Psychology

The aim of this paper is to compare and contrast two methods of treatment for avoidant personality disorder. Proponents of these methods will be examined for their views regarding the best method for treating avoidant personality disorder. Other experts views will be incorporated to gather the details regarding the disorder as well. Kantor (2003) distinguishes the avoidant personality disorder into four areas, and with this distinction, he proposed his therapeutic approach, labeled as the avoidance reduction technique as the best way to help individuals diagnosed with avoidant personality disorder. On the other hand, Benjamin (2003) proposed five categories of correct response to avoidant personality disorder.

The aim of this paper is to compare and contrast two methods of treatment for avoidant personality disorder. Specifically, the two treatments to be compared and contrasted will be the avoidance reduction technique and the psychoanalytical method. Proponents of these methods will be examined for their views regarding the best method for treating avoidant personality disorder. Other experts views will be incorporated to gather the details regarding the disorder as well. Kantor (2003) distinguishes the avoidant personality disorder into four group, and with this distinction, he proposed his therapeutic approach, labeled as the avoidance reduction technique as the best way to help individuals diagnosed with avoidant personality disorder. On the other hand, Benjamin (2003) proposed five categories of correct response to avoidant personality disorder.

Avoidant Personality Disorder
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), Avoidant Personality Disorder (APD) is a disorder that an individual suffers from, which makes him or her unnaturally or extremely shy, incapable of social interaction, excessively inhibited and reserved from others because of the fear of inferiority, humiliation and rejection (Benjamin, 1993).  According to Benjamin (2003), individuals diagnosed with APD are not taken seriously by their families or friends, their therapists or even by themselves. They all think that it is a normal phase to go through, especially if one is a teenager. Kantor (2003) showed that because this condition is taken lightly at the onset of the diagnosis, the families, friends, therapists or even the patient himself or herself are caught unaware and unprepared when the disorder become even more severe and the patient or other people around him or her end up being emotionally and physically hurt. Not understanding what Avoidant Personality Disorder can do to ones life, a person diagnosed with the condition may be unaware that their personalities are already abnormal to the point that that they annoy, frustrate and hurt a lot of people, especially themselves. To seek treatment when one is diagnosed with APD is imperative. Without treatment, those diagnosed with APD will continue being detached and aloof to the people and situations in their lives, because they cannot interact and socialize properly and ultimately can become an outcast or invisible in the society (Kantor, 2003). The worse consequence is that by being isolated from the society, an individual will have a high tendency to incur other serious psychopathological disorders, which could even be more detrimental to the persons and his families and friends health. Useful and enhanced psychotherapies are needed to reduce the avoidant behaviors or symptoms that a victim of APD suffers from.

According to Schut et al. (2005), some psychotherapists make interpretations too quickly, which is not a great idea, because such quick decisions often lead to more avoidant behaviors. The limitations of the study was that the results should be considered very preliminary given the small sample size and therefore low statistical powerand that it is possible that therapists varied in other important dimensions of interpretationsuch as varying accuracy or depth of their interpretations (Schuet et al., 2005).

Before deciding on the best psychotherapy, it is important to understand the true nature of the disorder. According to the DSM as examined by Benjamin (1993), APD is a disorder that produces an insisting pattern of social discomfort and inhibition, low self-esteem and high levels of sensitiveity to negative evaluations or critics. The disorder often inflicts individuals as early as during a persons young adulthood, and caused by various factors (Benjamin, 1993). The DSM provided a checklist of the criteria that could hint that a person is suffering from avoidant personality disorder. First, a person with APD tends to stay away from occupational activities that would entail him o her to connect or interact with others, mainly because they feel that they will be rejected, criticized or evaluated negatively. In relation to this, people with APD often encounter difficulty in fostering intimate relationships because they worry about being laughed at or made to look foolish (Benjamin, 1993). Another criterion that could be observed from people with APD is that they are too sensitive to negative evaluations. They are hurt too easily when they are given the slightest feeling of being disapproved or laughed at. Because they are hypersensitive to being criticized, during social situations, people with APD tend to focus too much on what the people are saying and ironically, they are too intent to observe whether someone is negatively evaluating them.  Another thing that could be observed from people with APD is that, even though they desire to be relatable to others, they do not foster many close friendships outside their immediate families (Benjamin, 19932).

An individual with APD further perceives himself or herself to be incapable of social interaction, unattractive and inferior to others. This perception significantly makes him or her more reluctant than others to engage in personal risks or try new activities because he or she believes that the outcome would just be embarrassing (Benjamin, 1993).  Other characteristics of people with APD are being too worried when they need to be in front of other people and exaggerating ordinary circumstances that they have to engage in, in order to avoid social gatherings or events (Benjamin, 1993).

