Antisocial Personality Disorder Resources

by Aunt Becky | May 14, 2019

What Is Personality?

Personality is a particular set of behaviors, traits, emotions, and patterns that make up a person, his character, and their individuality. Personality includes how we see the world, our thoughts, attitudes, and feelings. Personality is strongly influenced by our values, attitudes, perception of ourselves, and predicts our reactions to people, the world, stress, and problems.

While there are many different definitions of personality, most focus on the pattern of behaviors and characteristics that can help predict and explain a person’s behavior.

Explanations for personality can focus on a variety of influences, ranging from genetic explanations for personality traits to the role of the environment and experience in shaping an individual’s personality.

Environmental factors that can play a role in the development and expression of personality include such things as parenting and culture. How children are raised can depend on the individual personalities and parenting styles of caregivers as well as the norms and expectations of different cultures.

What Is A Personality Disorder?

A person’s personality may be influenced by experiences, environment (surroundings, life situations) and inherited – genetic – characteristics. A person’s personality typically stays the same over time.

While personality disorders differ from mental disorders, like schizophrenia and bipolar disorder, they do, by definition, lead to significant impairment. Personality disorders are estimated to affect about 10 percent of people, although this figure ultimately depends on where clinicians draw the line between a “normal” personality and one that leads to significant impairment.

A personality disorder is a way of thinking, feeling, and behaving that is different from the expectations of the culture, causes distress, problems functioning, and lasts over time. Personality disorders are almost always associated with marked social and personal disruption and are both pervasive and inflexible. While these behaviors can produce poor coping skills, leading to personal issues including anger, anxiety, depression, and distress, they are considered appropriate by the person with the disorder.

What is Antisocial Personality Disorder?

Some people have no regard for others and can cause harm to them without any regret or feelings of guilt. When this behavior is pervasive, a person may have a chronic mental health condition known as antisocial personality disorder. Sometimes people with antisocial personality disorder are called “sociopaths” or “psychopaths” depending upon the spectrum of severity of their disorder.

Antisocial Personality Disorder, often called sociopathy or psychopathy due to both being seen as subsets of Antisocial Personality Disorder (though which applies depends on the symptoms), is a mental health disorder in which a person has a long-standing pattern of exploiting, manipulating, or violating the rights of others. Antisocial Personality Disorder often begins in childhood or the teen years and pervades into adulthood.

What is a sociopath? People with antisocial personality disorder are willing to use deception or manipulation to get whatever they want, such as power or money. They may con people, use an alias; they may steal or use aggressive behavior to achieve their desires. Even when caught, they show no regret or guilt because they do not feel any remorse or guilt. These people are devoid a sense of empathy and do not consider the feelings of others without help. They also tend to act impulsively, which can lead to arrests and substantial time in prison.

There is a common myth in popular culture that people with ASD tend to be successful, charismatic people who hold positions of power, and while it’s true that there are high functioning sociopaths, they are not the norm. While sociopath path traits can include persuasiveness or charm, most people with the disorder will struggle with irresponsibility. They’re less likely to take advantage of employment opportunities, less likely to pay bills on time, and are at high risk of incarceration due to impulsive behaviors. They’re also likely to have a shorter life expectancy due to impulsive behaviors like substance abuse and criminal activity.

ASPD is associated with co-occurring mental health and addictive disorders and medical comorbidity. Rates of natural and unnatural death (suicide, homicide, and accidents) are excessive. ASPD is a predictor of poor treatment response. ASPD begins early in life, usually by age 8 years. Diagnosed as conduct disorder in childhood, the diagnosis converts to ASPD at age 18 if antisocial behaviors have persisted. While chronic and lifelong for most people with ASPD, the disorder tends to improve with advancing age. Earlier onset is associated with a poorer prognosis. Other moderating factors include marriage, employment, early incarceration (or adjudication during childhood), and degree of socialization.

Antisocial personality disorder is defined by a pattern of socially irresponsible, exploitative, and guiltless behavior. Symptoms include failure to conform to law, failure to sustain consistent employment, manipulation of others for personal gain, deception of others, and failure to develop stable interpersonal relationships.2 Lifetime prevalence for ASPD is reported to range from 2% to 4% in men and from 0.5% to 1% in women. Prevalence peaks in people age 24 to 44 years and drops off in people 45 to 64 years. The male-to-female ratio is estimated at between 2:1 and 6:1, depending on assessment method and sample characteristics. The prevalence of ASPD varies with the setting but can reach 80% in correctional settings.

ASPD is associated with co-occurring mental health and addictive disorders, including major depressive disorder, bipolar disorder, anxiety disorders, somatic symptom disorders, substance use disorders, gambling disorder, and sexual disorders.9,10 People with ASPD are at risk for traumatic injuries, accidents, suicide attempts, hepatitis C infections, and the human immunodeficiency virus. People with ASPD use a disproportionate share of medical and mental health services. ASPD has been identified as a predictor of poor treatment response in certain populations.

People with ASPD have high mortality rates owing to accidents, suicide, and homicide.One study showed elevated death rates from diabetes mellitus, suggesting that some people with ASPD may neglect their medical problems or fail to comply with medical regimens.People who have Antisocial Personality Disorder usually lack empathy (the ability to understand and appreciate the emotions of others), lean towards being cynical and callous, often scornful of the emotions, feelings, rights, and suffering of others. Those with Antisocial Personality Disorder may feel that they are above everyone else, that ordinary work is beneath them; they may have loudly-voiced opinions and come across as cocky or arrogant.

Even as they are contemptuous of the feelings of others, they may come across as charming, using expansive language to impress those around them, even as they exploit their personal and sexual relationships.

How Does Antisocial Personality Manifest In Early Life?

Antisocial behaviors typically have their onset before age 8 years. Nearly 80% of people with ASPD developed their first symptom by age 11 years. Boys develop symptoms earlier than girls, who may not develop symptoms until puberty. Robins has observed that a child who makes it to age 15 without exhibiting antisocial behaviors (that is, conduct disorder (CD)) will not develop ASPD. Other investigators have also reported that the presence of conduct disorders in childhood is a robust predictor of ASPD in adulthood

The DSM-5 definition of ASPD requires a history of childhood CD, the diagnosis used for persistent and serious childhood behavior problems. Once the child passes age 18 years, if the behavioral problems have persisted the diagnosis changes to ASPD. An estimated 25% of girls and 40% of boys with CD will later meet criteria for ASPD. A subset of antisocial adults have no history of childhood CD, but appear to meet adult criteria for ASPD; these people tend to have milder syndromes.

It should be noted that the making of a diagnosis of a conduct disorder only means that at the time, the child concerned has been behaving in a way that meets the specified criteria. It is purely a phenomenological description and carries no implications about the cause in any particular case. The child may spontaneously change over time and no longer meet criteria for a diagnosis. In some kids, the origins might be entirely outside the child, with the child reacting as any child might to a coercive, traumatic, or abusive upbringing. In others, it could be that the child had had a completely benign upbringing but was born with callous-unemotional traits that were displayed in all social encounters. The following are general characteristics of a child who has conduct disorder:

Younger children aged 3 to 7 years usually present with general defiance of adults’ wishes, disobedience of instructions, angry outbursts with temper tantrums, physical aggression to other people (especially siblings and peers), destruction of property, arguing, blaming others for things that have gone wrong, and a tendency to annoy and provoke others.

In middle childhood, from 8 to 11 years, the above features are often present, but as the child grows older and stronger, and spends more time outside the home, other behaviors are seen. They include: swearing, lying about what they have been doing, stealing others’ belongings outside the home, persistent breaking of rules, physical fights, bullying other children, being cruel to animals and setting fires.

In adolescence, from 12 to 17 years, more antisocial behaviors are often seen: being cruel to and hurting other people, assault, robbery using force, vandalism, breaking and entering houses, stealing from cars, driving and taking away cars without permission, running away from home, truanting from school, and abusing alcohol and drugs.

It must be noted that not all children who exhibit the types of behaviors listed in early childhood progress on to the later, more severe forms, such as antisocial personality disorder. In fact, only about half continue from those in early childhood to those in middle childhood; likewise, only about a further half of those with the behaviors in middle childhood progress to show the behaviors listed for adolescence.

However, the early onset group are important as they are far more likely to display the most severe symptoms in adolescence, and to persist in their antisocial tendencies into adulthood. The most antisocial 5% of children aged 7 years are 500 to 1000% more likely to display indices of serious life failure at 25 years, for example drug dependency, criminality, unwanted teenage pregnancy, leaving school with no qualifications, unemployment, and so on.

Longitudinal studies show that most children and young people with conduct disorders had prior oppositional defiant disorder and most (if not all) adults with antisocial personality disorder had prior conduct disorders.

Similarly, approximately 90% of severe, recurrent adolescent offenders showed marked antisocial behavior in early childhood. By contrast, there is a large group who only start to be antisocial in adolescence, but whose behaviors are less extreme and who tend to become less severe by the time they are adults.

What Causes Antisocial Personality Disorder?

The evidence below discusses many associations between antisocial behavior with a wide range of risk factors. The exact role in causation of most of these risk factors is unknown: while we know what, statistically, predicts conduct-problem outcomes, we do not know how or why. Establishing a risk factor is by no means straightforward, particularly as it is unethical to experimentally expose healthy children to risk factors to see whether those factors can cause new conduct problems. The use of genetically sensitive designs and the study of within-individual change in natural experiments and treatment studies have considerable methodological advantages for suggesting causal influences on conduct problems.

