January 13, 2026 • 36 mins
In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) unpack the DSM’s Avoidant Personality Disorder (AvPd), exploring its hotly debated history, the DSM criteria, and its overlap with social anxiety. We discuss the developmental aspects of AvPd, the challenges of low self-esteem with this disorder, and how it can cause problems in employment. We end with our own unfiltered thoughts on whether or not we think it should be a diagnosis, questioning the zeitgeist in which it was coined, the lack of historical research, and its overlap with multiple other personality disorders.
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Chapters 00:00 Intro, History, & Controversy 03:42 Avoidant Personality Disorder: DSM 05:41 Social Inhibition and Fear of Criticism 08:14 Intimacy Issues and Fantasy 10:41 Self-Perception and Feelings of Inadequacy 14:49 Taking Risks and Employment Issues 17:09 Developmental Implications of Avoidant Personality 19:04 Avoidant Personality vs Social Anxiety 24:29 Unfiltered Thoughts on Avoidant Personality Disorder 35:10 Summary & Conclusion
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(00:00):
Welcome to the personalitycouch podcast where
we discuss all things personalityand clinical practice.
I'm your host DocBok, and I'm here
with my cohost Doc Fish. Weare both licensed
clinical psychologists in privatepractice. And
today we are starting a newseries on avoidant
personality disorder. We have had a huge
(00:22):
response to our schizoid seriesand multiple questions
came up about the differencebetween schizoid
and avoidant because there'sa lot of overlap,
and they have similar if notthe same origins.
So in this episode, we go throughthe DSM criteria
for avoidant personalitydisorder, compare
and contrast it to socialanxiety disorder,
(00:42):
and also share our unfilteredthoughts and
skepticism about it as adiagnosis. We have
a lot to cover as usual.So let's dive in.
Avoidant coined by Millon in1969 is an active
aversion to social relationships, which
contrasts with schizoid personalityas a passive aversion
to relationships. Prior to 1969,Millon notes that
(01:07):
there were descriptions of whathe believes to be
avoidant, which mostly includedmistrustful
social styles and those withhistories of extreme
criticism in childhood. And that is what
he calls parental deprecation.Specifically,
he mentioned Fairburn's schizoid includes the
mistrustful social style andhistory of disapproval
(01:30):
from caregivers. So maybelike part of why schizoids
turtle or have like ahard protective shell.
Okay, so these features alsooverlapped with
Kohut's narcissistic personality,right? So in
the mistrust that others willattack their image
or ego, most likely in a waythat happened early
(01:51):
in childhood though, withthese hypercritical
parents. Exactly. But thenotherwise, he starts
his description of avoidantpersonality way later
than other personality types.Yes, yes. And this
is why we have mixed emotions about this personalitybecause its origins are much,
(02:11):
much later than other personalities.And also it
was coined at a time of heightenedcivil unrest
in the United States. So wetalk about this more
at the end, we have a lot ofopinions about it.
So stay tuned if you thinkthat's interesting.
Okay. But avoidant personalitydisorder wasn't
introduced in the DSM until1980, when schizoid
(02:34):
personality disorder wassplit into schizoid,
schizotypal and avoidant.Since that split,
though, theorists have been arguingand they still are.
Okay, so reading the letters that they
wrote back and forth to eachother in journals,
because that's how they communicatedat that
time. It's so entertaining.Check out the American
(02:54):
Journal of Psychiatry from about 1985 to 1989for some lovely comic filled reading.
Exactly. Yes, yes. And themain argument here
among these shrinks was howschizoid and avoidant
were split up in the actualDSM. So one of
the major critiques was thatthe DSM categories
(03:16):
overlapped too much and were too vague to
capture different disorders,which we actually don't
disagree with that. Butthat also led to a
deeper argument about whetherschizoid and avoidant
should conceptually be splitup in general,
which is the main point ofcontention among
these earlier shrinks dukingit out in the
(03:37):
American Journal of Psychiatry,right? But with that said,
let's hop to the DSM criteria that was so
hotly debated. So like anypersonality disorder,
the DSM-5-TR notes that hasto be lifelong,
pervasive, and present in multipleenvironments
and situations. So it's stable,it's enduring,
(03:59):
it doesn't just randomly showup one day. For
avoidant personality disorderspecifically,
the main patterns includesocial inhibition,
feelings of inadequacy and hypersensitivityto negative evaluation.
So social inhibition, meaninglike socially
restrained or holding backin relationships.
(04:20):
So if you've been followingalong with our
previous schizoid and schizotypal series,
you'll notice that the socialinhibition is part
of all three schizoid,schizotypal and avoidant.
And then there has to befour or more of the
following criteria. So thefirst criterion is
avoids occupational activitiesthat involve
(04:42):
significant interpersonalcontact because of
fears of criticism, disapprovalor rejection.
So basically work is influenceddue to fears of
negative evaluation, disapprovalor rejection,
especially work that involvessocial interactions.
So they attempt to avoid meaningfulinterpersonal
(05:02):
contact in their job, evenif it's important for
the job success or advancement.So for example,
they might turn down a promotionbecause they're
fearful that failing to doa good job in the new
position could result in otherscriticizing them.
Their avoidance can seriouslyimpact their job
functioning. So that fear, notjust a failing, but
(05:25):
of what people will say is fierce. Right.You can hear the underlying insecurity
and the need for social approval because
criticism is that scary. Exactly.And that leads me to the
second criterion, which isunwilling to get
involved with people unless certainof being liked.
(05:47):
Mm hmm. So that fear of what people will
say or wanting others to viewthem positively
is all encompassing and theyavoid new people
unless they are very sureof approval and not
rejection. They have a foundationalbelief that
others are critical, disapprovingand rejecting,
and they are super aware and vigilant of watchingothers' movements and expressions.
(06:11):
So then others need to passtests and jump
through hoops to shed thatdefault assumption.
Which sounds exhausting, right?And this means
that avoidants have a hard timemaking new friends
and often avoid group activities.So they might
become pretty isolated and don'toften have bigger
(06:32):
support networks again due to that fear.
Yes. Okay. And then we havethe third criterion,
which is shows restraint within intimate relationshipsbecause of the fear of being
shamed or ridiculed. So becauseof the fears
of being criticized or ridiculedor shamed,
exposed, et cetera, intimacy is hard and
(06:54):
troublesome. There's fear ofgetting too close.
So avoidants might act withrestraint, avoid
talking about themselvesand not share their
intimate feelings. But ifthey feel safe and
are super assured that theywon't be judged or
criticized, they can show interpersonal
intimacy. I actually, interestingly,I see this in the
(07:17):
paranoid personality dynamics too, right?
But conversely, because theyactually do desire
affection and acceptance fromothers, it can move
to fantasy. So they might fantasizeabout idealized
connections with others instead of
actually engaging in them. Sohere is some of that
(07:38):
overlap with schizoid, right?And resorting
to fantasy. This actuallyreminds me of an
episode we did recently on when paranoid
personalities kill. And wetalked about Timothy
McVey. Yes, because he hadfantasies about being
a superhero, which later developedinto interest
in the military and disillusionmentwith heroes.
(08:00):
And then that led to a muchbigger plot with the
Oklahoma City bombings. Sointeresting. Yeah.
