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Avoidant personality disorder

From Wikipedia, the free encyclopedia
(Redirected from Avoidant)

Avoidant personality disorder
Other namesAnxious personality disorder
Artwork showing a lonely woman in the midst of a crowd
Social inhibition is common in AvPD.
SpecialtyPsychiatry, clinical psychology
SymptomsSocial anxiety, social inhibition, feelings of inadequacy and inferiority, withdrawal
ComplicationsSubstance use disorders, self-harm, Major Depressive Disorder
DurationChronic
Risk factorsChildhood emotional neglect, genetic predisposition, repeated peer rejection in childhood, repeated childhood bullying
Differential diagnosisSocial anxiety disorder, schizoid personality disorder, schizotypal personality disorder, autism spectrum disorder
TreatmentPsychotherapy
PrognosisThe disorder causes socio-occupational impairment. Amelioration may be possible with treatment or time.

Avoidant personality disorder (AvPD), or anxious personality disorder, is a personality disorder characterized by excessive social anxiety and inhibition, fear of intimacy (despite an intense desire for it), severe feelings of inadequacy and inferiority, and an overreliance on avoidance of feared stimuli (e.g., self-imposed social isolation) as a maladaptive coping method.[1] Those affected typically display a pattern of extreme sensitivity to negative evaluation and rejection, a belief that one is socially inept or personally unappealing to others, and avoidance of social interaction despite a strong desire for it.[2] It appears to affect an approximately equal number of men and women.[2]

People with AvPD often avoid social interaction for fear of being ridiculed, humiliated, rejected, or disliked. They typically avoid becoming involved with others unless they are certain they will not be rejected, and may also pre-emptively abandon relationships due to fear of a real or imagined risk of being rejected by the other party.[3]

Childhood emotional neglect (in particular, the rejection of a child by one or both parents) and peer group rejection are associated with an increased risk for its development. However, it is possible for AvPD to occur without any history of abuse or neglect.[4]

Signs and symptoms

[edit]

Avoidant individuals are preoccupied with their own shortcomings and form relationships with others only if they believe they will not be rejected. They often view themselves with contempt, while showing a decreased ability to identify traits within themselves that are generally considered as positive within their societies.[5] Extreme shyness or anxiety may occur in social situations.[2]

Some with this disorder fantasize about idealized, accepting, and affectionate relationships because of their desire to belong. They often feel themselves unworthy of the relationships they desire, and shame themselves from ever attempting to begin them. If they do manage to form relationships, it is also common for them to pre-emptively abandon them out of fear of the relationship failing.[3]

Individuals with the disorder tend to describe themselves as uneasy, anxious, lonely, unwanted and isolated from others.[6] They often choose jobs of isolation in which they do not have to interact with others regularly.[7] Avoidant individuals also avoid performing activities in public spaces for fear of embarrassing themselves in front of others.

Causes

[edit]

There are limited research findings in regards to the causes of AvPD,[8][9] which have not yet been thoroughly elucidated.[10][9] It is believed that the development of AvPD is related to several factors,[9] including early childhood experiences, temperament, genetics and environment.[10][9]

Specifically, various anxiety disorders in childhood and adolescence have been associated with a temperament characterized by behavioral inhibition, including features of being shy, fearful and withdrawn in new situations.[11] These inherited characteristics may give an individual a genetic predisposition towards AvPD.[12]

Childhood emotional neglect[13][14][15][16] and peer group rejection[17] are both associated with an increased risk for the development of AvPD.[18] Some researchers believe a combination of high-sensory-processing sensitivity coupled with adverse childhood experiences may heighten the risk of an individual developing AvPD.[19]

Diagnosis

[edit]

Classification

[edit]

Classification of personality disorders differs significantly between the frameworks incorporated into the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). The DSM-5 includes two distinct diagnostic models for personality disorders; its main body (Section II) retains a traditional, categorical model of 10 putatively distinct PDs, whereas the hybrid categorical–dimensional Alternative DSM-5 Model for Personality Disorders (AMPD) is based on impairment in personality functioning as well as pathological personality traits, based on which PD diagnoses are constructed.[20][21] In the ICD-11, a dimensional model of personality disorders is implemented. Similarly to the AMPD, it is based on severity and pathological traits; however, it does not classify PD as types, and characterization of the disorder through trait qualifiers is optional.[22]