Genes:

Oddly, less than 10% of the families in any community account for more than 50% of that community’s criminal problems, which reflects a merge of genetic plus environmental risks for ASPD. Now, there is solid evidence from twin and adoption studies that conduct problems are substantially heritable.

Several studies have determined interactions between the families genetic history and the child’s environment while growing up can lead to an increase or decrease in a child’s potential to develop conduct disorders. The more stable and nurturing the environment, the less likely that the genetic predisposition will express itself in conduct disorder.

Both twin and adoption studies have found a link between antisocial behavior in the biological parent and adverse conditions in the adoptive home that predicted the adopted child’s antisocial outcome, which means that the genetic risk factors can modified by the rearing environment. One twin study found the experience of abuse was associated with an increase of 24% chance of developing conduct disorder for children at high genetic risk, but an increase of only 2% among children at low genetic risk. Such gene–environment interactions are being increasingly discovered. Awareness of a familial predisposition toward antisocial personality disorder actually increases the urgency to intervene and improve a the child’s environment.\

Pregnancy Complications And/Or Temperament:

Recent general population studies have found associations between life-long conduct problems and perinatal complications, minor physical anomalies, and low birth weight. Most studies support a bio-social model in which pregnancy complications might lead to vulnerability to other risks such as hostile or inconsistent parenting. Several prospective studies have shown associations between irritable temperament as an infant and conduct problems, but so far no consensus has been reached.

Cognitive Deficits:

Children with conduct problems have been shown to have increased rates of deficits in language-based verbal skills. Children who cannot reason or assert themselves with their words may attempt to gain control of social exchanges using aggression; which means that kids with low verbal IQ leads to to problems at school, which could mean that the child experience of school becomes unrewarding rather than a source of self-esteem and support.

Children and young people with conduct problems have been shown consistently to have poor tested executive functions. Executive functions are the abilities implicated in successfully achieving goals through appropriate and effective actions. Specific skills include learning and applying contingency rules, abstract reasoning, problem solving, self-monitoring, sustained attention and concentration, relating previous actions to future goals, and inhibiting inappropriate responses. These mental functions are largely, although not exclusively, associated with the frontal lobes.

Parenting Styles:

Studies have shown that parents of children with conduct problems tend to be less consistent in their use of rules, provide more vague commands, are more likely to react to their children based on how they felt (for example: bad mood) rather than based on what the child was actually doing, are less likely to check their children’s whereabouts, and were unresponsive to their children’s behaviors. Conduct problems are associated with hostile, critical, punitive and coercive parenting.

There is considerable evidence that children’s difficult behaviors do indeed evoke parental negativity. The fact that children’s behaviors can cause negative parenting does not mean that negative parenting has no impact on children’s behavior.

We now have the ability to intervene and change course of children’s antisocial behaviors by removing the harsh, cold, inconsistent parenting through parental education. Parenting classes can reverse poor patterns of parenting and promote positive encouragement of children with setting of clear, calmly enforced boundaries can lead to improvement of conduct problems.

Child/Parent Attachment:

The quality of the parent–child relationship is crucial to later social behavior, and if the child does not have the opportunity to make attachments with their parents, such as being put into foster care, typically leads to subsequent problems with antisocial behaviors. One study found that ambivalent and controlling attachment parenting predicted later conduct problems behaviors; disorganized child attachment patterns seem to be especially associated with conduct problems. While it seems obvious that poor parent–child relations in general predict conduct problems, it’s unknown if attachment difficulties have an independent causal role in the development of behavior problems. However, in adolescence there is evidence that attachment representations independently predict conduct symptoms over and above parenting quality.

Domestic Violence: 

Several researchers have found that children exposed to domestic violence between adults are subsequently more likely to themselves become antisocial. In one study, it was proposed that marital conflict influences children’s behavior because of its affect on emotional regulation; a child may respond to fear arising from marital conflict by controlling their reactions through denial of the situation. This can lead to developing the wrong appraisal of other social situations and poor problem-solving skills. Children’s antisocial behavior may be increased by domestic violence because children are likely to imitate aggressive behavior modeled by their parents. Through parental fights, children may learn that aggression is a normal part of relationships and that works to control others as well as aggression is okay, not punished.

Abuse

Many parents use physical punishment, and parents of children with antisocial behavior frequently resort to it out of desperation; associations between physical abuse and conduct problems are well-stablished. In a longitudinal study, child sexual abuse predicted conduct problem. However, sometimes some parents resort to severe and repeated beatings that are clearly abusive. This usually terrifies the child, causes great pain and overwhelms the ability of the child to stay calm, which leads the child to be less able to regulate their anger and teaches them a violent way of responding to stress. Unsurprisingly, it creates children who have more conduct problems.

Friendship groups

Children and young people with antisocial behavior have poorer peer relationships and associate with other children with similar antisocial behaviors. They have more aggressive and unhappy interactions with other children and they experience more rejection by children without conduct disorders.

What Are Some Symptoms of Antisocial Personality Disorder?

While antisocial personality disorder is a personality disorder diagnosed in adulthood, it has its precedent in childhood. The DSM-5’s criteria for ASPD require that the individual have conduct problems evident by the age of 15/Persistent antisocial behavior as well as a lack of regard for others in childhood and adolescence is known as conduct disorder and is the precursor of ASPD. About 25–40% of youths with conduct disorder will be diagnosed with ASPD in adulthood.

Conduct Disorder:

Conduct disorder (CD) is a disorder diagnosed in childhood that parallels the characteristics found in antisocial personality disorder. Conduct disorder is characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated. Children with this disorder often display impulsive and aggressive behavior, may be callous and deceitful, and may repeatedly engage in petty crime such as stealing or vandalism, and/or get into fights with other children and adults.These behaviors are typically persistent and may be difficult to deter with even with threats or punishment. Attention deficit hyperactivity disorder (ADHD) is common in this population; children with the disorder may also engage in substance abuse.

Conduct disorder is different from oppositional defiant disorder (ODD) as children with ODD do not commit aggressive or antisocial acts against other people, animals, and property; though it’s worth mentioning that many children diagnosed with ODD are subsequently re-diagnosed with conduct disorder.

Two developmental courses for CD have been identified based on the age at which the symptoms become present:

The first is known as the “childhood-onset type” and occurs when conduct disorder symptoms are present before the age of 10 years. This course is often linked to a more persistent life course and more pervasive behaviors, and children in this group express greater levels of ADHD symptoms, neuropsychological deficits, more academic problems, increased family dysfunction, and higher likelihood of displaying and engaging in aggression and violence

The second is called “adolescent-onset type” and occurs when conduct disorder develops after the age of 10 years. Compared to the childhood-onset type, less impairment in various cognitive and emotional functions are present, and the adolescent-onset variety may remit by adulthood.

In addition to this differentiation, the DSM-5 provides a specifier for a callous and unemotional interpersonal style, which reflects characteristics seen in psychopathy and are believed to be a childhood precursor to this disorder. Compared to the adolescent-onset subtype, the childhood onset subtype, especially if callous and unemotional traits are present, tends to have a worse treatment outcome.

Antisocial Personality Disorder:

Antisocial personality disorder is defined by a pervasive and persistent disregard for morals, social norms, and the rights and feelings of others. People who have this personality disorder typically have no problems exploiting others in harmful ways for their own gain or pleasure, and frequently manipulate and deceive other people, through wit and a façade of superficial charm or intimidation and violence. People who have ASPD are arrogant, think badly and negatively of others, and/or lack remorse for their harmful actions and have a callous attitude toward those they have harmed. Irresponsibility is a core characteristic of this disorder: people with antisocial personality disorder often have significant difficulties in maintaining stable employment as well as fulfilling their social and financial obligations; people with this disorder often lead exploitative, unlawful, or parasitic lifestyles.

Those with antisocial personality disorder are often impulsive and reckless, failing to consider or disregarding the consequences of their actions. They may repeatedly disregard and jeopardize their own safety and the safety of others and place themselves and others in danger. People who have ASPD are often aggressive and hostile, display a unregulated temper, and may lash out violently with provocation or frustration. People who have ASPD are prone to substance abuse and addiction as the abuse of various psychoactive substances is common in this population. These behaviors lead such people into frequent conflict with the law, and many people with ASPD have extensive histories of antisocial behavior and criminal infractions stemming back before adulthood.

Serious problems with interpersonal relationships are often seen in those with the disorder. Attachments and emotional bonds are weak, and interpersonal relationships often revolve around the manipulation, exploitation, and abuse of others. While they generally have no problems in establishing relationships, they may have difficulties in sustaining and maintaining them. Relationships with family members and relatives are often strained due to their behavior and the frequent problems that these people may get into.

A person cannot be diagnosed with antisocial personality disorder based on a single action. Behaviors that are explained by something else, such as addiction, trauma, or a cognitive disability, will also not be diagnosed as antisocial personality disorder. People with antisocial personality disorder struggle to follow or understand social rules about how to interact with others. They fail to see other people as beings worthy of consideration, kindness, or rights. They may not feel empathy or guilt.

However, not all people with antisocial personality disorder act on these emotions, nor do all people who violate the rights of others have a mental health condition. A person might be evaluated for antisocial personality disorder after interacting with police, seeking treatment for chronic relationship problems, or being involved in a negative experience with a child or partner.

