People with avoidant
personality disorder (APD) display a pattern of behavior which begins early
during their teenage years, with some traits such as extreme anxiety, shyness,
feelings of inadequacy and fear of being
rejected. (Drago, Marogna & Sogaard, 2016). Nowadays, about 1 to 2% of the
world population suffers from APD (Sanislow, Bartolini & Zoloth, 2012).
Those people tend to avoid social contact because they are afraid of criticisms
and judgments from others. Moreover, the fear of rejection makes them want to
be lonely rather than have close relationships, in the belief that they will be
neglected due to their detached behaviors (Furnham, 2017). All of this has a
negative impact on patient’s life and makes it difficult not only for them to
interact with society but also for psychologists and psychiatrists to deal with
APD. This paper, with the aim of raising people knowledge about APD, is carried
out to provide information about the symptoms, causes and treatments of this
2. Discussion of
information about APD
APD is one of the mental
health conditions, which was characterized by great shyness, social inhibition,
hypersensitivity to rejection and feelings of inferiority (Ekern, 2013). This
condition was classified as Cluster C, a category for fearful & anxious
disorders, and was acknowledged in the DSM (Diagnostic
and Statistical Manual of Mental Disorders) in 1980, according to Furnham
(2017). He also stated that APD is
equally common between two sexes and is estimated to affect from 0.5% to 1% of
the world population, although DSM suggests that the figure was approximately
2.4 %, and from 10% to 20% of psychiatric outpatients.
As reported by Ekern
(2013), APD has four subtypes, as almost all people with this disorder will
show a mixture of symptoms. The four main subtypes of APD are Phobic (being
extremely afraid of particular situations or objects), Conflicted (confusion,
being unable to settle worried feelings), Hypersensitive (greatly mistrustful,
apprehensive and fearful), and Self-deserting.
2.2. Symptoms of APD
Gluck (2014) stated that
APD initial signs appear during early years, but often seem to be normal until
late adolescence. Nearly all children express some anxiety and shyness when
interact with new people or situations; these behaviors seem to be normal, they
only become a big trouble if continue during adulthood.
According to WebMD
(n.d.), APD individuals have a tendency to avoid talking in social
circumstances for fear of embarrassment due to saying something wrong. They
also avoid social activities because of their fear of being criticized or
In addition, there are
many other symptoms that can be recognized, such as: reluctant to communicate
or make friends with others, except when they are sure that those people
certainly like them; worry about being ridiculed or shamed, even within close
relationships; diffident in interpersonal environments due to feelings of
inadequacy; feel uncomfortable, socially isolated and inferior to other people;
unwillingly take part in any activities that may make them being embarrassed
(Lucida Treatment, 2014). As reported by Bressert (2017), these symptoms will
decline along with ageing, as many people aged 40 and over suffer fewer
Gluck (2014) also noted
that some of APD symptoms can be visibly seen in many circumstances, but there
are also some symptoms happen inside their experiences which cannot be spotted
by naked eyes.
2.3. Causes of APD
scientists do not know exactly what are the reasons of APD, although it is
theorized by a number of experts that there are genetic, social and
psychological factors contribute to this mental problem’s causes (Bressert,
First of all, gene is a
possible reason for this illness. A study carried out in Norway on teenagers
indicated that the inheritability of APD is between 27% and 35%. Moreover,
approximately 83% of these genes also have some connections with other
personality disorders (Lucida Treatment, 2014).
Secondly, this disorder
appears may be due to the impact of social environment on people. Lucida
Treatment (2014) stated that individuals who have APD did not learn appropriate
skills to cope with different challenges from their childhood and adolescence.
Consequently, they become shy and afraid of facing new situation and have a
possibility of having APD.
to Hageman, Francis, Field
& Carr (2015) in their research, many studies indicated that there is a
connection between APD patient’s childhood experiences and development of APD.
A majority of people who suffer from APD experienced childhood maltreatment
such as sexual abuse or emotional neglect from their own parents. The
overprotection from parents can also lead to the initial beginning of APD’s
symptoms. Moreover, APD individuals have tendency to be teased by their peers
at a young age, about appearance, performance or behaviors. Consequently,
teasing can result in negative emotions and numerous difficulties in involving
in social circumstances. As the result, these experiences contribute to risk factors that can hurt these children mentally, and then makes them become potential patient of APD.
2.4. Treatments of APD
To deal with this issue,
APD individuals need to be cure accurately.
Currently, there is no medicine for treating APD (Draco et al., 2016). The typical way to treat this mental condition
is psychotherapy, according to Bressert (2017). However, this treatment has
some challenges, such as the requirement of interaction
between therapist and patient about personal things they are unwilling to talk
about, which could hurt them a lot. Therefore, therapists need to build a trustful
and therapeutic relationship with patient in order to prevent them from leaving
reported by Bressert
(2017), while some APD individuals can
withstand long-term psychotherapy, many people
go to therapist only when they are stressful, which is a common symptom of this
disorder. These short-term psychotherapies will only concentrate on the instant
problems in patient’s life, provide them some new coping skills. APD patient
will cancel the treatment as soon as the problem disappears.