Allison represents a reasonably "pure" or "prototypical" representation of an avoidant personality. However, as with most personality patterns, whether problematic or not, not all avoidant patterns closely resemble our panicky undergraduate. While Allison's style doesn't really combine characteristics of other disorders with her basic avoidant pattern, most avoidants exhibit features of other personality disorders, such as the schizoid, dependent, depressive, negativistic, schizotypal, and paranoid patterns. The resulting moods and actions that these individuals manifest give different colorations to the basic avoidant pattern that makes them unique from pure cases like Allison's. Such subtypes of the avoidant personality are reviewed in Figure 6.1. Actual cases may or may not fall into one of these combinations.
A defining feature of avoidant personality disorder is the conflict of longing for intimacy versus the fear of vulnerability that naturally ensues in a close relationship with another. In a similar manner, those with a negativistic personality (formerly referred to as
"passive-aggressive") are basically ambivalent about themselves and others. They idealize their close friends and companions, but should their sense of autonomy be threatened, they seek to undermine or humiliate them. What we are terming the conflicted avoidant is an avoidant pattern that combines features of the negativistic personality. Here, we may expect to see basic withdrawal tendencies of the avoidant pattern but expressed in a manner akin to the negativist's penchant for "interpersonal guerilla warfare."
If not withdrawn into isolation, conflicted avoidants may be experienced as petulant and sulking. They may attack others for failing to recognize their needs for affection, but accuse those who offer nurturance of seeking to compromise their independence. Disposed to anticipate disappointments and fearful of facing others openly, they may strike out indirectly by obstructing their actions and misrepresenting their wishes. They often report feeling misunderstood, unappreciated, and demeaned, and their mood is generally much more erratic than in the basic avoidant pattern. During periods when stresses are minimal, they may deny past resentments and portray an image of general contentment. Under slight pressures, however, their pacific surface quickly gives way to impulsive hostility. Unable to orient emotions and thoughts logically, they may at times become lost in personal irrelevancies and autistic asides, further alienating them from others. Relating to such individuals, undoubtedly, is an arduous process, requiring far more patience than most people are likely to offer. This interpersonal strategy, as you
Focus on Culture
Taijin kyoufu, literally "interpersonal fear," is a syndrome characterized by interpersonal sensitivity and fear and avoidance of interpersonal situations (Ono et al., 1996, p. 172). Presumably, its origins lie in the belief that blushing, eye contact, ugliness, and body odor are noticeable and troubling to others. Apparently common in Japan, the disorder is recognized as a culture-bound syndrome in the DSM-IV (APA, 1994) that resembles social phobia.
Ono and his associates (1996), however, argue that taijin kyoufu is really more closely related to the avoidant personality. In collectivist societies, such as Japan, the self is defined externally through its relationships with others. The self is, therefore, subordinated to the concerns of the group. In individualistic societies, such as the United States, the self is more an internal construct regarded as the individual's exclusive identity.
Because Japanese and American concepts of the self are so radically different, it is logical that the same disorder should be manifested in different ways in each culture. In individualistic societies, the avoidant personality fears criticism from others, negative evaluation, and rejection. This is followed by what Okonogi (1996) calls a Western-style type of shame: "One is concerned that one is not behaving as expected according to one's own ego ideal" (p. 175); that is, "I have failed to live up to my own standards." In a collectivist society, however, the avoidant personality is more likely to be manifest as a fear of offending others with one's behavior, with the discomfort that one's own characteristics may be causing to others. Logically then, taijin kyoufu subjects tend to be more concerned with their appearance and the impact that it may have on others.
Such cultural distinctions make another prediction as well. You would expect that social phobia, being more concerned with embarrassment to self, would be more prevalent in individualistic societies such as the United States and that avoidant personality disorder, taijin kyoufu, would have a higher prevalence rate in collectivist societies such as Japan. Although there are no studies of differential prevalence rates between these two countries, Ono and his colleagues (1996) offer data showing that the avoidant personality was the most frequently diagnosed personality in their study. More research is required on prevalence rates of personality disorders in different cultures.
can see, fulfills the avoidant's circular struggle; it vilifies others and discourages their closeness (keeping them safe from harm), yet ensures the avoidant's unwanted isolation.
Let's revisit our pure avoidant, Allison. It would seem far-fetched to imagine her seething with thoughts of revenge at those who fail to recognize her need for affection. Whereas the conflicted avoidant feels misunderstood, Allison believes that others see her for the inadequate person she sees in herself. She is far too fearful of negative evaluation to intentionally obstruct anyone.
In contrast with the conflicted pattern, the hypersensitive avoidant incorporates features of the paranoid personality, but exhibits greater reality contact. Whereas persons with paranoid personality disorder are generally autonomous to a fault and cannot acknowledge any personal vulnerabilities, even to themselves, hypersensitive avoidants are well aware of their own shortcomings but will attribute them as much to the maneu-verings of others as to themselves. Both are high-strung and prickly, vigilant to signs of rejection and abuse, and excessively wary of the motives of others. Moreover, their pervasive apprehensiveness is often accompanied by intense and labile moods that feature prolonged periods of edginess and self-deprecation. Hypersensitive avoidants strongly expect that others will be rejecting and disparaging but alternate between the profound gloom that often accompanies the basic avoidant pattern and the irrational projection of the paranoid. Either way, their usual strategy is a protective withdrawal that maintains a safe distance from all emotional involvement. Retreating defensively, some become more and more remote from others and from needed sources of support. Those who are more avoidant may express guilt and contrition, while feeling misunderstood, unappreciated, and demeaned by others. Those with a greater abundance of paranoid traits, however, find it difficult to contain their anger toward anyone who has been unsupport-ive, critical, or disapproving.