Those affected by Antisocial Personality Disorder may exhibit the following signs and symptoms:

• Making decisions based on one’s own needs and desires, without considering the needs of others
• Lacking concern for the needs, feelings, or pain of others, and lacking remorse after hurting others
• Exploiting others in relationships, making it difficult to have relationships
• Using lies, domination, or intimidation to control others
• Exhibiting manipulative behavior, including using charm or ingratiation for one’s own benefit
• Exhibiting dishonest or fraudulent behavior
• Not being concerned about how others feel; some people with antisocial personality disorder enjoy sadistic behavior, such as hurting others
• Feeling hostility, anger, or aggression, particularly in response to relatively small problems
• Lacking inhibitions, which may cause a person to disobey rules, abandon their commitments, or take unnecessary risks
• Sense of right and wrong is skewed or ignored
• Prone to lying and deception
• Shows a lack of remorse about harming others
• Violates the rights of others
• Frequent agitation
• Episodes of aggressive or violent behavior
• Tendency toward child abuse or neglect
• Tendency toward partner abuse or difficult relationships
• Chronic legal problems
• Uses charm or wit to manipulate others
• Intimidates people
• Difficulties holding down a job or acting responsibly at work

Millon’s Subtypes Of Antisocial Personality Disorder:

Theodore Milton identified five subtypes for antisocial behavior; however, someone with Antisocial Personality Disorder may experience none or many of these subtypes:

Malevolent Antisocial:

These people are a mixture of antisocial and paranoid or sadistic personalities, and are often considered to be the worst types of antisocial personality disorder. Malevolent antisocial people are belligerent, rancorous, vicious, malignant, brutal, callous, vengeful, and vindictive. Their actions are hateful and destructive as completed with a defiance of conventional life. Like the someone with paranoid personality disorder, malevolent antisocial personalities anticipate both betrayal and punishment. Instead of using verbal threats, however, these people secure their boundaries with cold-blooded ruthlessness that will avenge every mistreatment they believe others have done to them.

For malevolent antisocial personalities, feeling tender emotions are a sign of major weakness, and they interpret goodwill and kindness of others as hiding a deceptive ploy – so they are always on guard. Where sadistic traits are most prominent, they may display a chip-on-the-shoulder attitude and a willingness to confirm their strong self-image by victimizing those too weak to fight back or those whose fear may prove particularly entertaining. When confronted with displays of strength, malevolent antisocial personalities love posturing and pressuring their “opponents” until they feel they have “won.” Few make concession. rather they escalate confrontations as far as necessary, backing down only when clearly outgunned.

Covetous Antisocial:

These people feel that life has been excessively unfair to them. These people feel that life has not given them “their due;” that they have been deprived of their rightful amount of love, support, or material reward; while everyone else has received more than their share. Highly jealous of others who have received the bounty of a good life, covetous antisocial personalities are driven by an greedy desire for payback – to take what destiny refused them. Through deceit or destruction, their goal is compensation for the emptiness of life, rationalized by the belief that they alone can restore the imbalance in their lives. They seethe with anger and resentment, their greatest pleasure lies in taking control of the property and possessions of others. Some are overtly criminal. With a gigantic drive for revenge, these people are used to manipulating other people like pawns in a power game.

Regardless of their success, however, covetous antisocial personalities usually are insecure about their power and status, never quite feeling that they’ve been compensated for life’s “unfairness.” Ever jealous and envious, pushy and greedy, they often make ostentatious and wasteful displays of materialism and conspicuous consumption – buying exotic cars, huge homes, and/or elaborate jewelry as a way of boasting of their power and achievements to others. Most people who have covetous antisocial personalities feel a gaping sense of emptiness, juxtaposed with vague images of how different life should have been, if opportunity had blessed them, as it has so many others.

Some covetous antisocial personalities are simple thieves, and others become manipulative entrepreneurs who exploit people as objects to satisfy their desires. While they have little compassion for or guilt about the effects of their behavior, they never feel that they have acquired quite enough, never achieve a sense of contentment, and feel unfulfilled regardless of their successes, remaining forever dissatisfied yet insatiable.

Risk-Taking Antisocial:

Minor risk taking within a controlled environment allows us all a normal outlet for excitement and sensation-seeking, such as sky-diving. However, there are people for whom taking risks is intended to impress others around them with their behavior of courageous indifference to potentially deadly consequences. Risk-taking antisocial personalities, who combine antisocial and histrionic traits, deeply desire other people to see them as unaffected by what almost anyone else would surely experience as dangerous or frightening. While others shrink in fear, they are unfazed by the possibility of gambling with death or serious injury. Risk is sought as its own reward, a means of feeling stimulated and alive, not a means of material gain. While their pretense is being dauntless, intrepid, and bold, their hyperactive search for hazardous challenges is seen as foolhardy, if not stupid.

Risk-taking antisocial personalities are thrill seekers that want to to test their strength by performing for the attention, applause, and amazement of an audience. Otherwise, they would simply feel trapped by the responsibility and boredom of everyday life. The most important factors making them antisocial is the irresponsibility of their actions and their failure to consider the consequences for their own life, or the lives of others, as they pursue ever more daring challenges.

Reputation-Defending Antisocial:

Not all people who have antisocial personality disorder desire material possessions or power; some are motivated by the desire to extend, then defend, their reputation of bravery and toughness. Their antisocial acts are used to ensure that others notice them and provide them the respect that they deserve. This means that they’re always on guard against the possibility of belittlement. Society should know that the reputation-defending antisocial personality is someone significant, not to be easily dismissed, treated with indifference, taken lightly, or pushed around. Whenever their status or ability is slighted, they may erupt with ferocious intensity, posturing, and threatening until their rivals back down. Some reputation-defending antisocial personalities are loners, some are involved in gang activities, and others seek to impress peers with aggressive acts of leadership and/or violence that secures their status as the alpha male, the dominant member of the pack. Being tough and assertive is a defensive act intended to prove their strength and guarantee a reputation of major courage.

Nomadic Antisocial:

As the most widely held impression is that those who have antisocial personality disorder are incorrigible criminals who undermine the values of culture, some seek simply to run away from a society in which they feel unwanted, cast aside, or abandoned. Although most people who have antisocial personality disorder react antagonistically to social rejection, nomadic antisocial personalities tend to drift along at the margins of society, scavenging whatever resources they come across. The nomadic variant combines antisocial with schizoid and/or avoidant characteristics. Those with nomadic antisocial tendencies see themselves as doomed and only want to exist at the edge of the world that would almost certainly reject them. Mired in self-pity, they drop out of society to become gypsy-like roamers, vagabonds, or wanderers. With little regard for their personal safety or comfort, they may drift from one setting to another as homeless people involved in prostitution and substance abuse.

Adopted children who feel uneasy about their place in the world sometimes follow the path of the nomadic antisocial, wandering from place to place in a search for their true home or natural parents. Their sense of “being from nowhere” signifies alienation from self and others. This is why nomadic antisocial personalities often appear disconnected from reality and lack any clear sense of self-identity. Compared to other types, nomadic antisocial personalities often seem harmless because of their attitude of indifference and disengagement. Some are indeed vacant and fearful, but others are deeply angry and resentful. As a consequence of alcohol or substance abuse, they may act out impulsively, discharging their frustrations in brutal assaults or sexual attacks on those weaker than themselves.

How Is Antisocial Personality Disorder Diagnosed?

A person must be at least 18 years old to receive a diagnosis of antisocial personality disorder or any other personality disorders. To receive a diagnosis of ASPD, it must also be evidence that they qualified for a diagnosis of conduct disorder before the age of 15, as many of the symptoms of the two disorders are similar. A diagnosis of antisocial personality disorder will also not be given if the behaviors occur due to the symptoms of schizophrenia or bipolar disorder .Antisocial personality disorder falls under the dramatic/erratic cluster of personality disorders, “Cluster B.” and is one of the most well-known of the personality disorders as it is frequently associated with violence and crime.

Personality disorders, like Antisocial Personality Disorder, are not usually diagnosed by a general family practitioner. Instead, personality disorders should be diagnosed by a mental health professional like a psychologist or psychiatrist.

However, many people with Antisocial Personality Disorder do not seek out medical treatment or a diagnosis unless the disorder begins to significantly impact their lives.

General Diagnostic Guidelines For The ICD-10 And DSM-5 For Personality Disorders:

Conditions not directly attributable to gross brain damage or disease, or to another psychiatric disorder, meeting the following criteria:

1. markedly disharmonious attitudes and behavior, involving usually several areas of functioning, e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;
2. the abnormal behavior pattern is enduring, of long standing, and not limited to episodes of mental illness;
3. the abnormal behavior pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
4. the above manifestations always appear during childhood or adolescence and continue into adulthood;
5. the disorder leads to considerable personal distress but this may only become apparent late in its course;
6. the disorder is usually, but not invariably, associated with significant problems in occupational and social performance.

For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations. For diagnosing the subtypes of personality disorders, clear evidence is usually required of the presence of at least three of the traits or behaviors given in the clinical description.

Diagnosis of Antisocial Personality Disorder From The DSM-5:

The essential features of a personality disorder are impairments in personality (self and interpersonal), functioning, and the presence of pathological personality traits. To diagnose antisocial personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning (a or b):

a. Identity: Ego-centrism; self-esteem derived from personal gain, power, or pleasure.

b. Self-direction: Goal-setting based on personal gratification; absence of prosocial internal standards associated with failure to conform to lawful or culturally normative ethical behavior.

AND

2. Impairments in interpersonal functioning (a or b):

a. Empathy: Lack of concern for feelings, needs, or suffering of others; lack of remorse after hurting or mistreating another.

b. Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to control others.