DSM

[edit]

Retained from the DSM-IV, the categorical classification system in the DSM-5 groups ten categories of PD into three clusters.[23] Placed within cluster C – a cluster characterized by anxious and fearful presentations[23][24] – AvPD is described as "a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation",[25][26] for a diagnosis of which at least four out of seven diagnostic criteria must be met.[27][26] This system of classification has several limitations, such as each category capturing a heterogeneous set of presentations.[21]

With the intent to mitigate such issues and to create a system of classification with better empirical support, the AMPD was created.[21] Contained within Section III of the DSM-5 as an alternative to the categorical model,[20][28] it defines six specific personality disorders – one of them being AvPD – based on particular constellations of the characteristic manner in which the disorder impacts personality functioning, as manifested in impairments in the identity, self-direction, empathy and intimacy domains (criterion A), as well as a set of pathological personality traits characterizing the disorder (criterion B).[20][29] While criterion A thus captures the severity of the disorder, criterion B characterizes its "style".[29]

At least two of the elements of personality functioning must have a "moderate or greater impairment",[30] manifesting in, for example, the following being true for the identity domain: "[l]ow self-esteem associated with self-appraisal as socially inept, personally unappealing, or inferior; excessive feelings of shame".[20] The AMPD lists the following four pathological traits: anxiousness, withdrawal, anhedonia, and intimacy avoidance;[31] each of these is followed by a description of how the trait manifests in AvPD,[30] such as "reticence in social situations; avoidance of social contacts and activity; [and] lack of initiation of social contact" in the case of withdrawal.[20] A diagnosis requires that three of these traits are present in the subject, with anxiousness being required.[30] Furthermore, additional traits can be added as specifiers to the diagnosis.[20] Further requirements, for example relating to differential diagnosis, are embodied in criteria C–G.[21]

ICD

[edit]

The World Health Organization's ICD-11 has replaced the categorical classification of personality disorders in the ICD-10, in which anxious (avoidant) personality disorder (F60.6) was included as a distinct category,[1] with a dimensional model containing a unified personality disorder (6D10) with severity specifiers, along with specifiers for prominent personality traits or patterns (6D11).[32] Severity is assessed based on the pervasiveness of impairment in several areas of functioning, as well as on the level of distress and harm caused by the disorder,[33] while trait and pattern specifiers are used for recording the manner in which the disturbance is manifested.[7]

This ICD-11 case profile could belong to a person eligible for ICD-10 avoidant and dependent PD diagnoses.[34]

Anxious (avoidant) personality disorder has been found to be consistently associated with the ICD-11 trait domains Negative Affectivity (6D11.0) and Detachment (6D11.1),[35] reflecting anxiousness, low self-esteem, and social withdrawal.[35][7] "The complete Avoidant PD pattern of Negative Affectivity and Detachment is overall consistent with the description of Avoidant PD patients as being both fearful and emotionally inhibited".[7] Many studies also report a link to Anankastia (6D11.4), likely due to features such as emotional restraint and excessive caution aimed at avoiding negative outcomes.[35]

Differential diagnosis

[edit]

In the case of AvPD, differential diagnosis primarily concerns social anxiety disorder, which has significant similarities to AvPD, with the distinction between the two being a matter of inquiry.[36] Another personality disorder diagnosis could also be more suitable for a presentation considered for a diagnosis of AvPD; however, these can otherwise be diagnosed alongside AvPD, provided that the requirements for diagnosis are met for all of them (see § Comorbidity). Specifically, dependent, paranoid, schizoid and schizotypal personality disorders share features with AvPD while being possible to distinguish from it based on characteristic differences.[37]

Social anxiety disorder

[edit]