And I know that we're talkingabout avoidant here,
but there is some overlapwith paranoid and
schizoid, both really have difficulty
with intimate relationshipsand can resort to
fantasy to get their needsmet where it's safe
(08:21):
and people don't hurt you,which then leads
to criterion four. So theyare preoccupied with
being criticized or rejected in social
situations. So they think and worryabout this constantly,
which means they are always on alert for thepossibility of criticism or rejection.
And they can detect if someoneis being like even
(08:41):
the teensiest bit critical ordisapproving. Yeah,
so their threshold for pickingthat up is like
super low. And then, of course,they feel extremely
hurt. Yeah. So they reactstrongly to even the
most subtle cue that may suggestsomeone is mocking
them or showing contempt. And sometimes
they misinterpret others likeneutral gestures,
(09:04):
statements or responses as critical or
rejecting, which in turn confirmstheir self doubts,
which is technically a confirmation bias.
Yeah. Yeah. And in this way,avoidants have a hair
trigger very similar to borderline
personality, but borderlines arepreoccupied with fear of
abandonment and scan relationshipsfor the
(09:27):
slightest cue of being leftbehind. And they often
create dynamics in which thisfear is realized
for the avoidant, though, eventhe slightest whiff
of criticism can set themoff and lead to a
counter attack or possiblywithdraw from the
relationship. So both havehair triggers that
(09:47):
can look incredibly similar,but for slightly
different reasons. But basically the
avoidant's reaction to critiqueis like a borderline's
reaction to abandonment. Yes,that is a great point.
But also what if the avoidant'sreaction to critique
is parallel to the narcissisticreaction to
ego hits, which could alsobe criticism? Yep.
(10:11):
And this is where some ofthe early shrinks
were debating. Like, is theretoo much overlap with
the avoidant and other personalities?This is
such a good point. Yeah,because there's the
narcissism overlap too, whichagain, this makes
sense why this personality disorderis so debated
just in talking about it.We can see those
(10:31):
connections. Absolutely.But let's go to the
fifth criterion. So they'reinhibited in new
interpersonal situations becauseof feelings of
inadequacy. So because avoidantsfeel inadequate
and have low self-esteem, theyare not confident
acting like themselves innew situations. They
are afraid that no matterwhat they say or do,
(10:54):
others will see them as wrongand flawed. So
really they tend to not saymuch, if anything,
and then they fear and avoidany attention
because it might be criticalor rejecting. Thus,
they come across as shy, timid, quiet,
inhibited, lonely, isolated, andsometimes even invisible.
(11:16):
So this hypersensitivity torejection and low
self-esteem lead to reducedsocial functioning
and interactions, meaning thatthey may be hard
to get to know. However, theyreally do desire
and yearn to be social andinterpersonally active.
They're just really scared toessentially put their
psychological welfare in thehands of others.
(11:39):
Ooh, I like that. Yeah. Yeah.So then that leads
to a conflict of whether or not to put
themselves out there or to stayisolated, right? And just
enjoy the fantasies of socializationwhere it's
safe. And here I'm also justthinking about this
low self-esteem, this poorsense of self-worth,
(12:01):
and that's really what setsthe avoidants apart
from schizoids. So schizoidsoften have a cohesive
sense of who they are and theirself-esteem is less
contingent or often not atall contingent on
the appraisal from others. Yes,that's actually a
really good point. And thatbrings me to the next
(12:21):
criterion. So criterion sixis that they view the
self as socially inept, personally
unappealing, or inferior to others.So for some avoidance,
their belief that they aresocially incompetent
and personally unattractivecan be most intense
when interacting with strangers.But for many
(12:41):
other avoidants, they havemore difficulty with
repetitive interactions becauseit leads to
an increased expectationof sharing personal
information. And then thatincreases the risk
that any of their flaws or inferioritymight be seen,
which means they could be criticizedor rejected.
And this here is really sad.So to feel like you
(13:04):
don't have something to bringto the table in
relationships, that's tragic,right? This core
belief of not being enoughruns really, really
deep. So in therapy, I wouldbe asking, "Where did
you learn this message?" Yeah,and that kind of
pairs up with the initialconceptualization of
(13:25):
avoidants having highly criticalparents, like not
just invalidating parents, butcritical ones that
become an introject. So anintroject is like
when we absorb an external stimulusinto the self,
so it becomes part of us in our psyche,
like it's one with the psyche.So the critical
parent's voice becomes onewith the avoidant and
(13:47):
their core sense of identity.Yes, the introject,
yes. So then a core buildingblock of their
character is what you're sayingis feelings of
ineptitude, sometimes becauseof upbringing and
being reinforced in that way.Yeah, and I think
this is where avoiding getscloser to maybe phobic
(14:07):
characters and neuroses becausethey suppress their
own needs and impulses andself so that they
don't get criticized. Yeah,because that belief
about the self is so strong,it's integral to
the psyche. Yeah. And thenwith that, as ongoing
interpersonal commitments,either social or
work-related start requiring therepetitive interactions,
(14:31):
avoidants might start to convincethemselves over
time that others are seeingthem as valueless and
inferior. Oh, wow. And thenthat leads to distress
that's not tolerable and oranxiety that leads to
evading others or maybe evenquitting. And I
can see how this cycle of quittingjobs, right,
(14:51):
and starting a new one couldreally exacerbate
these fears and really makemore conflict. Like,
I can't stay in this job becausethey see me for
my faults and ineptitude. Butto get a new job is
to put myself out there againand risk being
seen as incompetent or not enough.Yes, and there
(15:11):
absolutely can be a historyof repeated job
changes. Yeah, it's actuallya major theme. The
biggest outward problems involvedwith avoiding
is difficult social and workfunctioning. And I can
see how that could lead toa stuck point of
unemployment in severe casesbecause going
through the interview processwhere you're putting
(15:33):
your best self out there, showcasingyour strengths,
right? Like, that's not goingto come naturally
to the avoidant. And the fearof rejection at the
interview or criticism canbe enough to keep the
individual from keeping a stablejob. Yeah. And
that's a great segue into thelast criterion. So
criterion seven is there'sunusual reluctance to
(15:57):
take personal risks or toengage in any new
activities because they mayprove embarrassing.
So they are actually likelyto like exaggerate
the potential dangers of ordinarysituations,
which basically just means thatthey can be super
anxious in a way that's outof proportion to the
actual event. Yeah, likea job interview, a
(16:19):
date, maybe new social interactions,right? So this
results in a lifestyle that is restricted
because they have high needsfor security,
assurance and certainty. Butas we know, life is
full of risks and unknowns.So this can lead to
missing out on really coolopportunities that
(16:40):
would help them feel more positivelyabout themselves.
So then what we have hereis this negatively
reinforcing cycle where theavoidant doesn't
feel confident enough todo something, which
then just fuels the fear thatthey're not good
enough because good experiences,
relationships, jobs, etc., don'tcome their way because they
(17:00):
have a hard time putting themselvesout there.
Yeah. All right. Well, that'swhat the DSM says
about the criteria, butit also highlights
interesting things in the developmentand course
of avoidant personality disorder.Ooh, let's
go there. Yes. Okay. So thereare points in
development where shyness andsocial withdrawal
(17:23):
and like stranger danger fearsthat lead to avoidant
behavior are appropriate.So early childhood,
middle childhood, sometimeseven adolescence.
