Avoidants are painfully sensitive to humiliation and social disapproval, and they actively seek protection from the perceived inevitable threats of others in the environment. The DSM-IV describes avoidants as exhibiting a pattern of inadequacy and a fear that their shortcomings will expose them to judgment and ridicule. Several normal variants have been proposed, including Oldham and Morris's sensitive and vigilant styles and the hesitating pattern by Millon, Weiss, Millon, and Davis.

The basic avoidant pattern is often mixed with other personality traits that are evidenced in several subtypes. The conflicted avoidant includes features of the negativistic personality where the basic withdrawal of the avoidant pattern is combined with the neg-ativist's tendency toward interpersonal guerrilla warfare. The hypersensitive avoidant includes features of the paranoid personality but exhibits greater reality contact. Phobic avoidants combine features of the dependent and avoidant personalities, being especially prone to experiencing social phobias. The self-deserting avoidant combines social avoidance with the ruminative self-devaluation of the depressive personality.

Most psychodynamic thinkers still consider the avoidant as part of the schizoid personality. However, three major psychodynamic theorists described personality patterns that are distinctly like the avoidant. Menninger (1930) described the isolated personality,

Fenichel (1945) formulated the notion of a phobic character, and Horney (1937) developed the concept of the detached type, individuals who believe, "If I withdraw, nothing can hurt me." As a defense, avoidants actively interfere with their painful preoccupations and tensions by intruding irrelevant thoughts or distorting their substantive meaning. In addition, avoidants indulge themselves excessively in fantasy and imagination, both as a means of replacing anxiety-arousing cognitions of inadequacy and low self-worth and as a means of gratifying needs that cannot be met due to social withdrawal. Avoidants may be seen as having a highly developed ego ideal, including a high level of aspiration and desires for self-actualization, paired with an intensely condemning superego that constantly finds fault with and disapproves of their every behavior. In effect, they have internalized parental standards of high achievement and social success, combined with blame and shunning for the smallest mistakes.

From a cognitive perspective, an information-processing model seems particularly useful in understanding the avoidant personality. The very contents of the cognitions seem to establish a pathological reciprocity with the structure of cognition, perpetuating the disorder. As avoidants consistently scan their environment for signs of danger, their information-processing system becomes flooded with excessive stimuli that prevent them from attending to other features. The cognitive perspective also holds that beliefs about the world, self, and others are critical in determining behavior (Beck et al., 1990). Avoidants' core beliefs, which are usually below the level of conscious awareness, are held to be unconditionally and eternally true. They influence how other beliefs are organized, especially when predicting the consequences of various courses of action, expressed as conditional if-then beliefs.

From an interpersonal perspective, the avoidant has a perpetual sense of social unease. This is not limited to a crowd of people; a single person can activate these feelings. Instead of confronting their anxiety, they escape social encounters whenever possible, only serving to perpetuate their problems. By narrowing their range of interpersonal experiences, they fail to learn new ways of behaving that might bring them greater self-confidence or a sense of personal worth. Their personality also seems to attract those who enjoy shaming and ridiculing them. Benjamin's SASB model captures the interpersonal development of the avoidant personality: Beginning life with normal attachment, caretakers' criticisms of flaws eventually result not only in avoidants' developing a poor self-image but also in helping them develop strong self-control and restraint that causes their hypersensitivity to error. Certain traumatic childhood experiences such as physical abuse, incest, or molestation may be sufficient to produce a lifelong pattern of social avoidance and interpersonal fearfulness that resembles the avoidant pattern (Stone, 1993).

Although in most cases a biological disposition is insufficient to result in an avoidant personality, there is evidence of some biological influence; however, specifics remain highly speculative. Some researchers (Siever & Davis, 1991) regard anxiety inhibition as providing one of the core psychobiological dispositions in the development of the avoidant personality. Some of the feelings of inadequacy in avoidants may have a basis in slow or uneven maturation, as this can elicit teasing from peers. The avoidant personality may also have a basis in biological temperament; although shyness is not specific to the avoidant personality, its presence does suggest a sense of inner shame or self-doubt characteristic of the avoidant.

The avoidant personality was originally conceived in 1969 as the actively detached pattern from Millon's biopsychosocial theory of personality. This means that there is a conflict between the person's desire for social contact and fear of exposure to shame for seeking it. Millon's more contemporary evolutionary theory (1990; Millon & Davis, 1996) maintains the active-detachment hypothesis but more clearly posits the motivating aim of protection against pain, to the extent of a virtual denial of life-enhancing possibilities. Whether by hereditary predisposition, a caustic and critical upbringing, or some blend of these two influences, the avoidant continually learns that psychic safety is a first priority worthy of taking all actions to ensure. As he or she gets more isolated by virtue of this approach, interpersonal skills among peers fail to develop, and those abilities that have developed dissipate.

Avoidants share characteristics with other personalities including schizoids, schizo-typals, and paranoids. They are also part of the anxiety spectrum. Historically, the central features characterizing the avoidant personality have been scattered throughout clinical literature. The avoidant was often confused with other personalities, such as the schizoid, and even confused as a pathway to developing schizophrenia. Avoidants are especially vulnerable to developing other clinical syndromes. Anxiety disorders, particularly generalized anxiety, social anxiety, and obsessive-compulsive disorder, are common in avoidants. They are also vulnerable to developing somatoform disorders, particularly body dysmorphic disorder, dissociative disorders, depressive disorders, and schizophrenic disorders.

The therapeutic prognosis for the avoidant personality is remarkably poor. The most basic characteristics of the avoidant run counter to the basic requirements of psychotherapy. Because of their intense sensitivity to negative evaluation, the therapeutic relationship is critical. Patience seems to be a key quality for the therapist to build a trusting relationship with the avoidant. Cognitive and cognitive-behavioral techniques seem to have some benefits, all designed to help avoidants overcome their social fears and gain a better sense of self-worth. Working from an interpersonal perspective, Benjamin (1996) suggests that avoidants possess a deep reservoir of anger and that the antidote to this pattern is accurate empathy and uncritical support. Family, couples, and group therapy can be beneficial in breaking patterns that perpetuate avoidant behavior. Psychodynamic treatment emphasizes a strongly empathic understanding of the experience of humiliation and embarrassment and insight into the role of early experiences in creating present emotions.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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