Avoidant Personality Disorder

Kantor's AvPD Subtypes

Kantor classes four types of avoidants, “according to the specific way their underlying social or relationship anxiety becomes manifest clinically”.

Shy/Social Phobic Avoidants

• Use withdrawal to manage their social anxiety
• Two subtypes: shy avoidants and social phobic avoidants
• Shy avoidants have difficulty forming relationships and can be very isolated
• These are the type of people to be standing awkwardly in a corner at parties, only talking to the people they know
• Social phobic avoidants “display their withdrawal mainly symbolically”
• Have a lot more in common with Social Anxiety Disorder, such as fear of public speaking or trouble with day to day interactions

“Mingles” Avoidants

• Unlike shy avoidants, they form relationships relatively easily, but keeping them is the difficult part
• Several subtypes:
  • Anxious type:
    • Too scared to maintain relationships
    • Black/white, catastrophic thinking: I will make connections easily / I can never make connections
  • Ambivalent type:
    • Too uncertain to maintain relationships without splitting
    • Splitting consists of dependent & clingy vs withdrawing & flighty
  • Masochistic type:
    • Fear both rejection and acceptance
    • “Arrange to fail” by (consciously or subconsciously) pursing relationships with unattainable people or people who dislike them
  • Dissociative type:
    • Extreme version of withdrawing by dissociating
    • May be comorbid with Dissociative Identity Disorder or other dissociative disorders
  • Hypomanic type:
    • Very sociable, with many friends, but often shallow relationships
    • When rejected, make frantic efforts to feel loved again
    • Rejection creates a sense of despair and emptiness

“Seven Year Itch” Avoidants

• Able and willing to form full, satisfactory relationships, but only for a finite amount of time
• Eventually feel restless and unhappy with their relationships, and often leave them, but will feel unhappy with their new ones too
• Don’t fear relationships but the continuing familiarity and intensity
• Feel controlled, become impulsive and impatient
• Fear losing their autonomy and identity
• Feel like there’s no challenge to the relationship anymore and “without challenge nothing means anything”

(Co-)Dependent Avoidants

• Often have parental/attachment issues
• May be in close relationships that are “all-encompassing”
• These codependent relationships function as a withdrawal strategy by focusing on one person instead of the world

Depression & Hypomania

Kantor suggests the following presentations when depression or hypomania is present alongside AvPD:

Depression

• Self-destructiveness:
  • Avoidants who aren’t depressed will often try to “get over” being avoidant by developing their relationships. Avoidants who have comorbid depression may deliberately destroy their relationships through self-sabotage
• Hypersensitivity:
  • While all people with AvPD are hypersensitive to criticism, depressed avoidants’ hypersensitivity will be increased, and extend to things not related to criticism or rejection. They may misinterpret positive gestures as negative ones.
• Selfishness:
  • Because depression tends to narrow people’s views of the ‘bigger picture’, and personality disorders compromise people’s ability to have effective interpersonal relationships, depressed avoidants can become selfish and focused on themselves.
• Anger:
  • People with AvPD tend to internalise their anger, but when depression is comorbid their anger might be taken out on other people instead of themselves, or both.
• Low self esteem:
  • Low self esteem is already a feature of AvPD, and depression makes it worse. This creates even more need for approval and an even more heightened sense of rejection. Depressed avoidants constantly feel criticised, rejected, humiliated and abandoned. They use their low self-esteem as a method for avoiding (e.g., “I’m scared of rejection and [/because] I already don’t feel good enough so I won’t interact”). This also ties in with self-destruction: “I don’t feel good enough” > “I won’t interact” > “No one is accepting me” > “I must really not be good enough” > [etc].
• Apathy & boredom:
  • Apathy and boredom are used to send (verbal or nonverbal) messages of “You’re not worth my time”, which is a different way self-destruction can present.
• Anxiety & panic:
  • Anxiety and panic in depressed avoidants can cause self-destructive behaviours, and may be taken out on others.
• Grief:
  • Avoidants dealing with grief after a loved one’s death may struggle with feeling like the relationship they just lost will always be better than any other future relationship. They may feel like no current or new relationship will ever live up to the one they had with their loved one. This is a coping mechanism for dealing with grief coinciding with AvPD views on relationships.

