Exploring Avoidant Personality Disorder and Social Anxiety

David and Rhonda begin with two emails (among many) from listeners asking for more help on the problem of social anxiety.

Email from “Margaret:”

Hi David,

How do you distinguish a personality disorder - say, for example, Avoidant Personality Disorder, from "just" (and I don't mean that in a derogatory way) being depressed and anxious?

I ask because I have a strong suspicion that I may be suffering from Avoidant Personality Disorder, and I think if you knew my history you would probably agree that there are strong signs (I have been having problems from my early childhood until now, and I am 30 years old now).

Also, a further question – is it possible to have severe anxiety without feeling like the confrontation with the thing you’re afraid of means you’re going to die? I have isolated myself completely, and I have no social life in any sense of the word – my only real contact with the outside world is through my job, because it is a necessity for living. But it’s not because I think I’m going to die if I hang around people – I just very strongly dislike it and ‘shut down’ or ‘freeze’ due to all the thoughts in my head about being negatively judged and watched, so I prefer to avoid contact with people, and in situations where I’m forced to endure it, I’ll usually find ways to ‘avoid’ or escape the situation. 

There are many ways I do this – since I was very young I’ve had the habit of purposely looking annoyed, so that people would not approach me, even though I secretly wish they would (oh, the paradox..), and at work I will often be listening to music with earphones – both because the music calms my anxiety, and because it makes me appear less ‘available’ to other people. 

In situations where I cannot escape crowds – say, in the canteen during my lunch break - I’ll sit by myself, as far away from everyone else as I can, and leave as soon as I have taken the last bite of my food. In college I would often hide in the bathroom by myself during breaks, or I would avoid interpersonal contact in some other way. And so on and so forth. These are just a few examples – I could give you a million others. 

I am aware of my own behavioral patterns but still feel powerless to change them. It’s like being an observer, observing yourself committing the same mistakes over and over, but with an anxiety so strong that rationality alone is not enough to change the behavior. After 30 years of this, it’s getting old. I have never felt any other way, so I cannot fathom what it means to lead a normal life.

I have never had a friend in any usual sense of the term, and I literally never spend time with anyone in my spare time except for my parents. As a consequence, I have never learned or understood how to make friends, and I have never been in an intimate relationship, or taken part in any of the social activities that are normal to other people (parties, school dances, etc.) The simplest things are rocket science to me. So, I’m interested to know when a person crosses over from “simply” being depressed or anxious into having a personality disorder.

If you use any of this for a future episode I am fine with that - you can even quote me directly. But I only ask that you please don't use my real name as to not jeopardize my job and so on. Thank you. 🙂

Kind regards,

Margaret

David explains that there is no such thing as “Avoidant Personality Disorder.” It is just an imaginary concept created by the American Psychiatric Association, and is applied to individuals with shyness that is so severe that it causes significant problems in their lives.

And yes, you can definitely deal with mild, moderate, or even extremely severe problems with the TEAM-CBT as well as exercises in my books, such as The Feeling Good Handbook, When Panic Attacks, and Intimate Connections.

They also read an email from “Abdul,” a podcast fan who’s been struggling with shyness.

I’m from Pakistan. Please make podcasts on shyness and public speaking and other anxiety issues.

I have anxiety shyness. My father has also anxiety. I know he is not happy. I also sometime feel exactly like him.

And one of my cousins is very much depressed. He is a cleaner in a garments shop. He always use to pack clothes all the time even if they are kept properly.

Dr burns please guide us. It would be very very helpful.

Sorry if I wrote anything unprofessional.

Thank you.

Several days later, David received an additional email from “Abdul:”

My social anxiety has returned back. In my office I feel very lonely. 

Here my negative thoughts:

1. I should say something impressive.
2. I'm good looking so I should not be anxious.
3. I should talk to girls.
4. I should say hi to people.
5. I should mix with people.

Today and next week, David and Rhonda will describe how to treat / overcome shyness using TEAM-CBT. David explains that this is probably his favorite problem to treat, since he himself has struggled with every conceivable form of social anxiety, so he really knows how to defeat this problem. 

But to start out, David and Rhonda want to see how shy YOU are, so they administered David's Shyness Test verbally to listeners. if you'd like to take the paper and pencil version, click here. You'll also find the scoring.

How did you do on the Shyness Test?

We'll publish them next week, too. You'll find Jason's Daily Mood Log, the Recovery Circle, the Downward Arrow Technique, and more. These visuals will help your learning!

We always start with a Daily Mood Log, focusing on how you were thinking and feeling at a specific moment when you felt shy. We don’t just throw techniques at patients based on a problem (shyness) or diagnosis (Social Anxiety Disorder). We're all different, so the treatment is highly individualized. 

Rhonda and David describe a shy young man  named Jason who wanted to flirt with an attractive woman checking groceries when he was inline at his local supermarket on a Saturday. However, he was flooded with Negative Thoughts and feelings, and by the time he got to the front of the line, he was so terrified that he avoided all eye contact with the checker, and didn't even say a word to her, when she checked his groceries. He left the store feeling like a total loser.

David and Rhonda talk about reducing the Outcome and Process Resistance before trying to “help” Jason, or any one who's anxious. Outcome Resistance means that Jason may have some pretty strong resistance to recovery, in spite of how much he's suffered, even if all he had to do was to press a Magic Button and be instantly cured.

Process Resistance, in contrast, means that if Jason does want to recover, he’ll have to use some Interpersonal Exposure Techniques that will be frightening to him. Is he willing to do that if David agrees to treat his shyness?

David and Rhonda illustrate how to do Positive Reframing , listing all the really positive things about Jason's negative thoughts and feelings.  They encourage listeners to turn off the podcast briefly, and see if they can list some positives before listening to the list that David and Rhonda generated. I'd encourage you to do that, too, while listening. Try it yourself before you see the "answers."

They discuss how they might issue a Gentle Ultimatum, along with Dangling the Carrot and “Sitting with Open Hands,” to reduce Jason’s Process Resistance. 

Once Jason's resistance has been reduced, they will go on to the M = Methods of the session, and focus on how to help Jason challenge the Negative Thoughts that Jason had while standing in line waiting to check his groceries.

Next week, they'll describe the methods they selected and describe what happened when David used them during his session with Jason.