There is debate as to whether avoidant personality disorder is distinct from social anxiety disorder. Both have similar diagnostic criteria and may share a similar causation, subjective experience, course, treatment and identical underlying personality features, such as shyness.[38][39][40] In contrast to social anxiety disorder, a diagnosis of avoidant personality disorder also requires that the general criteria for a personality disorder be met.[citation needed] It is contended by some that they are merely different conceptualizations of the same disorder, where avoidant personality disorder may represent the more severe form.[41][42] In particular, those with AvPD experience not only more severe social phobia symptoms, but are also more depressed and more functionally impaired than patients with generalized social phobia alone.[42] But they show no differences in social skills or performance on an impromptu speech.[43] Another difference is that social phobia is the fear of social circumstances whereas AvPD is better described as an aversion to intimacy in relationships.[44]

Other personality disorders

[edit]

A feature shared by AvPD with schizoid (SzPD) and schizotypal (StPD) personality disorders,[37] social isolation is characterized by it stemming from active avoidance of rejection in the case of AvPD.[36] Whereas people with AvPD desire to have relationships with other people and experience loneliness stemming from their isolation, those with SzPD and StPD may not experience discomfort stemming from it.[37] In regards to SzPD, the behavior giving rise to isolation is of a passive character, rooted in disinterest.[36] In regards to paranoid PD, the "reluctance to confide in others", which it shares with AvPD, stems from a "a fear of others' malicious intent", rather than from a "fear of being embarrassed or being found inadequate", as in the case of AvPD.[37]

AvPD shares "feelings of inadequacy, hypersensitivity to criticism, and [...] need for reassurance" with dependent personality disorder (DPD);[37][45] in addition, studies point to other shared features, these being: low self-confidence, self-depreciation, unassertive behavior and a fear of abandonment.[45] The disorders differ in that while people with AvPD worry excessively about being rejected and humiliated, those with DPD experience a need of nurturance,[37] which have been described as reasons why people with both disorders, respectively, lack assertiveness.[45] Moreover, reportedly, while people with AvPD engage in social withdrawal, those with DPD endeavor to be close to important others; other research indicates that a stable association with alexithymia also serves to differentiate AvPD from DPD.[45]

There is also an overlap between avoidant and schizoid personality traits and AvPD may have a relationship to the schizophrenia spectrum.[46]

Subtypes

[edit]

Millon's subtypes

[edit]

Psychologist Theodore Millon notes that because most patients present a mixed picture of symptoms, their personality disorder tends to be a blend of a major personality disorder type with one or more secondary personality disorder types. He identified four adult subtypes of avoidant personality disorder.[47][48]

Subtype Features Traits
Phobic avoidant Including dependent features General apprehensiveness displaced with avoidable tangible precipitant; qualms and disquietude symbolized by a repugnant and specific dreadful object or circumstances.
Conflicted avoidant Including negativistic features Internal discord and dissension; fears dependence; unsettled; unreconciled within self; hesitating, confused, tormented, paroxysmic, embittered; unresolvable angst.
Hypersensitive avoidant Including paranoid features Intensely wary and suspicious; alternately panicky, terrified, edgy, and timorous, then thin-skinned, high-strung, petulant, and prickly.
Self-deserting avoidant Including depressive features Blocks or fragments self-awareness; discards painful images and memories; casts away untenable thoughts and impulses; possibly suicidal.[48]

Others

[edit]

In 1993, Lynn E. Alden and Martha J. Capreol proposed two other subtypes of avoidant personality disorder:[49]

Subtype Characteristics
Cold-avoidant Characterised by an inability to experience and express positive emotion towards others.
Exploitable-avoidant Characterised by an inability to express anger towards others or to resist coercion from others. May be at risk for abuse by others.

Treatment

[edit]

Treatment of avoidant personality disorder has been researched only to a minor extent,[50] with a significant portion of the research being derived from studies of social anxiety disorder.[50][51] For AvPD, treatment can employ various techniques, such as social skills training, psychotherapy, cognitive therapy, and exposure treatment to gradually increase social contacts, group therapy for practicing social skills.[50][52] While the use of pharmacotherapy for treatment of AvPD is not known to have been researched, it can be used for treating comorbid conditions and has proven to be useful in treating social anxiety disorder.[50]

A key issue in treatment is gaining and keeping the patient's trust since people with an avoidant personality disorder will often start to avoid treatment sessions if they distrust the therapist or fear rejection. The primary purpose of both individual therapy and social skills group training is for individuals with an avoidant personality disorder to begin challenging their exaggerated negative beliefs about themselves.[53]