Hypomania

• Compulsive sexual behaviour:
  • Hypomania and hypersexuality are defenses against depression. Unlike actual sexual addiction/compulsivity, hypersexuality in AvPD hypomania is an anxiety reduction mechanism. A particularly common form of hypersexuality in AvPD is “compulsive autoeroticism”.
• “Superficial euphoric franticness”, i.e. hypomania
  • This can take many forms, but Kantor describes it in regards to relationships. He writes that hypomania in relationships is “a way for avoidants to relate poorly while simultaneously fooling themselves and others into thinking that they are relating well.” The way they do this is by having a large number of superficial relationships, avoiding intimate ones.
• Narcissism and grandiosity:
  • Hypomania can cause grandiosity and narcissism, which in people with AvPD can result in discarding relationships.
• Hostility:
  • Hypomania in avoidants usually results in “hyperrelatedness”, i.e. having a lot of superficial relationships. But it can result in hostility instead, leading to not having many relationships at all.

Kantor's “Mental Status Profile” of AvPD

Appearance

• Changes in appearance are rare, but if they happen it’s usually for a reason
• Avoidants may purposefully dress and act so that people will avoid them
• Avoidants with PTSD may dress in the same way they did at the time of the trauma (Kantor uses Vietnam veterans continuing to dress in 1960s fashion as an example); this is so they can continue to live in the past “in order to detach from relationships in the present”
• Avoidants may dress appealingly so that people will accept them for their looks

Behaviour

• Not all avoidants act shy and scared
• Sometimes avoidance is expressed somatically (as a physical symptom), e.g. sexual problems so that they can detach from partners (may or may not be consciously)
• Avoidants may withdraw only partially, or purposefully choose to be around people who they know will be unavailable
• Some avoidants will be able to go a long time without withdrawing, and when they do it’s usually sudden and without warning
• Some avoidants will merge their self-identity into another person, withdrawing from the rest of the world through their relationship

Speech

• Rate:
  • There are two types of avoidants: silent and over-talkative
  • Silent avoidants freeze up in fear
  • Over-talkative avoidants feel pressure of speech, using talking as an attempt to cover up fear and panic
  • May attempt to be the ‘life of the party’ so that they’ll be accepted
• Content:
  • May utilise social faux pas as an avoidance/withdrawal strategy
  • May talk about themselves too much, ask invasive questions, or talk at length about boring topics, as a way to distance themselves
  • May anxiously ask “is that ok?” or “is this right?” or similar questions

Thought

• ‘Cognitive errors’ lead to people with AvPD believing that they should fear relationships and closeness
• Many avoidants think catastrophically, i.e. any sign of someone being uninterested becomes a rejection causing the avoidant to withdraw

Affect (emotions)

• Some people with AvPD deal with their fears of rejection by protectively having blunted affect (lack of outward emotion); others become depressed or hypomanic
• A lot of avoidants are angry and can be hostile. Kantor relates this to timidity (flight) and hostility (fight) being two sides of the same coin
• “Anger is a way to cope defensively with closeness, distance is a way to cope defensively with anger.”

Insight (awareness)

• Good:
  • People with AvPD with good insight into their personality disorder are aware of their avoidance and the reasons behind it
  • Avoidants with good insight usually seek change through therapy
• Partial / Compromised:
  • This is where most people with AvPD fall
  • Some avoidants will be aware of their problems and seek change through lifestyle changes (new appearance, new city, new friends etc)
  • Some have good surface level insight, but compromised deeper insight
  • They’re aware of their avoidance and anxiety but not why
  • Other avoidants have good insight, but feel helpless to change
  • Most people with partial insight have a comorbid mood disorder
• Poor:
  • Avoidants with poor insight have “simply built their avoidance into their lives, unquestioningly, with little or no idea of why they are so uncomfortable and dissatisfied with their existence”
  • Rationalise their avoidance by saying that it’s just their preference, or justified for some other reason (career, minority status(es), rural location, etc)

Judgement

• “Bad judgement is a frequent companion of bad insight”, and “avoidance is by definition an act of bad judgment”
• Bad judgement is often the result of a comorbid mood disorder
• Depressed avoidants are often self-defeating and self-destructive, with low self-esteem
• They may find attention in a way that hurts them, making them look weak and vulnerable, and therefore playing into their AvPD rejection fears
• Hypomanic avoidants seek attention by being actively non-avoidant, “frantically intensifying the search for love in order to hide their fear of actually finding it”
• They are also self-defeating and destructive, but it’s because of compulsive, impulsive actions