Introduction

            Persons with avoidant personality disorder show an extreme sensitivity to rejection, which may lead to a socially withdrawn life. They are not asocial and show a great desire for companionship but are shy, they need unusually strong guarantees of uncritical acceptance. Such persons are commonly referred to as having an inferiority complex.

Extent of Problem:

            The prevalence of avoidant personality disorder is unknown as defined, it is common. No information is available on sex ratio or familial pattern. Infants classified as having a timid temperament may be more porn to the disorder than are those high on activity-approach scales.

Clinical Feature:

Hypersensitivity to rejection by others is the central clinical feature of this disorder. Persons with the disorder desire the warmth and security of human companionship but justify their avoidance of forming relationships by their alleged fear of rejection. When talking with someone, they express uncertainty and a lack of self-confidence and may speak in a self-effacing manner. They are afraid to speak up in public or to make requests of others, because they are hyper vigilant about rejection. They are apt to misinterpret other people’s comments as derogatory or ridiculing. The refusal of any request leads them to withdraw from others and to feel hurt.

In the vocational sphere, avoidant personality disorder patients often take jobs on the sidelines. They rarely attain much personal advancement of exercise much authority. Instead, at work they may seem simply shy and eager to please.

According to DSM-III-R persons with this disorder are generally unwilling to enter relationship unless they are given an unusually strong guarantee of uncritical acceptance. Consequently, they often have no close friends or confidants. In general, their main personality trait is timidity.

Course and Outcome:

Many avoidant personality disorder patients are able to function, provided they are in a protected environment. Some marry, have children, and live their lives surrounded only by family. Should their support and anger. Phobic avoidance is common, and avoidant personality disorder patients may give histories of social phobias or go on to such phobias during the course of their illness.

Treatment:

Psychotherapy

Psychotherapeutic treatment depends on solidifying an alliance with the patient. As trust develops, the therapist conveys an accepting attitude toward the patient’s fears, especially that of rejection. The therapist eventually encourages the patient to move out into the world to take what are perceived as great risks of humiliation, rejection, or failure. But the therapist should be cautious when giving assignment to exercise new social skills outside therapy, because failure may reinforce the patient’s already poor self-esteem.

Group therapy Group Therapy may help patients understand the effects that their sensitivity to rejection has on themselves and others. Assertiveness training is a form of behavior therapy that may teach patients to express their needs openly and improve their self-esteem.

Pharmacotherapy has been used to manage anxiety and depression when present as an associated feature. Some patients are helped by blockers, such as atenolol (tenormin), to manage autonomic nervous system hyperactivity, which tends to be high in patients with this disorder, especially when they approach feared situations.