As the self-esteem of the hypersensitive avoidant approaches collapse, many take on more severe paranoid features and come to believe that their "pathetic self" is the product of covert actions by others to undermine them or make them inhibit themselves. Those with preexisting paranoid traits may find it easier to believe that others are the cause of their inadequacy, an external attribution, than to believe that they are naturally inadequate, an internal attribution. The former shifts the blame and perhaps allows a remedy; the latter leads only to resignation. Avoidants who have paranoid traits, therefore, may find that these traits intensify as conditions become more stressful.
Allison exhibits some paranoid traits, but there are important differences; therefore, some very fine distinction must be made to correctly identify these distinctive patterns. Here, we must look to the origin of presenting features. For example, it is nearly impossible for Allison to sit in a class without believing that people who are laughing are laughing at her. This resembles an idea of reference, a classic paranoid characteristic where the perceiver gets the notion that people or things happening in the environment are somehow referring to her via a conspiracy of these people or things. Allison's, however, are produced by her intense self-consciousness because she sees the laughing as the natural product of what she is, evoked because she is laughable.
Like the avoidant, dependent personalities desire close personal relationships; unlike the avoidant's basic sense of mistrust, however, dependents invest their trust (and much of their sense of self) in a significant other and relentlessly dread the potential loss of that relationship. Phobic avoidants combine features of these two personalities. Trapped between desire and the possibility of abandonment, phobic avoidants find a symbolic substitute onto which to project or displace their fear and anger. A free-floating and barely tolerable sense of anxiety or dread is thus concretized and shifted away from its true object: It's not the boyfriend or girlfriend, but the dog next door that is to be feared. By fleeing the phobic object or situation, such individuals seek to free themselves by symbolically leaving fear behind. Such phobias express the avoidant's fear of personal rejection, humiliation, and shame. For many phobic avoidants, the expression of fear in the presence of the phobic object also represents a cry for compassion, a desire to make instrumental use of fear as a means of disarming rejection and abandonment threats by eliciting support from otherwise unsupportive persons. Thus, phobic avoidants may successfully distance themselves from anxiety-producing situations, while also soliciting a degree of tolerance from others: You can't really hate her for not wanting to take the job at the dam; she has a fear of drowning. Unfortunately, such attempts often backfire, for the phobia itself may elicit mockery.
Our case study, Allison, does not seem to fit this pattern, either. Note that while she does experience similar acute symptomology, hers are clearly panic attacks that relate directly to her interpersonal world, rather than displaced phobic reactions to inanimate "replacement" objects. She is not attempting to make her worries tangible and concrete as a phobic avoidant may do in projecting fears onto a dreaded stimuli. She is also not attempting to elicit support by her panic attacks; quite the contrary, these are an instrumental method of escape.
Note, too, that many personalities experience phobic syndromes. Some exhibit dramatic displays; others, being more constrained, show a motor restlessness and worry about being exposed as weak and inadequate. Irritable personalities seem always on edge, even when the phobic object is not present; avoidants hide their fears under a quiet public reserve.
A clear example of the influence of different personality domains is found in this last subtype of avoidant patterns. Self-deserting avoidants combine the social (interpersonal) retreating of the avoidant with the ruminative (cognitive) self-devaluation of the depressive personality. These individuals immerse themselves in a surrogate fantasy existence to avoid the discomfort of having to relate to others. They are not, however, unaware of their use of these tactics (unless, for example, they are concurrently experiencing a major depressive episode with psychosis), and this makes them painfully aware of their perceived inadequacies. Fantasy gradually becomes less effective, and their thoughts center more and more on the misery of their lives and the anguish of past experiences. Waking dreams are displaced by painful ruminations.
Thus totally interiorized, the feelings that motivated their initial withdrawal reverberate unremittingly. More and more, they cannot tolerate being themselves and seek to completely withdraw from their own conscious awareness, an existential abnegation of selfhood. Some become increasingly neglectful psychologically and physically, even to the point of neglecting basic hygiene. Some plunge into despair and are driven toward suicide, abandoning life as a means of ridding themselves of inner anguish and horror of their own identities. Others regress into a state of emotional numbness in which they are completely disconnected from themselves. In particularly severe cases, the structure of consciousness itself may split or fragment, leaving a regressive disorganization reminiscent of the schizotypal personality. As this process proceeds, self-deserting avoidants become outside spectators, observing from without the drama of their frightening transformation.
Allison's considerable alone time, which encourages her negative self-focus typical of this subtype, may suggest that she bears some resemblance to this pattern. However, the use of fantasy, as well as the nagging cognitions, is notably absent in her presentation.
While there are no absolute pure textbook avoidants, Allison's presentation, aside from a few notable traits that resemble those typically found in the preceding variants, seems to be most in line with the theoretically derived prototype.
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