From: “Synopsis of Causation – Personality Disorder” (for the Ministry of Defence), by Dr David Christmas (University of Dundee), September 2008.

“Cluster C (anxious/fearful) – contains avoidant personality… In terms of diagnostic criteria, for some personality disorders (histrionic, dissocial, and anxious/avoidant), ICD-10 has a slightly higher threshold, requiring more criteria to be met for diagnosis.”

Anxious (avoidant) personality disorder… Clinical features (4 should be present). People with anxious personality disorder exhibit a high degree of anxiety, feeling tense and apprehensive in most situations. They are preoccupied with being criticised or rejected in social situations. Often they will feel inferior, unattractive, or socially inept. As a result, they will frequently avoid social or occupational situations which involve personal contact for fear of criticism or fear of rejection. They are often afraid to trust people, and will avoid social contact unless they are certain of being liked. Due to their anxiety and need for physical security, they tend to lead a restricted lifestyle. These people may also have features of dependent personality disorder and many will meet criteria for social phobia.”

The dopaminergic system in the brain is involved with behavioural adaptation to rewarding stimuli. Associations have been reported with polymorphisms of the dopamine D2 receptor and schizoid/avoidant behaviours, suggesting that common abnormalities of dopamine function may contribute to disorders on the schizophrenic spectrum. Such findings have yet to be replicated by other genetic studies and remain associations only.”

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“Anxious (avoidant) personality disorder… Since the core feature of this disorder is avoidance of social situations, it is thought that such individuals may be on a spectrum that includes anxiety disorders such as social phobia. As with most personality disorders, a degree of inheritance of biological vulnerability is assumed and those with reduced self-esteem from overly-critical parenting tend to be socially avoidant, which will perpetuate the problem throughout schooling. Little is otherwise known about the causes of this personality disorder.”

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“Other studies have identified that individuals with PTSD are more likely to have personality dysfunction of a number of types: paranoid, borderline, and avoidant.”

“Psychodynamic psychotherapy. Only certain types of personality disorder may respond to ‘insight-oriented’ treatments such as psychodynamic psychotherapy. Such disorders include anankastic, anxious (avoidant), and dependent types. Such treatment may require as long as 5 years to show any benefit. The number of studies is small, but psychodynamic psychotherapy appears to have reasonable effect sizes.”

www.gov.uk/government/publications/synopsis-of-causation-personality-disorder

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