Avoidant personality disorder - more than just social anxiety?

July 27, 2012 8:51 PM

I think I have avoidant personality disorder. I've never actually been diagnosed, but when you look at the behaviors and symptoms, there's really no question about it. What is my question is, can I fix it? Can I deal with it? What do I do?

I honestly just want to be able to say to people, "Look, it's not that I think I am too good for you guys. It's not that don't like you guys. It's not that I am building bombs in my basement instead of going out. I just have social anxiety." I am sure they think it's those other things and I wish people knew that I do like them and want to connect with them, but I get really nervous. Telling people you have social anxiety only makes things more awkward, I would think. But the thing is, it's really limiting my life.

I just started this new job and I have skipped every single social gathering offered. Our top boss at my office boss (like, dude you will never see or talk to because he's really important) threw a happy hour to thank our department for performing so well and I skipped it. If anything, it would've been a huge networking opportunity for my career. Birthdays, goodbyes, whatever, I skip them all. I either have an excuse or I simply don't go. My social network for my career is tiny and if I ever went through any sort of personal crisis or hardship, I would only have my immediate family (parent, siblings) and that is it. I'm in a new city with zero friends and yet I feel so much more comfortable and in harmony when I'm by myself, communicating with "friends" online where I share common interests. I feel relieved when I get back to my apartment -- which is why I think I've never dealt with my disorder before, because all I need to do is go home and be by myself and then it feels fixed. But I do not have a girlfriend and I haven't dated in years (my social anxiety only exacerbating the limiting fact that I am gay) and I don't see how I will ever meet someone.

The example today illustrates it perfectly: I was invited to go hang out in my office and watch the opening ceremonies with this department I am part of, but don't actually sit with because of organizational structure, and the thought of walking over there (other side of the office) into their area terrified me. I see them for meetings, but I barely interact with them direct and it's almost always for work. Like, walking into a situation where there's a bunch of people who are friends who I barely know was too much. In reality, it might've been slightly awkward or just not that fun at worst, but in my mind it just scared me to go over there. I wouldn't know what to say or how to act, I'd look uncomfortable and I'd make an ass of myself is what I thought. (Everything seems worse than it probably is. Logically, I know this, but it doesn't matter. Once I went to a work happy hour a few years ago and I felt awkward and unable to get a good conversation going with anyone -- when I got home I cried my eyes out.) Anyway, today my coworkers messaged me over email and told me to come over and I said I would after I finished working on something, and instead after a while I just went home. I kept looking up worried someone would approach me and ask me why I didn't come over.

Part of it I think is confidence. I don't take care of myself and I need to make working out and eating healthy part of my life. The only times I did date in my life were when I was also working out like everyday or making some sort of effort to feel confident. But beyond that, I don't know what to do. It's not like working out totally fixed my anxiety.

Can a doctor help me with this? Are personality disorders immutable? Like 10 years ago as a teenager I suffered depression and social anxiety. It manifested itself in me being "avoidant" -- I started skipping school completely because the thought of walking down the hall and having someone say hello to me terrified me. I did therapy for a couple years and eventually took anti-depressants and an anti-anxiety medication, which worked enough to make me functional and have me do the rest of the work in getting me in a good place. I came out of the depression and anxiety doing pretty well -- it was shortly after that time, in college, when I was dating and I even lived with a roommate at one point.

I live a transient life, moving from place to place for my job. And that makes it all OK, because I tell myself it's OK I don't have any friends because I am new wherever I go. And some places are better than others, so if it sucks I know I get to leave soon. And if it doesn't and I find myself having somewhat of a social life, then that's awesome and I can enjoy it while it lasts (because it can't last with my job). The truth is, I have no friends. My best friends are people I don't see much and can communicate with mostly over email and text. In fact, I've had people I communicated via email and chat for work and we hit off great, but once things changed and we were in the same location and could hang out in person, the friendship stopped because I would get out of seeing them or when I did, I'd feel nervous and awkward.