But the difference is thatit subsides over
time as a youth gets olderand enters adulthood.
Now, in contrast for those with avoidant
personalities, the shynessfears, withdrawal,
(17:46):
they increase in severity with age, like
coming to a head in adulthood,which is interesting
because that's kind of whenwe start seeing a
focus on forming intimate relationshipswith others,
creating families of their own and
arguably when most people startworking full time.
This makes so much sense.Yeah. Yeah. And then
(18:09):
this developmental story arcis where you can see
that personality disorders existover time, right?
Because personality disordersdon't just come out
of nowhere. Sometimes at disorder level
functioning, the individualseems to get stuck
in a developmental stagefrom way earlier in
childhood. So not growingout of these quirks
(18:31):
can be an indicator of moregoing on. So something
else though, that's importantto point out is that
many people have traits ofavoidant personality.
We've talked a little bit abouthow it overlaps
with schizoid borderline, paranoid,
narcissistic, et cetera, but perthe DSM an avoidant trait
is that full blown personalitydisorder level
(18:52):
when it's pervasive, enduringand inflexible.
So it's going to cause majorlife disruption
and impairment in relationshipsand at work.
Exactly. The DSM also notesthat there's a ton
of overlap between avoidantand social anxiety.
And social anxiety is decently common. So
(19:13):
let's talk a little bit aboutthat. Yeah. Now,
I don't remember exactly who, but some
theorists suggested that socialanxiety is an ego
dystonic syndrome and avoidant personalitydisorder is an ego syntonic syndrome.
What does that mean? So itmeans that social
anxiety is outside of whothe person is. Well,
(19:34):
avoidant personality disorderis wrapped up in
the identity and the innerworkingsof the person.
That is so interesting. Sothis is a really
cool way to think about it. Likeis the dysfunction
one with the person or not?Similarly, some
theorists say that avoidantpersonality disorder
is a more severe form of socialanxiety disorder.
(19:57):
But while I think there's someoverlap personally,
like I think social anxietycan be part of
avoidant personality disorder.I do see some
distinct differences heretoo. Yes, there are
differences between socialanxiety and avoidant
personality, especially inrelation to self
concept. Avoidant personalitydisorder involves
(20:19):
pervasive, entrenched low self-esteem and
feelings of inferiority. Whilesocial anxiety simply
involves maybe sometimesfeeling negatively
about the self, but alsosometimes not. The
insecurity is not all encompassing.It is not
part of the whole person. Yeah.Yeah. Good point.
(20:39):
So then according to the DSM, avoidant
personality disorder can occurwithout social anxiety
disorder. So it's not necessarilya pathway of
severity or even a prerequisite.Like there are
also risk factors that increasethe chances of
developing social anxiety andthen different risk
(21:00):
factors that increase the chancesof developing
avoidant personality disorder.So this suggests
that they are two separatedisorders. Anyway,
let's talk about what socialanxiety disorder
is for a minute so that wecan understand the
overlap. Okay. So social anxietyis extreme fear
(21:21):
in social situations wherethey are potentially
being evaluated or scrutinizedby others. So for
example, new social interactions,eating or
drinking in public, giving aspeech, taking a test.
The fear is about a negativeevaluation from
others. It's less about apersonal feeling of
ineptitude or inadequacy,but more so that
(21:43):
their performance or socialinteraction will be
embarrassing, humiliating, offensiveto others, or
maybe leads to rejection frompeers. Yeah. So the
fear isn't just random or inconsistent,but it's
experienced consistently duringsocial situations.
Social situations are eitheravoided or if
they're unable to be avoided, theyare experienced with
(22:06):
intense fear and anxiety. Butthis fear is out of
proportion to the actual situationand it has to
last for six months or moreand it needs to cause
significant distress or impairmentin their ability
to function. Right. And it's not due to
substances, another medical condition,or another mental
(22:29):
disorder like panic disorder,body dysmorphia, or
autism. It can also be a performanceonly if the
fear is restricted to speakingor performing in
public. Right. Right. Yeah.So the overlap here
between social anxiety andavoidant personality
is that both put the emphasison others' feedback.
(22:51):
Right. But that feedback orfear of a certain
type of feedback is what triggersthe anxiety
in these types, which leads to avoiding
situations or people where thatfear could come to life.
For the socially anxious,it might be avoiding
giving that speech in speechclass or for the
avoidant not applying forthat promotion for
(23:14):
fear of criticism about themas an employee.
So the key difference betweenthem is that in
social anxiety, the individualis more so afraid
that their performance or thesocial interaction
will reveal something thatis not actually true
about them as a person. Sofor example, if they
can't make the grade, it meansthey're not a good
student. Or if someone said something
(23:36):
embarrassing, it means you're a badperson. Their anxiety about
their performance isn't relatedto a negative
self appraisal. In avoidant,it's almost like their
fear is being discovered as inept, which
confirms their self view, meaningthat any inkling of
perceived criticism meansthat they're outed.
(23:57):
So socially anxious individualsstill care about
the evaluation of others, but not because
they're trying to hide feelingsof ineptitude.
Right, right. It's almostthe opposite that
they're afraid it's going to revealsomething about them
that's not true. Like you said,like, Oh, I must
be a bad student if I can'tmake the grade. But
it's not like they believe that about
themselves. It's not like onewith their identity.
(24:19):
You got it.
Yeah. So super helpful to distinguish.So thank
you for bringing that up, DocFish. But I do want
to spend a little bit of timetalking about our
unfiltered thoughts about avoidant.I know we got
into this in another episode,a few ones back on
schizoid versus avoidant. ButI think we do need
to talk about that a littlebit here. So Doc
(24:39):
Fish, what are your unfilteredthoughts about avoidant
personality disorder? Oh boy.All right. Well,
honestly, avoidant personalitydisorder confuses
me. Why? Because it overlapstoo much with other
things. And I think maybe itmight fit better into
the anxious avoidant phobic psychodynamic
(25:00):
personality, but I'm also not100% sold on that
either. So avoidants in myexperience, like,
they do seem more neurotic ratherthan borderline or
psychotic. And their fearis of being seen
as inadequate, which is technicallynot even
something that develops until like, each
three, like a three year oldis essentially when you
(25:22):
start developing embarrassment.So before three,
you can't like... they don't.... theydon't understand
embarrassment. Anyway, soneurotic, that is
like, the core wound starts aroundage three or six;
borderline or psychoticis before that. So
like, I feel like it fitsin the neurotic box,
which is the phobic characterin psychodynamic.
(25:45):
I don't know. I don't know.It doesn't make sense
to me. And then there's aflavor of narcissism
in hiding and protecting theego. Oh, there's a
flavor of schizoid and like the social
inhibition and fantasy, a flavorof borderline because of
that like chase dodge dynamic.And I would say
a decently strong flavor ofparanoid and their
(26:08):
fear that others are dangerousdue to others'
capacity to reject or criticizethem. Yeah,
yeah, I'm hearing you here,Doc Fish. This is
really interesting. And I dothink that there's
a hidden underbelly of narcissismhere. It's more
of a vulnerable side to it,but it's still a pop
of color to this personalityto the avoidant
(26:30):
personality. And I do seewhat you're saying.
