Borderline personality disorder (BPD) and historical variants of the diagnosis were long held to represent an intractable syndrome of psychopathology consisting of interpersonal, intrapsychic, and affective disturbances. For years, patients labeled "borderline" were regarded pejoratively due at least in part to the lack of effective treatments. Prospective data from recent naturalistic follow-along studies along with the development of treatments with empirically demonstrated efficacy have changed how BPD is viewed. It is now less common to hide the diagnosis from the patient, and BPD has become a useful label to guide the treatment process and help the patient make sense of his or her suffering. Although it is now accepted that BPD is a treatment-responsive disorder and that remission is the norm, more work is needed to help patients achieve a higher level of functioning, and targeting persistent trait-like features suggests new directions for future efforts in treatment development.
In this chapter, the evolution of the avoidant personality disorder (AVPD) diagnosis, its current status, and future possibilities are reviewed. AVPD is a chronic and enduring condition involving a poor sense of self and anxiety in social situations, and it is marked by fears of rejection and a distant interpersonal stance. AVPD may be conceptualized at the severe end of a continuum of social anxiety. In the extreme, traits, mechanisms, and symptoms become integral to chronic dysfunction in personality and interpersonal style. While AVPD is a valid diagnostic construct, the optimal organization of AVPD criteria for the diagnosis, and the relationship of avoidant personality traits to anxiety, remain to be determined.
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