I've resigned myself to a life alone, but it's not what I want. Anyone with avoidant personality disorder ever gotten treatment or found anything that helps? Help for a lonely, awkward, scared person?

posted by anonymous to human relations (22 answers total)

Please don't diagnose yourself, hon. Go see a doc and print this out to show him or her. There is help and you do not have to live like this forever!
posted by St. Alia of the Bunnies at 8:55 PM on July 27, 2012 [3 favorites]

I did therapy for a couple years and eventually took anti-depressants and an anti-anxiety medication, which worked enough to make me functional and have me do the rest of the work in getting me in a good place. I came out of the depression and anxiety doing pretty well -- it was shortly after that time, in college, when I was dating and I even lived with a roommate at one point.

Wait, but it sounds like you *have* done something about this before - saw a doctor for avoidant behavior and social anxiety - and it worked? Can you start it up again? It seems to me that if therapy and medications made you functional enough to get to a good place, then that is really good evidence that this issue is not immutable.

(I sincerely apologize if this question isn't helpful but I'm just wondering if something has changed in your situation that takes this off the table or is making you think it wouldn't apply now?)
posted by cairdeas at 9:05 PM on July 27, 2012 [3 favorites]

i don't think st. alia's response is unhelpful, honestly. you've decided you have a personality disorder, but self-diagnoses are notoriously inaccurate. if you are suffering from something treatable like generalized anxiety disorder, then by far the best way to get that treatment is by seeing a qualified psychiatrist, the best one you can afford. i'm not saying this is the way things are, because i'm not a doctor and even if i were, you can't diagnose anyone over the internet, but you owe it to yourself to get qualified help rather than seeking out people who are going to validate your self-diagnosis.
posted by facetious at 9:10 PM on July 27, 2012

I've never known anyone with avoidant personality disorder, but I have known people with borderline and histrionic personality disorders who were able to benefit from treatment. They had to commit to their treatment in a very real and strident way. They had to really, really want to get better -- but they did benefit. I don't know if that would be true of someone with avoidant personality disorder, but it does indicate that personality disorders are not necessary "immutable", as you put it.

Also, I know you're feeling jacked up right now, but St Alia is right. She was addressing something you haven't asked about, but that still may need to hear: That self-diagnosis is not a great idea in your situation. You may have avoidant personality disorder, but you may have something else that could be even more responsive to treatment. For instance, something with a hellacious case of social phobia could have written this post, too.
posted by Coatlicue at 9:12 PM on July 27, 2012

Can a doctor help me with this? Are personality disorders immutable?

I think St. Alia's answer is relevant to that question.

A doctor or therapist may very well be able to help with this. It's probably unlikely that this part of you will go away completely, but it is likely that you can get some help with managing it, and reducing the amount it interferes with life you want to live. This help might be pharmacological, or it might be a set of techniques for managing things yourself, or a combination of the two.
posted by aubilenon at 9:12 PM on July 27, 2012

You can't diagnose yourself at all here, and neither can we. Please see a doctor. They can help you, but you need to be willing. Diagnosing yourself does nothing but keep you from the truth. Believe me. Best of luck.
posted by two lights above the sea at 9:12 PM on July 27, 2012 [1 favorite]

I can give you a list of reasons why seeing a doctor right now isn't going to happen: I don't have time to one every week given my work schedule. I probably can't afford it. I will be moving somewhere else in a few months. Etc.

All I really want to know is if this can be treated and what that entails exactly. You can tell everyone to go to a doctor or see a therapist for their problems. That's not what I am asking for. We can pretend a doctor already diagnosed me. I wanted to hear some other people's experiences on dealing with social anxiety or this disorder or techniques for coping. Maybe gleam a tiny bit of hope. But I guess that was too much to ask. I shouldn't have even bothered posting this.
posted by AppleTurnover at 9:20 PM on July 27, 2012

It sounds like cognitive behavioral therapy might help. It helps you work on identifying and correcting the behaviors that are problematic first (like ducking out on social gatherings, etc) to help you break the cycle of negative feelings. I'm not qualified in any way but I've done a lot of reading to figure out ways to fit myself, and CBT comes up a lot in these kinds of conversations.