There's a lot of overlap with other
personality types. And actually,as you were talking,
it reminded me of the Enneagram. So the
Enneagram is another classificationsystem. We won't get
into all the ins and outs ofthat. But just real
quick as a nugget for thoseof you who know the
Enneagram, the avoidant soundsto me like the
(26:50):
unhealthy side of the Enneagramsix, which is
this more fearful personalitytype in this
classification system. Okay,so that is exactly
what I was thinking. Because so, so okay,
the six is a fearful type,they desire support,
but then it neighbors theseven, which is like
(27:13):
kind of narcissistic, it canbe and the five,
which can be very schizoid-ish, which are... that's
like two of the things thatoverlaps for like the
pops of flavor. And then,well, counterphobic
sixes are like, they're sixes,but they go against
the grain. So they are stillfearful, but they
(27:36):
run towards fear. Yes, yes. That'sa way to beat it.
Yeah, yeah. And they can,if really, really
unhealthy, they can be on thetrack to paranoid.
Right. So that makes, yeah, that makesme think maybe a six. Anyway,
no, I appreciate your inputhere. Yeah, yeah. And
then also what you brought upabout going back to
(27:56):
developmental stages and allof that. And that is
all important to the functionof the psyche and the
personality. But with the Enneagram
specifically, like, I'm just thinkingabout like, this is the
head center of functioning,we're talking about
five, six, and seven, and,you know, being prone
to withdrawal or even self absorptioninto fantasy
(28:18):
or the maybe some grandiositythere too. So I think,
I think that there's something here, but
anyway, this is just a littlenugget for our listeners
and viewers who are avid Enneagramfans. But let
us know in the comments, ifyou guys would want a
series on Enneagram, there'sreally a lot to
unpack. That's a whole different,fascinating,
awesome classification systemthat we love. But
(28:41):
it is a lot to get into. AndI don't want to lose
people in explaining all ofit because it's so
much. But if you are interested,let us know,
because we can, we can go there, but you
need to let us know thatwe should go there.
Open the nerdy box. Right. Okay.
Pandora's box. Yeah. All right. Well, DocBok, what do you actually think of
(29:06):
avoidant personality disorder?Yeah, yeah.
I'm not too far off of whereyou are with this,
Doc Fish. But the piece thatstands out to me is
like, why in the world werewe so stinking late
to the game in naming avoidantpersonality
disorder and specificallythe 1960s, right?
(29:27):
Spawning from Schizoid, theysplit them up. But
like 1960s was a time of massivecivil unrest.
There was a global distress.It was the civil
rights movement here in theStates. Like racial
tensions were at a boilingpoint. President JFK
was assassinated. I mean, likethere were so many
(29:48):
things in the 60s that peoplewere on edge and
there was a time of risingup too. So as I said
before in our other episodewhere we talked
about this, like if we were todip a ladle from the
personality soup into thezeitgeist of that
time, like would more fearfulpersonalities come up
(30:12):
in that ladle? I think theywould. So kind of
similar to now, like if wewere to take a ladle
full of dysfunctional personalities,like right
now in this post pandemic timeframe,I think we
would see different flavorsthan we would had we
taken a ladle back in 1990?Like there has to be
longevity. And will this personalitywithstand the
(30:35):
test of time? Like that's, that'sthe question in
my head here. Yeah, that's fascinating. Sothat actually kind of reminds me of how
hysterical personality was coined duringa time of female sexuality suppression.
Or paranoid personality really popped upand increased with the recent pandemic.
(30:56):
So like there is stuff that'srelated to the
social world. Oh, absolutely.Yeah. Personality is
definitely correlated withthe social world.
But again, like some stuff withstandsthe test of
time and generations, likenarcissism, for
example, I mean, hello, we havethat. There's examples of
that in the Bible, for goodnesssake. Or if
(31:17):
you just look across the centuries,there's been
grandiose characters or narcissisticcharacters,
like among, among others, there'sother personality
styles that also withstandthe test of time.
But that sticks out to me aslike, one of the most
significant ones, but would avoidant,would avoidant
withstand the test of time?And then that leads me
(31:38):
to the question, what ifit is just a trait,
right? Yeah. So a trait thatmaybe you can turn the
volume up and it could existin any personality
disorder, maybe at varying levels,but especially
if there's disorder levelpersonality, maybe
they're more prone to having thatvolume knob turned up.
(32:00):
So again, similar to narcissism.So narcissism
is also a trait. It's alsokind of one of the
first ingredients in all themajor personality
disorders. So if you're making,if you're making
a personality cookie, so to speak, your
narcissism is going to be the flourin the recipe. Like,
you got to have it. It's goingto be there. So
avoidant maybe is like yourchocolate chips or
(32:21):
your raisins or whatever you put in your
cookies. Like maybe there canbe a pop of color there
that gives more texture tothe dysfunction. But
yeah, again, I think maybethere's like a volume
button that goes up and downdepending, depending
on the personality disorder.So I don't know what
your thoughts are about that,but yeah, I mean,
that makes sense. I think that'sa, that could be
(32:43):
a very real possibility. Ihave to sit with that
a little more. Yeah. Yeah. Sothen the last thing
that, that comes to mind for me is I am
skeptical about Millon and as muchas we love him, he is a
awesome personality theoristin our opinion, one
of the greatest of all times,if not the greatest
of all time, I can't help butwonder if his ego
(33:05):
got in the way here, becauseif I recall, he needed
a personality to contrast againstschizoid, right?
Active and passive. Yep. Heneeded an active. And,
and I can't help but wonderlike, did he make this
up? Like he seemed really convincedof it and maybe
he was, but he had a lot ofpushback about it.
(33:25):
A lot of people arguing withhim in the journals
and not just there, but alsoin the DSM task
force. So the task force thatis designed to basically
say, do we keep this in theDSM or do we not
like a group of, of researchersand shrinks that get
together. And there was a lotof pushback, right?
Like not everyone was thrilledabout it becoming
a personality disorder. Andhe was telling them
(33:47):
to sit down and they didn'tknow what they were
talking about. Right there.There was a lot
of controversy and arguingit about it being a
separate disorder. So yeah, itis super interesting
to read their discussions andpassive aggressiveness
about it. Yeah. Yeah. That'sa possibility.
Yeah. So it was hotly debatedand, and I see why
(34:10):
because I'm still on thefence about it. And
maybe in this series, I willcome to a different
conclusion as will you Doc Fish as we're
getting into the research, gettingour hands dirty,
looking at where this camefrom and is it real
and kind of up against ourclinical experience.
But I mean, with clinical experience, Ihave, I have diagnosed it like, yeah,
(34:31):
yeah. I have technicallyseen patients that
check the boxes in the DSM, right?But typically when
I do diagnose it, there'smore textures and
layers and colors to theirpersonality that that
diagnosis alone doesn't capture. So yeah,
anyway, that's where I'm at. I'm,I'm sus. I'm sus on
this one. I hear you. I amalso skeptical. I am.
(34:55):
Yeah. And last thing I'll sayhere is if you're
interested in hearing moreabout this, check out
our avoidant versus schizoidepisode, because we
do go into more in depth aboutour opinions here
and what the research says.So I will link that
in the show notes, but so fortoday, we learned
about avoidant personalitydisorder according to
the DSM, how it's differentfrom schizoid, and our
(35:17):
skepticism surrounding thisdiagnosis. So we hope
that you'll tune in for therest of the series.
So don't forget to like subscribe,give us a shout.
