7 Signs of Avoidant Personality Disorder

- Understanding the process of diagnosing a

personality

disorder

is difficult, but Dr. Ramani makes it simple. In this episode, he explains what the path to a diagnosis should and shouldn't be and explains the seven criteria used to diagnose

avoidant

personality

disorder

. Okay, Dr. Ramani, what does it mean to diagnose someone with

avoidant

personality disorder? - You know, Kyle, as with all personality disorders, it's not just a quick and easy process. Many times, when we reach the diagnosis of a personality disorder, it may require multiple interactions with a client to hear how they are doing in various areas of their life, with their friends, in their family, with their partner, at work or in life. school, because personality disorders tend to be generalized.

So if it's someone who doesn't want to give a sales talk, but is doing well in those other areas. It takes time to get all that information. So in essence, to figure this out, we need a series of clinical interviews, or at least start treatment with someone. If a person with avoidant personality disorder enters treatment, it is very possible that they do so because they feel alone and frustrated, and not being able to connect with other people, that could be what attracts them. So when we're presented with that kind of presentation problem, we're going to think about a lot of things.

Is this person socially anxious? Is this person depressed? Do you know what's going on here? And then we'll go deeper. And once we see the omnipresence of it, it might even take us a few weeks, maybe even a few months, to get straight to the top. We will also see, for example, how they perceive how other people see them? Is it more about being anxious or really feeling inadequate and having people reject them? People who have social anxiety simply react more to the physiological reactions they have at the moment. And yes, they worry about, you know, being wrong, so to speak, but for the person who experiences avoidant personality disorder, it really is, it's the fear of rejection, the fear of criticism, the hypersensitivity.

The topics are a little different, so it's a very nuanced path. And I have to tell you, I've been working with clients for maybe the first six weeks. I thought he has social anxiety. And around week eight or nine, I was like, no, this might be more widespread than that. And it will show me how much more serious and consistent it is. And then I might do some more work, once I realize that his avoidant personality is figuring out those fears and focusing on them more as a generalized pattern than an anxiety disorder. - I imagine that most people come because of depression. - Depression is probably one of the main reasons why people ever receive mental health treatment.

But I have to tell you that there are also a lot of things in life that involve people, relationship problems, dating problems, but a lot of them are relationship problems. And that's a lot of what brings people across the threshold of my office, problems in a marriage, problems with a parent, problems with an adult child, something like that, and that we can analyze from there. So sometimes people even come in with a completely different kind of problem, and then they end up coming in through the back door of this one. So, it really takes a lot of interviews and time.

Sometimes people do psychological tests or evaluations and give them a series of tests, and those tests will give them insight into these patterns. And that's almost a faster way to achieve that end goal, but no matter what, you still need to spend time with a client to understand them holistically. - So what are the criteria and DSM for avoidant personality disorder? - Again, it is this generalized pattern of fear of rejection and social insufficiency, characterized by a kind of social inhibition. The first, and to such an extent that it creates a feeling of social and work deterioration, which hinders work, hinders life.

So the first criterion is that these are people who avoid occupational activities that have a lot of interpersonal interaction because they are basically afraid of making a mistake and looking stupid or making a mistake or criticism. And so, you can see how that could prevent someone from getting a job. It's a pretty weird job where you never have to come into contact with other people. And in some industries it is a requirement. So, they will do everything they can to avoid that, including doing things like avoiding promotions, avoiding transfers, avoiding some kind of career advancement, which can hurt them in many ways.

Lower income, you know, growth in their job, job security, but they will do everything they can to avoid it. The second is that they are not willing to get involved with other people unless they are sure they will be accepted. Now, when you think about it, when will we have that kind of security? There's something almost childish about that, right? And what happens then is that you rarely get that security and are unlikely to form close personal relationships. And this is where I also say there's a danger in that, because sometimes it's easy for someone to manipulate them or trick them or play with them because they can find someone who will actually accept them because they're trying to get something from them. money or something like that.

And so, in those cases, the person almost feels like it's a guarantee: come to our place of worship and you can come be with us and we all love you. You can see with that vulnerability that everyone likes them, no matter what. You can see how that's really a trap to fall into dangerous and costly situations with people who don't really have your best interests at heart and could be very manipulative or emotionally abusive, okay? People with this pattern also show restraint or withdrawal in intimate relationships because they fear that their partner will embarrass or ridicule them.