Prognosis

[edit]

Avoidant personality disorder is chronic.[54] Its symptoms often appear early in childhood, and they may subsequently increase in severity in adolescence and early adulthood.[55] Research findings suggest that the symptoms of AvPD tend to persist over time;[56][54] however, there is some research suggesting that the condition may be ameliorated or go into remission over time and with the help of treatment.[54][55] This disorder causes impairment in socio-occupational functioning,[54] with those affected having an increased likelihood of lower education and obtaining disability benefits; cohabitation and marriage are also less likely with AvPD.[57]

Epidemiology

[edit]

Reported to be at around 1.5%–2.5%, the prevalence of AvPD has also been estimated to be both lower and significantly higher than that.[57] Its prevalence in clinical settings has been estimated between 5.1 and 55.4%,[58] with one study finding this to be 14.7% in psychiatric outpatients.[59] It has been reported to ostensibly occur with equal frequency in males and females,[60] with some studies indicating a higher prevalence among women.[61][57]

Comorbidity

[edit]

AvPD is reported to be especially prevalent in people with anxiety disorders, although estimates of comorbidity vary widely due to differences in (among others) diagnostic instruments. Research suggests that approximately 10–50% of people who have panic disorder with agoraphobia have avoidant personality disorder, as well as about 20–40% of people who have social anxiety disorder. In addition to this, AvPD is more prevalent in people who have comorbid social anxiety disorder and generalised anxiety disorder than in those who have only one of the aforementioned conditions.[62] Substance use disorders are also common in individuals with AvPD[63]—particularly in regard to alcohol, benzodiazepines, and opioids[64]—and may significantly affect a patient's prognosis.[65][66]

Some studies report prevalence rates of up to 45% among people with generalized anxiety disorder and up to 56% of those with obsessive–compulsive disorder.[67] Post-traumatic stress disorder and dependent personality disorder are also commonly comorbid with avoidant personality disorder.[68][2] People suffering from AvPD are prone to self-loathing and, in certain cases, self-harm.[medical citation needed]

Earlier theorists proposed a personality disorder with a combination of features from borderline personality disorder (BPD) and avoidant personality disorder, called "avoidant-borderline mixed personality" (AvPD/BPD).[69]

History

[edit]

The avoidant personality has been described in several sources as far back as the early 1900s, although it was not so named for some time. Swiss psychiatrist Eugen Bleuler described patients who exhibited signs of avoidant personality disorder in his 1911 work Dementia Praecox: Or the Group of Schizophrenias.[70] Avoidant and schizoid patterns were frequently confused or referred to synonymously until Kretschmer (1921),[71] in providing the first relatively complete description, developed a distinction.[citation needed]

Given that it is a poorly studied personality disorder and in light of prevalence rates, societal costs, and the current state of research, AvPD qualifies as a neglected disorder.[72]

See also

[edit]

Social:

