CLUSTER C : PERSONALITY DISORDERS

Avoidant Personality Disorder

Description:
Avoidant personality disorder is characterized by feelings of extreme social
inhibition, inadequacy, and sensitivity to negative criticism and rejection. Yet
the symptoms involve more than simply being shy or socially awkward.
Avoidant personality disorder causes significant problems that affect the ability
to interact with others and maintain relationships in day-to-day life.

Avoidant Personality Disorder Symptoms

Avoidant personality disorder symptoms include a variety of behaviors, such

as:

 Avoiding work, social, or school activities for fear of criticism or

rejection. It may feel as if you are frequently unwelcome in social
situations, even when that is not the case. This is because people with
avoidant personality disorder have a low threshold for criticism and
often imagines themselves to be inferior to others.
 Low self-esteem
 Self-isolation

When in social situations, a person with avoidant personality disorder may be

afraid to speak up for fear of saying the wrong thing, blushing, stammering, or
otherwise getting embarrassed. You may also spend a great deal of time
anxiously studying those around you for signs of approval or rejection.
A person who has an avoidant personality disorder is aware of being
uncomfortable in social situations and often feels socially inept. Despite this
self-awareness, comments by others about your shyness or nervousness in
social settings may feel like criticism or rejection. This is especially true if you
are teased, even in a good-natured way, about your avoidance of social
situations.
What causes avoidant personality disorder?

The exact cause of avoidant personality disorder is not known. However, it is

believed that both genetics and environment play a role. It is believed that
avoidant personality disorder may be passed down in families through genes
but this has not yet been proven. Environmental factors, particularly in
childhood, do play an important role. Shyness, often normal in young children,
lasts into adolescents and adulthood in those with avoidant personality
disorder. Those with the disorder often report past experiences of parental or
peer rejection, which can impact a person’s self-esteem and sense of worth.

Social Impact of Avoidant Personality Disorder

Avoidant personality disorder causes a fear of rejection that often makes it
difficult to connect with other people. You may be hesitant to seek out
friendships, unless you are certain that the other person will like you. When
you are involved in a relationship, you may be afraid to share personal
information or talk about your feelings. This can make it difficult to
maintain intimate relationships or close friendships.

According to the American Psychiatric Association’s Diagnostic and Statistical

Manual of Mental Disorders (DSM-5), a person diagnosed with avoidant
personality disorder needs to show at least four of the following criteria:

 Avoids occupational activities that involve significant interpersonal contact, because

of fears of criticism, disapproval, or rejection.
 Is unwilling to get involved with people unless they are 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 risks or to engage in any new activities
because they may prove embarrassing.

Avoidant behavior may commonly be seen in children or adolescents, but a

diagnosis of a personality disorder cannot be made in childhood because
shyness, fear of strangers, social awkwardness, or being sensitive to criticism
are often a normal part of child and adolescent development.
A mental health professional can assess your symptoms, make an accurate
diagnosis, and suggest the appropriate treatment options.
Avoidant Personality Disorder and Other Conditions

Other mental health disorders can occur along with avoidant personality
disorder. Treatments in these cases will be designed to help with the
symptoms of each disorder. A few of the conditions that most frequently occur
with avoidant personality disorder include:

 Social phobia, in which a person experiences overwhelming anxiety and

self-consciousness in common social situations.
 Dependent personality disorder, in which people rely excessively on
others for advice or to make decisions for them.
 Borderline personality disorder, in which people have difficulties in many
areas including social relationships, behavior, mood, and self-image.

Many avoidant personality disorder symptoms are commonly shared among

these other conditions, particularly in the case of generalized social phobia.
Because of this, the disorders can be easily confused. It may take some time
for a mental health professional to make a clear diagnosis and choose the
appropriate treatments for you.

Nursing Interventions
Clients with personality disorder often are involved in long-term
psychotherapy to address issues of family dysfunction and abuse.

 Promoting client’s safety. The nurse must always seriously consider

suicidal ideation with the presence of a plan, access to means for
enacting the plan, and self-harm behaviors and institute appropriate
interventions.
Promoting therapeutic relationship. Regardless of the cllinical setting, the nurse must provide
structure and limit setting in the therapeutic relationship; in a clinic setting, this may mean seeing
the client for scheduled appointments of a predetermined length rather than whenever the client
appears and demands the nurse’s immediate attention.
 Establishing boundaries in relationships. The nurse must be quite
clear about establishing the boundaries of the therapeutic relationship
to ensure that neither the client’s nor the nurse’s boundaries are
violated.
 Teaching effective communication skills. It is important to teach basic
communication skills such as eye contact, active listening, taking turns
talking, validating the meaning of another’s communication, and using
“I” statements.
  Helping clients to cope and to control emotions. The nurse can help
the clients to identify their feelings and learn to tolerate them without
exaggerated responses such as destruction of property or self-harm;
keeping a journal often helps clients gain awareness of feelings.
 Reshaping thinking patterns. Cognitive restructuring is a technique
useful in changing patterns of thinking by helping clients to recognize
negative thoughts and feelings and to replace them with positive
patterns of thinking; thought stopping is a technique to alter the
process of negative or self-critical thought patterns.
 Structuring the client’s daily activities. Minimizing unstructured time
by planning activities can help clients to manage time alone; clients can
make a written schedule that includes appointments, shopping, reading
the paper, and going for a walk.

Medical Management
Caregivers should be vigilant about suicidal potential and should document their
assessments in the medical record at each visit.

 Psychotherapy. Psychotherapy is at the core of care for personality disorders;

because personality disorders produce symptoms as a result of poor or limited
coping skills, psychotherapy aims to improve perceptions of and responses to
social and environmental stressors.
 Inpatient care. Because the underlying disorder remains basically unchanged
by inpatient interventions, length of stay should be minimized to avoid
dependency that subverts recovery from the circumstances prompting the
hospitalization.
 Transfers. Some patients hospitalized in the psychiatric units of general
hospitals, where stays are generally shorter than 2 weeks, may require
transfer to psychiatric hospitals that can provide long-term care.

Pharmacologic Management
Medications are in no way curative for any personality disorder; they should be viewed as an adjunct
to psychotherapy so that the patient may productively engage in psychotherapy.

 Antidepressants. The selective serotonin reuptake inhibitors (SSRIs) and newer

antidepressants are safe and reasonable effective; however, because the depression of most
 patients with personality disorders stems from their limited range of coping capacities,
antidepressants are usually less effective than in patients with uncomplicated major
depression.
 Anticonvulsants. These agents are useful for stabilizing the affective extremes in patients
with bipolar disorder, but they are less effective in doing so in patients with personality
disorders; they have some demonstrated efficacy in suppressing impulsive and particularly
aggressive behavior in patients with personality disorder.
 Antipsychotics. Response to antipsychotics in patients with a personality disorder is less
dramatic than it is in true psychotic axis I disorders, but symptoms such as anxiety, hostility,
and sensitivity to rejection may be reduced.

Assessment and Diagnostic Findings

 Toxicology screen. Substance abuse is common in many personality
disorders, and intoxication can lead patients to present with some
features of personality disorders.
 Screening for HIV and other sexually transmitted diseases. Patients with
personality disorders often exhibit impulse control, and may act without
regard to risk; such behavior can lead to infection with a sexually
transmitted disease.
 CT scanning. Computed tomography scanning with
appropriate blood work can be carried out if organic etiology is
suspected.
 Radiography. Radiography can be indicated for injuries from fighting,
motor vehicle accidents, or self-mutilation.