First Study To Explore What It’s Like To Live With Avoidant Personality Disorder: “Safe When Alone, Yet Lost In Their Aloneness”

By Christian Jarrett

In the first study of its kind, researchers have asked people to describe in their own words what it’s like to live with Avoidant Personality Disorder (AVPD) – a diagnosis defined by psychiatrists as “a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation”. Like all personality disorder diagnoses, AVPD is controversial, with some critics questioning whether it is anything other than an extreme form of social phobia.

To shed new light on the issue, lead author Kristine D. Sørensen, a psychologist, twice interviewed 15 people receiving outpatient treatment for AVPD: 9 women, 6 men, with an average age of 33, and none of them in work. Writing in the Journal of Clinical Psychology, Sørensen and her colleagues said the overarching theme to emerge from the in-depth interviews was the participants’ struggle to be a person. “They felt safe when alone yet lost in their aloneness,” the researchers said. They “longed to connect with others yet feared to get close.” In the researchers’ opinion, the participants’ profound difficulties with their “core self” and in their dealings with others do indeed correspond to “a personality disorder diagnosis”.

Beneath the overarching theme of struggling to be a person, there emerged two main themes, the first being “fear and longing“. This included participants’ descriptions of having to put on a mask when socialising and their difficulty feeling normal.  “I notice that you spend incredible amounts of energy. You just spend your entire consciousness in just not … trying not to make a fool out of yourself and appear normal.” (Steve). This constant performance meant they felt other people never really knew them. “I have never felt seen. Not even my mother knew me like that. I know I have missed it. I never felt loved.” (Lily). There were some rare exceptions to these difficulties. For instance, one participant said they felt authentic when with their young daughter, yet other participants described how, as their children grew older, their usual insecurities returned even when in their company.

Another difficulty that was mentioned repeatedly was the dread of getting close to others. “I am very, very suspicious of people. Not that they would harm me physically, but what are their intentions? Or they seem nice, but really, they are not.” (Eva). Coping measures included only interacting through email or text message, and when in physical company, avoiding eye contact.

The participants also described a conundrum – the solitude that brought them comfort and safety was also suffocating. They were “feeling sad, almost grieving when they were alone”, the researchers said. “There comes a heaviness, like ‘now you are alone again little man, and you will never manage this; you will die alone’” (Peter). To cope, the participants said they kept busy playing computer games and listening to music. Most effective in this regard were physical sports and hobbies like making music, yet sadly the relief evaporated as soon as thoughts of being evaluated crept into mind.

The second main theme was “A doubting self” – including chronic insecurity and a fleeting sense of self. Participants had the perception that other people breeze through life and have no trouble being themselves. Related to this, the participants were constantly struggling to make sense of their own persistent insecurities. “There is always something grinding in my head, so there is no rest. I do not know how to answer myself to make it better” (Anita).

The constant acting and pretense when in company led to feelings “like one is not even there” (Amanda). Sometimes this developed into an emotional hollowness. “I think that it is real fun or should be, but I do not feel anything” (Eva). After wearing a mask for so many years, some participants feared they had forgotten who they truly were underneath. “I feel like I do not know myself anymore” (Amanda). On the positive side, participants found time in nature was therapeutic, especially when immersed in a physical challenge. “There it is only me. I do not have to perform something for others to see. I find enormous pleasure from reaching the mountaintop. Then, you are kind of free” (Elsa).

In short, the researchers said that their participants spend so much time “reflecting on themselves that it seemingly disrupted their everyday life functioning”. They also lacked feelings of belonging, attachment and intimacy. Their suspicion of others and the burden of keeping up appearances “caused the participants to retreat from and thus miss social experiences that might have provided more trustworthy and comforting answers to questions related to the inner mental lives of themselves or others.”

Sørensen and her colleagues said these insights could be useful for therapists. The therapeutic alliance (a warm, trusting relationship between therapist and client) – always important – will be even more critical for clients with avoidant personality disorder. “The therapeutic relationship provides an opportunity for persons diagnosed with AVPD to experience being met with acceptance and understanding,” the researchers said.

They added that “through a reflective process, patients might begin to make sense of why they do not manage what seems easy for most people. With this realization, their motivation to encounter new social learning might increase, together with a beginning of acceptance of life’s inherent uncertainties. Research on treatment of AVPD has been scarce and inconclusive, but the suggestions above do align with promising recommendations emphasizing the importance of social skills training and drawing on findings from social cognition research on mentalization, self‐other differentiation, interpersonal grounding for building a self‐concept, and affect consciousness.”

