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Avoidant Personality Disorder

It is believed that personality disorders, of which there are ten, affect up to one-fifth of the general population. They are categorized into clusters A, B, and C: ‘A’ is the eccentric and odd cluster, ‘B’ is the erratic and dramatic cluster, and ‘C’ is the anxious and fearful cluster (American Psychiatric Association, 2013). Personality disorders can be quite complex and challenging to diagnose and treat as their diagnostic criteria can overlap across disorders and sometimes even across clusters. However, this framework allows for easier identification and management.

  • Explain the diagnostic criteria for your assigned personality disorder.

Avoidant Personality Disorder is part of the fearful and anxious C cluster, and it essentially describes a behavioral pattern in which the client feels socially inadequate and is excessively withdrawn. It consists of seven individual criteria, of which the patient must meet at least four. In some cases, they may be grossly introverted and overly sensitive to slights or criticism, whether actual or perceived. People with Avoidant Personality Disorder tend to require excessive reassurance that they will not be ridiculed or criticized before they can move on with normal social situations. These may include friendships, intimate relationships, family connections, occupational or academic settings, and any social setting where there may be even a minimal risk of rejection or embarrassment (Merck Manual Professional Version, online).

Avoidant Personality Disorder has similarities to social anxiety disorder which is a factor to consider when making a diagnosis. According to Lampe and Malhi (2018), the severity continuum hypothesis suggests that Avoidant Personality Disorder is in fact a severe form of social anxiety disorder. Nonetheless, Avoidant Personality Disorder has ties to attachment theory related to parenting style, and the patient’s own self-concept and temperament that set it aside from Social Anxiety Disorder. As such, the authors suggest Avoidant Personality Disorder should remain its own individual disorder.

Dependent Personality Disorder may be co-diagnosed with Avoidant Personality Disorder due to the fact that these clients tend to become considerably emotionally attached to those whom they have opened up to and deemed safe and nurturing to be around.

  • Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned personality disorder.

Treatment for Avoidant Personality Disorder can consist of medication, therapy, or both. Clients struggling with personality disorders can benefit greatly from a combination approach since medication can make it easier for them to assimilate the benefits of psychotherapy. Antidepressants and anxiolytics are the psychopharmacologic agents most appropriate for Avoidant Personality Disorder. Psychotherapeutic approaches may include supportive and/or psychodynamic psychotherapy, and cognitive-behavioral therapy geared toward improving social skills (Merck Manual Professional Version, online).

  • Describe clinical features from a client that led you to believe this client had this disorder. Align the clinical features with the DSM-5 criteria.

A client that comes to mind with regards to Avoidant Personality Disorder is a 25-year-old female who presented to the clinic with symptoms of anxiety. She is a recent nursing graduate and lives at home with her parents. She reports that her parents never allowed her to go out and encouraged her to focus only on school, otherwise they would stop paying for her college education. She struggled to interact with others all through her academic program.

Now that she has graduated and has started her first nursing job, she is having difficulties relating to and communicating with her patients and coworkers alike. She reports she feels like she does not know what she is doing because she is an inexperienced nurse, unlike her coworkers who have several years of patient care experience. She is constantly afraid she will inadvertently cause patient harm through any variety of mistakes she could make. Although her coworkers have been mostly supportive and are willing to teach her, her charge nurse has made comments that make her feel intimidated to the point that she is already considering leaving her current position rather than having any type of confrontations. This client states she even has anxiety when answering the phone in the nurse’s station and will deliberately walk away when it rings so another staff member will answer it. She appears to be somewhat comfortable when caring for patients who are intubated or otherwise unconscious, but patients who are awake and alert and their families have proven to be challenging for her to interact with. Whenever they ask any questions, she ‘freezes’ and never has a concrete answer and tends to find another staff member to answer for her.

At home, this client does not interact much with her family and does have disagreements with them over what she perceives to be them being oppressive and invalidating towards her. She does not go out with friends despite now having her own money and spends her time with her pets and working on custom-made dolls she sometimes sells online.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Lampe, L., & Malhi, G. S. (2018). Avoidant personality disorder: current insights. Psychology research and behavior management11, 55–66. https://doi.org/10.2147/PRBM.S121073

Merck Manual Professional Version. Avoidant Personality Disorder (AVPD). Ac