Avoidant Personality Disorder

What Causes Avoidant Personality Disorder?

The exact cause of AVPD has not yet been discovered. Several factors, however, seem to put an individual at increased risk of AVPD.

• Family history and genetics. People with AVPD often have a family history of personality disorders or other mental illnesses. Scientists suspect a genetic component to AVPD, but no definite association with any gene or group of genes has been discovered.
• Brain physiology. Some studies have identified differences in the structure of the brains of people with AVPD as compared to those without the disorder. However, it is unclear how these brain differences might cause the symptoms of the disorder.
• Personality traits. Children who are extremely shy, inhibited, risk-averse, and sensitive seem more likely to develop AVPD.
• External factors. Many people with AVPD have encountered situations and events that may have influenced the development of the disorder. These factors include rejection from parents or peers, abuse, or neglect in childhood.

Is Avoidant Personality Disorder Hereditary?

Scientists have not yet been able to identify a specific genetic component that increases the risk of AVPD. Inherited genes may likely increase an individual’s susceptibility to AVPD, but the disorder’s actual development may result from external triggering circumstances.

How Is Avoidant Personality Disorder Detected?

AVPD, like all personality disorders, involves a pattern of symptomatic behavior that remains consistent for a long time. Because of this, the disorder is usually not diagnosed in children. However, signs of the condition may appear in childhood, and certain childhood personality traits have been associated with AVPD

Possible indicators of AVPD risk include:

• Extreme shyness or inhibition
• Awkwardness or discomfort with social situations
• Oversensitivity to criticism or rejection
• Pessimism or poor self-image
• Unwillingness to try new things
• Avoidance of risk
• Attachment to routines

Don’t hesitate to seek treatment for yourself or a loved one if these signs interfere with daily functioning.

How Is Avoidant Personality Disorder Diagnosed?

Diagnosis of AVPD begins with determining that the patient has a cluster of symptoms that meet the diagnostic criteria for the disorder. A doctor will start with a physical exam to rule out biological problems that may be causing symptoms. After these exams, if the doctor suspects that AVPD or another personality disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment to solidify the diagnosis further.

Diagnostic steps may include:

• A physical exam. This exam will rule out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

The results of the psychological assessments will be compared to the diagnostic criteria for AVPD in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM criteria for AVPD include:

• A persistent pattern of behavior shows avoidance of social contact, feelings of inadequacy, and hypersensitivity to criticism or rejection.
• At least four symptoms are present.
• The symptoms begin by early adulthood.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Avoidant Personality Disorder Treated?

There is no cure for AVPD, and no medications are commonly used to treat the core disorder itself. Instead, the most common treatment course involves psychotherapy, with drugs sometimes used to treat other co-existing mental illnesses.

Therapies

Several different types of psychotherapy have proven to be effective at managing the effects of AVPD. Various therapies may be more or less effective for different individuals, and the most effective treatment may change over time, even in individual cases.

Commonly used therapeutic approaches include:

• Cognitive-behavioral therapy (CBT). This type of treatment focuses on teaching the patient to recognize inaccurate perceptions about themselves and others and develop strategies for dealing with these misperceptions when they occur.
• Psychodynamic therapy. This type of therapy helps the patient to identify their patterns of behavior. The therapist is likely to encourage examining the patient’s emotions, beliefs, and early childhood experiences.
• Family or group therapy.

Medications

Medications are usually not used to treat AVPD itself. However, medicines may be used to treat symptoms such as depression or anxiety, which often co-exist with AVPD. The drugs used to treat these symptoms include selective serotonin reuptake inhibitors (SSRIs), anxiolytics, and monoamine oxidase inhibitors (MAOIs). Medicines are rarely used on their own, and the most effective treatments combine medications with psychotherapy.

How Does Avoidant Personality Disorder Progress?

Treatment may help some people with AVPD learn how to interact socially more successfully. However, the treatment process must be followed consistently over a relatively long time. Unfortunately, people with AVPD and other personality disorders are often reluctant to pursue treatment and stick with it over the long term.

Left untreated, AVPD can have significant adverse effects on a person’s life, including:

• Lack of success at work or school
• Unemployment or financial difficulties
• Social isolation
• Health difficulties caused by avoidance of medical care
• Depression
• Anxiety
• Substance abuse
• Eating disorders
• Suicide or suicide attempts

How Is Avoidant Personality Disorder Prevented?

There is likely no way to prevent AVPD from developing, but parents and caregivers who provide a nurturing and supportive environment for their children may be able to remove some of the disorder’s risk factors.

When signs of AVPD emerge, early intervention can sometimes successfully prevent the condition from producing its most destructive complications.

Avoidant Personality Disorder Caregiver Tips

Many people with avoidant personality disorder also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with AVPD:

• The majority of people with AVPD also suffer from depression.
• As many as 15 percent of people with obsessive-compulsive disorder (OCD) also have AVPD.
• Panic disorder is common in people with AVPD.
• Other anxiety disorders, especially social anxiety disorder (SAD). SAD and AVPD have very similar symptoms, and the two conditions often co-exist.
• Eating disorders such as bulimia or anorexia are common complications of AVPD.
• Some people with AVPD also have other personality disorders, such as borderline personality disorder.
• Alcoholism and substance abuse are common consequences of AVPD.