References

[edit]
  1. 1 2 Anxious [avoidant personality disorder] in ICD-10: Diagnostic Criteria Archived 2016-06-18 at the Wayback Machine and Clinical descriptions and guidelines. Archived 2014-03-23 at the Wayback Machine
  2. 1 2 3 4 Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, D.C: American Psychiatric Association. 2013. pp. 672–675. ISBN 978-0-89042-554-1.
  3. 1 2 Hoeksema N (2014). Abnormal Psychology (6th ed.). McGraw Education. p. 275. ISBN 978-1-308-21150-3.
  4. ↑ "Avoidant Personality Disorder – Environmental Factors". Archived from the original on 2014-10-28. Retrieved 2013-07-22.
  5. ↑ Will, Retzlaff, ed. (1995). p. 97
  6. ↑ Millon T, Davis RD (1996). Disorders of Personality: DSM-IV and Beyond, 2nd Edition. p. 263.
  7. 1 2 3 4 Bach B, Kramer U, Doering S, di Giacomo E, Hutsebaut J, Kaera A, et al. (2022-04-01). "The ICD-11 classification of personality disorders: a European perspective on challenges and opportunities". Borderline Personality Disorder and Emotion Dysregulation. 9 (1): 12. doi:10.1186/s40479-022-00182-0. ISSN 2051-6673. PMC 8973542. PMID 35361271.
  8. ↑ Weinbrecht et al. 2016, p. 3, "Etiology".
  9. 1 2 3 4 Torrico & Sapra 2024, "Etiology".
  10. 1 2 Lampe & Malhi 2018, pp. 60–61, "Toward an understanding of etiological factors".
  11. ↑ Suzanne M. Sutherland, M.D. (2006). "Avoidant Personality Disorder Causes, Frequency, Siblings and Mortality — Morbidity". Avoidant Personality Disorder. Armenian Medical Network. Archived from the original on 2007-09-30. Retrieved 2007-02-26.
  12. ↑ Lenzenweger MF, Clarkin JF (2005). Major Theories of Personality Disorder. Guilford Press. p. 69. ISBN 978-1-59385-108-8.
  13. ↑ Johnson JG, Smailes EM, Cohen P, Brown J, Bernstein DP (2000). "Associations between four types of childhood neglect and personality disorder symptoms during adolescence and early adulthood: findings of a community-based longitudinal study". Journal of Personality Disorders. 14 (2): 171–87. doi:10.1521/pedi.2000.14.2.171. PMID 10897467.
  14. ↑ Joyce PR, McKenzie JM, Luty SE, Mulder RT, Carter JD, Sullivan PF, et al. (2003). "Temperament, childhood environment and psychopathology as risk factors for avoidant and borderline personality disorders". Australian and New Zealand Journal of Psychiatry. 37 (6): 756–64. doi:10.1080/j.1440-1614.2003.01263.x. PMID 14636393. S2CID 154962.
  15. ↑ Johnson JG, Cohen P, Brown J, Smailes EM, Bernstein DP (1999). "Childhood Maltreatment Increases Risk for Personality Disorders During Early Adulthood". Archives of General Psychiatry. 56 (7): 600–6. doi:10.1001/archpsyc.56.7.600. PMID 10401504.
  16. ↑ Battle CL, Shea MT, Johnson DM, Yen S, Zlotnick C, Zanarini MC, et al. (2004). "Childhood Maltreatment Associated With Adult Personality Disorders: Findings From the Collaborative Longitudinal Personality Disorders Study". Journal of Personality Disorders. 18 (2): 193–211. doi:10.1521/pedi.18.2.193.32777. PMID 15176757.
  17. ↑ Sperry L (2003). "Avoidant Personality Disorder". Handbook of diagnosis and treatment of DSM-IV-TR personality disorders. Philadelphia: Brunner-Routledge. pp. 59–79. ISBN 978-0-415-93569-2.
  18. ↑ Eggum ND, Eisenberg N, Spinrad TL, Valiente C, Edwards A, Kupfer AS, et al. (2009). "Predictors of withdrawal: Possible precursors of avoidant personality disorder". Development and Psychopathology. 21 (3): 815–38. doi:10.1017/S0954579409000443. PMC 2774890. PMID 19583885.
  19. ↑ Meyer B, Ajchenbrenner M, Bowles DP (December 2005). "Sensory sensitivity, attachment experiences, and rejection responses among adults with borderline and avoidant features". Journal of Personality Disorders. 19 (6): 641–658. doi:10.1521/pedi.2005.19.6.641. ISSN 0885-579X. PMID 16553560.