Benjamin (1993) discussed the causes of APD with the help of the Structural Analysis of Social Behavior and pinpointed that the main trigger of APD is a persons historical background. A person with APD has the highest likelihood that he had been ridiculed or mocked in the past, making him phobic for a repeat of these negative situations by not interacting altogether. This is why people with APD has a high level of self-control, self-blame and are hypersensitive.  In a person with APDs history, his or her flaws might have also been highlighted so much that he or she attacks his or personality now. This lead him or her to simultaneously try to please others while shutting himself or herself from others (Benjamin, 1993). Furthermore, in the past, he or she might have also been encouraged to withdraw socially by an outsider such that he or she developed an unnatural fear of the outsiders and just focus on forming family loyalty. Kantor (2003) refuted this view that the main catalyst in triggering APD is historical background.

While Benjamin (1993) solely focused on interpersonal causes of avoidant personality disorder, Kantor (2003) finds causes from various points of view interpersonal, evolutionary, developmental, psychodynamic, cognitive, social and biological. Kantors viewpoints should be considered because it is crucial to examine the disorder with different viewpoints, because that gives a bigger picture and better suggestion for psychotherapies for the disorder. From evolutionary point of view, the avoidant personality disorder has three causes. The first reason is that becoming human entails a degree of loss of animal warmth and spontaneity (Kantor, 2003). The second reason is the insect taboo Kantor mentions how Freud relates avoidance to the horror of insect, which leads to forbidding any sexual relationship between members of the same clan, but he thinks this is too extreme. The third reason of evolutionary point of view is Freuds death instinct. The avoidants have unconscious urge to return to the primordial ooze, a lure of ashes to ashes that in all of us interferes too soon with our finest workcauses us to abandon, often in spite of ourselves, those whom we might love (Kantor, 2003). The cause of the avoidant personality from developmental point of view is that most avoidants react to new relationships as if they were in old relationships, therefore, avoiding new people and situations as if they were difficult people or traumatic situations from the past (Kantor, 2003). Early physical, emotional or any kind of trauma can contribute to avoidant behaviors. For example, excessive parental control can cause a child to feel like one is forced to commit in a relationship severe criticisms of both the childs positive ad negative emotions can cause child to become aloof and become more avoidant. Kantor (2003), from psychodynamic viewpoint, states that avoidant personality disorder is caused by conflicts about sex, conflicts about anger, anxiety, and defense and symptom. The patients become avoidant, because they experience second thoughts about their romantic impulses. Also, the patients become avoidant because they typically get mad when they fear becoming more dependent or less dependent than they want to be. When they feel like the situation is not under their control, they become angry and then guilty about being angry immediately afterwards. To hide this emotion, they withdraw from those around them. Lastly, from the psychodynamic view, one of the main cause of the avoidant personality disorder is anxiety with regard to being humiliated. To become less anxious, they will avoid situations that they know will arouse these emotions, which are often social gatherings.

On the other hand, Leising et al. (2009) showed the diagnostic usefulness of the IIP-64 in screening for avoidant personality disorder both at the level of general personality pathology. IIP-64 is Inventory of Interpersonal Problems. They asked 159 female participants to do IIP-64 and did structured clinical interview. Then, the diagnoses of avoidant personality disorder were predicted with good diagnostic accuracy by a single scale of the IIP-64 (Leising et al., 2009). Their result was that the socially inhibited scale was the only necessary predictor in avoidant personality disorder. This means a research can identify this disorder in a simple and powerful way. Also, they found that one of the noteworthy findingis that a single self-report scale with only eight items quite accurately predicted the diagnosis that resulted from a lengthy interview-procedure (Leising et al., 2009). The limitation with Leising and his colleagues (2009) study is that this only their examination is only done on 10 DSM-IV personality disorders, such that the IIp-64 cannot be considered as an accurate diagnostic for avoidant personality disorder holds for other personality. Furthermore, the sample population was all females, even if there are evidences that that male and female participants respond in different ways  to the IIP-64.

Treatments for Avoidant Personality Disorder
With Kantors (2003) view of the five areas to distinguish causes behind APD, he proposed a certain type of psychotherapy to reduce the symptoms of APD.  His goal is to evolve a dedicated, eclectic, holistic, action-oriented therapeutic approach to reduce avoidance. It is dedicated, because it is focused on the distancing process in all its aspectsand it is eclectic and holistic, because it deals with a broad range of core avoidant issues (Kantor, 2003). Also, he focuses not only in cognitions of the patients but also the actions to reduce the avoidant behavior for example, exhorting patients to convert from avoidance to non-avoidance by facing their fears now by exposing themselves directly to situations that make them anxious. This makes the leap from understanding to action much more effectively. He basically combined all the relevant methods and techniques from the major schools of psychology in use today to help an avoidant become less shy, more outgoing, and increasingly comfortable with close, intimate and committed relationships (Kantor, 2003). Kantor broadens the range of psychotherapy skills in order to have more helpful therapeutic approach.