B. Pathological personality traits in the following domains:

1. Antagonism, characterized by:

a. Manipulativeness: Frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one’s ends.

b. Deceitfulness: Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events.

c. Callousness: Lack of concern for feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one’s actions on others; aggression; sadism.

d. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior.

2. Disinhibition, characterized by:

a. Irresponsibility: Disregard for – and failure to honor – financial and other obligations or commitments; lack of respect for – and lack of follow-through on – agreements and promises.

b. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing and following plans.

c. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; boredom proneness and thoughtless initiation of activities to counter boredom; lack of concern for one’s limitations and denial of the reality of personal danger.

C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or sociocultural environment.

E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

F. The individual is at least age 18 years.

Diagnosis of Antisocial Personality Disorder From ICD-10:

The WHO’s International Statistical Classification of Diseases and Related Health Problems, tenth edition (ICD-10), has a diagnosis called dissocial personality disorder (F60.2)

It is characterized by at least 3 of the following:

1. Callous unconcern for the feelings of others;
2. Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations;
3. Incapacity to maintain enduring relationships, though having no difficulty in establishing them;
4. Very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
5. Incapacity to experience guilt or to profit from experience, particularly punishment;
6. Marked readiness to blame others or to offer plausible rationalizations for the behavior that has brought the person into conflict with society.

The ICD states that this diagnosis includes “amoral, antisocial, asocial, psychopathic, and sociopathic personality/” Although the disorder is not synonymous with conduct disorder, presence of conduct disorder during childhood or adolescence may further support the diagnosis of dissocial personality disorder. There may also be persistent irritability as an associated feature

It is a requirement of the ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

How Is Antisocial Personality Disorder Treated?

It’s unfortunate that Antisocial Personality Disorder is often grossly misunderstood by the public as well as mental health professionals. The stigma of labels like “sociopath” and “psychopath” means that those with Antisocial Personality Disorder often are discriminated against in the mental health community, especially since the pervasive lack of remorse may come across as not having any feelings whatsoever. This can greatly hinder diagnosis and treatment.Individuals with Antisocial Personality Disorder are not easily motivated to change their patterns of behaviors, but it can be done. Threats are almost never a good motivator for those with Antisocial Personality Disorder, but intensive approaches to draw connections between a person’s actions and their feelings may help. Emotions are a key aspect of treatment, as those with antisocial personality disorder have very few emotionally-rewarding relationships. Reinforcing any emotions – aside from anger – is important, as expressing emotions is a sign of progress that the therapy may be working.

The treatment of choice for antisocial personality disorder is psychotherapy, coupled with treatment of other co-morbid diagnoses with medication. The recommended treatment for someone with antisocial personality disorder will also depend on their circumstances, taking into account factors such as age, offending history and whether there are any associated problems, such as alcohol or drug abuse and addiction.The person’s family and friends will often play an active role in making decisions about their treatment and care.

Treatment should address any co-occurring disorders, which often include attention-deficit/hyperactivity disorder, borderline personality disorder, and impulse control disorders such as gambling disorder or sexual disorders. Because a majority of people with antisocial personality disorder will also have a substance abuse disorder, a person may need to complete detoxification as the first step of treatment, with the substance abuse and personality disorder then treated simultaneously. Medications may be used to treat co-morbid conditions, but there are no indications that medications will help to treat antisocial personality disorder.

Self-help groups designed specifically for those with Antisocial Personality Disorder may be very helpful, as those with antisocial personality disorder often feel more at ease discussing feelings and behaviors with their peers in a supported environment. However, it must be made clear that the group therapy is not a place to brag about exploits and bad behaviors.

Psychotherapy, or talk therapy, is usually the treatment recommended for antisocial personality disorder. A therapist can help a person manage negative behaviors and build interpersonal skills they may lack. Often the first goal is simply to reduce impulsive behaviors that can lead to arrest or physical harm. Family therapy might be a useful option to educate family members and improve communication, and group therapy may also help when limited to people with the disorder. Often, the most effective way for a person with antisocial personality disorder to learn better coping skills is to face up to the consequences of their behavior.

Democratic Therapeutic Communities (DTC)

Evidence suggests community-based programs can be an effective long-term treatment method for people with antisocial personality disorder, and is becoming increasingly popular in prisons. DTC is a type of social therapy that aims to address the person’s risk of offending or re-offending, as well as their emotional and psychological needs. It’s based around large and small therapy groups and focuses on community issues, creating an environment where both staff and prisoners contribute to the decisions of the community.There may also be opportunities for educational and vocational work.

The recommended length of treatment is 18 months, as there needs to be enough time for a person to make changes and put new skills into practice.

Relationships With Someone Who Has Antisocial Personality Disorder:

A healthy intimate relationship is extremely difficult to establish with an adult who, at their very core, seeks to control and demean another person. Their lack of care or concern regarding the impact of their actions can further exacerbate the pain for their mates. It can be difficult for loved ones to move past their flippant manner of inflicting harm: “He hurt me and he didn’t seem to care.”

Aside from problems such as minimal empathy, antagonism, manipulation, and anger, 6 additional things that hinder safe relationships with a psychopath include:

No Capacity To Bond:

At the beginning of intimate relationships, people who have ASPD are often typically excited and stimulated by their new partner; while it may feel good, this state can easily be mistaken as bonding and deep caring for their mate. Unfortunately, this tends to be the dopamine-driven stage of romantic love that can feel like addictive attraction. Once that fades, so does their interest in their partner, and typically at this stage they begin to show display disdain for their partner.

Dysfunctional Cycles:

People who have ASPD often demonstrate a predictable cyclical style of romantic relationships common for those with cluster B personality disorders. They idealize, devalue, and then discard their partners, with no concern for the pain they cause. Given that they never had an actual bond with their mate in the first place, walking away from the relationship causes them little to no discomfort. Many are happy to move along to the next target, particularly if they left their former mate in the “loser” position.

Cycle of Dysfunctional Relationships with Cluster B Personality Disorders:

Idealization -> Devalue -> Disregard -> Repeat

They Can’t And Won’t Apologize:

ASPD is a disorder that hinders the ability of a person to feel natural guilt and remorse for the hurts they cause others; they also here is a tendency to engage in immoral behavior. When they do hurt someone or cause damage, these people usually will not apologize. If what appears to be an apology is offered, it is rarely beyond words and tends to include an element of distancing and minimizing (“I made a mistake”). They feel no guilt and remorse because these emotional states are not within their capacity, therefore, the typical apology that naturally follows when one has caused harm will be absent. Their stance is typically, “Move on,” “Let it go,” “You’re too sensitive,” or, “Why are you still talking about that—it’s in the past!”

High Levels of Narcissism: 

People who have ASPD  have an incredibly inflated, grandiose sense of themselves. They do not need or care about the approval of others. Any desire they have for control or worship is associated with feelings of superiority, not insecurity. Unfortunately, for the person with psychopathy, there tends to be no genuine interest in friendships.

People As “Objects:”

People who have ASPD have a strong need for power and control and often place others in the role of “loser,” even those who demonstrate loyalty, trust and love toward them. Psychopathic individuals usually have a “use” for those they keep close. They consider some people puppets, who will defend them, agree with them, or sacrifice their reputation to protect them. They choose to have numerous puppets. For many with psychopathy, this role is also assigned to their intimate partner.

Immorality:

ASPD is a disorder that has immorality as a core feature. When there is immorality, harm to others tends to follow. It would not be uncommon for someone with this condition to have secret/dual lives, pervasive hateful thoughts, or a consistent pattern of violating behaviors, including Internet trolling, using children as pawns, abusing/bullying others, or forcing a partner to have sex.

Coping When a Loved One Has Antisocial Personality Disorder:

If you have a loved one with antisocial personality, it’s common to feel discouraged and upset. Try to remember that lack of remorse or empathy is a symptom of their personality disorder may assist as you set realistic expectations for how your loved one can improve. With treatment, some people with antisocial personality disorder do learn to form positive relationships, be more responsible, and respect the boundaries of others. Others simply cannot not, and family members will have to consider how they want to respond to this challenge. One interesting fact is that people with antisocial personality disorder who are married tend to improve over time compared to single people.

Caring for a person with antisocial personality disorder can be difficult and challenging. Depending on the circumstances, families can play an important part in supporting a person with antisocial personality disorder, but they may also need help and support themselves. Get support. Join a group. Find a knowledgeable therapist. There are plenty of people who can help you in your journey. Take advantage of them all.

Get support. Join a group. Find a knowledgeable therapist. There are plenty of people who can help you in your journey. Take advantage of them all.

Be informed. Learn the symptoms. Recognize the course of the illness. Understanding what you’re dealing with is half the battle.

Don’t argue. People with ASPD love to bicker. They’re quick to point out where you and others are wrong. Refuse to take part in the discussion. If they don’t stop debating, you can always walk away.

Don’t believe lies. If you think they’re lying, they probably are. That’s what folks with ASPD do. Don’t point out the flaws in their logic. Don’t try to sway them to your point of view. State your case, then remain silent. You’ll feel and appear stronger if you do.

Set firm guidelines. Decide how you’ll handle particular issues. For instance, you may decide not to bail them out of jail or hang up if they become verbally abusive on the telephone. You can’t change their behavior, but you can change how you respond.

Let go of guilt. You didn’t cause your loved ones’ problems. And there’s little you can do to fix them. Feeling bad only wastes precious emotional resources. Save your energy for something useful.

Take care of yourself. Dealing with another’s ASPD can be exhausting. Make sure your personal needs are met before dealing with theirs.

