A Long-Term Therapy for Avoidant Personality Disorder

People diagnosed with Avoidant Personality Disorder (APD) display hallmark symptoms of feelings of inadequacy, extreme sensitivity to criticisms, and social inhibition, all of which are often accompanied by other emotional problems, ranging from depression, hyper-anxiety, to uncontrollable loss of temper. According to one study made by the American Psychiatric Association, as one type of Cluster C personality disorder officially recorded by the Diagnostic and Statistical Manual of Mental Disorders, Symptoms of APD create inconvenience and varying levels of harms to patients regardless of their desires for connections (American Psychiatric Association, 2013). It is agreed that notable characteristics led by the diagnosis of this mental disease significantly reduce individuals to a negative situation shaped by factors of extreme anxiety, discomfort, as well as isolation from the outside world. For a long time, the likelihood of relation between the development of APD and dysfunctional social behaviors featuring fears and reluctance of contacts has remained high and increasingly served as one object of the investigation made by many clinicians and researchers (James Reich, 2010). Examinations based on different methods and evaluating criteria have been focusing on APD’s ways of influencing social behaviors. As a growing number of researchers show interests in the factors that lead to the psychological illness, people’s experience in their early childhood has been identified as related to the patterns of Avoidant Personality Disorder (Ingeborg Eikenaes, Jens Egeland, Benjamin Hummelen, Theresa Wilberg 27 March 2015). With numerous studies engaging in the childhood responding system’s relevancy to the gradual formation of APD, perceptions concerning the role of adverse childhood experience are primarily targeted at emotional abuse, sexual abuse, and neglects caused at both physical and emotional levels (TK Hageman, AJ Francis，AM Field, and SN Carr 2015). Children who are shy, when exposed to unprotected conditions where suitable supports and guidance from parents are lacking, are likely to eventually meet the diagnostic standards of APD thar can cause severe impairments affecting mental, somatic, and social activities of individuals (Anna Weinbrecht, Babette Renneberg, Johanna Boettcher, Lars Schulze 2016).

Facing the evidence that reveals the linkage between the primary signs of APD and early manifestations of children, few apparent improvements in the researching field, however, have occurred in terms of making clear the forms of this mental disorder. Largely due to the nature of being difficult to be diagnosed, this particular mental disorder is confronting challenges regarding the efficient mitigation of hypersensitivities and withdrawals in people. Nowadays, by giving treatments that are aimed at identifying unconscious thoughts and improving patients’ daily behaviors in professional and social areas, psychotherapy is the most commonly used and effective method in countering fears and inferiority during self-assessments (Rose Kivi, Marijane Leonard Retrieved in 2016). However, it was pointed out by a research conducted in 2005 that the addictive use of substance, such as marijuana, heroin, and cocaine, has been ignored during most psychotherapy sessions, contributing to a vicious cycle of Avoidant Personality Disorder and substance abuse and worsening the health of patients (Giancarlo Dimaggio, Madddalena D’Urzo, Manuela Pasinetti, Giampaolo Salvatore, Paul Lysaker, Dario Catania, Raffaele Popolo 2015). Therefore, a knowledge of substance abuse, from which people with APD could achieve temporary reliefs, and childhood maltreatment, leads to the conclusion that the combining force of the two aspects contributes to a social outcome of fears, inhibitions, and self-devaluations. This essay, through concentrating on these factors, aims to elaborate on their dominating effects in giving rise to ill mental functions that hinder people’s interpersonal and social relationships and develops a coping strategy involving extensive treatments and in-depth investigations. This essay illustrates that a full package of methods, including ease of compulsive use of drugs, emotional bonds with patients, awakenings of self-awareness, and provision of knowledge considering patients’ performances and their impacts on the quality of familial and social life, would resolve the therapeutic problems and bring hope to APD patients. The availability and full implementation of this strategy would promote positive changes in the reduction of low self-esteems, inadequate feelings, and the overall pessimism of patients. A comprehensive analysis of the psychological needs of patients and negative factors caused by their living environments, combined with follow-up surveys on their adaptation to treatments, requires a long period in order to achieve full recoveries of patients.

Also known as Anxious Personality Disorder, Avoidant Personality Disorder tends to afflict people through making them suffer from feelings of incompetence, timidity, as well as self-negation in extreme cases. It turns out possession of these feelings, which result in varying levels of morbidity manifested in the avoidance of social connections and low life performances in different spheres, could most probably be caused by childhood experiences. Based on the observation of Andrea Markel, who is one Medicine Researcher from the United States, patterns of avoidant behaviors, which are the result of one’s social, genetic, and mental practice, are caused by traumatic events that occur to children whose actions could be generalized as “learned behaviors (Andrea Markel July 2012)”. In a majority of cases, children in their early age go through unhappy experiences characterized by violence carried out by their family members, disagreement or rejection, as well as exposure to occasions that cause fears. Confrontations of these feelings, when ignored by parents who achieve failures in providing educational supports at the right time, could leave severe traumas on the minds of children and hinder their paths to future through causing mental disorders (Peter R. Joyce, Janice M. McKenzie, Suzanne E. Luty, Roger T. Mulder, Janet D. Carter, Patrick F. Sullivan and C. Robert Cloninger, 2003). In other words, childhood emotional restraints and shyness worsened by the negligence of parents offer an essential premise for the formation of pathological functions, which could be Avoidant Personality Disorder shadowing future adults’ life.