We've also got blogs, visuals,and references that
coincide with each episode atwww.personalitycouch.com.
But on that note, that'sa wrap. Thank you
for joining us today on thisepisode. Be well,
(35:39):
be kind, and we'll see younext time on the
personality couch. This podcastis for informational
purposes only and does not constitute a
professional relationship. If you'rein need of professional
help, please seek out appropriateresources
in your area. Information aboutclinical trends
or diagnoses are discussed inbroad and universal
terms and do not refer to anyspecific person or
(36:02):
case.
Welcome to the personalitycouch podcast where
we discuss all things personalityand clinical practice.
I'm your host DocBok, and I'm here
with my cohost Doc Fish. Weare both licensed
clinical psychologists in privatepractice. And
today we are starting a newseries on avoidant
personality disorder. We have had a huge
(00:22):
response to our schizoid seriesand multiple questions
came up about the differencebetween schizoid
and avoidant because there'sa lot of overlap,
and they have similar if notthe same origins.
So in this episode, we go throughthe DSM criteria
for avoidant personalitydisorder, compare
and contrast it to socialanxiety disorder,
(00:42):
and also share our unfilteredthoughts and
skepticism about it as adiagnosis. We have
a lot to cover as usual.So let's dive in.
Avoidant coined by Millon in1969 is an active
aversion to social relationships, which
contrasts with schizoid personalityas a passive aversion
to relationships. Prior to 1969,Millon notes that
(01:07):
there were descriptions of whathe believes to be
avoidant, which mostly includedmistrustful
social styles and those withhistories of extreme
criticism in childhood. And that is what
he calls parental deprecation.Specifically,
he mentioned Fairburn's schizoid includes the
mistrustful social style andhistory of disapproval
(01:30):
from caregivers. So maybelike part of why schizoids
turtle or have like ahard protective shell.
Okay, so these features alsooverlapped with
Kohut's narcissistic personality,right? So in
the mistrust that others willattack their image
or ego, most likely in a waythat happened early
(01:51):
in childhood though, withthese hypercritical
parents. Exactly. But thenotherwise, he starts
his description of avoidantpersonality way later
than other personality types.Yes, yes. And this
is why we have mixed emotions about this personalitybecause its origins are much,
(02:11):
much later than other personalities.And also it
was coined at a time of heightenedcivil unrest
in the United States. So wetalk about this more
at the end, we have a lot ofopinions about it.
So stay tuned if you thinkthat's interesting.
Okay. But avoidant personalitydisorder wasn't
introduced in the DSM until1980, when schizoid
(02:34):
personality disorder wassplit into schizoid,
schizotypal and avoidant.Since that split,
though, theorists have been arguingand they still are.
Okay, so reading the letters that they
wrote back and forth to eachother in journals,
because that's how they communicatedat that
time. It's so entertaining.Check out the American
(02:54):
Journal of Psychiatry from about 1985 to 1989for some lovely comic filled reading.
Exactly. Yes, yes. And themain argument here
among these shrinks was howschizoid and avoidant
were split up in the actualDSM. So one of
the major critiques was thatthe DSM categories
(03:16):
overlapped too much and were too vague to
capture different disorders,which we actually don't
disagree with that. Butthat also led to a
deeper argument about whetherschizoid and avoidant
should conceptually be splitup in general,
which is the main point ofcontention among
these earlier shrinks dukingit out in the
(03:37):
American Journal of Psychiatry,right? But with that said,
let's hop to the DSM criteria that was so
hotly debated. So like anypersonality disorder,
the DSM-5-TR notes that hasto be lifelong,
pervasive, and present in multipleenvironments
and situations. So it's stable,it's enduring,
(03:59):
it doesn't just randomly showup one day. For
avoidant personality disorderspecifically,
the main patterns includesocial inhibition,
feelings of inadequacy and hypersensitivityto negative evaluation.
So social inhibition, meaninglike socially
restrained or holding backin relationships.
(04:20):
So if you've been followingalong with our
previous schizoid and schizotypal series,
you'll notice that the socialinhibition is part
of all three schizoid,schizotypal and avoidant.
And then there has to befour or more of the
following criteria. So thefirst criterion is
avoids occupational activitiesthat involve
(04:42):
significant interpersonalcontact because of
fears of criticism, disapprovalor rejection.
So basically work is influenceddue to fears of
negative evaluation, disapprovalor rejection,
especially work that involvessocial interactions.
So they attempt to avoid meaningfulinterpersonal
(05:02):
contact in their job, evenif it's important for
the job success or advancement.So for example,
they might turn down a promotionbecause they're
fearful that failing to doa good job in the new
position could result in otherscriticizing them.
Their avoidance can seriouslyimpact their job
functioning. So that fear, notjust a failing, but
(05:25):
of what people will say is fierce. Right.You can hear the underlying insecurity
and the need for social approval because
criticism is that scary. Exactly.And that leads me to the
second criterion, which isunwilling to get
involved with people unless certainof being liked.
(05:47):
Mm hmm. So that fear of what people will
say or wanting others to viewthem positively
is all encompassing and theyavoid new people
unless they are very sureof approval and not
rejection. They have a foundationalbelief that
others are critical, disapprovingand rejecting,
and they are super aware and vigilant of watchingothers' movements and expressions.
(06:11):
So then others need to passtests and jump
through hoops to shed thatdefault assumption.
Which sounds exhausting, right?And this means
that avoidants have a hard timemaking new friends
and often avoid group activities.So they might
become pretty isolated and don'toften have bigger
(06:32):
support networks again due to that fear.
Yes. Okay. And then we havethe third criterion,
which is shows restraint within intimate relationshipsbecause of the fear of being
shamed or ridiculed. So becauseof the fears
of being criticized or ridiculedor shamed,
exposed, et cetera, intimacy is hard and
(06:54):
troublesome. There's fear ofgetting too close.
So avoidants might act withrestraint, avoid
talking about themselvesand not share their
intimate feelings. But ifthey feel safe and
are super assured that theywon't be judged or
criticized, they can show interpersonal
intimacy. I actually, interestingly,I see this in the
(07:17):
paranoid personality dynamics too, right?
But conversely, because theyactually do desire
affection and acceptance fromothers, it can move
to fantasy. So they might fantasizeabout idealized
connections with others instead of
actually engaging in them. Sohere is some of that
(07:38):
overlap with schizoid, right?And resorting
to fantasy. This actuallyreminds me of an
episode we did recently on when paranoid
personalities kill. And wetalked about Timothy
McVey. Yes, because he hadfantasies about being
a superhero, which later developedinto interest
in the military and disillusionmentwith heroes.
(08:00):
And then that led to a muchbigger plot with the
Oklahoma City bombings. Sointeresting. Yeah.
And I know that we're talkingabout avoidant here,
but there is some overlapwith paranoid and
schizoid, both really have difficulty
with intimate relationshipsand can resort to
fantasy to get their needsmet where it's safe
(08:21):
and people don't hurt you,which then leads
to criterion four. So theyare preoccupied with
being criticized or rejected in social
situations. So they think and worryabout this constantly,
which means they are always on alert for thepossibility of criticism or rejection.