Be informed. Learn the symptoms. Recognize the course of the illness. Understanding what you’re dealing with is half the battle.

Don’t argue. People with ASPD love to bicker. They’re quick to point out where you and others are wrong. Refuse to take part in the discussion. If they don’t stop debating, you can always walk away.

Don’t believe lies. If you think they’re lying, they probably are. That’s what folks with ASPD do. Don’t point out the flaws in their logic. Don’t try to sway them to your point of view. State your case, then remain silent. You’ll feel and appear stronger if you do.

Set firm guidelines. Decide how you’ll handle particular issues. For instance, you may decide not to bail them out of jail or hang up if they become verbally abusive on the telephone. You can’t change their behavior, but you can change how you respond.

Let go of guilt. You didn’t cause your loved ones’ problems. And there’s little you can do to fix them. Feeling bad only wastes precious emotional resources. Save your energy for something useful.

Take care of yourself. Dealing with another’s ASPD can be exhausting. Make sure your personal needs are met before dealing with theirs.

Know yourself – what you are willing to tolerate and what you refuse to tolerate. Once you know your own boundaries, explain those boundaries to the antisocial person. Explain what actions you will take if and when those boundaries are violated.

Follow through with your plan each and every time.

Expect deception, manipulation, and betrayal.

Keep your finances separate. Do not loan money that you expect to be repaid.

If in a romantic relationship, do not trust the antisocial person to be alone with your friends and family, as cheating is highly likely, and a betrayal of this type is often very damaging.

Have backup plans for child-care, dates, etc. as the antisocial person is not likely to be dependable.

Maintain personal safety at all times. Keep a cell phone charged and on your person, keep enough gas in the car to get away, and, if necessary, inform a friend that you may need to stay with him/her sometimes. Know where shelters are in your area. Call 9-1-1 if the person becomes violent.

It is not recommended to have a romantic relationship with a person with antisocial personality disorder due to the emotional and/or physical damages that may be inflicted. However, if, for some reason, you feel you cannot end the relationship, keep yourself safe at all times.

Additional Resources for Antisocial Personality Disorder:

Aftermath: Surviving Psychopathy – dedicated to educating the public regarding the nature of psychopathy and its cost to individuals and society. We seek to support the families and victims of those with psychopathy.

Out of the Fog provides information and support for those with a loved one who has a personality disorder.

Avoidant Personality Disorder Resources

by Aunt Becky | May 9, 2019

What Is Personality?

Personality is a particular set of behaviors, traits, emotions, and patterns that make up a person, his character, and their individuality. Personality includes how we see the world, our thoughts, attitudes, and feelings. Personality is strongly influenced by our values, attitudes, perception of ourselves, and predicts our reactions to people, the world, stress, and problems.

While there are many different definitions of personality, most focus on the pattern of behaviors and characteristics that can help predict and explain a person’s behavior.

What Is A Personality Disorder?

A person’s personality may be influenced by experiences, environment (surroundings, life situations) and inherited – genetic – characteristics. A person’s personality typically stays the same over time.

While personality disorders differ from mental disorders, like schizophrenia and bipolar disorder, they do, by definition, lead to significant impairment. Personality disorders are estimated to affect about 10 percent of people, although this figure ultimately depends on where clinicians draw the line between a “normal” personality and one that leads to significant impairment.

A personality disorder is a way of thinking, feeling, and behaving that is different from the expectations of the culture, causes distress, problems functioning, and lasts over time. Personality disorders are almost always associated with marked social and personal disruption and are both pervasive and inflexible. While these behaviors can produce poor coping skills, leading to personal issues including anger, anxiety, depression, and distress, they are considered appropriate by the person with the disorder.

There are 10 specific types of personality disorders. Personality disorders are long-term patterns of behavior and inner experiences that differs significantly from what is expected. The pattern of experience and behavior begins by late adolescence or early adulthood and causes distress or problems in functioning.

Without treatment, personality disorders can be long-lasting. Personality disorders must affect at least two of the following areas:

• Way of thinking about oneself and others
• Way of responding emotionally
• Way of relating to other people
• Way of controlling one’s behavior

What Is Avoidant Personality Disorder?

No one enjoys criticism, rejection, or embarrassment, but sometimes certain people spend their entire life avoiding these situations altogether, by in part, avoiding situations that could produce such situations. They may avoid confrontations, not take credit for work that is theirs, distance themselves from others, and try to avoid any interactions with other people. Sometimes, these socially-challenged people who have a over-the-top reaction to rejection while feeling consistent feelings of inadequacy are diagnosed with a personality disorder, a mental illness known as avoidant personality disorder (AVPD).

Avoidant personality disorder is one of a group of mental illnesses called personality disorders, which are characterized by feelings of nervousness and fear. People with avoidant personality disorder have poor self-esteem and feel very down about themselves and the ways in which they relate to others. Often. people who have AvPD have an intense fear of rejection and being negatively judged by others. These feelings make them very uncomfortable in social situations, leading them to avoid group activities and contact with others.

AVPD (also called Anxious Personality Disorder or Anxious (Avoidant) Personality Disorder) is a personality disorder that is characterized by a pattern of withdrawal, self-loathing and an extremely heightened sensitivity to criticism. People who have AVPD usually consider themselves socially unsuccessful and socially awkward tend to remove themselves from social situations (whenever possible) in the hopes of avoiding the feeling – or risk – of feeling rejected by others. They spend a lot of time focusing on their shortcomings and are very hesitant to form relationships in which rejection is possible, which naturally often results in feelings of loneliness, becoming disengaged from relationships at work, and having few people they truly feel safe with. People with AVPD might also refuse a promotion, make excuses to miss meetings, or be too fearful to engage in events where they might make friends.

Those who live in a relationship with a person who suffers from avoidant personality disorder often recognize that something is not quite right with the behavior of their family member or loved-one but often don’t have any idea what the “not quite right” bit is. Partners and loved ones of those who have AvPD may feel trapped in the relationship and frustrated by their loved-one’s tendency to pull them away from family, friends, and other “everyday” social settings.

People who are in a relationship with a person who suffers from AVPD may also experience pressure to isolate themselves along with them or pressure to protect them from criticism or to create an artificial or dysfunctional “bubble” or ideal environment around them in which they can escape the risk of negative self-thought.

Avoidant personality disorder (AvPD) is a Cluster C personality disorder; cluster C personality disorders are those in which the affected exhibit a notable pattern of severe social anxiety, social inhibition, feelings of inadequacy and inferiority, extreme sensitivity to negative evaluation and rejection, as well as avoidance of social interaction despite a strong desire for intimacy. The behavior is usually noticed by early adulthood and occurs in most situations.

People with AvPD often consider themselves to be socially inept,  personally unappealing, and avoid social interaction for fear of being ridiculed, humiliated, rejected, or disliked. They generally avoid becoming involved with others unless they are certain they will be liked. As the name suggests, the main coping mechanism of those with AvPD is avoidance of feared situations. Childhood emotional neglect (in particular, the rejection of a child by one or both parents) and peer group rejection are associated with an increased risk for its development; however, it is possible for AvPD to occur without any notable history of abuse or neglect.

Is Avoidant Personality Disorder The Same As Social Anxiety?

There remains much controversy over the notion that social anxiety disorder is simply an advanced form of AvPD. Researchers and clinicians used to believe that avoidant personality disorder only occurred in conjunction with social anxiety disorder (SAD). However, more recent research has shown that there is a significant percentage of people with AVPD who do not meet the criteria for social anxiety disorder.

Let’s examine this further:

Social anxiety disorder (SAD) is, naturally, very distressing for those who must cope with it in their daily lives. Typically, people with SAD understand that their fears of rejection and criticism are out of proportion with reality, though these reactive thought patterns persist. They may give a lot of energy to imagining worst-case scenarios but do not venture out of the house to face these possibilities. These habits make forming and maintaining friendships and relationships extremely challenging, and people with advanced social anxiety disorder may live very isolated lives. The resulting stress of SAD may also cause nervous physical symptoms, such as sweating, dizziness, trembling, difficulty breathing, upset stomach, increased heart rate, and tension within the body.

The overwhelming symptoms of social anxiety can contribute to the trauma of social situations in the end, generating more fear and anxiety in the future.

Symptoms of avoidant personality do disorder mirror those of social anxiety disorder but reach further into a person’s understanding of their own identity and their dysfunction in everyday life.

People with avoidant personality disorder:

• Have extremely low self-esteem because they believe that they are inferior, incompetent, and entirely deserving of the rejections they anticipate from others.
• Are incredibly sensitive to criticism –  real or imagined – to such point that it is so crippling that they have very few, or even no, social interactions on a regular basis.
• May not be able to succeed in a job because of the socialization it requires and opt for jobs in which they can work at home
• Are often without friendships and romantic relationships, if they want these connections in their lives. Looking for real connections with people raises the stakes, and people with avoidant personality disorder may feel extreme anxiety about interacting with these people.

Those with social anxiety disorder may have low self-esteem in social situations but do not actually believe they are inferior or worthy of the outside judgments they fear, while those with avoidant personality disorder internalize this criticism so completely that they believe the pending hostile perspective is justified. Their perception is distorted so much so that they do not even see themselves as they are in reality—let alone how the world and the people around them really are. It is as if avoiding others and social situations is a way of avoiding themselves, however. they continue to live with these fears and distress, withdrawing further and becoming severely isolated. They may develop overwhelming anxiety in anticipation of going to the grocery store, simply walking out to the mailbox, or having an unexpected visitor show up at the door.