  20. 1 2 3 4 5 6 Clark 2025, pp. 267–268, "Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)".
  21. 1 2 3 4 Rodriguez-Seijas C, Ruggero C, Eaton NR, Krueger RF (2019). "The DSM-5 Alternative Model for Personality Disorders and Clinical Treatment: a Review". Current Treatment Options in Psychiatry. 6 (4): 284–298. doi:10.1007/s40501-019-00187-7. ISSN 2196-3061.
  22. ↑ Zimmermann et al. 2019, p. 2, "PD Chapter in ICD-11".
  23. 1 2 Sanislow & Hector 2020, pp. 302–303, "Introduction".
  24. ↑ American Psychiatric Association 2013, p. 646.
  25. ↑ American Psychiatric Association 2013, p. 673, "Diagnostic Features".
  26. 1 2 Sanislow & Hector 2020, pp. 304–305.
  27. ↑ American Psychiatric Association 2013, pp. 672–673, "Diagnostic Criteria".
  28. ↑ Clark 2025, p. 267, "Introduction".
  29. 1 2 Zimmermann et al. 2019, p. 2, "Alternative DSM-5 Model for PD".
  30. 1 2 3 American Psychiatric Association 2013, pp. 765–766, (AMPD) "Avoidant Personality Disorder".
  31. ↑ Weinbrecht et al. 2016, pp. 1–2, "Diagnostic Aspects".
  32. ↑ Bach & First 2018.
  33. ↑ Swales MA (2022-12-15). "Personality Disorder Diagnoses in ICD-11: Transforming Conceptualisations and Practice". Clinical Psychology in Europe. 4 (Spec Issue) e9635. doi:10.32872/cpe.9635. ISSN 2625-3410. PMC 9881116. PMID 36760321.
  34. ↑ Bach & First 2018, pp. 7–9.
  35. 1 2 3 Simon, Lambrecht & Bach 2023, p. 5, 2.7. "Anxious (avoidant)".
  36. 1 2 3 Torrico & Sapra 2024, "Differential Diagnosis".
  37. 1 2 3 4 5 6 American Psychiatric Association 2013, pp. 674–675, "Differential Diagnosis".
  38. ↑ Ralevski E, Sanislow CA, Grilo CM, Skodol AE, Gunderson JG, Tracie Shea M, et al. (2005). "Avoidant personality disorder and social phobia: distinct enough to be separate disorders?". Acta Psychiatrica Scandinavica. 112 (3): 208–14. doi:10.1111/j.1600-0447.2005.00580.x. PMID 16095476. S2CID 16517625.
  39. ↑ Nedic A, Zivanovic O, Lisulov R (2011). "Nosological status of social phobia: contrasting classical and recent literature". Current Opinion in Psychiatry. 24 (1): 61–6. doi:10.1097/YCO.0b013e32833fb5a6. PMID 20966756. S2CID 31505197.
  40. ↑ Reichborn-Kjennerud T, Czajkowski N, Torgersen S, Neale MC, Orstavik RE, Tambs K, et al. (2007). "The Relationship Between Avoidant Personality Disorder and Social Phobia: A Population-Based Twin Study". American Journal of Psychiatry. 164 (11): 1722–8. doi:10.1176/appi.ajp.2007.06101764. PMID 17974938. S2CID 23171568.
  41. ↑ Reich J (2009). "Avoidant personality disorder and its relationship to social phobia". Current Psychiatry Reports. 11 (1): 89–93. doi:10.1007/s11920-009-0014-0. PMID 19187715. S2CID 40728363.
  42. 1 2 Huppert JD, Strunk DR, Ledley DR, Davidson JR, Foa EB (2008). "Generalized social anxiety disorder and avoidant personality disorder: structural analysis and treatment outcome". Depression and Anxiety. 25 (5): 441–8. doi:10.1002/da.20349. PMID 17618526. S2CID 9179813.
  43. ↑ Herbert JD, Hope DA, Bellack AS (1992). "Validity of the distinction between generalized social phobia and avoidant personality disorder". J Abnorm Psychol. 101 (2): 332–9. doi:10.1037/0021-843x.101.2.332. PMID 1583228.
  44. ↑ Comer R (2014). Fundamentals of abnormal psychology (PDF). New York, NY: Worth Publishers. pp. 424–427. ISBN 978-1-4292-9563-5.
  45. 1 2 3 4 Lampe & Malhi 2018, pp. 58–59, "Relationship to dependent personality disorder".
  46. ↑ David L. Fogelson, Keith Nuechterlein (2007). "Avoidant personality disorder is a separable schizophrenia-spectrum personality disorder even when controlling for the presence of paranoid and schizotypal personality disorders". Schizophrenia Research. 91 (1–3): 192–199. CiteSeerX 10.1.1.1019.5817. doi:10.1016/j.schres.2006.12.023. PMC 1904485. PMID 17306508.
