Phobic and friendless
People suffering with Avoidant Personality Disorder must want change
By Patti Carmalt-Vener 07/09/2009
Dear Patti,
Our daughter Paige is beautiful, smart and very sweet but has always been painfully shy. She gets really nervous around people she doesn’t know because she’s enormously afraid that others won’t like her. Even now, at 27, she gets embarrassed and flustered when talking to strangers. Paige automatically assumes people will find her boring and unattractive (which couldn’t be further from the truth). We don’t know why she lacks self-confidence and has such low self-esteem but it has been very difficult for us to helplessly watch her painful lifelong struggle. We had high hopes she’d outgrow these difficulties, but so far she hasn’t.
Paige was recently diagnosed with Avoidant Personality Disorder. When my wife and I talked to her doctor, he said that, unlike depression or anxiety, a personality disorder is almost impossible to treat. Why is this considered untreatable? She isn’t unstable or having trouble functioning; she just has trouble liking herself and being around others. We don’t want her to give up on finding help and we don’t want her to keep hiding from the world.
—Herb
Dear Herb,
Anxiety and depression are often intermittent or temporary disorders where the symptoms clearly feel uncomfortable and patients usually want help. Your daughter’s personality disorder may be difficult to treat and therapy may move slowly at first because she might have convinced herself that her feelings and behaviors are normal. She may tend to avoid seeking help because she’s unaware that her own thoughts and actions are causing the very problem that impairs her life and general happiness.
Avoidant Personality Disorder (AvPD) — sometimes referred to as anxious personality disorder — is characterized by an invasive, persistent pattern of social inhibition, shyness, distrust of others and feelings of inadequacy and inferiority. Individuals with AvPD are extremely sensitive to being negatively evaluated by others because they’re afraid they’ll be rejected, disliked, ridiculed or criticized.
They tend to avoid social interaction because they consider themselves to be socially inept or personally unappealing. It’s typical — as in your daughter’s case — to have low self-esteem and self-worth, feelings of inadequacy and an inability to relate to others unless they’re certain they’re liked. So is a habitual reluctance to engage in new activities because they may prove embarrassing.
While Paige may desire close relationships, the idea of rejection and humiliation may be so painful she might choose to be lonely rather than risk trying to connect with others.
Her treatment may employ various techniques, such as social skills training, cognitive-behavioral therapies to restructure her thinking processes and group therapy sessions in an empathetic environment to gradually increase social contacts and help her overcome her anxieties. Most importantly, she’ll need to find a therapist who has the ability to gain and keep her trust. (People with AvPD often start avoiding treatment sessions if they distrust the therapist or fear rejection.) Once a level of trust is established, the therapist will start challenging her negative beliefs about herself and the high price she’s been paying to maintain these destructive patterns. Paige needs to want to change and to reject the belief that she’s helpless to alter her symptoms. Her therapist can help her learn to identify the sources of her stress, take responsibility for her actions and become start working toward freeing herself from her self-imposed loneliness.
As Paige regains control of her life it will be beautiful for you to watch as growth occurs, her self-esteem and confidence improve and her true self emerges. Healing is possible.
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