If you really can't fit a therapist into your schedule there are workbooks and such that you can work through on your own. But before you rule that out, I would really make sure that none of the CBT therapists in your area will see you on a schedule that can meet your needs. (And make sure that not wanting to see a therapist isn't part of the social-avoidance thing. Maybe you can think of it as your first success in overcoming it.)

Given that you say you had therapy before and it helped, and this is such a behavior-driven problem, I think it's likely that working on it some more will help again.
posted by bleep at 9:30 PM on July 27, 2012

I feel so much more comfortable and in harmony when I'm by myself, communicating with "friends" online where I share common interests. I feel relieved when I get back to my apartment

IANAT...

However, I am just like this. I fricking LOVE to be all alone in my apartment. I like my friends online because I can politely log off when I want to be alone, and never feel "drained" by their presence. Nothing is more sweet to me than alone time.

So please don't confuse enjoying being alone with:

Like 10 years ago as a teenager I suffered depression and social anxiety

or:

Part of it I think is confidence. I don't take care of myself and I need to make working out and eating healthy part of my life.

In other words, you seem to be trying to throw all your issues (whether they be perceived or real) into the same diagnoses. You can have boat loads of confidence and be the most gorgeous person on earth and still like to be alone.

I would suggest really digging down deep and deciding if you truly like being alone because you are afraid/anxious, or if you just like being alone. Separating your issues may help you decided what is a problem versus a preference.
posted by Shouraku at 9:31 PM on July 27, 2012

I wanted to hear some other people's experiences on dealing with social anxiety or this disorder or techniques for coping. Maybe gleam a tiny bit of hope. But I guess that was too much to ask. I shouldn't have even bothered posting this.

Honey, I felt like this for YEARS- terrified of people, hated socializing, felt like I was the most awkward, most inept, most horrible and foolish person in the room, was convinced that everyone hated me and I was fundamentally unlikable- and the thing that helped me the most was medicine and therapy. I used the EXACT same excuses for why I couldn't pursue therapy and medicine as you are. I didn't have money or time and I was always about to move somewhere or go back to school or change my insurance and it had to wait.

After, like, what felt like about four days on the right medicine I could see that I had tortured myself for YEARS for no reason. I hope you won't do that as well.
posted by Snarl Furillo at 9:31 PM on July 27, 2012 [14 favorites]

We can pretend a doctor already diagnosed me.

This is exactly what we cannot, in fact, do. You would need to actually have a mental health professional evaluate your symptoms and give you a diagnosis, because the internet is not able to do so, and neither are you yourself. It's actually not going to help you to label yourself, get depressed about being whatever label, get mad at the internet for not supporting your self-diagnosis, and then feeling lost.

Here's a secret, from a mental health professional (but IANYMHP): the label doesn't really matter anyway. The diagnosis is just words and numbers. What matters is addressing the symptoms/behaviors that are troubling you, directly and effectively. What do YOU think would help YOU to feel more confident and comfortable?

You don't need to have weekly appointments if you can't afford it, and you don't need to assume that you can't see a therapist because you move around a lot, for what that's worth.
posted by so_gracefully at 9:32 PM on July 27, 2012 [21 favorites]

You gradually want to expose yourself to social situations that may be awkward or uncomfortable for you in a safe way. CBT therapists often go with their client to a specific place - say, a shopping centre - and there is a gradual introduction to the shopping centre experience that increases in length each time they go. You can do things like this on your own, but ultimately the buck stops with you.

Find low-risk events and situations that have very little weight to them and experience them. Feel uncomfortable, weird, awkward, and see how they have very little bearing on anything. Learn to feel comfortable within them and learn the skills you need to function in them. Gradually increase your exposure to these situations so that eventually you're dealing with situations like networking events.

It's a bit like driving a car - you don't take a car immediately out on the freeway - you start off in the back streets and build up your confidence slowly, acquiring more knowledge about how to do things as you go.

I had a fairly awkward lunch with an old friend recently and I don't feel much about it other than the fact that it was awkward. Ten years ago, I probably wouldn't have met with that friend at all or if I had have I would be still sitting here, days later, freaking out about all of the specific things that were said and just how massively awkward everything was. So it is possible to change things.

