PSY4761: Personality disorders. Extensive elaboration of the learning objectives associated with task 2: Avoidant and dependent personality disorder. Includes citations and notes from the tutorial in orange. For all tasks, see the bundle.
Video
Question 1. The psychiatrist plays a person with Avoidant PD, which symptoms can you find
in this clip? Why doesn’t she want the promotion?
Situatie: deze persoon wordt gebeld dat ze een promotie krijgt. Echter wil ze deze niet
aannemen.
Quotes:
“I like where I’m at right now: I know everybody”
Anders zou ze nieuwe mensen leren kennen die haar wellicht afwijzen/negatief
beoordelen. Nu is ze er zeker van dat deze mensen haar aardig vinden
“I’m not cut out for managing people”
Gevoel van minderwaardigheid/dat ze het niet kan
“I would be just too stressed out”
Overgevoeligheid voor afwijzing of kritiek (dan heeft iemand namelijk meer
verantwoordelijkheid en kan iemand falen)
1. What is the clinical picture (phenomenology) of Avoidant PD?
DSM-V criteria avoidant personality disorder
Een diepgaand patroon van geremdheid in gezelschap, gevoel van tekortschieten en
overgevoeligheid voor een negatief oordeel, beginnend in de vroege volwassenheid en tot
uiting komend in diversie situaties, zoals blijkt uit vier (of meer) van de volgende kenmerken:
1. vermijdt beroepsmatige activiteiten die belangrijke intermenselijke contacten met zich
meebrengen vanwege de vrees voor kritiek, afkeuring of afwijzing
2. heeft onwil om bij mensen betrokken te raken, tenzij er zekerheid bestaat dat men
hem aardig vindt
3. toont gereserveerdheid binnen intieme relaties uit vrees vernederd of uitgelachen te
worden.
4. is gepreoccupeerd met de gedachte in sociale situaties bekritiseerd te worden of
afgewezen te worden.
5. is in intermenselijke situaties geremd vanwege het gevoel tekort te schieten.
6. ziet zichzelf als sociaal onbeholpen en voor anderen onaantrekkelijk of minderwaardig.
7. is uitzonderlijk onwillig persoonlijke risico’s te nemen of betrokken te raken bij nieuwe
activiteiten omdat deze hem in verlegenheid zouden kunnen brengen.
,2. Is Avoidant PD better defined as a syndrome of social avoidance (i.e., DSM-definition), or
a more general avoidant syndrome that includes both social and non-social avoidance?
In other words: is the DSM-assumption that social behavior is the only behavior social
phobics avoid accurate?
Taylor, C.T., Laposa, J.M., & Alden, L.E. (2004). Is avoidant personality disorder more than
just social avoidance? Journal of Personality Disorders, 18, 571-594.
Abstract
Although social avoidance is a defining feature of avoidant personality disorder (APD), some
theorists posit that APD is characterized by a broader pattern of avoidance that extends
beyond social situations. This paper describes four studies that examined the different types
of nonsocial avoidance hypothesized to characterize APD in three undergraduate student
samples and a clinical sample of adults with APD. The findings revealed low to moderate
associations between APD and emotional and novelty avoidance, as well as avoidance of
various nonsocial events. The results provide support for contemporary models of APD.
Introduction
Avoidant personality disorder (APD) is characterized by a desire for interpersonal affiliation,
together with feelings of inadequacy, hypersensitivity to negative evaluation, and fears of
rejection (DSM-IV). Consequently, the central features of APD are pervasive social inhibition,
withdrawal, and avoidance. Although social avoidance is a prominent feature of APD, studies
highlight additional facets of avoidance that extend beyond social situations, such as
avoidance of unpleasant emotions. The goal of the present work was to establish whether
APD as operationalized in the DSM-IV is associated with a pattern of avoidance that extends
beyond social situations.
The term avoidant personality first appeared in the writings of Millon. Consistent
with contemporary definitions of APD, Millon described the avoidant individual as being
hypersensitive to potential rejection and humiliation, and highly socially avoidant. He also
noted that a central feature of this personality pattern was low tolerance for negative
emotions, accompanied by the use of avoidant strategies and cognitive interference to
protect the individual from the intense psychic pain arising from those emotions. Given their
feelings of inadequacy and negative self-worth, avoidant individuals were thought to suffer
from constant painful thoughts about their situation. Millon believed that avoidant
individuals exerted significant effort to ward off those unbearable cognitions and feelings.