And they can detect if someoneis being like even
(08:41):
the teensiest bit critical ordisapproving. Yeah,
so their threshold for pickingthat up is like
super low. And then, of course,they feel extremely
hurt. Yeah. So they reactstrongly to even the
most subtle cue that may suggestsomeone is mocking
them or showing contempt. And sometimes
they misinterpret others likeneutral gestures,
(09:04):
statements or responses as critical or
rejecting, which in turn confirmstheir self doubts,
which is technically a confirmation bias.
Yeah. Yeah. And in this way,avoidants have a hair
trigger very similar to borderline
personality, but borderlines arepreoccupied with fear of
abandonment and scan relationshipsfor the
(09:27):
slightest cue of being leftbehind. And they often
create dynamics in which thisfear is realized
for the avoidant, though, eventhe slightest whiff
of criticism can set themoff and lead to a
counter attack or possiblywithdraw from the
relationship. So both havehair triggers that
(09:47):
can look incredibly similar,but for slightly
different reasons. But basically the
avoidant's reaction to critiqueis like a borderline's
reaction to abandonment. Yes,that is a great point.
But also what if the avoidant'sreaction to critique
is parallel to the narcissisticreaction to
ego hits, which could alsobe criticism? Yep.
(10:11):
And this is where some ofthe early shrinks
were debating. Like, is theretoo much overlap with
the avoidant and other personalities?This is
such a good point. Yeah,because there's the
narcissism overlap too, whichagain, this makes
sense why this personality disorderis so debated
just in talking about it.We can see those
(10:31):
connections. Absolutely.But let's go to the
fifth criterion. So they'reinhibited in new
interpersonal situations becauseof feelings of
inadequacy. So because avoidantsfeel inadequate
and have low self-esteem, theyare not confident
acting like themselves innew situations. They
are afraid that no matterwhat they say or do,
(10:54):
others will see them as wrongand flawed. So
really they tend to not saymuch, if anything,
and then they fear and avoidany attention
because it might be criticalor rejecting. Thus,
they come across as shy, timid, quiet,
inhibited, lonely, isolated, andsometimes even invisible.
(11:16):
So this hypersensitivity torejection and low
self-esteem lead to reducedsocial functioning
and interactions, meaning thatthey may be hard
to get to know. However, theyreally do desire
and yearn to be social andinterpersonally active.
They're just really scared toessentially put their
psychological welfare in thehands of others.
(11:39):
Ooh, I like that. Yeah. Yeah.So then that leads
to a conflict of whether or not to put
themselves out there or to stayisolated, right? And just
enjoy the fantasies of socializationwhere it's
safe. And here I'm also justthinking about this
low self-esteem, this poorsense of self-worth,
(12:01):
and that's really what setsthe avoidants apart
from schizoids. So schizoidsoften have a cohesive
sense of who they are and theirself-esteem is less
contingent or often not atall contingent on
the appraisal from others. Yes,that's actually a
really good point. And thatbrings me to the next
(12:21):
criterion. So criterion sixis that they view the
self as socially inept, personally
unappealing, or inferior to others.So for some avoidance,
their belief that they aresocially incompetent
and personally unattractivecan be most intense
when interacting with strangers.But for many
(12:41):
other avoidants, they havemore difficulty with
repetitive interactions becauseit leads to
an increased expectationof sharing personal
information. And then thatincreases the risk
that any of their flaws or inferioritymight be seen,
which means they could be criticizedor rejected.
And this here is really sad.So to feel like you
(13:04):
don't have something to bringto the table in
relationships, that's tragic,right? This core
belief of not being enoughruns really, really
deep. So in therapy, I wouldbe asking, "Where did
you learn this message?" Yeah,and that kind of
pairs up with the initialconceptualization of
(13:25):
avoidants having highly criticalparents, like not
just invalidating parents, butcritical ones that
become an introject. So anintroject is like
when we absorb an external stimulusinto the self,
so it becomes part of us in our psyche,
like it's one with the psyche.So the critical
parent's voice becomes onewith the avoidant and
(13:47):
their core sense of identity.Yes, the introject,
yes. So then a core buildingblock of their
character is what you're sayingis feelings of
ineptitude, sometimes becauseof upbringing and
being reinforced in that way.Yeah, and I think
this is where avoiding getscloser to maybe phobic
(14:07):
characters and neuroses becausethey suppress their
own needs and impulses andself so that they
don't get criticized. Yeah,because that belief
about the self is so strong,it's integral to
the psyche. Yeah. And thenwith that, as ongoing
interpersonal commitments,either social or
work-related start requiring therepetitive interactions,
(14:31):
avoidants might start to convincethemselves over
time that others are seeingthem as valueless and
inferior. Oh, wow. And thenthat leads to distress
that's not tolerable and oranxiety that leads to
evading others or maybe evenquitting. And I
can see how this cycle of quittingjobs, right,
(14:51):
and starting a new one couldreally exacerbate
these fears and really makemore conflict. Like,
I can't stay in this job becausethey see me for
my faults and ineptitude. Butto get a new job is
to put myself out there againand risk being
seen as incompetent or not enough.Yes, and there
(15:11):
absolutely can be a historyof repeated job
changes. Yeah, it's actuallya major theme. The
biggest outward problems involvedwith avoiding
is difficult social and workfunctioning. And I can
see how that could lead toa stuck point of
unemployment in severe casesbecause going
through the interview processwhere you're putting
(15:33):
your best self out there, showcasingyour strengths,
right? Like, that's not goingto come naturally
to the avoidant. And the fearof rejection at the
interview or criticism canbe enough to keep the
individual from keeping a stablejob. Yeah. And
that's a great segue into thelast criterion. So
criterion seven is there'sunusual reluctance to
(15:57):
take personal risks or toengage in any new
activities because they mayprove embarrassing.
So they are actually likelyto like exaggerate
the potential dangers of ordinarysituations,
which basically just means thatthey can be super
anxious in a way that's outof proportion to the
actual event. Yeah, likea job interview, a
(16:19):
date, maybe new social interactions,right? So this
results in a lifestyle that is restricted
because they have high needsfor security,
assurance and certainty. Butas we know, life is
full of risks and unknowns.So this can lead to
missing out on really coolopportunities that
(16:40):
would help them feel more positivelyabout themselves.
So then what we have hereis this negatively
reinforcing cycle where theavoidant doesn't
feel confident enough todo something, which
then just fuels the fear thatthey're not good
enough because good experiences,
relationships, jobs, etc., don'tcome their way because they
(17:00):
have a hard time putting themselvesout there.
Yeah. All right. Well, that'swhat the DSM says
about the criteria, butit also highlights
interesting things in the developmentand course
of avoidant personality disorder.Ooh, let's
go there. Yes. Okay. So thereare points in
development where shyness andsocial withdrawal
(17:23):
and like stranger danger fearsthat lead to avoidant
behavior are appropriate.So early childhood,
middle childhood, sometimeseven adolescence.
But the difference is thatit subsides over
time as a youth gets olderand enters adulthood.
Now, in contrast for those with avoidant
personalities, the shynessfears, withdrawal,
(17:46):
they increase in severity with age, like
coming to a head in adulthood,which is interesting
because that's kind of whenwe start seeing a
focus on forming intimate relationshipswith others,
creating families of their own and
arguably when most people startworking full time.
This makes so much sense.Yeah. Yeah. And then
(18:09):
this developmental story arcis where you can see
that personality disorders existover time, right?