If you don't see a therapist, it is all really up to you. It's completely do-able, though.
posted by heyjude at 9:39 PM on July 27, 2012 [1 favorite]

Come on, AppleTurnover, two of the questions you asked were "Can a doctor help me with this?" and "What do I do?" It seems really unfair to lash out at people who were taking their time to answer your question and sincerely doing their best to be helpful and offer words of support.
posted by cairdeas at 9:40 PM on July 27, 2012 [4 favorites]

I don't know about avoidant personality disorder, but I've experienced severe social anxiety and clinical depression. Not what you want to hear apparently, but the right meds and therapy (but mostly the right meds, emphasis on right) have made the difference for me. I went from being someone who would sweat severely, get a headache, feel nauseous, and have a hard time breathing just while getting ready to go out to someone who exhibits none of those symptoms while getting ready and attending social events. I wasn't always that way but I had a lower level of social anxiety that was exacerbated by other issues. I definitely have participated in the same behaviors you described. No one here can diagnose you, but the answer is yes, personality disorders are treatable. Most require a combination of medication, counseling, and behavioral changes that are not easy to make, but pay off in the long run. You can make excuses for why this just isn't possible for as long as you want, but then things won't change. You sound miserable and lonely. You don't have to be either. Best of luck.
posted by katemcd at 9:44 PM on July 27, 2012

I can give you a list of reasons why seeing a doctor right now isn't going to happen: I don't have time to one every week given my work schedule. I probably can't afford it. I will be moving somewhere else in a few months. Etc.

All I really want to know is if this can be treated and what that entails exactly.

Let's assume your self diagnosis is 100% correct. The treatment still involves going to a doctor. You did this once already and it helped, so you already have good evidence that it can be treated!

Consider that your extreme defensive reaction to the advice you're getting here is itself a symptom: you're avoiding getting help for yourself. Your list of excuses for why you don't want to go to a doctor is the same avoidant behavior that is negatively shaping the rest of your life. (Literally exactly the same: you move constantly so you have an excuse for why you don't have friends; now you're using it as an excuse for why you can't seek help.) Money and time are bad excuses -- this is your potential happiness we're talking about here; that's worth spending money on, and you can make time for it. You really can.

You don't have to resign yourself to being alone and unhappy. But the first step in solving this has to be to seek out a therapist and a doctor. Treatment is probably going to involve some combination of medication and talk therapy or behavioral training and learning how to take care of yourself and physical exercise which is good for the mood and for self confidence and it's going to be a lot of work and you're going to hate doing it but it will still be better than where you are right now.
posted by ook at 9:59 PM on July 27, 2012 [12 favorites]

A friend of mine does have avoidant personality disorder (and I'm diagnosed with schizoid). Can we do something about it? Probably, yes. You can't "cure" a personality, but you can ease the symptoms and get to a point where you overcome the distressing ones. Can we deal with it? Yes, sure. Are we happy with our lives? For the most part, yes. You, however, don't sound like you're happy with your life at all. And that's the difference.
Thing is, you say you like being alone, but you also mention several times that you don't want to be alone. So you don't actually like it. You tell yourself you like it and come up with excuses why it is okay, but that's not the same as liking it. It's pretty much the opposite. It doesn't matter if you have avoidant personality disorder, social anxiety, general anxiety disorder or depression (or none of these); you obviously profit from seeing a therapist and can't "deal with it" on your own. Otherwise you'd not be asking this question.
So that's your answer: Yes, you can treat it and yes, you can deal with it - but not without professional help. Get over the real fear - that a professional tells you your self-diagnosis isn't correct and you'd lose the easy way out; telling people "it's not you, it's my illness, don't judge me, I can't change it".
posted by MinusCelsius at 12:01 AM on July 28, 2012 [1 favorite]

Give up caffeine for a couple of weeks and see if that shifts your mind around to the point where seeking professional help seems more doable.
posted by flabdablet at 4:11 AM on July 28, 2012

Someone who was once studying to be a therapist here.

