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Summary MHS4503 - Avoidant Personality Disorder
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Samenvatting van alle artikelen over vermijdende persoonlijkheidsstoornis (MHS4503)
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AVOIDANT PERSONALITY DISORDER (CLUSTER C)VERMIJDENDE PERSOONLIJKHEIDSSTOORNIS
Source: DSM-V (APA, 2015)
Een pervasief patroon van sociale geremdheid, gevoelens van insufficiëntie en hypersensitiviteit
voor een negatieve beoordeling, beginnend op jongvolwassen leeftijd en aanwezig in uiteenlopende
contexten, zoals blijkt uit vier of meer van de volgende kenmerken.
o Vermijdt beroepsmatige activiteiten die significante persoonlijke contacten met zich
meebrengen, vanwege vrees voor kritiek, afkeuring of afwijzing.
o Is onwillig om betrokken te raken met mensen, tenzij hij of zij er zeker van is aardig te
worden gevonden.
o Gedraagt zich gereserveerd in intieme relaties vanwege de vrees voor gek te worden gezet
of te worden uitgelachen.
o Is gepreoccupeerd met de gedachte in sociale situaties te worden bekritiseerd of afgewezen.
o Is geremd in nieuwe interpersoonlijke situaties vanwege insufficiëntiegevoelens.
o Beschouwt zichzelf als sociaal onbeholpen, onaantrekkelijk als persoon, of minderwaardig
ten opzichte van anderen.
o Is uitzonderlijk onwillig om persoonlijke risico’s te nemen of nieuwe activiteiten te
ontplooien omdat hij of zij hierdoor in verlegenheid zou kunnen worden gebracht.
-Zelfbeeld: kwetsbaar en incompetent
-Beeld anderen: kritisch en vernederend
-Kernopvatting: ‘als mensen mij echt leren kennen, wijzen ze me af’
-Strategie: vermijding
-Emoties: angst, schaamte, depressie, verdriet
-Temperament: lage dopamine, hoge serotonine, verlegenheid
-Opvoeding: overbezorgd, afwijzend of ouders zelf ontwijkend
Clinical description
The main features of avoidant personality disorder are persistent social inhibition (characterized by
avoidance of a wide range of social situations), feelings of inadequacy, and hypersensitivity to
negative evaluation and criticism. These tendencies appear in late childhood or early adolescence. Pts
are fearful of criticism, disapproval and rejection, and they automatically assume that others will be
critical and disapproving. They will avoid school, work and all group activities because of these fears.
Pts are generally shy, and cannot easily talk about themselves for fear of being ridiculed or shamed.
They also have a clear bias for interpreting ambiguous information and comments in a negative way.
Individuals with avoidant personality disorder are particularly ill at ease with strangers and will
usually avoid interactions with strangers at all costs.
Avoidant PD has many features in common with social
anxiety disorder. However, individuals with social
anxiety disorder tend to be made anxious by social
situations where particular levels of performance might
be required whereas the personality disorder is more
associated with (1) fear of personal interactions and
social relationships generally, (2) the criticism and
rejection that they believe will be associated with these
types of experiences, and (3) difficulties in being open
with people they are close to.
1
, SOCIAL PHOBIA AND AVOIDANT PERSONALITY DISORDER
Source: Lampe & Sunderland (2015)
Abstract
Avoidant personality disorder (AvPD) is regarded as a severe variant of social phobia (SP),
consistent with a dimensional model. The present study hypothesized that there are qualitative
differences between AvPD and SP. To test this hypothesis, the authors compared three groups (SP
only, AvPD only, and SP/AvPD) using epidemiological data (10,641 adults).
o The SP/AvPD group (n = 69) reported more distress and comorbidity than the SP only
(n = 196) and AvPD only (n = 116) groups, which did not differentiate from each other.
o More feared social situation were endorsed in the SP only group compared to the AvPD only
group.
Although the finding of few differences between SP only and AvPD only fails to provide support for
the hypothesis of qualitative differences, the finding that the AvPD only group appears more similar to
the SP only group than to the SP/AvPD group also fails to provide support for the alternative
continuity hypothesis.
The greater distress and additional comorbidity with depression associated with SP/AvPD may be due
to the additional symptom load of a second disorder rather than simply representing a more severe
variant of social phobia.
Introduction
The overlap between SP and AvPD has been estimated at 0-63% for non-generalized social phobia
(non-GSP) and 25-89% for generalized social phobia (GSP). This overlap may be due to drawing
conclusions from studies in which all persons had SP.
Despite the problems with criterion overlap and studies based on SP pts, there is support for viewing
AvPD as a distinct category of disorder. After controlling for depression, differences in treatment
outcome between SP only and SP/AvPD were seen more for self-esteem and trait anxiety than for SP
and avoidance, and lower self-esteem independent of the severity of comorbid SP was also reported.
It has been argued both that SP fulfils many of the criteria for a PD and that AvPD behaves like an
illness with a 50% remission rate over 24 months and remising following CBT. AvPD without
comorbid SP is rare, but a small number of studies suggest that it may be quite common.
The authors hypothesized that there are qualitative differences between AvPD and SP that are
obscured or undermined by studies that are based only on individuals meeting criteria for SP. It was
expected that the AvPD only group would be more likely to be divorced, separated, or never married;
less likely to be employed; less likely to have completed higher education; more distressed; more
disabled; to endorse more social anxiety symptoms; have more comorbidity; and to be no different
from the SP/AvPD group on these measures.
Pts were asked about six specific social situations (eating/drinking in public, talking to strangers,
writing while being watched, taking part of speaking in a meeting or class, going to a party or other
social gathering, giving a speech or talking in public), and were asked whether they had experienced
‘an unusually strong fear of any other situation where you could be the centre of attention’.
2
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