Millon’s original ideas are elaborated on by suggesting that the essential feature of
APD is pervasive social, behavioral, cognitive, and emotional avoidance. Beck and Freeman
suggest that although the occasional use of avoidant strategies for particular situations is
relatively common, such avoidance is ubiquitous in people with APD. In their cognitive
theory, Beck and Freeman emphasize the mediating role of cognitive schemas in APD, one
aspect of which is the APD person’s beliefs about emotions. They posit that because these
patients hold dysfunctional assumptions about experiencing negative emotions, they actively
avoid thinking about matters that produce dysphoria (cognitive avoidance), and act in ways
that permit them to maintain this avoidance (behavioral avoidance). Given that such
strategies provide a temporary reduction in dysphoria, avoidant behaviors are negatively
reinforced and eventually become fixed and automatic, thereby perpetuating the
individuals’ underlying pathology. Although Beck and Freeman focused primarily on
, avoidance of negative emotions, their observations about cognitive and behavioral
avoidance may extend to avoidance of other affective states, such as anger and even
positive emotions. Some researchers suggest that avoidant people are deficient in their
ability to experience pleasure and even report actively avoiding positive events.
In addition to cognitive, behavioral, and emotional avoidance, historical depictions of
APD include other nonsocial aspects of avoidance (e.g., avoidance of novelty and risk).
Researchers working within the Five Factor Model (FFM) of personality found that APD was
characterized by low levels of excitement-seeking. In a similar vein, research that examined
APD revealed a strong positive relationship between APD and harm avoidance.
To date, there are no studies directly examining cognitive models of APD. In
particular, no work has examined whether people with APD avoid thinking about and
experiencing emotions. Although the FFM and psychobiological models of APD include the
notion of avoidance of risk and novelty, these ideas were abandoned in the DSM-IV.
In this paper, we describe a series of studies that examined the different types of
avoidance hypothesized to characterize APD, namely avoidance of emotions, novelty, and
risk. There were two goals: (1) To develop measures that would reliably assess avoidance of
emotions, novelty, and risk; and (2) to evaluate relationships between those measures and
APD features in nonclinical and clinical populations.
Study 1
The goal of Study 1 was to assess two facets of nonsocial avoidance highlighted in cognitive
and personality models of APD, namely avoidance of emotions and avoidance of novelty. To
accomplish this, we drew on theories of Beck and Freeman and Millon, and historical
depictions of APD in the DSM to develop measures of emotional and novelty avoidance. In
addition, we were interested in examining associations between our measures of avoidance
and self-reported APD traits in a large student sample.
Our efforts to develop research instruments to assess the domains of novelty
avoidance and emotional avoidance met with partial success. The analysis of items reflecting
avoidance of risk and novelty yielded two internally consistent, interpretable components.
One component was characterized by a preference for engaging in familiar activities and a
discomfort with respect to novelty, while the second component reflected uneasiness with
routine and a desire to seek out novel situations and activities.
Analysis of items reflecting avoidance of emotions revealed four interpretable
underlying dimensions. Two components represented cognitive and behavioral expressions
of emotional avoidance, and a third component reflected negative beliefs about
experiencing emotions. A fourth component reflected social fears about displaying
emotions, a concept that is consistent with descriptions of APD in the DSM (i.e., hyper-
sensitivity to negative evaluation). The first two item sets displayed good internal
consistency, however, components reflecting negative beliefs about emotions and avoidance
of negative emotions had relatively few items and exhibited only moderate internal
consistency.
Avoidant traits were positively associated with preference for familiarity, and to a
lesser extent, were negatively associated with novelty seeking. Those findings are consistent
with earlier depictions of APD in the DSM, which described the avoidant individual as
experiencing discomfort when doing things outside of his or her normal routine, which
would consequently lead them to engage in efforts to avoid novel or risky situations.
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