Sometimes it may be difficult to distinguish whether a person has social anxiety disorder or avoidant personality disorder, or both conditions. Typically, a person with AVPD will experience anxiety and avoidance in all arenas of life, whereas a person with social anxiety may only have fears specific to certain situations, such as public speaking or performing.

What is a Cluster C Personality Disorder?

Different personality disorder diagnoses are organized by cluster,” and those who have Cluster C personality disorders experience characteristics and feelings that involve being particularly anxious or fearful. Avoidant personality disorder is a Cluster C personality disorder, as are dependent personality disorder, and obsessive-compulsive personality disorder.

How Common Is Avoidant Personality Disorder?

It is estimated that about 2.5 percent of the population has avoidant personality disorder and seems to affect men and women equally. It generally begins in infancy and childhood and continues into adulthood. As with most personality disorders, avoidant personality disorder usually is not diagnosed in people younger than 18 years of age.

New information has found that in several separate clinical studies, Avoidant Personality Disorder may actually affect anywhere from 1.8% to 5.2% of the general population. Remember this, people who are diagnosed with Avoidant Personality Disorder also frequently meet the criteria for other personality disorders.

This table below shows how statistically likely it is that a person who is diagnosed with AVPD will also meet the criteria for another personality disorder. The more positive the number, the more likely it is that a person will be diagnosed with the second personality disorder listed. The more negative the number, the less likely it is that a person will be diagnosed with the second personality disorder in the table.

What Causes Avoidant Personality Disorder?

Researchers don’t completely understand what causes avoidance personality disorder, but they believe it is a combination of genetics and environmental factors, meaning that as of this writing, no single cause is to blame for the development of Avoidant Personality Disorder. The following factors may greatly influence the development of AvPD, but there’s no accepted single root cause for the disorder.

Early Childhood Experiences:

Millon and others considered early interactions with parents as an important etiological factor in AVPD. The likely importance of early caregiver experiences is underscored by adoption studies. Increased odds of PD in adoptees were evident in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) study, but the odds were highest, about double that of non-adoptees, for paranoid, antisocial, and avoidant PDs.

Early childhood experiences may be linked to the development of AVPD. Research suggests that children who see their caregivers as lacking in affection and encouragement and/or experience rejection from them may be at increased risk. So are children who experience abuse, neglect, and an overall lower level of care. In response to these experiences, children may avoid socializing with others as a coping strategy.

Some studies suggest that patients with AvPD are more likely to see their parents as less affectionate, more rejecting, guilt-engendering, and less encouraging of achievement than matched controls. AvPD has been linked to a recalled history of neglect, abuse, overprotection, and lower care. The CLPS found relatively few differences between AvPD and other PDs on experiences of physical or emotional abuse, or caretaker emotional denial. However, there are some noteworthy differences: those with a primary diagnosis of AvPD reported fewer positive relationships with other adults, poorer parental social ability, less sexual abuse, and physical neglect than a group of persons with other PDs. Research has also discovered associations mediated in part by a maladaptive schema of belief in the need to subjugate personal needs, wants, and desires to avoid negative interpersonal outcomes, although overall few relationships with early maladaptive schemas were evident.

In summary, despite some variability of findings, there seems to be reasonable support for an association between neglect and emotional abuse, and perhaps less encouragement by early caregivers and later AvPD symptomatology. Recall bias influenced by underlying hypersensitivity cannot be excluded as a contributor to these findings, but twin studies point to some role for environmental factors, and negative experiences within the family would appear a likely candidate.

Attachment style:

Attachment provides an explanatory model for the link between temperament, adverse childhood environment, and personality disorders. An attachment style referred to as avoidant, detached, or dismissing (also referred to as an “anxious/avoidant” style) has been proposed to contribute to the development of AvPD. This attachment style may be associated with a negative self-concept and a fear of intimate relationships. A fearful attachment style – involving a desire for intimacy in the presence of interpersonal distrust and fear of rejection – is now thought to be of major relevance to people who have AvPD. Indeed, Bartholomew regarded the fearful style, when extreme, as typical of AVPD.

A number of studies have confirmed the theorized relationship between AvPD and both anxious and avoidant strategies. Using the four-category model of Bartholomew and Horowitz, which posits that attachment is classified into one of four groups determined by positive or negative views of the self and positive or negative views of others, some studies also identified a fearful attachment style in AVPD. In the four-category model, the fearful attachment style may be the most disabling, since it is associated with negative views of both self and other. Research suggests that experiences with critical, demeaning, and neglectful early caregivers may increase the risk of developing a fearful attachment style.

These findings are important because attachment style is highly relevant to assessment and treatment; It is more difficult for a therapist to establish and maintain a relationship with a person who is distrustful of others, is hypersensitive to criticism and rejection, and relies on avoidant coping strategies.

Links between early childhood experiences and core features of AVPD: hypervigilance, avoidance, low self-esteem, and negative self-concept:

It’s been postulated that a child may develop hypervigilance as a coping strategy when a parent is inaccessible or inconsistent and this hypervigilance may then move to other social situations. This might be expected to apply equally to social anxiety disorder. Others suggest that repeated negative experiences with parents might lead the child to expect unpleasant or distressing interactions, and to then employ avoidance as a coping strategy. Over time, this might become the default strategy. The resulting social isolation then predisposes these people to feel greater emotional distress. Millon viewed parental rejection or denigration as a critical factor in the loss of self-esteem in the child.

A role for temperamental factors has also been proposed with some supportive evidence:

• Personality rigidity
• Hypersensitivity
• Major harm avoidance
• Low novelty-seeking
• Overactive behavioral inhibition system

It also seems likely that social anxiety disorder and AVPD share some temperamental vulnerability factors:

• Negative emotionality (neuroticism)
• Behavioral inhibition
• Shyness

Temperamental factors may increase the person’s vulnerability to the effects – and possibly even the risk – of negative childhood experiences. They may also influence the selection of coping strategies, such as avoidance, and the adverse impact of maladaptive strategies. A relationship between attachment and temperament has also been described. For example, the amount and expression of distress an infant experiences upon separation from the early caregiver may be influenced by temperamental traits, and the responsiveness of the caregiver may influence attachment.

Genetic factors:

Genetic studies have the potential to offer insight into the relative contributions of genes and environment, as well as more specifically to inform the question of diagnostic validity. A heritability coefficient for AVPD of 0.64 has been estimated in one study. Initial and 10-year follow-up genetic findings in people who had avoidant personality disorder and social anxiety disorder using data from the Norwegian Twin Registry indicated that genetic influences on AVPD were stable over time, but the genetic risk for SAD was more variable.

The authors concluded that environmental factors contributed to co-occurrence of AVPD and SAD, and that there are potentially distinct factors underlying SAD and AVPD.

In summary, these studies suggest a complex relationship between genes, temperament, early childhood environment, attachment style, and personality in AVPD, which remains to be fully elucidated. The research indicates some shared vulnerability with SAD, but also some points of difference.

What Are Some Of The Characteristics of Avoidant Personality Disorder?

The following is a list of some of the more common characteristics and traits of people who suffer from Avoidant Personality Disorder (AVPD) from Out of The Fog:

These traits are listed as a guideline only and are not intended for actual or diagnosis or as diagnostic criteria. People who suffer from avoidant personality disorder are each unique and so each person will display a different subset of traits. It’s also important to remember that everyone displays “avoidant” behaviors from time to time. Therefore, if a person exhibits one or some of these traits, that does not necessarily qualify them for a diagnosis of AVPD.

Always/Never Statements are declarations containing the words “always” or “never” especially used in arguing in interpersonal relationships, while often used, these statements are usually not true They are commonly used but rarely true.

Avoidance – Purposefully withdrawing from relationships with others as a preemptive defensive measure to help reduce the risk of rejection, accountability, criticism, or exposure.

Blaming – Rather than identifying ways of dealing with a problem together, these people blame other people who “created the problem.”

Catastrophizing – Automatically assuming a “worst case scenario” in absolutely every situation, thus wrongly characterizing minor or moderate problems or issues as catastrophic events.

Circular Conversations – People who engage in circular conversations (generally within the context of an argument) can go on almost endlessly, repeating the same patterns, never coming to an actual conclusion together.

Confirmation Bias – The tendency involves paying much more attention to things that reinforce their already-held beliefs rather than things which contradict them.

“Control-Me” Syndrome – Some people have the tendency to engage in relationships with people who have a controlling narcissistic, antisocial, or “acting-out” nature.

Cruelty to Animals – acts of violence toward helpless animals have been discovered to statistically occur more frequently in those who have a personality disorder rather than the general population more often in people who suffer from personality disorders than in the general population.

Denial – the imagination or belief that some awful, traumatic situation didn’t exist and that they have no memory of the event.

Dependency – far out of normal and appropriate constant reliance by an adult to another adult, allowing the other adult to make decisions about illness, health, and personal and emotional well-being

Depression – Many individuals who have been diagnosed are also diagnosed with depression and depression symptoms

Escape To Fantasy – Instead of dealing with the present crisis or the here and now, a person escapes to a fantasy world

Identity Disturbance – a distorted and/or inconsistent view of themselves

Imposed Isolation – occurs when abuse leads a person becoming isolated from their support network, including friends and family.

Lack of Object Constancy – An inability to remember that people or objects are consistent, trustworthy and reliable, especially when they are out of your immediate field of vision.

Low Self-Esteem – negatively distorted view of self that is disingenuous to reality

Magical Thinking – Looking for supernatural connections between external events and one’s own thoughts, words and actions.

