Masquerade_of_ 2009-08-10 17:24:54
Was going through some of my documents online, and came across
something i’d made notes on, years ago, about AvPD. I noticed that
there are always questions about Social Phobia, etc., so thought i’d
incl. the info on differential diagnosis from the book. This book was
Disorders, but a search hasn’t turned up the source. In any case, i
hope this helps.
“It is apparent that features of this disorder overlap with other
diagnostic categories, most notably schizoid personality disorder,
social phobia, and agoraphobia. Therefore, to make a differential
diagnosis it is important that the therapist inquire about the beliefs
and meanings associated with various symptoms.
“For example, both APD (AvPD) and schizoid personality disorder are
characterised by a lack of close relationships. However, avoidant
patients desire friendships and are bothered by criticism two
attributes not shared by schizoid patients, who are satisfied with
little social involvement and are indifferent to being criticized by
“APD shares some of the cognitive and behavioural features of social
phobia and agoraphobia. However, while persons with social phobias
are fearful of humiliation and have low confidence in their social
skills, they do not avoid close relationships just certain social
circumstances (such as public speaking or large parties). Patients
with agoraphobia may present behaviours similar to those with APD.
However, agoraphobic avoidance is associated with fears of being in a
place where help for a personal disaster may not be available, rather
than fears of intimacy.
“Another diagnostic consideration is that patients with APD often seek
treatment for related Axis I disorders. These include anxiety
disorders (e.g., a phobia, panic disorder, generalised anxiety
disorder), affective disorders (such as major depression or
dysthymia), substance abuse disorders, and sleep disorders.
“It is important that proper diagnosis of APD be made early in
therapy. As will be discussed below, the Axis I disorders may be
treated successfully with standard cognitive methods, as long as the
therapist includes strategies to overcome the characteristic avoidance
that might otherwise cause roadblocks to treatment success.
“Somatoform disorders and dissociative disorders may also accompany
APD, although less commonly. Somatoform disorders may develop because
physical problems can have secondary gain in providing a reason for
social avoidance. Dissociative disorders occur when the cognitive and
emotional avoidance patterns of patients are so extreme that they
experience a disturbance in identity, memory, or consciousness.”
There is more info on the background of this disorder, incl.
conceptualisation, historical perspectives (one account dating back to
(then) 40yrs), cognitive, behavioural, and emotional avoidance,
discounting positive data, self-criticism, fear of rejection,
underlying assumptions about relationships, misevaluation of others’
reactions, etc. Feel free to ask any specific questions, if
interested, and i’ll provide what i have here.
Alternatively, a search on the topic of Personality Disorders in a
Library may prove useful in locating the book. Someone here may also
recognise, and provide the title.
Justin 2009-08-10 17:25:06
From what I’ve read, avoidant personality disorder is simply a more severe
case of social phobia.
Gravitys rainb 2009-08-10 17:25:21
AvPD does want to interact with others, but avoids social situations,
usually over fear of embarrassment. Either schizoid or schizotypal (i
forget) is simply a loner type.
I personally feel it’s best to get it from the DSM, rather than reading
2nd and 3rd hand material.
Cogge` 2009-08-10 17:25:24
the DSM merely says “a pervasive pattern of…exhibiting 3 or more (or
whatever number for each thing) of the following traits. Many reputable
researchers do studies in epidemiology to determine patterns and causation.
The DSM itself alone is not very helpful because things *do* seem the same
often. Psychiatrists go to school a long time to interpret the cause and
effect mechanisms and the triggers to rule out differential dianoses and
choose which illness they believe the person has. In addition, many
insurance companies are selective in which illnesses they will provide
reimbursement for, and so frequently the practicianer is forced to chose a
diagnosis which is covered over a diagnosis which is not. Personality
disorders which are axis 2 disorders are frequently limited by insurance
companies in treatment options. Borderline Personality D/O has alot of
overlapping features with bipolar d/o and often people will be labeled with
bipolar because they can get more comprehensive treatment for an axis 1 d/o.
than an axis 2 d/o. I am not sure what you are referring to when you say
2nd or 3rd hand material, because 1st hand would be the patient experiencing
the symptoms, so *everything else* is at least 2nd hand.
BTW, schizoid is the one you were thinking of as being “kind of a loner
type”, although a personality d/o by definition has to cause significant
social and occupational impairment of functioning, so I imagine that
schizoid people have alot of difficulty above and beyond being a “loner”
Schizotypal is basically like a less impaired form of schizophrenia. My
brother is actually dxed with schizotypal PD, but I often wonder if he isn’t
really just schizophrenic.
Masquerade_of_ 2009-08-10 17:25:34
Cogge, couldn’t have said it better, and I would have had to say
something, so thanks.
In case anyone was interested, the book the info is from is called:
Cognitive Therapy of Personality Disorders, by Aaron T Beck, et al
From Book News, Inc.
has been developed and practiced there. The second includes other
contributors, and expands the discussions of clinical assessment, the
role of emotions, and the therapy relationship. After exploring
historical, theoretical, and therapeutic aspects it focuses in turn on
several specific personality disorders.Copyright 2004 Book News,
Inc., Portland, OR
(excerpt from Amazon.com, on 2nd edition)
Cogge` 2009-08-10 17:25:51
My pdoc and I just had a discussion yesterday about the difference between
OCD and OCPD. I have some obsessive compulsive tendencies, but he was
saying he thinks it is OCPD, and not OCD–if you look at the symptoms of
both, the DSM criteria, it would be hard to tell the difference, but he says
OCPD is more reward based, because you can offer a reasonable (relatively
speaking)explanation for the obsessive compulsive behaviors. For example,
when I have to go to a public place where I have to sit–like a restaurant
or a church service–I can almost immediately identify where I need to sit.