  47. ↑ Theodore Millon (2004): Chapter 6 – The Avoidant Personality (p.187). Personality Disorders in Modern Life. Archived 2017-02-07 at the Wayback Machine Wiley, 2nd Edition. ISBN 0-471-23734-5.
  48. 1 2 Millon T (2015). "Personality Subtypes Summary". Institute for Advanced Studies in Personology and Psychopathology (millon.net). Archived from the original on 2017-06-21. Retrieved 2013-01-08.
  49. ↑ Peter D. McLean, Sheila R. Woody: Anxiety Disorders in Adults: An Evidence-Based Approach to Psychological Treatment. p. 129, ISBN 978-0-19-802759-1.
  50. 1 2 3 4 Lampe & Malhi 2018, p. 62, "Treatment".
  51. ↑ Weinbrecht et al. 2016, pp. 3–4, "Treatment".
  52. ↑ Weinbrecht et al. 2016.
  53. ↑ Eckleberry, Sharon C. (March 25, 2000). "Dual Diagnosis and the Avoidant Personality Disorder". The Dual Diagnosis Pages: From Our Desk. Archived from the original on December 16, 2006. Retrieved February 6, 2007.
  54. 1 2 3 4 Torrico & Sapra 2024, "Prognosis".
  55. 1 2 American Psychiatric Association 2013, p. 674, "Development and course".
  56. ↑ Weinbrecht et al. 2016, p. 3, "Stability of Symptoms".
  57. 1 2 3 Lampe & Malhi 2018, pp. 56–57, "Demographic, symptom, and disability correlates of AVPD".
  58. ↑ Sperry 2016, p. 77.
  59. ↑ Weinbrecht et al. 2016, p. 1, "Introduction".
  60. ↑ Schulte Holthausen & Habel 2018, p. 5, "Avoidant Personality Disorder".
  61. ↑ Sanderson WC, Wetzler S, Beck AT, Betz F (February 1994). "Prevalence of personality disorders among patients with anxiety disorders". Psychiatry Research. 51 (2): 167–174. doi:10.1016/0165-1781(94)90036-1. PMID 8022951. S2CID 13101675.
  62. ↑ Lampe & Malhi 2018, p. 57, "Comorbidity".
  63. ↑ Verheul R (2001-08-01). "Co-morbidity of personality disorders in individuals with substance use disorders". European Psychiatry. 16 (5): 274–282. doi:10.1016/S0924-9338(01)00578-8. PMID 11514129. S2CID 29066695.
  64. ↑ "Personality disorders and substance use" (PDF). National Drug Strategy. Archived (PDF) from the original on March 27, 2018.
  65. ↑ "Personality + substance use" (PDF). National Drug and Alcohol Research Centre. Archived (PDF) from the original on December 4, 2017.
  66. ↑ Van Velzen, C. J. M. (2002). Social Phobia and Personality Disorders: Comorbidity and Treatment Issues. Groningen: University Library Groningen. (online version Archived October 30, 2021, at the Wayback Machine)
  67. ↑ Gratz KL, Tull MT (August 30, 2012). "Exploring the relationship between posttraumatic stress disorder and deliberate self-harm: the moderating roles of borderline and avoidant personality disorders". Psychiatry Research. 199 (1): 19–23. doi:10.1016/j.psychres.2012.03.025. ISSN 0165-1781. PMC 3407331. PMID 22521897.
  68. ↑ Kantor M (2003) [1993], Distancing: A Guide to Avoidance and Avoidant Personality Disorder (Revised ed.), Westport, Connecticut: Praeger Publishers
  69. ↑ Millon T, Martinez A (1995). "Avoidant Personality Disorder". In Livesley WJ (ed.). The DSM-IV Personality Disorders. Guilford Press. pp. 218. ISBN 978-0-89862-257-7.
  70. ↑ Kretschmer E (1921). Körperbau und Charakter. J. Springer.
  71. ↑ Weinbrecht et al. 2016, pp. 5–6, "Discussion".

Bibliography

[edit]
  • Sperry L (2016). "Avoidant Personality Disorder". Handbook of diagnosis and treatment of DSM-5 personality disorders: assessment, case conceptualization, and treatment (Third ed.). New York, NY: Routledge, Taylor & Francis Group. pp. 73–92. doi:10.4324/9780203763728. ISBN 978-0-415-84191-7. LCCN 2015040215.
[edit]
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