Struggling to be a person: Lived experience of avoidant personality disorder

Christian Jarrett (@Psych_Writer) is Editor of BPS Research Digest

14 thoughts on “First Study To Explore What It’s Like To Live With Avoidant Personality Disorder: “Safe When Alone, Yet Lost In Their Aloneness””

  1. It’s fantastic to see this condition being investigated and taken as seriously as it should be. I have a few personality disorders but the anxious avoidance gives me the biggest challenge in life. I’ve learned to live with it and mould my life around it and to others l am sure it’s invisible but to myself it’s very much there. Thank you for this article.

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    1. Nice response Finley and a good article capturing the dilemma succinctly. I would liken this condition to Michael Balint’s basic fault much -like living in California or by Vesuvius. A person learns too live with the fact that aloness and anxiety are personal givens but also bring creativety to his or her life.Negative judgements can begin in childhood but persist throughout life also by numerous reinforcements – family, friends, the workplace and of course oneself!

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  2. I studied Psychology in my 20’s, so now in my 40’s, hopefully just about to receive an ASD diagnosis, APD(why the V?) adds a further element of confusion to my situation. I’ve never had a relationship, can’t trust anyone, but want to, although I have this constant reminder in my mind that my suspicions are evidentially based, not invented, like religiosity or phobias. I even have confidence in my lack of trust, as the one most kind person I’ve ever met I tried trusting, turned out to be screwing our mutual boss, without her boyfriend’s knowledge, hence confirming the rationality of my suspicions of people generally and hypergamous women specifically. There are so many spot on behaviours that I have in APD, like the chronic desire to both be alone and not lonely. I would love the intimacy and validation of a relationship, but I know that most women cheat when they fulfil their base survival needs, via an exploitable and controllable ‘husband material’ type guy, i.e. someone who can be managed at low expenditure by the woman, but who gives over 30 years of his income and support, for a much smaller return, i.e. rationed access to sex, domestic labour, companionship and economies of scale that a relationship brings, such as cheaper living costs. I worked in a company where 95% of the managers where openly having affairs with other workers. Up to then, I thought maybe 25% of people are treacherous and have no honour. After that, it became sadly apparent that I had been completely correct to see the worst in Women and Men. How is it rational to trust, when the factual evidence of people’s behaviour, contradicts completely, how people actually behave. I think that APD maybe should be an additional tack on diagnostic label, but not a condition in itself, as my chronic social anxiety and dysfunction are already explained adequately by the ASD umbrella. It feels like the overactive sensitivity to criticism, not wanting to put yourself up for a possible failed judgement process, is a part of the anxiety within ASD. Chiefly I think the ASD is an absence of delusion that it is logical to trust, when all evidence points to the contrary. To me Aspergers and the blunt statement of facts, is what makes this avoidant behaviour possible, we tell ourselves the truths, whereas, neurotypical people, lie to themselves and say believe, have faith, trust, then get cheated on. In this sense, neurotypical relationship trust is the equivalent of religion to an autistic person’s empiricism, hahahaaaa.

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    1. Trust is not naive per se. It can be done from a position of naiveté, but an informed person can trust as an act of courage. It’s like a moral sacrifice made in the establishment of genuine connection and friendship. As irrational as trust might seem from some perspectives, it is 100% vital in honest human bonding, and, as such, it is not an irrational decision to decide to trust those you’d wish to establish a relationship with.

      Also, in case you care, everything from “I know that most women cheat” is belief and projection. You seem to care about facts and rationality, so I’m sure you’d care about having these facts right as well. It seems that you’ve had your fair share of bad work environment, and I’m sorry to hear that. But this experience isn’t representative of all or even most people. I don’t know if you are open to these thoughts—maybe you’ve rejected them right away—but I thought I’d just leave them here for you to consider in case you’re the you that cares.

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  3. I hope I never find myself so hurt by life that I end up being ‘assessed’ by a psychiatrist or a psychologist and offered ‘treatment’ for some illness/disorder they believe I have.

    Can anyone really understand someone else beyond the superficial based on a few questions and tick box questionnaires in the confines of the clinic or perhaps the odd home visit? You can live with someone for decades only to discover the person you thought you knew was just part of the story telling mechanisms we seem bound to.

    its a lifetimes work to try and find fragments of yourself most often grown in a relatively small sphere of experience out of a vast potential of experiences. It seems most of what we do, say, ‘choose’ etc are bound together with a multitude of complexities utterly beyond our comprehension or control.

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  4. Hey! There are several AVPD Facebook groups that you can join if you are looking for support and for a community of people who understand what having AVPD is like… I invite you to join!

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