Anxious (Avoidant) Personality Disorder

Anxious Personality Disorder is Characterized by intense sensitivity to rejection & active isolation from the social environment.

They desire interpersonal relationships but they avoid any chance of disapproval.

They have intense feelings of inferiority & low self-esteem.

Epidemiology:

👉 <1% in general population.
👉About 10% in clinical population.

Aetiology:

1. Genetics:

Avoidant personality disorder may be partly inherited.

2. Biological:

•Dysregulation of serotonin & dopamine systems is seen in patients of avoidant personality disorder.
•Increased activity in regions associated with fear & anxiety prefrontal Cortex, amygdala & hippocampus is also seen.

3. Developmental:

Children who are belittled(less important) criticized & rejected by parents have decreased self-esteem, resulting in social avoidance.

Clinical Features:

ICD-10 criteria:F60.6

1. Persistent & pervasive feelings of tension & 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 life style 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.

Course:

👉Childhood:

Fear of strangers, shyness & isolation during school years.

👉Adolescence:

Most shyness in childhood gradually dissipates.
When it evolves into avoidant personality disorder, shyness may worsen when social & interpersonal relationships become more complex & demanding.

👉Old age:

The disorder tends to remit or become less evident.

Comorbidity:

👉Depression
👉Dysthymia
👉Anxiety disorder
👉Social phobia

Differential Diagnosisa:

👉Social phobia:

In social phobia, impairment & distress are more intense.

Social phobia, usually starts in middle adulthood.

👉Dependent personality disorder:

Paitents with dependent personality disorder focus on being care for rather than rejection.

However,both disorders often co-occur & diagnosed together.

👉Schizoid personality disorder:

Schizoid personality disorder is characterized by passive social isolation (rather than active social isolation of avoidant subjects).

👉Paranoid personality disorder:

Paranoids lack confidence in others.
(Avoidants lack confidence in themselves).

Treatment:

👉Pharmacotherapy:
•Benzodiazepines
•Antidepressants
•Beta-Blockers

👉Psychotherapy:
•Reinforce assertiveness & self-esteem.
•Restructure cognitive distortions.

Reference:

  • New Oxford Textbook of Psychiatry(2nd edition).
  • ICD-10 Classification of Mental and Behavioural Disorders.

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