Another retrospective study conducted by Harvard Medical School and McLean Hospital in 2003 did a thorough investigation into the elements of risks and early signs of APD announces a similar result capable of adding convincing proofs for the linkage between the severe syndrome and childhood experiences. By adopting a method named Childhood Experiences Questionnaire-Revised, the study selects a number of 146 adults diagnosed with APD as the object of comparison with 371 mentally ill people with different types of personality disorders, and 83 patients reported with major depression disorders and no personality disorders. By placing its primary goal on assessing the early role in society and pathological childhood behaviors, in the form of interviews given by professional clinicians, outcomes of the study provide a valuable perspective on the relation. It shows that compared with the depressed group and respondents developing other personality disorders, adults who develop APD display a poor level of athletic skills during their childhood and adolescent periods, few participations in hobbies during adolescence, and a low degree of adolescent popularity in society than (David Rettew, Mary C. Zanarini, Shirley Yen, Carlos M. Grilo, Andrew E. Skodol, M. Tracie Shea, Thomas H Mcglashan, Leslie C. Morey, Melissa A. Culhane, and John G. Gunderson March 2012).

Regardless of the conclusion that different kinds of abuse are not particular to APD, the study indicated that patterns of APD are manifested in encounters during childhood. In understanding the ways of development of personality disorders, Joel Paris offers another authoritative explanation through the application of a biopsychosocial model and a focus on cumulative and interactive effects of childhood (Joel Paris, 1994). Paris notes that with complex factors accumulated by biological, psychological, as well as social activities, children’s temperaments susceptible to varying difficulties could develop into the pathological syndrome when they are affected by traumatic losses and neglects. Instead of overcoming their shyness, a certain number of children having introversive behaviors enter a worse situation when their families couldn’t provide necessary supports. It is not difficult to comprehend that with the passing of time, psychological and emotional obstacles in maintaining healthy social interactions reduce children to withdrawals and nervousness, the continuation of which could ultimately meet standards of the diagnosis of avoidant and dependent personality disorder. Hence, traits of shyness and timidity that are possible to end in morbidity of APD patients, whether severe or relatively mild, can be summarized as complex factors caused by insensitivities of parents, negative mental experiences, and inadequate protections of environments.

As one object of research, Avoidant Personality Disorder has been little studied and confronting a situation of few apparent progresses, with the focus mainly placed on searches for evident proofs over distinctive aspects separating APD from other disorders (Lisa Lampe, January 2016). Besides, among the studies that emphasize APD as their central concentration, addresses of the whole issue primarily deal with two fields: pursuits of helpful therapeutic methods that merely involve case studies or controlled investigations and etiological examinations including early attachments and their impacts. Of the reasons contributing to the difficulties of the advancement of this psychiatric area, one primary factor lies in deep complexities concerning the diagnosis of Avoidant Personality Disorder that could differ itself from symptoms of other psychiatric diagnoses (Toshimasa Maruta, Masaaki Kato, Chihiro Matsumoto, Makio Iimori August 2012). As a well-recognized treatment, psychotherapy is one approach most commonly applied by therapists to APD, with detailed measures of face-to-face talk therapies laying the foundation on whether psychiatric disorders of patients could fit into several standards. Avoidance of activities requiring contact with the outside world, reluctance in maintaining relationships, fears of rejections, and inferior senses serve as the frame of references helping therapists identify thoughts that patients are unaware of and encouraging them to replace restraints with values that are correct and positive.

After an evaluation over the efficiency of the therapy generally used, one research entitled “Metacognitive Interpersonal Therapy for Co-Occurrent Avoidant Personality Disorder and Substance Abuse” offered criticism of significant flaws. Several co-authors, while developing their version of therapeutic plans, explained that the co-occurrence between people’s personality disorders, including APD, and their addictive habits of using heroin, cocaine, or alcohol is very common. According to these researchers, substance abuse problems are crucial factors that aggravate the health of the mentally ill people and facing a peril due to clinicians’ inability to treat the abuse as one significant priority of solutions. The persuasiveness of their literature could be seen in one example that illustrates numerous patients’ behaviors combining personality disorders and overuse of substance. By borrowing data from one study conducted in 2014, several authors’ efforts of demonstrating the relation is shown in the announcement that the co-occurrence between substance abuse and personality disorders is so common that about 90% of people who develop an addition to drugs are personality disordered (Morken, K., Karterud, S., and Arefjord, N, 2014).

