Avoidant personality disorder? - Social Anxiety Forum
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post #1 of 21 (permalink) Old 12-24-2009, 10:44 PM Thread Starter
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Avoidant personality disorder?


Does anyone know what the difference is between social anxiety disorder and avoidant personality disorder? Looking at the DSM entries their symptoms seem identical, has anyone here been diagnosed with AvPD?
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post #2 of 21 (permalink) Old 12-24-2009, 11:11 PM
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I've been diagnosed with both, by the same therapist. I'm not sure what the distinction is, other than that one is classified as an anxiety disorder and the other is classified as a personality disorder. Maybe it's cognitive vs. behavioral or something.

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post #3 of 21 (permalink) Old 12-25-2009, 12:17 AM
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AvPD is an axis II disorder. SA is an axis I. But they do have lots of overlap in symptoms. Most people who have AvPD (like me) develop SA or GAD. I think I'm more in the GAD category. But a person could have SA without having AvPD. Here's the way I have heard the difference:

In Personality Disorders in Modern Life, they explain very well the difference between Axis I disorders and Axis II disorders. With that information people should distinguish easily an Axis I disorder like Social Anxiety and an Axis II disorder like Avoidant Personality Disorder.


They explain that:
Axis I disorders are analogous to diseases. They are ultimately the reason why you end up in psychiatric treatment. Those are depression, anxiety, depersonalisation, psychosis, and all those mental disorders that you can have. So they are analogous to the flu, the cold, the plague, etc: this is why you end up in the hospital.

Axis II disorders are analogous to the immune system. Personality disorders are analogous to a compromised immune system. In normal people, events in life are unlikely to lead to an Axis I disorder. However, if you have a personality disorder, you are almost certain to develop Axis I disorders, since it's as if you have a weakened immune system: any minimal infection leads to development of a disease. And like with compromised immune systems, you can also have something analogous to auto-immune diseases where the mere fact of having a personality disorder will lead to an Axis I disorder without requiring any life event at all. ; similar to auto-immune diseases like Lupus and Multiple Sclerosis, where the disease is caused by the immune system itself. The "immune system" is so overreactive that it ends up destroying instead of protecting the person.


For example, if you see Avoidant Personality Disorder as a compromised immune system (a defense mechanism, because that's really what it is), then you can see what "diseases" it makes you particularly prone to. A defense strategy that involves avoiding difficulties will simply reinforce the tendency to "avoid", such as increasing the fight or flight response, making you more and more prone to anxiety over time. It will become very easy to develop a "disease" like social anxiety even under minimal pressure, and with strong cases of avoidance, the "immune system" itself can end up spawning social anxiety by itself without even needing an outside agent. Same thing that this immune system makes you very likely to develop depression over minimal life event, and even develop depression "just like that" with no life event attached to it.

So Social Anxiety Disorder and AvPD are not even the same "category" of disorders. Axis I and Axis II are not based on the same assumptions. "Anybody" is at risk of developping SAD when under suffisant pressure, but somebody with AvPD will need significantly less pressure, and AvPD can go as far as to spawn SAD by its mere presence.

In other words, if you have an Axis II disorder, Axis I disorders will be the story of your life. You can get immediate help for Axis I disorders, but Axis II disorders tend to be particularly hard to solve and many people simply take the easy route of solving the Axis I disorders that the Axis II spawns.
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post #4 of 21 (permalink) Old 12-25-2009, 04:17 AM
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Quote:
Research has found few differences between the kinds of symptoms that people with SAD and APD have. Because of the similarities between SAD and APD, people are often diagnosed as having both disorders. Like SAD, the central fear of people with APD is rejection, ridicule and humiliation by others. However, people with APD tend to have a broader range of symptoms, and the symptoms tend to be more severe.
http://socialanxietydisorder.about.c...a/avoidant.htm

and this site has a good chart on the differences between them: http://www.anxietyhelp.org/information/avpd_vs_sad.html
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post #5 of 21 (permalink) Old 12-25-2009, 11:32 AM
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based on the names, Id say with one you get anxious and with the other you avoid but may not get anxious

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post #6 of 21 (permalink) Old 12-25-2009, 11:42 AM
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Never heard of Avdp, but it sounds like I have both. It sucks but I'm gonna have to deal w/ it.
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post #7 of 21 (permalink) Old 12-25-2009, 11:59 AM
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Diagnosed with both, and my avoidance is pretty extreme. I totally agree with the assessment of just how disabling AvPD can be.

Interesting that this points out the following:

Quote:
Unlike many other personality disorders, AvPD responds to antidepressants.

MAOIs (Nardil, Parnate), SSRIs, SNRIs, benzodiazepines (Klonopin, Xanax, for non-drug-addicts).
A lot of psychiatrists are of the belief that all personality disorders (or really any Axis II disorder), practically by definition, cannot be treated with medication. Good luck getting benzos strictly for a personality disorder!

But the DSM is constantly evolving, these disorders are largely categorized for the sake of convenience, easy communication, and treatment recommendations rather than necessarily being linked by any common pathology, and for all we know, what we call AvPD could be grossly miscategorized. There is so much overlap between AvPD, social anxiety, and even atypical depression that it gets pretty damn confusing.
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post #8 of 21 (permalink) Old 12-25-2009, 04:05 PM
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TO Scarpia: Thanks. That's the best distinction between the two I've read yet. Good explanation. I've been asking the same questions. I believe I have both AvPD and SAD.

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post #9 of 21 (permalink) Old 12-26-2009, 06:16 PM
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Some shrinks want to put the personality disorders on axis I- the borderline personality disorder especially. It doesn't seem likely to happen though.