Personality Disorders are called "personality disorders" because they are an integral part of the personality. There is, for example, Obsessive Compulsive Disorder and Obsessive Compulsive Personality Disorder. Sound like the same thing, right? You'd be wrong. Someone with obsessive compulsive personality disorder can function and may not see what is wrong with their obsessive tendencies because it is just a part of who they are. Someone with obsessive compulsive disorder is upset by their symptoms and can't function because of them. Personality disorders are tricky beasts because you can't really change personality the way you can, say, treat depressive disorders with medication and because they can be a nuanced variation on another disorder that lacks the personality component.

Point being, if you have a personality disorder, the only people who have business diagnosing you are a psychiatrist, psychologist, independent social worker, professional clinician, mental health counselor, or whatever licensing terms your area uses for professional mental health worth workers.

You appear to be distressed by how you interact or do not interact with other people. This is negatively affecting your life and you want to change it. You need to see the people who can, at the very least, diagnose you if a diagnosis can be made. Whether you then seek treatment within the health systems available to you or choose an alternative method to work on your situation is up to you. But personality disorders are serious things. If you think you have one, it's worth finding out for sure. You should be able to have a one time evaluation with a testing psychologist or psychiatrist who can provide some more insight on what may be going on and can suggest treatment methods.
posted by zizzle at 5:25 AM on July 28, 2012 [1 favorite]

I'm going to go against what everyone is saying here. In particular: if you are suffering from something treatable like generalized anxiety disorder, then by far the best way to get that treatment is by seeing a qualified psychiatrist, the best one you can afford.

I am going to reframe your question by removing the medical model. What you are suffering from is problems in living. Our culture likes to call this a disease and offer high priced solutions but I'd like to suggest that there are better ways to think about your situation, and that living is inherently problematic and, yes, scary.

The phrase I used, "problems in living" is not mine, but was popularized by a psychiatrist, Harry Stack Sullivan. I'd like to add another phrase "There is nothing wrong with you." This is the title of a book by Cheri Huber--one, I might add, that is often recommended in AskMe.

It is the feeling that there's something about you that makes you different and wrong that powers what you have called "social anxiety disorder." You feel somehow unacceptable by others so why would you be comfortable around them? You could reify this wrongness as a disease and seek an expensive expert, or you can accept that your discomfort around others makes actual sense from the perspective you are taking. Part of what you would learn in CBT is that the feelings that keep you isolated are intensified by the cognitive distortion that they are justified by your wrongness--your "disease." That it is normal to feel some anxiety in meeting new people but that you can learn to tolerate these feelings and not use them to distort the situation to make you feel bad about yourself and to withdraw socially. In fact, you have successfully participated in the social world in the past and it is mainly the distance from this past that makes you feel uncomfortable now. This discomfort then becomes the norm and you avoid more and it becomes self-perpetuating.

OK. Now that I've played contrarian a bit, let me concede that the others posting here aren't totally wrong when they say that therapy can help you with your suffering. Psychiatrists can prescribe pills to ease your more uncomfortable feelings and talk therapy can make you feel better about what you're going through and give you more perspective, but as you say: "I can give you a list of reasons why seeing a doctor right now isn't going to happen: I don't have time to one every week given my work schedule. I probably can't afford it. I will be moving somewhere else in a few months. Etc."

Others may ease their social anxiety with a drink or two (you could call it self-medicating, but it's extremely common and considered a normal accompaniment to meeting new people in our culture) but they don't believe they are treating a disease--just "lubricating."

If you choose to go the therapy route, you might find an inexpensive social worker is more helpful than a psychiatrist, "the best you can afford." Therapy isn't a particularly efficient market and paying more is no guarantee that you'll be getting someone better.

P.S. IAAT, but not yours.
posted by Obscure Reference at 6:05 AM on July 28, 2012 [11 favorites]

These diagnostic labels, "avoidant personality disorder," etc., are ways to lump groups of people together, mostly for insurance purposes. They are not diseases with common origins and known "cures."