Because personality disordersdon't just come out
of nowhere. Sometimes at disorder level
functioning, the individualseems to get stuck
in a developmental stagefrom way earlier in
childhood. So not growingout of these quirks
(18:31):
can be an indicator of moregoing on. So something
else though, that's importantto point out is that
many people have traits ofavoidant personality.
We've talked a little bit abouthow it overlaps
with schizoid borderline, paranoid,
narcissistic, et cetera, but perthe DSM an avoidant trait
is that full blown personalitydisorder level
(18:52):
when it's pervasive, enduringand inflexible.
So it's going to cause majorlife disruption
and impairment in relationshipsand at work.
Exactly. The DSM also notesthat there's a ton
of overlap between avoidantand social anxiety.
And social anxiety is decently common. So
(19:13):
let's talk a little bit aboutthat. Yeah. Now,
I don't remember exactly who, but some
theorists suggested that socialanxiety is an ego
dystonic syndrome and avoidant personalitydisorder is an ego syntonic syndrome.
What does that mean? So itmeans that social
anxiety is outside of whothe person is. Well,
(19:34):
avoidant personality disorderis wrapped up in
the identity and the innerworkingsof the person.
That is so interesting. Sothis is a really
cool way to think about it. Likeis the dysfunction
one with the person or not?Similarly, some
theorists say that avoidantpersonality disorder
is a more severe form of socialanxiety disorder.
(19:57):
But while I think there's someoverlap personally,
like I think social anxietycan be part of
avoidant personality disorder.I do see some
distinct differences heretoo. Yes, there are
differences between socialanxiety and avoidant
personality, especially inrelation to self
concept. Avoidant personalitydisorder involves
(20:19):
pervasive, entrenched low self-esteem and
feelings of inferiority. Whilesocial anxiety simply
involves maybe sometimesfeeling negatively
about the self, but alsosometimes not. The
insecurity is not all encompassing.It is not
part of the whole person. Yeah.Yeah. Good point.
(20:39):
So then according to the DSM, avoidant
personality disorder can occurwithout social anxiety
disorder. So it's not necessarilya pathway of
severity or even a prerequisite.Like there are
also risk factors that increasethe chances of
developing social anxiety andthen different risk
(21:00):
factors that increase the chancesof developing
avoidant personality disorder.So this suggests
that they are two separatedisorders. Anyway,
let's talk about what socialanxiety disorder
is for a minute so that wecan understand the
overlap. Okay. So social anxietyis extreme fear
(21:21):
in social situations wherethey are potentially
being evaluated or scrutinizedby others. So for
example, new social interactions,eating or
drinking in public, giving aspeech, taking a test.
The fear is about a negativeevaluation from
others. It's less about apersonal feeling of
ineptitude or inadequacy,but more so that
(21:43):
their performance or socialinteraction will be
embarrassing, humiliating, offensiveto others, or
maybe leads to rejection frompeers. Yeah. So the
fear isn't just random or inconsistent,but it's
experienced consistently duringsocial situations.
Social situations are eitheravoided or if
they're unable to be avoided, theyare experienced with
(22:06):
intense fear and anxiety. Butthis fear is out of
proportion to the actual situationand it has to
last for six months or moreand it needs to cause
significant distress or impairmentin their ability
to function. Right. And it's not due to
substances, another medical condition,or another mental
(22:29):
disorder like panic disorder,body dysmorphia, or
autism. It can also be a performanceonly if the
fear is restricted to speakingor performing in
public. Right. Right. Yeah.So the overlap here
between social anxiety andavoidant personality
is that both put the emphasison others' feedback.
(22:51):
Right. But that feedback orfear of a certain
type of feedback is what triggersthe anxiety
in these types, which leads to avoiding
situations or people where thatfear could come to life.
For the socially anxious,it might be avoiding
giving that speech in speechclass or for the
avoidant not applying forthat promotion for
(23:14):
fear of criticism about themas an employee.
So the key difference betweenthem is that in
social anxiety, the individualis more so afraid
that their performance or thesocial interaction
will reveal something thatis not actually true
about them as a person. Sofor example, if they
can't make the grade, it meansthey're not a good
student. Or if someone said something
(23:36):
embarrassing, it means you're a badperson. Their anxiety about
their performance isn't relatedto a negative
self appraisal. In avoidant,it's almost like their
fear is being discovered as inept, which
confirms their self view, meaningthat any inkling of
perceived criticism meansthat they're outed.
(23:57):
So socially anxious individualsstill care about
the evaluation of others, but not because
they're trying to hide feelingsof ineptitude.
Right, right. It's almostthe opposite that
they're afraid it's going to revealsomething about them
that's not true. Like you said,like, Oh, I must
be a bad student if I can'tmake the grade. But
it's not like they believe that about
themselves. It's not like onewith their identity.
(24:19):
You got it.
Yeah. So super helpful to distinguish.So thank
you for bringing that up, DocFish. But I do want
to spend a little bit of timetalking about our
unfiltered thoughts about avoidant.I know we got
into this in another episode,a few ones back on
schizoid versus avoidant. ButI think we do need
to talk about that a littlebit here. So Doc
(24:39):
Fish, what are your unfilteredthoughts about avoidant
personality disorder? Oh boy.All right. Well,
honestly, avoidant personalitydisorder confuses
me. Why? Because it overlapstoo much with other
things. And I think maybe itmight fit better into
the anxious avoidant phobic psychodynamic
(25:00):
personality, but I'm also not100% sold on that
either. So avoidants in myexperience, like,
they do seem more neurotic ratherthan borderline or
psychotic. And their fearis of being seen
as inadequate, which is technicallynot even
something that develops until like, each
three, like a three year oldis essentially when you
(25:22):
start developing embarrassment.So before three,
you can't like... they don't.... theydon't understand
embarrassment. Anyway, soneurotic, that is
like, the core wound starts aroundage three or six;
borderline or psychoticis before that. So
like, I feel like it fitsin the neurotic box,
which is the phobic characterin psychodynamic.
(25:45):
I don't know. I don't know.It doesn't make sense
to me. And then there's aflavor of narcissism
in hiding and protecting theego. Oh, there's a
flavor of schizoid and like the social
inhibition and fantasy, a flavorof borderline because of
that like chase dodge dynamic.And I would say
a decently strong flavor ofparanoid and their
(26:08):
fear that others are dangerousdue to others'
capacity to reject or criticizethem. Yeah,
yeah, I'm hearing you here,Doc Fish. This is
really interesting. And I dothink that there's
a hidden underbelly of narcissismhere. It's more
of a vulnerable side to it,but it's still a pop
of color to this personalityto the avoidant
(26:30):
personality. And I do seewhat you're saying.
There's a lot of overlap with other
personality types. And actually,as you were talking,
it reminded me of the Enneagram. So the
Enneagram is another classificationsystem. We won't get
into all the ins and outs ofthat. But just real
quick as a nugget for thoseof you who know the
Enneagram, the avoidant soundsto me like the
(26:50):
unhealthy side of the Enneagramsix, which is
this more fearful personalitytype in this
classification system. Okay,so that is exactly
what I was thinking. Because so, so okay,
the six is a fearful type,they desire support,
but then it neighbors theseven, which is like
(27:13):
kind of narcissistic, it canbe and the five,
which can be very schizoid-ish, which are... that's
like two of the things thatoverlaps for like the
pops of flavor. And then,well, counterphobic
sixes are like, they're sixes,but they go against
the grain. So they are stillfearful, but they
(27:36):
run towards fear. Yes, yes. That'sa way to beat it.
