Experts disagree on the precise nature of the avoidant personality disorder. Some regard it as nothing more than an extreme form of social anxiety, others as something distinct and separate. There is also disagreement about its origins, with some blaming environment, some genetics, and some a combination of the two. But one thing can be agreed upon: the avoidant personality disorder, though relatively rare, is certainly unpleasant.
In essence, those with an avoidant personality disorder (or AVPD) regard the world as fundamentally dangerous and avoid social interaction in case it leads to shame, humiliation, embarrassment, or rejection. Unsurprisingly, most have poor self-esteem and consider themselves dull, unlikeable, or inadequate in some way. When faced with a job interview, a date, or an office Christmas party, they will shake, tremble, and sweat. Many will have had panic attacks, or will have literally passed out, in such situations.
More generally, they will organise their life so as to ensure minimal contact with others. For example, they may be cold and distant towards their neighbors, avoiding eye contact, failing to return a smile, and so on. At the end of the working day, they may catch a late bus, or take a longer route home, so as to avoid their fellow workers. Their leisure time will be solitary and probably involve some form of escape, like computer games, fantasy fiction, or sci-fi movies. When they cannot avoid other people and are forced to interact, they do all they can to keep the conversation shallow and impersonal.
It should be emphasized, however, that those with AVPD are rarely happy with their situation. Whereas someone with Asperger’s, for example, may actually prefer to be alone, those with AVPD often crave friendship, love, and intimacy.
The consequences of an AVPD should be obvious. They will probably have few friends, or none at all, and may struggle to maintain, or even begin, a career. Most fail to live up to their potential: not attending college because they cannot face the socialising, for example, or doing a poorly paid job because it involves minimal stress and social interaction. Others are unable to work at all. Many avoiders continue to live in the family home, either because they cannot afford to move out or because they know that if they did they'd be completely alone. To escape the emptiness and humiliation they often turn to alcohol or drugs, and many suffer from other forms of mental illness brought on by the disorder, including depression, insomnia, and even agoraphobia.
Avoidance is essentially a form of defence. When an avoider turns down a dinner party invite, or eats his lunch in the car instead of the office canteen, he does so to protect himself. Those without an AVPD will naturally ask what could be so terrible that you'd prefer to end up isolated. But it must be remembered that the fear experienced by someone with AVPD can be overwhelming and paralyzing.
Unfortunately, many become trapped in a cycle of shame and avoidance. They feel intense social anxiety when confronted with social situations, and so they avoid. This in turn holds them back. Their friends start to go to parties, lose their virginity, begin a part-time job etc and they don't. They now become even more afraid of personal questions. What if someone asks them if they have a boyfriend? What if someone asks why they don't have a job? The only solution is to redouble their efforts to avoid, so this is what they do. But that means staying in every night, which in turn deepens their shame, encouraging more avoidance, and so on.
In his book Disorders of Personality (1981), Theodore Millon argues that avoidance begins when a child, timid and sensitive by nature, is exposed to negative social experiences, such as bullying, rejection, or humiliation. In response, they develop what Millon calls an 'active-detached' coping mechanism. The child has learnt that the world is a dangerous place and that people are not to be trusted – get too close and you are likely to be hurt. So he goes through the motions of living but does so in a guarded, detached manner, never exposing his real self.
In their book Cognitive Therapy of Personality Disorders, Beck and Freeman suggest a mixture of biological sensitivity and early traumatic experiences are to blame. Certain beliefs develop ("if I let people get too close, they will reject me or ask embarrassing, personal questions just to spite me" etc) and out of these come self-harming rules of conduct ("keep away from people, and keep your mouth shut"). Every experience is then filtered through a distorted lense, with the avoider seeing dangers where none exist and interpreting neutral statements as slights or rejections.
Avoidance soon becomes a habit, and one that is difficult to break. One popular form of treatment is known as exposure therapy. The individual makes a point of always going against his or her avoiding instincts. So, for example, if they find themselves standing outside an adult education class with their heart pounding and a voice in their head screaming at them to run for the exit, they force themselves inside. The fear spikes and then ebbs away. The next day, they find some other challenge and again allow the fear to spike and ebb away. The more they do this, going against their avoiding instincts, the more the brain 're-wires'. Obviously, this would demand great courage and a grim, stoical endurance.
A gentler approach would begin with medication. Tranquilizers calm the nervous system; SSRI antidepressants raise mood and confidence. As these take effect, the sufferer could then begin cognitive behavioral therapy. CBT, as it is sometimes known, will teach them to bring their thoughts under control. Avoiders often develop harmful beliefs in response to bullying or rejection: that they are unlikeable, boring, weird etc. Over time, these thoughts form subconscious 'core beliefs'. CBT teaches the victim to challenge these beliefs. Once the medication and CBT have taken effect, the individual is then ready for exposure.
Those who develop such a personality disorder often suffer a great deal. And naturally their loved ones worry about them. Unfortunately, if untreated it can lead to a life of emptiness, loneliness, and unfulfilled ambition.