So what that means is that they are reluctant to share about themselves, they are reluctant to share their vulnerabilities, their intimate thoughts or feelings, because they are afraid that, for example, let's say they shared a romantic or sexual fantasy that their partner would would make fun of them or even embarrass them. So that fear means that they almost feel like they are, and some people might interpret it as almost like they are being distant, cold, distant, too shy, but they do it out of fear. - Yes. - Of feeling ashamed. The fourth continues that concern. They worry about being criticized in social situations.

So as a result, for example, they won't give an opinion, right? They won't share, even if they have an opinion on something, they will hold back from it, because as you can imagine, especially in these very polarizing times, they will be so afraid that someone would make fun of them for having that opinion. So, they will show not only in an intimate relationship, but in any social situation, that the fear of being rejected or criticized makes them hold back, actually sharing anything that is meaningful for fear of that rejection. The fifth criterion for this disorder is that they feel inhibited when they are in a new interpersonal relationship because they feel inadequate.

So, that could be a new friendship, that could be a new colleague, that could be a new partner. But because they feel so inadequate, they feel less, they repress a lot or they feel very, very uncomfortable. And they often somehow belittle what they do. I've worked with many clients who have the most interesting jobs, but sometimes they're quirky or off the grid and they're almost ashamed of it. Then they hold back and say: I don't want to tell anyone what I do because they will make fun of me. And if that happens, even once, that can inhibit them for many, many years after that.

So, that's always their fear. Then they won't even go there. And it's hard because you can't determine how the world will react to someone, but because they feel so inadequate, especially when they meet new people, they really hold back. The sixth criterion is that people with avoidant personality disorder judge themselves. They consider themselves socially inept and less socially skilled than other people. So that's literally their identity when they come in. So, oh, don't ask me or don't let me talk to them. I'm the wrong person. They will always assume that everyone has more social skills. In many ways, that is a cognitive distortion, but it seems very, very real to them.

And what that means is that, once again, they are socially inhibited. They don't take risks. They miss many opportunities. And because of that, it continues to reinforce their identity as socially inept. When, you know, they just say that this is largely happening to them up here and that they rarely get to test themselves, so to speak, socially. Finally, people with avoidant personality disorder are very reluctant to take any kind of risk to try something new, especially in front of other people, because they are afraid of embarrassing themselves. So let me tell you this right now: a person with avoidant personality disorder will never go to karaoke, okay?

That's the kind of thing. They will never be the person who goes on stage, nor will they volunteer, nor will they even go on stage at their brother's wedding. That would be very disturbing because he was very afraid of embarrassing himself. And again, there's even this interesting phenomenon, where they're also afraid of embarrassing other people, who are embarrassed by seeing their discomfort. Makes sense? - He does. - It's almost like something reciprocal. So, because they never take any risks, they miss out on a lot of life. You know, like if they don't do it, they might be afraid, for example, if there was a cool pond to jump off a rock, they wouldn't do it because they're afraid to jump into the water.

Wrong way. They may feel inhibited from trying something on vacation or trying a new activity or something like that. So, they miss a lot about life and look at it almost with nostalgia, but because they are so afraid of being embarrassed, they don't try something new. And they lose, they lose many opportunities for growth, curiosity, meeting new people and advancing at work. But that fear of embarrassment overrides all that kind of desire to do it. - The reason it's important for viewers to know what the criteria are and the DSM, which is the manual that professionals use to make these diagnoses, is because that's what you're going to have in the back of your mind, while you put someone through this diagnostic process.

Now, when you put someone through this, or when someone goes through this process with a professional, are there things that I should pay attention to that would be a red flag of, wow, this professional is not doing their job, whether fast ? To diagnose them with something or something? - I think diagnosing quickly is something I would have difficulty with. And the problem is that nowadays there is sometimes a quick diagnosis because several agencies are waiting for a diagnosis. - That's what people want. - Does that make sense? They need it, they want it, the insurance, call it what you want.