Manipulation – The practice of steering an individual into a desired behavior for the purpose of achieving a hidden personal goal.

Masking – Covering up one’s own natural outward appearance, mannerisms and speech in dramatic and inconsistent ways depending on the situation.

Neglect – A passive form of abuse in which the physical or emotional needs of a dependent are disregarded or ignored by the person responsible for them.

Objectification – The practice of treating a person or a group of people like an object.

Obsessive-Compulsive Behavior – An inflexible adherence to arbitrary rules and systems, or an illogical adherence to cleanliness and orderly structure.

Panic Attacks – Short intense episodes of fear or anxiety, often accompanied by physical symptoms, such as hyperventilating, shaking, sweating and chills.

Parentification – A form of role reversal, in which a child is inappropriately given the role of meeting the emotional or physical needs of the parent or of the family’s other children.

Passive-Aggressive Behavior – Expressing negative feelings in an unassertive, passive way.

Perfectionism – The maladaptive practice of holding oneself or others to an unrealistic, unattainable or unsustainable standard of organization, order, or accomplishment in one particular area of living, while sometimes neglecting common standards of organization, order or accomplishment in other areas of living.

Sabotage – The spontaneous disruption of calm or status quo in order to serve a personal interest, provoke a conflict or draw attention.

Selective Competence – Demonstrating different levels of intelligence, memory, resourcefulness, strength or competence depending on the situation or environment.

Self-Loathing – An extreme hatred of one’s own self, actions or one’s ethnic or demographic background.

Self-Victimization – Casting oneself in the role of a victim.

Splitting – The practice of regarding people and situations as either completely “good” or completely “bad”.

Testing – Repeatedly forcing another individual to demonstrate or prove their love or commitment to a relationship.

Thought Policing – Any process of trying to question, control, or unduly influence another person’s thoughts or feelings.

Tunnel Vision – The habit or tendency to only see or focus on a single priority while neglecting or ignoring other important priorities.

What Are The Symptoms of Avoidant Personality Disorder?

While avoidant personality disorder symptoms include anxiety during social contexts, they also differ sharply from social anxiety in the underlying beliefs and sense of self that drive their anxiety. Fear of social interaction arises from a deeply held sense of insecurity, inferiority, and ineptness. In contrast, many people with social anxiety disorder have healthy self-esteem and do not believe themselves to be inferior to others; social anxiety is not rooted in a particular self-image.

The symptoms of avoidant personality disorder are a highly specific set of beliefs that drive disordered behavior.

To receive a diagnosis, a person must have experienced these components by the time they reach earl adulthood. They also must experience at least four of the following AVPD symptoms, these include:

• Extremely low self-esteem
• Avoidance of activities at work that involve interpersonal contact due to fear of criticism or rejection
• Believing oneself to be inferior, inept, or unappealing to others
• Unwillingness to interact with others unless certain they will receive a positive response
• Highly sensitive to criticism or perceived rejection
• Feeling inadequate and being inhibited in new social situations
• Reluctance to enter social situations or form relationships
• An absence of friendships
• Hesitancy in intimate relationships due to fear of shame
• Preoccupation with criticism in social situations
• Extreme shyness that arises out of fear of doing something wrong
• Unwillingness to try new things for fear of humiliation or embarrassment

Living with avoidant personality disorder can be extremely limiting, as fear and rumination over perceived shortcomings can make even the most simple activities into (possible) emotional minefields.

It is also important to remember that people with this condition do not lack a desire for social contact; in fact, most people with AvPD deeply want to form close relationships and be able to engage in social interactions, but are so restrained by their disruptive thoughts and distorted self-image that they are unable to participate in such activities. If they do have social relationships, they are likely with people considered to be “low-risk” in terms of rejection, humiliation, or judgment, severely restricting social options.

For people with this disorder, the fear of rejection is so strong that they choose isolation rather than risk being rejected in a relationship. The pattern of behavior in people with this disorder can vary from mild to extreme. In addition to their fear of humiliation and rejection, other traits of people with this disorder include the following:

• They are oversensitive and easily hurt by criticism or disapproval.
• They have few, if any, close friends and are reluctant to become involved with others unless certain of being liked.
• They experience extreme anxiety (nervousness) and fear in social settings and in relationships, leading them to avoid activities or jobs that involve being with others.
• They tend to be shy, awkward, and self-conscious in social situations due to a fear of doing something wrong or being embarrassed.
• They tend to exaggerate potential problems.
• They seldom try anything new or take chances.

A diagnosis will require a psychological evaluation by a mental health professional. This evaluation will also rule out other potential diagnoses or determine whether a person has more than one diagnosis.

Psychologist Theodore Millon notes that because most patients present a mixed picture of symptoms, their personality disorder tends to be a blend of a major personality disorder type with one or more secondary personality disorder types. He identified four adult subtypes of avoidant personality disorder:

Lynn E. Alden and Martha J. Capreol, in 1993, proposed two other subtypes of avoidant personality disorder:

How Are General Personality Disorders Diagnosed?

Before a diagnosis of a personality disorder can be made, they must first meet the criteria for a personality disorder.

The two relevant major systems of classification for personality disorders must be met before any type of specific diagnosis (such as Avoidant PD) can be made.

• International Classification of Diseases (11th revision, ICD-11) published by the World Health Organization
• The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition, DSM-5) by the American Psychiatric Association.

Both have deliberately merged their diagnoses to some extent, however some differences remain. There are accepted diagnostic issues and controversies with regard to distinguishing particular personality disorder categories from each other. Before a specific diagnosis is made, the general criteria put forth by the ICD-11 and DSM-V must be met.

General Criteria For Diagnosing Personal Disorders:

Both diagnostic systems provide a definition and six criteria for a general personality disorder. These criteria should be met by all personality disorder cases before a more specific diagnosis can be made.

The ICD-10 lists these general guideline criteria:

• Markedly disharmonious attitudes and behavior, generally involving several areas of functioning; e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;
• The abnormal behavior pattern is enduring, of long standing, and not limited to episodes of mental illness;
• The abnormal behavior pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
• The above manifestations always appear during childhood or adolescence and continue into adulthood;
• The disorder leads to considerable personal distress but this may only become apparent late in its course;
• The disorder is usually, but not invariably, associated with significant problems in occupational and social performance.

The ICD adds: “For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations.”

Chapter V in the ICD-10 contains the mental and behavioral disorders and includes categories of personality disorder and enduring personality changes which are defined as, “ingrained patterns indicated by inflexible and disabling responses that significantly differ from how the average person in the culture perceives, thinks, and feels, particularly in relating to others.”

The specific personality disorders in the ICD-11: paranoid, schizoid, dissocial, emotionally unstable (borderline type and impulsive type), histrionic, anankastic, anxious (avoidant) and dependent. In addition, there are the following personality disorders:

• Other specific personality disorders (involves PD characterized as eccentric, haltlose, immature, narcissistic, passive–aggressive, or psychoneurotic.)
• Personality disorder, unspecified (includes “character neurosis” and “pathological personality”).
• Mixed and other personality disorders (defined as conditions that are often troublesome but do not demonstrate the specific pattern of symptoms in the named disorders).
• Enduring personality changes, not attributable to brain damage and disease (this is for conditions that seem to arise in adults without a diagnosis of personality disorder, following catastrophic or prolonged stress or other psychiatric illness).

In the proposed revision of ICD-11, all discrete personality disorder diagnoses will be removed and replaced by the single diagnosis “personality disorder.” Instead, there will be specifiers called “prominent personality traits” and the possibility to classify degrees of severity ranging from “mild”, “moderate”, and “severe” based on the dysfunction in interpersonal relationships and everyday life of the patient.[

In DSM-5, any personality disorder diagnosis must meet the following criteria:

• An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:
• Cognition (i.e., ways of perceiving and interpreting self, other people, and events).
• Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response).
• Interpersonal functioning.
• Impulse control.
• The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
• The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.
• The enduring pattern is not better explained as a manifestation or consequence of another mental disorder.
• The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) stresses a personality disorder is an enduring and inflexible pattern of long duration that leads to significant distress or impairment and is not due to use of substances or another medical condition. The DSM-5 lists personality disorders in the same way as other mental disorders:

DSM-5 lists ten specific personality disorders: paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent and obsessive-compulsive personality disorder.

The DSM-5 also contains three diagnoses for personality patterns not matching these ten disorders, but nevertheless exhibit characteristics of a personality disorder:

• Personality change due to another medical condition – personality disturbance due to the direct effects of a medical condition.
• Other specified personality disorder – general criteria for a personality disorder are met but fails to meet the criteria for a specific disorder, with the reason given.
• Unspecified personality disorder – general criteria for a personality disorder are met but the personality disorder is not included in the DSM-5 classification.

World Health Organization (WHO) Criteria:

If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests to rule out physical illness as the cause of the symptoms.

The World Health Organization’s ICD-10 lists avoidant personality disorder as anxious (avoidant) personality disorder. It is a requirement of ICD-10 that all personality disorder diagnoses also satisfy a set of general personality disorder criteria.

AvPD is characterized by at least four of the following symptoms according to the ICD-10:

• Persistent and pervasive feelings of tension and apprehension
• Belief that one is socially inept, personally unappealing, or inferior to others
• Excessive preoccupation with being criticized or rejected in social situations
• Unwillingness to become involved with people unless certain of being liked
• Restrictions in lifestyle because of need to have physical security
• 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.

