Avoidant Personality Disorder and Missing Social Cues That are Obvious to Others

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Reader’s Question

I am 19 years old, and I’m reasonably sure I have Avoidant Personality Disorder. I understand when someone diagnoses themselves they’re usually wrong, but I’ve spent a considerable amount of time researching it. I feel extremely sensitive to rejection and have only one good friend (who I can trust is “safe”), and the only people I truly open up to are my step-mother and my father. I also utilize escapism when I feel horrible. I could add more, but I think that’ll be enough.

My question is how do I deal with it? I can perform well in passing interactions, at the workplace, and other practicalities due to the work my parents have put into me after moving away from my mother’s at 16. My issues are that I still cannot function well in more formal social settings, in a group, or with extended one on one interaction with someone I am not familiar with. I still feel fearful that I’m saying something wrong or especially that I’m missing something that is obvious to others, such as a social cue.

I want to be better, to be normal, although I understand that is a lofty goal. Please, can you recommend a course of action? Should I see a therapist or are there other ways?

Psychologist’s Reply

Avoidant Personality Disorder means that you’re anxious and it makes sense to you that you’re anxious. It means that the things around you all go wrong, it’s you’re fault, but when you do what seems to be the right thing, you fail. It means that you have a hard time accepting praise or success as anything deeply meaningful or encouraging, but you tend to feel crushed by the slightest setback or ‘failure’. Although there is nothing in the diagnostic manual about the development of this personality disorder, we can be certain that it gets its seed very, very early in your development. Because you mention difficulties with your mother for the first 16 years of your life, I’m thinking that these experiences with her somehow fueled your low image of yourself.

To deal with this, first realize that you are coming to an understanding, or at least a hypothesis about yourself at a very early age. Most people who do see their perception of things as somehow distorted come to see it in their 40s. So, you have an opportunity to intervene early and prevent the years of pain you might suffer in the future. People who come to therapy later in life spend time, sweat and tears coming to terms with their personal distortions, and more time and tears grieving for the time they’ve lost suffering with their symptoms. When therapy goes well, no one asks if therapy was the right thing to do. They only grieve that they didn’t start sooner.

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Now, you can approach your problem in a number of ways. You can learn some basic communication skills and practice them. This is perhaps the most direct and easiest way to approach the problem. Assertive communication can go a long way toward improving social interactions and building confidence in your participation in conversation. Second, you can focus on your feelings of rejection and anxiety. Doing this may not make you feel better, but it makes you better at feeling. That is, you can feel more deeply, tolerate the lows with less distress, and make yourself available to greater joys. Finally, you can focus on the things that underlie your feelings: the relationships you have had with significant others that have built this personality structure. This can be an extremely anxiety provoking process, but it has the potential to yield the loftiest results.

Of course, I recommend you approach the problem in all three ways with the help of a skilled, psychodynamically oriented psychologist. You needn’t do it all at once. You can start with assertiveness training and find a therapist to help you with the difficulties you encounter with that. Starting this way, you can achieve some quick, early successes and build your confidence for the skirmishes that lie ahead.

If you are suffering with a personality disorder, then finding the right help is necessary for treatment. You can’t do it alone because the things that cause you problems make sense to you. How can it be wrong if it seems right to you? Someone else can point out the issues, but how can you do that for yourself?

One word about choosing a therapist. Since you may be struggling with issues with your mother, then finding a female psychologist may be more challenging than working with a male. I point this out because you may feel like confronting things head-on, in which case a female psychologist would facilitate that more readily. Or, you may feel like you need more safety and support before delving into those confrontations, which you may be able to accomplish more easily at first with a male. Choosing the right therapist for you will have more to do with their personality than their gender, but it’s something to keep in mind as you interview therapists and make a choice.

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