Obscure Reference, in my opinion, says it best with: "It is the feeling that there's something about you that makes you different and wrong that powers what you have called 'social anxiety disorder.' You feel somehow unacceptable by others so why would you be comfortable around them?"

yes he got your self-diagnostic label wrong, but it doesn't matter.

well maybe it does matter: it's interesting that the label you've chosen is a personality disorder ("Axis II"), rather than an "acute" (Axis I) disorder. You've decided that your condition is a more recalcitrant, lifelong one, *and* you appear quite "resistant" to doing anything about "it" (you).

I could say more, like about how your identity seems to be very tied up with this "disorder," even though of course you hate "it." I would wonder how you might actually feel if you were more "one with" other people (if you were to loosen those tight boundaries you have around yourself that you experience as protective against your anxiety).

And other stuff I would ask you about if I were your therapist - but I'm not.

Avoidant Personality Disorder seems like a "cause" of your problems because it's a "disorder" and disorders and diseases are the causes of problems, right? well, in this case, think about it. The avoidance is actually the Result, not the Cause. The result of what? Anxiety. So there we are, in the anxiety again, and round and round. Nothing about this "diagnosis" answers the question, "*Why* are you so anxious around people?" And now we are back to the initial quote from Obscure Reference's post.

Anyway, back to "practical solutions":

What can you do without professional assistance? you could do that "systematic desensitization" kind of thing where you provide yourself with tiny "doses" of the thing you fear (like tell yourself, "I'm going to sit with these people, but only only for five minutes, then I'm going to excuse myself"), that sort of thing. And you could do some reading like Cheri Huber's book. If it were me I'd want to more about "how did this happen to me? why do I have the point of view about myself that I have developed? Is it necessary for me to maintain this point of view? if so, why? What if I gave it up? What are the dangers? What is scary about people in person, not in a computer? etc."

But most important, I want to chime along with the others who say, you don't have to keep living like this, and staying in one place for the purpose of obtaining some help might be worth professional advancement that comes at the cost of remaining in this terribly painful state you're in.
posted by DMelanogaster at 7:06 AM on July 28, 2012 [3 favorites]

We can pretend a doctor already diagnosed me.

We can, but we really, really shouldn't. I sometimes struggle with hypochondria, and believe me when I tell you that diagnosing yourself is a terrible, terrible idea. I know you're approaching this is some kind of "what if I'm right about this" scenario, but the more you think about it that way, the more you're going to convince yourself that you have this personality disorder, and that there's nothing that can be done.

Why would you do that? Because your anxiety is familiar to you, and comfortable in a way, and so some part of you is resisting getting better. This makes sense, since right now you're scared of social interaction, and getting better is going to involve social interaction, so of course the idea of improvement is going to make you anxious. But that anxious part of you is going to keep throwing up roadblocks, supplying you with reasons why you can't go to the doctor, and convincing you that it's hopeless and you're stuck this way. But it's not, and you're not.

If anti-anxiety medication has helped you in the past, it may help you again now. The only way to know is to go see a psychiatrist. You don't go to a psychiatrist every week. You go once for a diagnosis, and then every few months to make sure things are still working. If you had tuberculosis or pneumonia, you'd go to the doctor. Go to one now.
posted by Ragged Richard at 9:00 AM on July 28, 2012 [4 favorites]

I think it's just very difficult to meet people we can relate to. Some people relate to a broader range of personalities and therefore seem to have unlimited friends. I know people like this and I would never want to trade places with them. While it works for them, it would never work for me, as I see these relationships being superficial, albeit pleasant, and draining. I would much, much rather spend time by myself than with people I am not really bonded to. Like you, I do feel lonely, but being more sociable would not alleviate this, and in fact would just stress me out, as it does you. Instead, I have taken the approach of working on unconditional acceptance of myself. If I happen to meet someone I click with, then I nurture that relationship, although I admit it happens so rarely it's almost a nonissue. But there are people out there who will fit the bill, so in the meantime work on unconditional acceptance, meaning deeply loving who you are always, no exceptions.
I recommend books by Mark Epstein, MD, a psychiatrist who specializing in the great big void we feel and how to live happily with it.
posted by waving at 7:33 AM on September 4, 2012