The PDs are;

Cluster A - the odd and eccentric:

paranoid - characterized by irrational suspicions and mistrust of others.

schizoid - lack of interest in social relationships, seeing no point in sharing time with others, misanthropy, introspection.

schizotypal - characterized by odd behavior or thinking.

Cluster B - dramatic, emotional or erratic

Antisocial - a pervasive disregard for the law and the rights of others.

Borderline - extreme "black and white" thinking, instability in relationships, self-image, identity and behavior.

Histrionic - pervasive attention-seeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions.

Narcissistic - a pervasive pattern of grandiosity, need for admiration, and a lack of empathy.

Cluster C - the anxious - us!

Avoidant - social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction.

Dependent - pervasive psychological dependence on other people

Obsessive compulsive - characterized by rigid conformity to rules, moral codes and excessive orderliness.

But any of the PDs can cause someone to have anxiety, not just the cluster C. I did notice that most of the people on here who took the personality disorder test scored high on avoidant.
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post #10 of 21 (permalink) Old 12-29-2009, 11:54 PM
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My psychiatrist said that since SAD and AVPD are so similar they were even thinking of collapsing them together in the new version of the DSM. He also said that the treatment is the same for both disorders. I was told by my psychiatrists and therapists that AVPD is a pattern of behavior that has existed for a long long time. It starts out as SA but becomes AVPD without treatment. AVPD is where the person deals with anxiety through avoidance. However the person still feels anxiety if they have to do things they don't like. It's just that they try to structure their lives in ways to avoid the things that make them feel anxiety.
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post #11 of 21 (permalink) Old 12-31-2009, 08:13 PM
 
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Yeah, generalized anxiety disorder (chronic feelings of anxiety), social anxiety disorder (shyness from social situations), avoidant personality disorder (avoidant behavioural patterns)... Their symptoms feed into each other in a loop. There's no surprise that they have overlapping symptoms as well.

Once we know what our symptoms are, the labels are no longer important. After all, the DSM is just a tool. It isn't perfect and depends largely on the politics behind the guys who made the DSM.

Besides, scarpia's post refers largely to Personality Disorders in Modern Life (2004) by Theodore Millon, who influenced big time to the multi-axial structure of the DSM we have today. In fact, once this Millon guy dies, I really don't know whether this Axis I/Axis II diagnostic structure of mental disorders will remain.

If you want to know more about the personality structure Millon propose, you can visit his website and explore a little bit, particularly about the relationships among Axis I, Axis II, and Axis IV psychopathology.
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post #12 of 21 (permalink) Old 12-31-2009, 08:18 PM
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Great post, i found out about AvPD yesterday and i couldnt tell the difference either.
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post #13 of 21 (permalink) Old 10-25-2011, 09:57 PM
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Quote:
Originally Posted by antonina View Post
My psychiatrist said that since SAD and AVPD are so similar they were even thinking of collapsing them together in the new version of the DSM. He also said that the treatment is the same for both disorders. I was told by my psychiatrists and therapists that AVPD is a pattern of behavior that has existed for a long long time. It starts out as SA but becomes AVPD without treatment. AVPD is where the person deals with anxiety through avoidance. However the person still feels anxiety if they have to do things they don't like. It's just that they try to structure their lives in ways to avoid the things that make them feel anxiety.
This was helpful, thanks. I'm glad this thread exists because I feel like I have both these things.

Disorders are fun...
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post #14 of 21 (permalink) Old 10-26-2011, 04:42 AM
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I think I have both APD and SA

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post #15 of 21 (permalink) Old 10-26-2011, 06:00 PM
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Originally Posted by wrongnumber View Post
The DSM is profoundly flawed in it's conceptualisation of mental disorders. For instance there have been times in my life where I fit the criteria for AvPD, but at other times I don't (such as now).

The American Psychiatric Association (authors of DSM) are obsessed with categorising mental illness when in fact mental illness cannot be clearly categorised, because it exhists on a continuum of sevirity and on different dimensions of symptoms. I personally don't believe there is a difference between SA and AvPD, except that one is more severe than the other. Any *difference* is arbitrary, poorly described by the DSM, and is up to the subjective opinions/ perceptions and biases of a psychiatrist/ health worker to discern. In the past few years there has been a move away from ''labelling'' people however, as doctors are realising the futility of categorising mental illness/disorders.

I once had a therapist who tried to diagnose me with as many disorders as possible in order to get me on as many meds as possible. I'm forgetful? I have ADD! Low self-esteem? I need to be put on Paxil! Etc. It's like all the flaws in my personality are a symptom of something or other.
When my flaws start impairing my ability to function, then I'll start worrying about them. My tendency to forget things, for instance, can easily be solved with post-it notes.
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post #16 of 21 (permalink) Old 03-14-2012, 01:57 AM
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I found this article to be helpful

http://socialanxietydisorder.about.c...a/avoidant.htm

Sometimes I just want to
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post #17 of 21 (permalink) Old 03-14-2012, 02:36 AM
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Isn't it kind of pointless to classify disorders so precisely? Since every case is different anyway?
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post #18 of 21 (permalink) Old 03-14-2012, 03:49 AM
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Yeah it's hard to differentiate. Think you'd be hard pressed to find anxious people without some degree of APD. Isn't that what we're all about? Avoiding things that cause extreme anxiety.

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post #19 of 21 (permalink) Old 03-14-2012, 04:16 AM
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yes i have apd too

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post #20 of 21 (permalink) Old 03-22-2012, 04:01 PM
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Diagnosed first with SAD, then AvPD by my shrink.

Quote:
Originally Posted by Lovesick Loner View Post
TO Scarpia: Thanks. That's the best distinction between the two I've read yet. Good explanation.
I second that. Thanks to scarpia for typing that up
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