Yeah, yeah. And they can,if really, really
unhealthy, they can be on thetrack to paranoid.
Right. So that makes, yeah, that makesme think maybe a six. Anyway,
no, I appreciate your inputhere. Yeah, yeah. And
then also what you brought upabout going back to
(27:56):
developmental stages and allof that. And that is
all important to the functionof the psyche and the
personality. But with the Enneagram
specifically, like, I'm just thinkingabout like, this is the
head center of functioning,we're talking about
five, six, and seven, and,you know, being prone
to withdrawal or even self absorptioninto fantasy
(28:18):
or the maybe some grandiositythere too. So I think,
I think that there's something here, but
anyway, this is just a littlenugget for our listeners
and viewers who are avid Enneagramfans. But let
us know in the comments, ifyou guys would want a
series on Enneagram, there'sreally a lot to
unpack. That's a whole different,fascinating,
awesome classification systemthat we love. But
(28:41):
it is a lot to get into. AndI don't want to lose
people in explaining all ofit because it's so
much. But if you are interested,let us know,
because we can, we can go there, but you
need to let us know thatwe should go there.
Open the nerdy box. Right. Okay.
Pandora's box. Yeah. All right. Well, DocBok, what do you actually think of
(29:06):
avoidant personality disorder?Yeah, yeah.
I'm not too far off of whereyou are with this,
Doc Fish. But the piece thatstands out to me is
like, why in the world werewe so stinking late
to the game in naming avoidantpersonality
disorder and specificallythe 1960s, right?
(29:27):
Spawning from Schizoid, theysplit them up. But
like 1960s was a time of massivecivil unrest.
There was a global distress.It was the civil
rights movement here in theStates. Like racial
tensions were at a boilingpoint. President JFK
was assassinated. I mean, likethere were so many
(29:48):
things in the 60s that peoplewere on edge and
there was a time of risingup too. So as I said
before in our other episodewhere we talked
about this, like if we were todip a ladle from the
personality soup into thezeitgeist of that
time, like would more fearfulpersonalities come up
(30:12):
in that ladle? I think theywould. So kind of
similar to now, like if wewere to take a ladle
full of dysfunctional personalities,like right
now in this post pandemic timeframe,I think we
would see different flavorsthan we would had we
taken a ladle back in 1990?Like there has to be
longevity. And will this personalitywithstand the
(30:35):
test of time? Like that's, that'sthe question in
my head here. Yeah, that's fascinating. Sothat actually kind of reminds me of how
hysterical personality was coined duringa time of female sexuality suppression.
Or paranoid personality really popped upand increased with the recent pandemic.
(30:56):
So like there is stuff that'srelated to the
social world. Oh, absolutely.Yeah. Personality is
definitely correlated withthe social world.
But again, like some stuff withstandsthe test of
time and generations, likenarcissism, for
example, I mean, hello, we havethat. There's examples of
that in the Bible, for goodnesssake. Or if
(31:17):
you just look across the centuries,there's been
grandiose characters or narcissisticcharacters,
like among, among others, there'sother personality
styles that also withstandthe test of time.
But that sticks out to me aslike, one of the most
significant ones, but would avoidant,would avoidant
withstand the test of time?And then that leads me
(31:38):
to the question, what ifit is just a trait,
right? Yeah. So a trait thatmaybe you can turn the
volume up and it could existin any personality
disorder, maybe at varying levels,but especially
if there's disorder levelpersonality, maybe
they're more prone to having thatvolume knob turned up.
(32:00):
So again, similar to narcissism.So narcissism
is also a trait. It's alsokind of one of the
first ingredients in all themajor personality
disorders. So if you're making,if you're making
a personality cookie, so to speak, your
narcissism is going to be the flourin the recipe. Like,
you got to have it. It's goingto be there. So
avoidant maybe is like yourchocolate chips or
(32:21):
your raisins or whatever you put in your
cookies. Like maybe there canbe a pop of color there
that gives more texture tothe dysfunction. But
yeah, again, I think maybethere's like a volume
button that goes up and downdepending, depending
on the personality disorder.So I don't know what
your thoughts are about that,but yeah, I mean,
that makes sense. I think that'sa, that could be
(32:43):
a very real possibility. Ihave to sit with that
a little more. Yeah. Yeah. Sothen the last thing
that, that comes to mind for me is I am
skeptical about Millon and as muchas we love him, he is a
awesome personality theoristin our opinion, one
of the greatest of all times,if not the greatest
of all time, I can't help butwonder if his ego
(33:05):
got in the way here, becauseif I recall, he needed
a personality to contrast againstschizoid, right?
Active and passive. Yep. Heneeded an active. And,
and I can't help but wonderlike, did he make this
up? Like he seemed really convincedof it and maybe
he was, but he had a lot ofpushback about it.
(33:25):
A lot of people arguing withhim in the journals
and not just there, but alsoin the DSM task
force. So the task force thatis designed to basically
say, do we keep this in theDSM or do we not
like a group of, of researchersand shrinks that get
together. And there was a lotof pushback, right?
Like not everyone was thrilledabout it becoming
a personality disorder. Andhe was telling them
(33:47):
to sit down and they didn'tknow what they were
talking about. Right there.There was a lot
of controversy and arguingit about it being a
separate disorder. So yeah, itis super interesting
to read their discussions andpassive aggressiveness
about it. Yeah. Yeah. That'sa possibility.
Yeah. So it was hotly debatedand, and I see why
(34:10):
because I'm still on thefence about it. And
maybe in this series, I willcome to a different
conclusion as will you Doc Fish as we're
getting into the research, gettingour hands dirty,
looking at where this camefrom and is it real
and kind of up against ourclinical experience.
But I mean, with clinical experience, Ihave, I have diagnosed it like, yeah,
(34:31):
yeah. I have technicallyseen patients that
check the boxes in the DSM, right?But typically when
I do diagnose it, there'smore textures and
layers and colors to theirpersonality that that
diagnosis alone doesn't capture. So yeah,
anyway, that's where I'm at. I'm,I'm sus. I'm sus on
this one. I hear you. I amalso skeptical. I am.
(34:55):
Yeah. And last thing I'll sayhere is if you're
interested in hearing moreabout this, check out
our avoidant versus schizoidepisode, because we
do go into more in depth aboutour opinions here
and what the research says.So I will link that
in the show notes, but so fortoday, we learned
about avoidant personalitydisorder according to
the DSM, how it's differentfrom schizoid, and our
(35:17):
skepticism surrounding thisdiagnosis. So we hope
that you'll tune in for therest of the series.
So don't forget to like subscribe,give us a shout.
We've also got blogs, visuals,and references that
coincide with each episode atwww.personalitycouch.com.
But on that note, that'sa wrap. Thank you
for joining us today on thisepisode. Be well,
(35:39):
be kind, and we'll see younext time on the
personality couch. This podcastis for informational
purposes only and does not constitute a
professional relationship. If you'rein need of professional
help, please seek out appropriateresources
in your area. Information aboutclinical trends
or diagnoses are discussed inbroad and universal
terms and do not refer to anyspecific person or
(36:02):
case.
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