It is almost always on the aisle–I hate to feel “trapped” by being squished
between people, and its even worse if I am up against the wall. I also like
to have my back to the wall and face the majority of the people. This
sounds neurotic, and I admit, it is, but as my pdoc explained, I have alot
of anxiety and it feels safer to see who is in the room and to not have
things going on behind my back that I can’t see–or to feel trapped between
a bunch of people or against the wall. This has the reward function of
sitting in a “safer” spot where I can feel a stronger sense of control. In
the case of OCD–the checking and repetitive behaviors make no rational
sense, either to the observer or to the sufferer himself. This distinction
is only made though deductive reasoning on the part of people such as pdocs
who have studied human biology and behavior extensively.
I have known people with both AvPD and social phobia, and my observation is
that people with AvPD (my husband has alot of these traits) can sometimes
function in casual situations, but it is interpersonal situations such as
friendships and relationships which prove difficult for them; social phobia,
in my observation, is more anxiety in group situations and the feeling of
having to “perform” (for lack of a better word) and being embarrassed or
humiliated, but one on one relationships are less difficult. I had a friend
in college who had social phobia and though she generally had alot of
anxiety all the time, she still was more comfortable with 1/1 relationships
than functioning in groups. FWIW
Fc045 2009-08-20 06:40:44
I was diagnosed as schizo after a battery of “psychological” tests at a
mental health center.
I told them I had social phobia but the doc just labled me schizo. Next
thing I knew, he wanted to put me
on nardil. After a week on it I refused to take anymore since I was just
sleeping all the time from
it like a tranquilizer. Haven’t been back to mental health services since..
So “agoraphobia” is something completely different than AvPD? Is there
really a difference between Social phobia
and AvPD? Fear of interpersonal relations and group interaction. Isn’t it
just the same?
Cogge` 2009-08-20 06:40:46
when you say “schizo” do you mean schizoid? One difference between schizoid
and AvPD/social phobia, is both AvPD and social phobia desire to have
interaction with people but are just impaired in their ability to do so.
Social phobia is more anxiety driven, and AvPD is more low self esteem
driven. Scizoid people have similar traits in that they avoid social
contact, but schizoid people don’t care. They are perfectly happy with no
connections to other people. Which begs the question as to why it is
considered a PD, as by definition it has to create distress for the person
in social and occupational functioning. If you are SzPD, you don’t really
care if you have alot of (or any!) friends, so therefore there is not the
distress which is in AvPD and social phobia, where people are conflicted as
to how they can have these relationships and avoid unpleasent contact which
causes anxiety or depression.
Masque 2009-08-25 07:52:22
The causes/development, processes, maintenance, and consequences
(pathology) of each of the disorders vary enough to afford a different
diagnosis (by a competent professional), so that the crux of the
problem can be treated (if possible).
Therefore agoraphobia, social phobia, AvPD, etc., all have varying
pathologies. Agoraphobia is “anxiety about being in places or
situations from which escape might be difficult (or embarrassing), or
fear of being outside of the home alone, or of traveling.”
Social phobia/anxiety and AvPD overlap with regards to
withdrawing/avoiding certain situations out of fear, and therefore
relating to others, however, the underlying pathology differs.
As cogge mentioned, social phobics are bothered by their response
(anxiety) to particular situations, their feelings, whereas primarily
the AvPDer isn’t.
In contrast the life of an AvPDer is “primarily consumed by diffuse,
ongoing dysfunctional relationships characterised by remoteness,
shyness, and/or a tendency to recoil from closeness and intimacy.”
This fear in the context of interpersonal relationships is the main
marker for diagnosing AvPD.
So, social phobics withdraw from interpersonal situations, as opposed
to interpersonal relationships.
edition), there is further elaboration, such as:
“In both Social Phobia and AvPD social anxiety is the “core lesion”
with withdrawal a key defense mechanism used to cope. But while social
phobics choose to express their social anxiety indirectly and
symbolically in the form of withdrawal from specific trivial prompts,
avoidants choose to express their social anxiety more directly, in the
form of ongoing interpersonal withdrawal behaviours including shyness,
as well as problems with meetings, mingling with, moving close to, and
remaining intimate and involved with, actual people.”
Another highlight: “[…] Unconsciously [social phobics] make a choice
to be less interpersonally shy, remote, and withdrawn than avoidants,
that is, to remain more interpersonally outgoing and related than
patients with AvPD. They desire and hope to keep their whole
personality out of it. So they involve only part of their personality,
doing so intentionally in order to leave the rest of the personality
intact. As a result, unlike many patients with AvPD, social phobics
are by nature outgoing, and able to form close and lasting
relationships, and even to do so easily. They tend to be happily and
permanently attached or married to someone, and they are often
professionally quite successful. Their problems tend to consist merely
of troublesome islets of panicky withdrawal. This insular expression
of social anxiety in turn spares the rest of their lives, permitting
full and satisfactory relationships to take place on the mainland.”
“In contrast, patients with AvPD wear their faint avoidant hearts on
their sleeves. They present clinically with mild to severe generalised
relationship difficulties. They fear closeness and intimacy and
commitment itself, not a substitute, stand-in, or replacement for
these. As a result, avoidants are clinically more socially anxious and
withdrawn than they are phobic, that is, they present not with an
encapsulated fear on the order of of a fear of public speaking but
either with a generalised shyness that consists of difficulty meeting
people, or with an ambivalence about relationships that consists of
difficulty in sustaining relationships with people they have already
met. As a consequence, they are either painfully tentative about
seeking out relationships in the first place or, if not tentative, then
ambivalent about the relationships they find, so that they start
relationships only to then pull bacfk from them.”
Hope this helps
Leonard martin 2009-08-25 07:56:43
That was really helpful!
“Everything that rises must converge”