From Normality to Abnormality

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You may be noticing a tinge of "medical student syndrome"; that is, in reading this and the previous chapter, you may identify aspects of your own personality that coincide with the personality patterns already described. Take heart: This is not unusual! A healthy personality maintains shades of many of the personalities described in this book, albeit in a greater state of balance and flexibility. You must also recognize that there is no sharp boundary between normality and pathology. Instead, personality styles (which we all have) are on a continuum with personality disorders. As the level of pathology and number of rigid traits increase, however, so does the likelihood that difficulties will be created in multiple venues of human life, including job, family, school, and recreation. At the border between normality and pathology, these difficulties can often be attributed to a few maladaptive traits, and these characteristics can be treated in relative isolation. At more pathological levels, however, there are fewer personality strengths and many more extreme traits. These interweave so completely that the total person becomes the driving force behind most of his or her problems.

Several normal-range variants of the avoidant personality (i.e., people exhibiting a slightly higher balance and preference for avoidant styles) have been proposed in the literature. Of the better-known variants are Oldham and Morris's (1990, 1995) sensitive and vigilant personality styles. Sensitive persons generally are comfortable in familiar surroundings and thrive within the context of a small group of trusted intimates. They are deeply concerned about the feelings and opinions of others and need their approval to flourish. Interpersonally, they are courteous and restrained. They avoid ambiguity, instead preferring situations where the expectations of others are well known and easily confirmed. Sensitive persons do not readily reveal themselves to others; they share their thoughts and dreams only after some time and only when they feel safe. Because they are very private persons, they may self-disclose too infrequently to deepen their relationships, frustrating others to the point that a real sense of intimacy is lost. Many are lovers of art and literature, and some express their vivid imaginations by becoming absorbed in acts of artistic creation. Combining the sensitive with the following characteristics of the vigilant style results in a more complete representation of the normal-range avoidant. Vigilants are hyperalert to criticism and prefer to deal with others cautiously. They are highly aware of goings-on in their surroundings and are ever on the outlook for potential threats to their safety or esteem.

Millon et al. (1994) describe a hesitating pattern that combines slightly more pathological aspects of the sensitive and vigilant styles. Such persons are sensitive to social indifference and rejection, feel unsure of themselves, and are unusually wary in new social or interpersonal situations, especially with strangers. Ill at ease and self-conscious, they anticipate difficulties in relationships and fear embarrassment. Most prefer to work alone or in small groups where they know that people have accepted them. Once established in a social milieu, they are likely to open up, be friendly and cooperative, and participate with others productively.

Allison exhibits many of these more normal characteristics, but in an exaggerated and uncompromising form, so she falls into the range of pathology. Sensitive persons, as described by Oldham and Morris (1995), are comfortable within a small group of trusted intimates; Allison's social circle, however, has shrunk to almost nothing. If she could be sure of approval, she might indeed open up to someone. As it is, however, she has difficulty naming friends, so she is unlikely to have the chance. That keeps her safe, but it also keeps her isolated, part of the vicious circle that sustains her pathology. Whereas sensitives self-disclose too little to grow in intimacy in their relationships, they at least have some relationships. Allison can remember only one real boyfriend, to whom she was too afraid to reveal anything about herself for fear of being dumped. Like the vigilant style, she is highly aware of her social surroundings. However, she is so highly aware of her own presence in her social surroundings that feelings of self-consciousness have escalated into panic attacks.

Characteristics of an avoidant personality style can also be developed by creating a less intense or extreme version of existing DSM-IV criteria, an approach pursued by Sperry (1995). Thus, those at the disordered end of the spectrum exaggerate the difficulties and dangers involved in deviating from conventional routine, while those in the normal range simply prefer the familiarity of habit and are more comfortable with the known than the unknown but do not resist novelty when clear benefits are shown. Similarly, the disordered has no close friends or confidantes and avoids interpersonal interactions. In contrast, the normal simply feels a close allegiance with family and friends and tends to be a homebody but can venture forth as necessary and deal effectively with the world at large. The disordered is hypersensitive to criticism and refuses to become involved with others unless certain of being liked; the normal is simply cautious and deliberate.

Allison falls on the pathological side of each of these contrasts. She could not, for example, venture out at will to engage the world on her own terms, even for substantial benefit. Instead, she minimizes her expeditions into the social world, leaving her house perhaps only for absolutely necessary errands and the regularly scheduled grocery store trip. She makes no effort to make small talk with anyone she may come in contact with on such occasions because she prefers to stay under the radar of any watchful, potentially critical eyes, rather than develop a familiar relationship with any store or business owner. Far beyond being interpersonally cautious and deliberate, her hypersensitivity to disapproval does not even allow her to make eye contact with the interviewer, whose role is by definition to be constructive and empathic.

Other diagnostic criteria can also be put on a continuum. The disordered individual fails to share himself or herself socially and may present a false face; the normal is simply shy and reserved but also truthful. The disordered is most often an under-achiever whose social anxiety makes consistent job performance difficult; the normal is more likely to maintain consistent employment but work behind the scenes. Again, Allison falls consistently more toward the pathological end of these contrasts. She is far beyond shy and reserved, as was evidenced by her false face she presented to her former boyfriend and by her ongoing attempts at anticipating and conforming to all expectations of others when she is forced into social situations. As a volunteer at the botanical gardens, she is also an underachiever. Far beyond a simple anxiety that might make consistent job performance difficult, Allison has never held a real job.

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Responses

  • Isto Julin
    How normality becomes abbormality?
    1 year ago

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