Avoidant Personality Disorder Brain Science

Some scientists have been working to identify differences in the brains of people with avoidant personality disorder and those of healthy people. Because both AVPD and borderline personality disorder (BPD) feature hypersensitivity to negative perceptions in interpersonal interactions, at least one study has compared brain structure in people with these two disorders to healthy brains.

The study found similarities in the brains of people with BPD and AVPD, and those similarities were not present in healthy brains. This suggests that at least some of the neurological processes that might underlie BPD may also be at work in AVPD. These atypical processes include:

• Functional differences. Scientists have determined that in the brains of people with BPD, the parts of the brain that control emotion might not communicate effectively with the areas of the brain that control decision-making. These parts of the brain include the amygdala, the hippocampus, and the medial temporal lobes. The result of this miscommunication can be subtle but fundamental. Studies have shown, for example, that BPD patients often misidentify facial expressions, attributing negative emotions to neutral expressions.
• Chemical differences. Studies have shown that BPD sufferers may have problems processing or producing certain brain chemicals, such as the hormone oxytocin and the neurotransmitter serotonin. These chemicals are vital contributors to functions such as mood regulation, emotional responses, and social bonding.

Research is ongoing into these and other differences, and scientists are trying to understand the role these differences play in the development of the disorder.

Avoidant Personality Disorder Research

Title: Effectiveness of PTSD-treatment Compared to Integrated PTSD-PD-treatment in Adult Patients With Comorbid PTSD and CPD (PROSPER-C)

Stage: Recruiting

Principal investigator: Kathleen Thomaes, MD, PhD

Sinai Centre

Arkin, Netherlands 

Post-traumatic stress disorder (PTSD) is highly comorbid with personality disorders (PD), mainly borderline (BPD) and cluster C personality disorders (CPD). It is not clear yet what treatment is most effective for those who suffer both PTSD and PD. There is a growing preference in clinicians for evidence-based PTSD treatments, such as Eye Movement Desensitization and Reprocessing (EMDR) or Imagination and Rescripting (ImRs), because these treatments are relatively short, and there is some evidence that comorbid PD symptoms might resolve as well. However, at least 30-44% of PTSD patients do not sufficiently respond to PTSD treatments or are excluded because of suicidality or self-harm. PD treatments are more intensive than PTSD treatments, e.g., Dialectical Behavior Therapy (DBT) and Schema-Focused Therapy (SFT). There is some evidence that integrated PTSD-PD treatment is twice as effective as PD treatment alone, but integrated PTSD-PD treatment is not yet directly compared to PTSD treatment alone. This study will address this knowledge gap, including secondary outcome measures on functioning, quality of life, and cost-effectiveness.

For patients with comorbid PTSD and CPD, ImRs-only will be compared to integrated SFT-ImRs (PROSPER-C).

Psychological (cognitive, affective, and relational) and neurobiological candidate predictors and mediators of treatment outcome will be investigated through a machine-learning paradigm to develop a clinically useful and individual prediction instrument of treatment outcome. Example predictors and mediators are educational level, working memory, hyper- and hypo-arousal, therapeutic alliance and social support, resting-state fMRI, an emotional face task fMRI, cortisol levels from hair samples, and (epi)genetic markers.

For the neurobiological prediction, a subgroup of patients will undergo MRI scans, as will healthy controls as control subjects.

Title: Changes in the Brain as Borderline Patients Learn to Regulate Their Emotions

Stage: Completed

Principal investigator: Harold W. Koenigsberg, MD

Icahn School of Medicine at Mount Sinai

New York, NY 

Borderline Personality Disorder (BPD) is a common psychiatric disorder found in approximately 2% to 6% of the population. It is characterized by intense and rapid mood changes, self-destructive behavior, suicidality, and tumultuous relationships. In addition to the emotional costs of the suffering experienced by borderline patients and their loved ones, BPD patients typically function at a level substantially below that of individuals with comparable intellect. The difficulty controlling emotion, so central to the disorder, has proved particularly difficult to treat. The present study utilizes the latest neuroimaging findings in BPD to generate new ideas for the psychotherapy of the disorder.

This project builds upon our previous neuroimaging work, which has shown that when BPD patients try to control their emotions by employing a method that healthy people frequently use quite effectively — taking an emotional distance from what is upsetting – BPD patients are not able to quiet down the part of their brain that sends out emotional alarm signals. The objective of the present study is to determine whether giving BPD patients special training in using this healthy distancing strategy can help them improve their ability to regulate their emotions and return their brain activity to a more normal pattern. The investigators will do this by using fMRI to record brain activity as BPD subjects try to use distancing to reduce their emotional reactions to upsetting pictures before any training, then to have them receive specific training in the distancing strategy. After this training, we will again obtain an fMRI scan to determine whether their pattern of brain activation has normalized and whether they have been able to better reduce their negative reactions to the pictures. If this is effective, it will show that such training may help BPD patients better regulate their emotions and would support a program to further develop and incorporate distancing training into the psychotherapy of BPD patients.

A second objective of the present study is to determine whether the tendency of BPD patients to become increasingly sensitized to negative situations when they are re-experienced (as shown by increased activity of the brain’s emotional alarm system) will reduce with additional exposure, as it does in patients with phobias, or will continue to increase. Knowing this can help the therapist plan how to most therapeutically approach disturbing life experiences in the psychotherapy of BPD patients.

This project represents an important step in brain imaging research since it applies information learned about brain activity patterns to develop new approaches to psychotherapy. It addresses a serious, prevalent, and difficult-to-treat disorder.