In the first study of its kind, researchers have asked people to describe in their own words what it’s like to live with Avoidant Personality Disorder—a diagnosis defined by psychiatrists as “a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.” Like all personality disorder diagnoses, AVPD is controversial, with some critics questioning whether it is anything other than an extreme form of social phobia.
To shed new light on the issue, lead author Kristine D. Sørensena, a psychologist, twice interviewed 15 people receiving outpatient treatment for AVPD. The researchers said the overarching theme to emerge from theinterviews was the participants’ struggle to be a person. “They felt safe when alone, yet lost in their aloneness,” the researchers said. They “longed to connect with others yet feared to get close.” In the researchers’ opinion, the participants’ profound difficulties with their “core self” and in their dealings with others do indeed correspond to “a personality disorder diagnosis”.
Beneath the overarching theme of struggling to be a person, there emerged two main themes, the first being “fear and longing.” This included participants’ descriptions of having to put on a mask when socializing and their difficulty feeling normal. This constant performance meant they felt other people never really knew them. There were some rare exceptions to these difficulties: For instance, one participant said they felt authentic when with their young daughter, yet other participants described how, as their children grew older, their usual insecurities returned even when in their company.
Another difficulty that was mentioned repeatedly was the dread of getting close to others. Coping measures included only interacting through email or text message, and when in physical company, avoiding eye contact.
The participants also described a conundrum—the solitude that brought them comfort and safety was also suffocating. They were “feeling sad, almost grieving when they were alone,” the researchers said. To cope, the participants said they kept busy playing computer games and listening to music. Most effective were physical sports and hobbies like making music, yet sadly the relief evaporated as soon as thoughts of being evaluated crept into mind.
The second main theme was “a doubting self”–including chronic insecurity and a fleeting sense of self. Participants had the perception that other people breeze through life and have no trouble being themselves. Related to this, the participants were constantly struggling to make sense of their own persistent insecurities.
The constant acting and pretense when in company led to feelings “like one is not even there,” as one participant put it. Sometimes this developed into an emotional hollowness. After wearing a mask for so many years, some participants feared they had forgotten who they truly were underneath. On the positive side, participants found time in nature was therapeutic, especially when immersed in a physical challenge.
In short, the researchers said that their participants spend so much time “reflecting on themselves that it seemingly disrupted their everyday life functioning.” They also lacked feelings of belonging, attachment, and intimacy. Their suspicion of others and the burden of keeping up appearances “caused the participants to retreat from and miss social experiences that might have provided more trustworthy and comforting answers to questions related to the inner mental lives of themselves or others.”
Sørensena and her colleagues said these insights could be useful for therapists. The therapeutic alliance (a warm, trusting relationship between therapist and client)—always important—will be even more critical for clients with avoidant personality disorder. “The therapeutic relationship provides an opportunity for persons diagnosed with AVPD to experience being met with acceptance and understanding,” the researchers said.
Christian Jarrett is the author of the forthcoming book Personology: Using the Science of Personality Change to Your Advantage.
This is an edited version of an article that originally appeared on Research Digest, published by the British Psychological Society. Read the original article.
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