Subjective experience of the origin and development of avoidant personality disorder

Abstract

Objective To better understand how persons diagnosed with avoidant personality disorder (AVPD) make sense of the origin and development of their current everyday struggles. Methods Persons with AVPD (N = 15) were interviewed twice using semi‐structured qualitative interviews, which were analyzed through interpretative‐phenomenological analysis. Persons with the first‐hand experience of AVPD were included in the research. Results The superordinate theme, “a story of becoming forlorn,” encompassed three main themes: “it goes all the way back to when I was little,” “there was a distance between others and me,” and “transitions made it worse.” Conclusions Though the results are not necessarily specific to AVPD, the findings clarify how people with AVPD can make sense of their current struggles by constructing developmental life stories in the interplay between themselves as persons and the growing demands of their social world. Furthermore, childhood relational vulnerabilities may challenge the ongoing development of social cognition and skills.

The significance of connectedness: avoidant personality disorder patients’ subjective experiences of change after attending a specialized treatment program

“…So, perhaps the participants who fared worse experienced their relational agency as poor: How could they be in control of what happened to them in an interpersonal space driven by both their need to position themselves within the social rank system and their need for belonging when all their previous experiences had likely taught them that control is out of their reach? Many people diagnosed with AvPD have a history of neglect and trauma, bullying, a growing relational and emotional distance to others, and a fear of abandonment ( Rettew et al, 2003 ; Eikenaes et al, 2015 ; Hageman et al, 2015 ; Sorensen et al, 2020 ). Thus, their perception of having to adapt to others, fearing the intentions of others, and feeling excluded in the social or intimate world may likely reduce or limit their sense of both personal and relational agency ( Sorensen et al, 2019a ).…”

“…Avoidant personality disorder is associated with significant interpersonal and attachment difficulties, and patients often present extensive social impairment ( Beeney et al, 2015 ; Eikenaes et al, 2015 ; Kvarstein et al, 2021 ). Many AvPD patients describe developmental experiences characterized by emotional distance and inhibition, a sense of detached insecurity in close relationships, reduced verbal sharing of psychological states, and deficient social learning experiences ( Sorensen et al, 2020 ). People diagnosed with AvPD may struggle with ongoing insecurity and doubt, both longing for and fearing connecting relationally to others as well as to themselves, thereby resorting to various coping strategies that could alienate them from their sense of self and agency ( Millon, 1992 ; Sorensen et al, 2019a ; Weme et al, 2023 ).…”

Psychotherapy as making

“…For instance, when baking a cake it is necessary to understand the causal effect of heat on cake ingredients. Similarly, in therapy, (Carter et al, 2017;Midgley et al, 2017;Sørensen et al, 2020). Another strategy is to use time in therapy to talk about causality and develop a shared causal understanding (Eells et al, 2011;Newman et al, 2013;Larkings et al, 2019Larkings et al, , 2021.…”

“…An important characteristic of the experience of therapy is that it can often involve acting in new ways – a client who is depressed may have always suppressed their feelings, and as a result will have little basis for being able to know what kind of effect being more open to feelings will have on them ( Paul and Healy, 2018 ). An important strategy for learning about ‘what will work for me’ in therapy is to develop a causal explanation of how one’s problems developed, and what has been successful (or not) in the past in relation to managing them ( Carter et al, 2017 ; Midgley et al, 2017 ; Sørensen et al, 2020 ). Another strategy is to use time in therapy to talk about causality and develop a shared causal understanding ( Eells et al, 2011 ; Newman et al, 2013 ; Larkings et al, 2019 , 2021 ).…”

Combined group and individual therapy for patients with avoidant personality disorder—A pilot study

“…Poor reflective functioning both regarding own and others mind are characteristic of patients with severe disorder (16)(17)(18). Further, fearful and detached attachment, emotional distancing, lack of feeling close or connected, difficulties sharing personal material and deficient social learning experiences are part of the core problems of many patients (19)(20)(21)(22)(23). Such features may vary among patients, but will influence the patients' motivation for treatment, their ability to form a working alliance with a therapist or therapy group, and the therapeutic processes (24-26).…”