That is a problem. And psychiatric diagnosis is not like diagnosing anemia, where you stick a needle in someone's arm, draw some blood, do a test, and say, oh, you have anemia. This is an art with many nuances. And it's something that over time, more so, a person who may initially seem socially anxious, over time we learn that he has an avoidant personality, then we learn that he is drinking a lot and he drinks a lot to control it. You know what I'm talking? - Yes. - And so, this is something that blossoms over time. And I think there needs to be real respect for that process.

So if someone says, I can take care of that in three sessions, you know. And so I think the quick cure-all, that I have some magic way, a magic bullet, a magic pill, if you will, to make all of this go away, I think people should be wary of that. I wish we did. And me too. - I wish there was some mantra I could give someone and say, say this 10 times and that's it. - If that is not the case. And while I have seen extraordinary growth for many clients in therapy, not only with myself, but with many of my colleagues who are physicians, this is sometimes not only a slow process, it can be a slow process, but it is also an arduous process.

I mean, it's a commitment on both sides, the therapist and the client. So I think anyone who wants to, we can deal with this in just a few sessions. I have a magic manual that will make this go away, very quick diagnosis. And more than anything, because the way we get to the diagnosis is an evolving process, someone who gets so stuck, like, no, you have this, no, you have this, as more information comes in about where they are. a person, that's also important too. And I'm going to be frank with you. I don't talk to my clients in terms of their diagnosis.

I do not like that. I don't want it to be hello, Kyle, my, whatever you are, my anxious person. You know, we'll talk about it in general terms, like I'd rather talk about avoidant personality disorder and not use those three words. I prefer to call it things like, you know, your fear in social situations. - I get it, I get it. - And I keep coming back to that terminology. For me, diagnoses are brief. - I understand. - And I like to talk to my clients in terms of the ingredients,because it is the ingredients that cause them distress. - Yes. - And I think that's a much more meaningful conversation. - Yes, I agree with that 100%.

Has someone ever walked into your office and said, Hello, Dr. Ramani, thank you for having me? Do I have an avoidant personality? So no one notices. - Nobody has ever said that, no. I've had people come into my office and say, Hi, I have narcissistic personality disorder or Hi, I have borderline personality disorder. They may have seen other doctors, but never in my career has someone walked into my office and said, this is what I have. - Because? - I think, first of all, the name is strange, right? You know, so they think they're struggling with things like, they get very anxious around other people. - Anxiety, yes. - So they consider it an anxiety disorder.

The idea of ​​avoiding it, the name wouldn't even make sense to them. And I think that many times these people have been called socially awkward, ultra shy, those types of words have been used. So they don't even think this is a more consistent diagnostic pattern. You have to remember that this is one of those patterns that is getting a little bit more research interest recently, but it's not like patterns like borderline personality. There has been tons and tons of research done on them, mainly because it is a much more distressing disorder for people who experience it, but avoidant personality is also very uncomfortable.

So we're surely seeing more and more work on it. - What would you say is, in your experience, the typical age at which someone is diagnosed with APD? - You know, I think with all personality disorders, and I stand by this, we don't really make these diagnoses much before we're 18 years old. Personality still develops during adolescence. And I'm more in favor of even postponing the age between 21 and 25, because I think teenagers in our culture now go up to 25, frankly. And I'm not even talking about that irony. I mean, that's serious. - I understand. - We call it transitional adulthood, but it is simply expanded adolescence.

So, I like to see the personality take shape before I put a label on it. But I think we would start to see these patterns in early late adolescence and early adulthood in a systematic way. However, these are people who have struggled with this pattern of fear, fear of rejection, fear of inadequacy, feeling socially inhibited, probably throughout their childhood. - Good. - So it's not like they're doing well socially and then one day they get to, you know, 18 and suddenly they become, you know, it becomes more difficult for them socially. This pattern has been there. - Just for fun.

I walk into his office and let's say a few sessions have passed. You start to think he might have APD. What kind of questions would you hear? - Tell me, you know, tell me about how, tell me about your friends. Tell me about the people you spend time with, okay? Discover your love life and go deeper into your relationship. How many relationships have they had? How long have they lasted? How did they meet? What are your relationships like within your family, your workplace? So I would really do some research into how all of your social relationships feel.

