A sign that something has shifted

Jump forward to now…. the reason I started to write about avoidance is that I had a landmark experience the other night, I went to our work Christmas Party.

I came home with the intention of writing about how different my experience was this year. However, once I started writing, I found that I had to start from the beginning about how much of shift I have made, given how ingrained avoidance has been in my life.

At around age 25, I was referred to St Vincent’s Hospital Anxiety Disorders clinic by the psychiatrist I had been seeing at the time for anxiety and depression. After taking a battery of tests and interviews, a panel of doctors told me that I had a severely avoidant personality along with perfectionist tendencies that were resonant with obsessive compulsive disorder.

They explained that this had been my coping mechanism. Rather than experience constant suffering, I avoided all of the situations that caused me anxiety and panic.

I did nothing about it then. I don’t think I comprehended what it meant, or perhaps wanted to avoid having to change as that was my deepest fear. Letting go of my way of coping would have left me very exposed and vulnerable.

“The person, who risks nothing, does nothing, has nothing, is nothing, and becomes nothing. He may avoid suffering and sorrow, but he simply cannot learn and feel and change and grow and love and live.”
Leo F. Buscaglia

Instead, I have found ways of coping that have eliminated the causes of anxiety. By avoiding taking steps to change, I have literally locked myself away in my home and within my depression.

I have included some information on this disorder that explains so much of my experience. I am so damned thankful my most recent psychiatrist prescribed me Parnate. Not only do I not feel depressed, I feel like connecting with people for the first time. I am experiencing peacefulness. It is truly changing my life.

Avoidant Personality Disorder

 

Aspect

 

Key feature

Hypersensitivity to negative evaluation by other people which results in social withdrawal and low self-esteem

 

Diagnostic Criteria (DSM-IV)

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
2. is unwilling to get involved with people unless certain of being liked
3. shows restraint within intimate relationships because of the fear of being shamed or ridiculed
4. is preoccupied with being criticized or rejected in social situations

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views self as socially inept, personally unappealing, or inferior to others

is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

Diagnostic Criteria (ICD-10)

Personality disorder characterized by at least 3 of the following:

1. persistent and pervasive feelings of tension and apprehension;
2. belief that one is socially inept, personally unappealing, or inferior to others;
3. excessive preoccupation with being criticized or rejected in social situations;
4. unwillingness to become involved with people unless certain of being liked;
5. restrictions in lifestyle because of need to have physical security;
6. avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection

Associated features may include hypersensitivity to rejection and criticism.

 

Comorbidity

Dysthymic Disorder, major depression, anxiety disorders. Individuals with Avoidant Personality Disorder may have comorbidity with some other personality disorder such as DPD (Dependant Personality Disorder), BPD (Borderline Personality Disorder), and more severe schizophrenic disorders.

 

Age of onset

Onset is in adolescence or early adulthood.Cannot be diagnosed until adulthood (age 18)

 

Sex distribution

Found equally in both males and females

 

Etiology

Weak evidence of major biogenic influences; full development of Avoidant personality disorder is likely due to significant environmental influences, including parental rejection or peer rejection

 

<p class="MsoNormal” style=”MARGIN: 0cm 0cm 0pt”>Personality traits

Extroversion

Significantly higher levels of low extroversion (introversion) than in social anxiety disorder

 

Self-Esteem

View themselves as defective, unable to fit in with others, being unlikable, and being inadequate. Individuals with avoidant personality disorder usually refer to themselves with contempt

 

View of Others

Individuals with avoidant personality disorder view the world as unfriendly, cold, and potentially humiliating; they come to expect that attention from other people will be degrading or rejecting

 

Sensitivity

Slightly higher levels of interpersonal sensitivity and mistrust in avoidant personality disorder than in social anxiety disorder

 

Reaction to criticism

Individuals with avoidant personality disorder tend to respond to low-level criticism with intense hurt

 

Neuroticism

Significantly higher levels of neuroticism in avoidant personality disorder than in social anxiety disorder, with or without other comorbid personality disorders

 

Functioning

Social

Severe social inhibition and feeling of social inadequacy and inferiority

Greater disability on all levels than in social anxiety disorder

 

Intimate Relationships

Appear self-involved and uncaring, but long for affection and fantasize about idealized relationships.

Restraint in intimate relationships; few or no close friends, but intimacy is possible with people who are experienced as safe

 

Occupational

More impaired in avoidant personality disorder than in social anxiety disorder; greater disability on all levels

 

Physical Symptoms

<p class="MsoNormal” style=”MARGIN: 0cm 0cm 0pt”>None

 

Treatment

Medications

Unlike many other personality disorders, avoidant personality disorder responds to antidepressants.

MAOIs (Nardil, Parnate), SSRIs, SNRIs, benzodiazepines (Klonopin, Xanax, for non-drug-addicts)

 

Therapy

CBT, CBGT. Behavioural therapy consisting of graduated exposure, social skills training, and systematic de-sensitization.  Cognitive therapy consisting of alteration of patterns of negative self-talk

 

 

So what had changed?

 

I’ll talk about my night out in my next entry.