The DSM-V criteria for diagnosis of AvPD:

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) also has an Avoidant Personality Disorder diagnosis that refers to a widespread pattern of inhibition around people, feeling inadequate, and being extremely sensitive to negative evaluation. Symptoms begin by early adulthood and occur in a range of situations. Four of seven specific symptoms should be present, which are the following:

• Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
• Is unwilling to get involved with people unless certain of being liked
• Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
• Is preoccupied with being criticized or rejected in social situations
• Is inhibited in new interpersonal situations because of feelings of inadequacy
• Views self as socially inept, personally unappealing, or inferior to others
• Is unusually reluctant to take personal risk or to engage in any new activities because they may prove embarrassing

Differential Diagnosis: 

Avoidant personality disorder must be distinguished from the following 2 disorders:

Social phobia: Differences between social phobia and avoidant personality disorder are hard to spot. Avoidant personality disorder involves more pervasive anxiety and avoidance than social phobia, which is often specific to situations that may result in public embarrassment (eg, public speaking, performing on stage). However, social phobia may involve a broader avoidance pattern and thus may be hard to distinguish. The 2 disorders often occur together.

Schizoid personality disorder: Both disorders are characterized by social isolation. However, patients with schizoid personality disorder become isolated because they are disinterested in others, whereas those with avoidant personality disorder become isolated because they are hypersensitive to possible rejection or criticism by others.

Other personality disorders may be similar in some ways to avoidant personality disorder but can be distinguished by characteristic features (eg, by a need to be cared for in dependent personality disorder vs avoidance of rejection and criticism in avoidant personality disorder).Other personality disorders may be similar in some ways to avoidant personality disorder but can be distinguished by characteristic features (eg, by a need to be cared for in dependent personality disorder vs avoidance of rejection and criticism in avoidant personality disorder).

How Is Avoidant Personality Disorder Treated?

Avoidant personality disorder is a chronic, lifelong condition that will continue to disrupt emotions, thoughts, and behaviors unless treatment is sought. Today, there is a wide variety of interventions that can be used to both alleviate acute symptoms and break through the disordered beliefs that underlie those symptoms. These include psychopharmacological and psychotherapeutic treatment options. Of particular note is cognitive behavioral therapy, which aims to replace damaging patterns of thought and behavior with healthier, reality-based alternatives as well as desensitize patients to those situations that act as triggers for symptoms. Additionally, trauma-focused therapies may help you explore the roots of your disorder and create strategies for processing the pain of traumatic childhood experiences while giving you a framework for creating secure attachments. Due to the intensity of the disorder and its profound impact on functionality, long-term residential treatment is often the best treatment milieu, offering the ability to participate in a broad range of therapies to overcome distress.

Treating personality disorders is difficult, because people with these disorders have deep-rooted patterns of thinking and behavior that have existed for many years. However, people with avoidant personality disorder tend to be good candidates for treatment because their disorder causes them significant distress, and most feel the need to develop relationships with other people and reduce the amount of distress they experience at public or at work. This desire can be a motivating factor for people with avoidant personality disorder to follow their treatment plans.

Symptoms will generally decrease in intensity with age, with the peak level of symptoms displayed in their 40s or 50s. Many people with Avoidant Personality Disorder do not seek out treatment, thinking that they are not good enough or that their symptoms don’t matter, even though the disorder has a significant impact upon their lives. Typically help is sought when life becomes too stressful and they are unable to cope with it.

It is extremely important to understand that treating any personality disorder can be difficult, as many of the symptoms have been experienced for many years. Treatment of avoidant personality disorder can employ various techniques, such as social skills training, psychotherapy, cognitive therapy, and exposure treatment to gradually increase social contacts, group therapy for practicing social skills, and sometimes drug therapy.

Significant improvement in the symptoms of personality disorders is possible, with the help of treatment and individual effort.

However, if you are living with avoidant personality disorder, the condition itself can present unique barriers to treatment. Many people with this condition are highly reluctant to enter into mental health treatment due to the social contact inherent to such care. As such, finding the right treatment environment that will encourage participation and foster feelings of safety is paramount. A key issue in treatment is gaining and keeping the patient’s trust, as people who have avoidant personality disorder may start avoiding treatment sessions if they distrust the therapist or fear rejection. Those with Avoidant Personality Disorder often have low self-esteem about any social interactions, often finding it difficult to see the positive in life. This may be challenging for a therapist, as the person may under-report symptoms, deeming them unimportant. A more thorough, detailed interview may be required.

Being a personality disorder, which are chronic and long-lasting mental conditions, avoidant personality disorder is not expected to improve with time without treatment. Being that it is a poorly studied personality disorder and in light of prevalence rates, societal costs, and the current state of research, AvPD qualifies as a neglected disorder.

The following features may help to make treatment less intimidating and more productive:

• Experienced and compassionate clinicians: It is critical that the treatment you choose is staffed by clinicians who have the experience and compassion necessary to effectively address avoidant personality disorder symptomatology. This includes a deep understanding of individual challenges and how to form strong therapeutic alliance. These will allow you to feel safe and comfortable throughout the treatment process.
• Medications should only be prescribed for specific diagnoses occurring co-morbidly (other mental illnesses) that someone with Avoidant Personality Disorder may have.
• Appropriate therapies: While CBT is often particularly helpful for people struggling with avoidant personality disorder, many are initially reluctant to participate in verbally-based therapies that require direct social interactions. As such, the availability of non-verbal therapies, such as holistic, creative, and experiential modalities, can help you feel more comfortable in exploring yourself. These therapies can help bolster your confidence and give voice to your struggles in a supportive and nonjudgmental environment, enhancing your ability to participate in verbal therapies as time goes on.
• Gradual independence: Healing from avoidant personality disorder doesn’t happen overnight and overcoming the functional limitations caused by the disorder can take time. Providing you with the support you need at each stage of healing will be crucial to ensuring that you are met where you are at and are not overwhelmed by responsibilities for which you are not ready. This includes support not only with emotional wellbeing, but with concrete skill-building to increase independence, resilience, and self-reliance. For people with avoidant personality disorder, breaking through isolation, building and maintaining social relationships, and fostering the ability to fulfill educational and professional goals will be of particular importance.
• Psychotherapy Psychotherapy, or talk therapy, is the primary avoidant personality disorder treatment and may include cognitive-behavioral therapy, which focuses on reducing negative thought patterns and building social skills. Sometimes group therapy is used to help people with similar challenges and create a safe space to build solid relationships. Family therapy can also prove useful so that family members understand the condition and can provide a supportive environment that promotes growth and healthy risk-taking.Therapy is generally short-term and oriented toward solution-based approaches looking for solutions to specific life problems. the primary purpose of both individual therapy and social skills.
• Therapy in a safe and encouraging environment can help you explore the intense anxiety you experience in social situations and your fear of rejection or criticism. Together, you and your therapist can practice challenging negative beliefs and explore the small but significant steps you can take to build solid friendships, be more engaged at work, and develop intimate relationships with others.
• Group Therapy Group therapy may be useful if the person with Avoidant Personality Disorder agrees to attend sessions, although group therapy is often a tool that is used later in treatment, once the person feels more comfortable in social situations. Group therapy is designed for people with avoidant personality disorder to start challenging their exaggerated negative beliefs about themselves.

With appropriate care delivered in an environment of love, you can come to uncover your own strengths and purpose and harness your inner resources for healing. The guidance of clinicians will be paramount to this process, but so too will the support of your peers, who can help you learn and practice new social skills and reframe your understanding of yourself as a competent social actor. Most importantly, you will be empowered to develop a strong sense of self-worth, helping you remove the current of self-devaluation that underlies avoidant personality disorder, releasing you from fear and opening up infinite possibilities for your future.

Without treatment, a person with this disorder can become isolated from society, causing long-term

For Loved Ones: Coping Strategies for Avoidant Personality Disorder:

What To Do For A Loved One:

First, in order to understand what our loved one is going through we must understand how their personality disorder functions. Education and understanding is key for a relationship with someone who has AvPD.

It doesn’t make you a bad person to feel annoyance or displeasure, you may feel frustrated at their irrational behavior. You may feel the pressure to choose between caring for the person who is behaving in an avoidant way and your desire for healthy social interaction. You may feel pressured to become a hermit with them, and begin to resent that pressure.

Detach yourself emotionally from any dysfunctional attitudes. You don’t have to agree with them and you don’t have to fight with them. You can agree to disagree.

Maintain healthy outside interests, recreational pursuits and supportive relationships.

Get support from people who understand personality disorders. Join a support group.

What Not To Do For A Loved One:

Don’t blame yourself for the avoidant behavior and attitudes of a loved one. This isn’t and never will be your fault.

Don’t give in to pressure to isolate yourself from healthy relationships. The pressure may be particularly strong to give in and begin to isolate yourself as much as your loved one. This is nor fair to you, your social life, and your way of life. Keep up with your relationship with others at all cost.

Don’t try to “thought police” the person with the personality disorder. Thought Policing is a term used to describe the assumption that they know exactly what another person is thinking. You’re not omniscient (probably) and sometimes, no matter how well you know the person, you will make an assumption that hurts your loved one.

Don’t try to control their behavior – focus on being healthy yourself. It’s not worth it to tangle yourself up trying to control the behavior of your loved one, you can’t do it, it won’t work, and you too need to be healthy.

Additional Resources for Avoidant Personality Disorder

Out of the Fog – information and support for those with a loved one suffering any type of personality disorder.

Avoidant Personality Disorder – Support group and website devoted to people with Avoidant Personality Disorder and those who love them.