And what I think would then start to emerge is the same theme over and over again. Yeah, I don't really have that many friends. They may even need to say: I have never been in a relationship or that I find it difficult to get into a relationship. I don't really like dating. They may report intact family relationships, but I wouldn't be surprised if we found that their family relationships were also plagued by anxiety, given the origins of this pattern. But I would like to see if there is coherence around the fears, the fears of inadequacy, all those fears that run through all relationships.

And once we got there, I would point it out. - Yeah. - It's not like I'm trying to do some kind of voodoo magic. I'll say, do you see the consistency in this pattern? And they will say yes. And I'm actually somewhat aware of it. I never thought of it that way. A lot of times when we do it, it's almost like taking all the things out of someone's house and putting them in a pattern. Oh, I never knew I had 27 pairs of black shoes. - That's a metaphor. Yes that's how it is. Oh my God.

That is my conclusion. - Yes. - That's so big. That's important in an even broader conversation about mental health and therapy. - Yes Yes. - It's like walking into your house and saying, I didn't know I had three can openers. - Okay, and we're unpacking and laying everything out. So, a good psychologist, a good therapist, lays out all the information. And I actually make drawings for each of my clients or diagrams that help me see, you know, the patterns that I have, like all these weird ways that I do it. It's really just for me. But once I start seeing a pattern, I go into the next session and sniff it out.

And then I present, I say, look at this, this is something I'm noticing. How do you feel? And they'll say, I don't agree with that. And then I respect that because we're not going to, I'm not going to be right all the time. You'd be lucky if you were right 75% of the time. And then say, okay, and then I'll work with them collaboratively. But a lot of times when they have 27 pairs of black shoes, they say, shoot, I guess they were in them, because of all the ones scattered throughout the house. And now that I see them here like that, that's really what it becomes.

So we look for the pattern and see that universality. And once they see that, then we can really begin, that's when we start to enter childhood. - Yes. - Do you know what, what, where do you think this came from? And that's where we often get into ideas of shame, how they were treated by their peers. They may even have had a very, very humiliating first sexual experience. For example, they may have been embarrassed during a kiss with a partner, from the beginning, or, you know, it could even be, in some cases, that there was sexual abuse or unwanted sexual contact, which could also push into this area. of feeling fear around social interaction, especially if they feel embarrassed about it, as some children do.

And so any of those things can contribute to this. So, we go and listen, no one, very few customers, I should say, will open with that. That's something you work on respectfully. And so, we understand that and we start helping them connect the dots because a lot of these people say, I'm just awkward. And then we can say: I don't think you're just awkward. Do you understand where this is coming from? And it is no longer about a leaf and a tree. You are showing them the roots, the trunk and the entire tree. And they will say. - So good. - Oh, now I see, thank you. - Yes. - And that's liberating for them because they almost felt like they were being hit in a sea.

I am like this because something is wrong with me. - Yes. - And when they realize that it is part of a much longer story, a tree, so to speak. - Then they will say, now I understand this and we can start. We can't stop ringing the doorbell. The past happened. But you can think about it differently. - Yes, for our viewers, who this could be their first or second series that they watch from MedCircle, that is a very important point, just to understand therapy, in general, that it is not there to disappear, now, we are I'm going to watch everything that happens to you. so we can give you a label.

It is simply understanding the truth about your life. - Yes. - And the areas you're really good at. - Yes. - And the areas in which you can improve and get closer and closer to that more optimal way of life. - Well well. - What is a common misdiagnosis that people with avoidant personality disorder receive? - The most common, and it may not be a misdiagnosis, but it may not be exactly the right diagnosis, is probably social anxiety disorder. - Yes, I imagined that. - Or other anxiety disorders. You may also see some misdiagnosis, so to speak, potentially of something like depression because the person is struggling a lot with social isolation and feeling sad about that social isolation.

And many people with depression have inaccurate assessments of themselves, like they see themselves as socially unqualified or socially inferior, so that's what depression is about. So, that could also be an early misdiagnosis. - Yes, all, all excellent points. In our next episode, Dr. Ramani will give you some quick and easy tips on what he can do to find the right provider for you. A critical part of your mental health journey will be featured in our next episode.