The Biological Perspective

Shyness And Social Anxiety System

Treating Social Phobias and Social Anxiety

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The emotional vista of the avoidant personality is one of constant and confusing undercurrents of anxiety, sadness, and anger. Anguished by most all actions and events, they vacillate between unrequited desires for affection and pervasive fears of rebuff and embarrassment. The confusion and emotional irresolution they experience frequently lead to a general state of numbness. As noted, avoidant personalities have a deep mistrust of others and a marked deflated image of their own self-worth. They have learned to believe, through painful experiences, that the world is unfriendly, cold, and humiliating, and that they possess few of the social skills and personal attributes by which they can hope to experience the pleasures and comforts of life. They anticipate being slighted or demeaned wherever they turn. They have learned to be watchful and on guard against the ridicule and contempt they expect from others.

Portraits similar to the avoidant personality have been put forward by psychobiologi-cal researchers. In 1970, before the avoidant appeared in the DSM-III, Klein distinguished two schizoid subtypes. The first was noted by an asocial disposition, which he believed was accurately labeled in the DSM. A second type was described as a "shy, socially backward, inept, obedient person who is fearful and therefore isolated but appreciates sociability and would like to be part of the crowd" (p. 189). These characteristics, Klein noted, occurred in conjunction with anticipatory anxiety and low esteem. Other researchers (Siever & Davis, 1991, p. 1655) regard anxiety inhibition as providing one of the core psychobiological dispositions in the development of personality. Exploring beyond the safety of a nearby caretaker is an important development task for all children; those with a low threshold for anxiety would be seen as shy, inhibited, and fearful. They would not form new relationships easily, would avoid new situations, and would be particularly alert to the possible negative consequences of their actions. In turn, inhibition would interfere with learning new assertive behaviors and prevent such children from competing effectively with peers.

The biological development of most personality disorders is still speculative, but much exploration in this realm is underway. Still, a biological disposition alone is likely insufficient to result in the adult expression of the disorder; we are not exclusively biological beings. We may say with some certainty, however, that the deep inadequacy of some avoidant personalities may have a basis in physical maturation. Slow or uneven physical development can elicit teasing from peers that compounds a deep sense of awkwardness or inferiority; children who are already somewhat self-conscious for other reasons might then become even more so, eventuating in an avoidant pattern. The likelihood is probably increased when parents respond to atypical development with embarrassment or disappointment. Those who expect their children to progress rapidly through the usual stages of physical and psychological development may experience considerable anxiety and dismay over even small deviations and shortcomings.

As the child matures, feelings of shame expressed by parents in response to lack of achievement are likely to instill a sense of defectiveness or incompetence, even when the child performs above the norm. An athletic father who becomes frustrated and disappointed with his lanky and uncoordinated son, for example, implicitly communicates the idea that love and acceptance are contingent on superior performance. Similarly, an intellectually normal child whose mother is a highly intelligent college professor and has the same ambitions for her daughter may internalize her mother's disappointment and damn herself for not being smart enough. In both cases, the covert message is, "You are not good enough to be my child. You have not become what I expected or wanted. It is a chore to love you." Such examples are not exclusively biological, but instead highlight the interaction of the biological and social in producing characteristics observed in the total organism. The case of Sean (Case 6.2) illustrates this dynamic. When children are somehow never good enough, they internalize as their own self-image the shame their parents apparently felt just by having them.

There is evidence that the avoidant personality has a basis in 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. Kagan, Reznick, and Snidman

CASE 6.2

A first-year college student, Sean hardly associated with anyone. In the clinical interview, he seemed to want to make contact, but he frequently stuttered, causing him to retreat in embarrassment. Otherwise, he expressed almost no emotion.

His second computer programming course was the immediate problem.1 Though he was fluent in several computer languages, his professor wanted the students to work in groups, to collaborate in building chunks of a single large project. Sean was scared. "I try to work on it, but I can't concentrate." His voiced shrank to a whisper. "They're g . . g . . going to think I'm an idiot." His solution was to drop the class, though he had an A average going into this, the last assignment of the semester. In fact, his grades were exceptional overall. Nevertheless, Sean could report no friends, and confessed, "I'm lousy at meeting people. I guess I think they won't like me or something. I'm awkward. I'm a clutz. I just don't have many qualities others are interested in, I guess. But I'm great with computers."

In the first several sessions of therapy, he seemed to be holding back, as if he were looking for what a therapy client should do, in order not to disappointment expectations for progress. These transference issues were difficult to discuss at first, though eventually they led to a breakthrough, whereby Sean was able to see the link between present and past, and began to express his emotions more freely.

Sean's problems had their origin with his father, an aggressive and financially successful physician, noted for authoring a breakthrough surgical procedure. His mother was a shy woman who had worked as a high school teacher before they were married. From birth, he was an unusual baby. He cried incessantly and failed to develop a coherent schedule of feeding and sleeping. Worse, he was easily upset, and cried at the sight of anyone other than his mother.

From the start, Sean's father had little tolerance for his son. When he found out that Sean, now age 7, was afraid of the dark, he locked his son in the pitch black basement for hours, until the crying stopped. As Sean grew up, he failed to meet developmental milestones as fast as his older brother, thus disappointing his father again and again. Even his younger brother outgrew him. In physical education class, he was always picked last for teams. He dreaded coming up to bat, and he dreaded that the ball might somehow find its way to him. The other kids called him simply "The runt."

Sean's performance in school, though below that of his older brother, was nevertheless well above average. Even so, his father joked that the other boys would go on to good medical schools and Sean would go to nursing school. As Sean himself was acutely aware, his anxiety about measuring up to the other boys in his programming group had its origin in the many unfavorable comparisons he suffered at home.

Avoidant Personality Disorder DSM-IV Criteria

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

(1) avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection

(2) is unwilling to get involved with people unless certain of being liked

(3) shows restraint within intimate relationships because of the fear of being shamed or ridiculed

(4) is preoccupied with being criticized or rejected in social situations

(5) is inhibited in new interpersonal situations because of feelings of inadequacy

(6) views self as socially inept, personally unappealing, or inferior to others

(7) is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

Reproduced with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association.

1 Numbers mark aspects of the case most consistent with DSM criteria, and do not necessarily indicate that the case "meets" diagnostic criteria in this respect.

(1988) studied 2-year-old children who exhibited either extreme behavioral restraint or extreme spontaneity in an unfamiliar context. At 7 years of age, the children were examined again. The majority of the restrained group remained quiet and socially avoidant, whereas those who were spontaneous became talkative and social. Although at 2 years, individuals have already passed through the phase at which early attachments are formed, it is possible that avoidants possess a constitutionally based fearful or anxious temperament, that is, a hypersensitivity to potential threat that accounts for such surprising continuity between age ranges.

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    Why a person is shy biological perspective?
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