Behind the statistics, there is a more outstanding problem generally defined as the culture of illicit drug use, an issue that deserves attention from not only medical organizations engaging in effective treatments but also governmental policies. Substance abuse involving prescription drugs as well as alcohol is one phenomenon capable of providing short-term reliefs for the mentally disordered people who desire to elevate their images during sustaining interpersonal relations. In the case of Avoidant Personality Disorder, people lean on the substance to deal with the pathological syndrome, including withdrawals and depressions. Although the nation’s position in fighting against the abuse pattern has been consistent and clear, illegal drugs have been the main source of people’s additions, adding difficulties for the recoveries of APD patients. It is estimated by the Office of National Drug Control Policy that about $ 100 billion worth of illicit drugs were traded in 2013 (Chris Matthews, September 2014). Data from the Organization of American States gives an estimate that sales of cocaine arrived at $34 billion in 2013. Governmental policies on drug controls, measures against deliveries of unlicensed drugs, distributing procedures, and possessions of individuals have been steps away from success. Supplies of drugs and purity have reached an unprecedented high when governmental attempts are primarily employed on giving interdictions and enforcing law, rather than the improvement of the health of citizens (Wood E, Tyndall MW, Spittal PM, et al., 2003). Without any question, the nation’s lack of power regarding eliminations of illegal drug trades and the co-occurrence between substance abuse and mental illness provides room for the consideration of more effective treatments able to help overcome the severity of APD and facilitate positive bodily and psychological changes of the mentally diseased persons.

While proposing a solution addressed as Metacognitive Interpersonal Therapy, several authors, Giancarlo Dimaggio, Madddalena D’Urzo, Manuela Pasinetti, Giampaolo Salvatore, Paul Lysaker, Dario Catania, and Raffaele Popolo, drew an emphasis on clinicians’ imbalanced operations. Through introducing a method involving five central pathological steps, their aim was to resolve the shortcomings of today’s operations that either neglect APD symptoms or the effects of substance abuse. Implementation of drug therapies, improvement of fundamental metacognitive abilities, emotional ties, maladaptive interpersonal schemas, and facilitation of the use of adaptive tackling skills, were included as the major steps supporting their arguments. It should be noticed that in giving their solution, these authors ignored one important fact that was confirmed in 1989 by one research: Avoidant Personality Disorder that occurs frequently is determined by forces of long-term habits beginning at childhood period and requires long time to adapt to treatments, making insufficient of a short-term therapy (Lynn Alden, 1989, pp.763). It is likely that Metacognitive Interpersonal Therapy, through basing on displayed symptoms of morbidity and disorders, brings benefits to APD patients suffering from the cycle of drugs and long-standing sensitivities and fears. However, positive changes improving the condition of disordered people’s habitual avoidance don’t equal one hundred percent recoveries from their mental illness. By delivering a therapy where lengths of treatments may last for several months, they are losing sight of one of the most extraordinary truths: psychological impairments are so severe that a longer period of time is required to counter complicated factors, ranging from biological and psychological consequences to environmental effects that are hard to measure.

The procession of treatments, considering the seriousness of patients’ withdrawals, hyper-anxieties, as well as extremely low ability in accepting criticisms, should be patient and slow, even slower than with individuals who are afflicted by fears and inhibitions in society. Long-term treatments for substance abuse aim to prevent individuals from continuing their addictive use of drugs and combine behavioral therapy with medications, daily observations, selections of drugs varying in accordance with physical conditions of different patients (nihseniorhealth.gov., Retrieved in 2016). During the process, the objective of behavioral therapies, which could be monitors of contingency or Cognitive Behavioral Therapy, is to block individuals’ desires for drugs and minimize possibilities of relapse through programs of positive life-value communications. In order to give meaningful talks, addresses of early traumatic memories and experiences leading to feelings of low-esteems or unpleasant events are inevitable for maintaining mutual trust in the clinician-client relationship. Besides, the promotion of open-mindedness from the treatment objects creates convenience for courageous attitudes in viewing their past, increasing self-recognition, and relieving tensions. As the foundation of the treatment, these steps play a crucial role in helping avoidant personality disordered patients step away from their psychological shadows and boost their confidence.

An educational purpose during giving therapeutic treatments, especially when dealing with the psychologically avoidant patterns originating from early life stages, becomes significantly crucial for patients to shake off the illness and move forward. Active and frequent instructions over their mental status, the significance of maintenance of interpersonal relationships, including marriages and intimate parent-children contacts, and knowledge of social responsibilities are critical for their transformation of attitudes. The implementation and optimization of this tool of education is solidly based on one principle that is enduringly valuable: individual actions that shape moods of families and communities draw profound impacts on society. The relation between the mental activities of every single individual constituting society and the ethos of a nation is inseparable. This fact provides insights for the nature of a long-term clinical intervention that includes a slow process of keeping track of patients as well as their situations of adapting to treatment requirements or meeting program targets. By countering substance abuse and disrupting the pattern of people’s habitual psychological avoidance, a higher level of compatibility between personal behaviors and social conduct, which is the goal of this therapeutic strategy, is needed. Instead of focusing on the speed of improvements of avoidant personality disordered patients, an ultimate purpose of clinicians, when assessing the benefits of these necessary steps, should be put on complete recoveries regardless of the duration of time.