I see. Thank you.
And that's liberating for them because they almost felt like they were being buffeted on a sea like I'm just like this because there's something wrong with me. And when they realize it's part of a much longer story, a tree, if you will, then they'll say, now I get this. And we can start we can't unring the bell. The past happened. Right. But they can think about it differently. Yeah.
For our viewers who this might be their first or second series that they've watched for MedCircle, that's such an important point for just to understand therapy in general, that it's not there to go, now we're going to look at everything that's wrong with you so we can give you a label. It's just understanding the truth about your life and the areas that you're really great in and the areas that you can be better in and just getting closer and closer to that more optimal way of living.
What is a common misdiagnosis that people with avoidant personality disorder will get? The most common and maybe not misdiagnosis, but like it may not be the exact right diagnosis is probably social anxiety disorder or other anxiety disorders. You may also see some misdiagnosis, if you will, potentially of something like depression because the person is struggling so much with social isolation and they feel sad about that social isolation. And many people with depression have inaccurate appraisals of themselves, like they view themselves as socially unskilled or socially inferior. That's the depression talking then, so that could be an early misdiagnosis as well. Yeah, all excellent points. In our next episode, Dr.
Ramani is going to give you some quick, easy advice on what you can do to help yourself find the right provider for you, a critical piece of your mental health journey coming up in our next episode. .
S K R Y B O T
Skrybot. 2023, Video transcriptions from YouTube
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