Kators (2003) suggested treatment revealed that there are other types of avoidants present besides those described by DSM, as cited by Benjamin (1993). There are people with avoidant personality disorder that display their disorder not typically like the others.  For instance, there are the people with APD who are neither shy nor phobic, yet cannot foster close relationships because they fear being committed and intimate to other people. In fact, according to Kantor (2003), there are four types of people diagnosed with APD. To understand these four types would make his suggested treatment effective or any psychotherapy being suggested by other experts. The first type of people diagnosed with APD is those who distances themselves or withdraw themselves from others. The second type is those who distances themselves yet have limited and superficial intimate relationships. The third type of people with APD distance by first forming what at least appear to be satisfactory relationships that seem to do well superficially, while the last type of these people distance by becoming deeply involved with a regressive relationship with one other person to reduce or eliminate other worldly contact totally. 

The first type, known as ShySocial Phobic Avoidants, uses withdrawal mechanisms to deal with their extreme social anxiety (Kantor, 2003). This type can be divided again into two subgroups shy avoidants and social phobics. The social phobics are extremely isolated and are unable to function well in society, such as not being able to focus and concentrate due to extreme anxiety and feeling sick, therefore, quitting a job. The shy type is less isolated and can go to single bars or parties, but they function poorly once they are out, such as standing off by themselves and speaking only to the person they came with. These two subgroups both share the similarity, which is to withdraw from the society not to feel rejected or humiliated they are neophobeswho cannot initiate relationships because they fear what an unknown fate holds in store for them (Kantor, 2003).

The second type is mingles avoidant. Unlike Type I, Type II look completely different on the outside and give the opposite impressions from the Type I, who is self-conscious, introverted and lacking in self-confidence (Kantor, 2003). They are not neophobes like Type I, but in fact, they are neophiles they are comfortable in socializing and like making new relationships. However, they are not good at keeping the new relationships last. This type is also divided into several subgroups the anxious, the ambivalent, the masochistic, the dissociative, and the hypomanic type. The anxious type fears maintaining relationships, because they think the possibility of being criticized, humiliated and rejected is too big and this is too painful for them (Kantor, 2003). By taking the anticipated rejections too seriously, they are afraid of getting attached to another person. However, at the same time, they expect a miracle to happen of connecting to a new person in a next party. The ambivalent type is too uncertain be in any relationships without vacillating they play hard-to-get, but they condemn others for being too remote and unfriendly and on the other hand, condemn others for coming too close, like moving in and occupying their space. The masochistic type fear being rejected, but they want it secretly at the same time, because they fear acceptance even more they join groups of other avoidants with the similar problems (Kantor, 2003). The dissociative type patients have multiple personalities, so when they face any danger, they run away or enter another personality, thinking its happening to me but it is of no consequence (Kantor, 2003). They last subgroup of Type II avoidants does not want to settle down and jumps from one to another, trying to avoid any serious relationships.

Another name for Type III avoidants is seven year itch avoidants (Kantor, 2003). They can form satisfactory relationships, but for short term periods only. Even if they can commit fully and appear to do well, they will eventually end up feeling restless, question their commitment and quit the relationships they are in quickly and abruptly. They avoid continuance and familiarity, not rejection, which is different from other types of avoidant personality disorder. The last type of avoidants, DependentCodpendent avoidants, is extremely dependent on one person or ones family to hide from other relationships. This is usually a very unhealthy relationship its hostile-dependent relationship. One usually thinks the other has taken me away from everybody and feels ones freedom is threatened forever (Kantor, 2003). They seek safety in the few people, who are similar to themselves. This makes Type IV avodiants become defensively dependentby regressing on their family, a close friend, or a lover, surrounding themselves with a protective shell in order to hide out from a world that they perceive to be threatening and rejecting (Kantor, 2003).

While Kantors (2003) suggested treatment relies on these four types of people with APD, Benjamin (1993) believes that there are five categories of correct responses facilitating collaboration, facilitating pattern recognition, blocking maladaptive patterns, strengthening the will to give up maladaptive patterns and facilitating new learning. For facilitating collaboration, the therapist needs to be warm and protective, because the patients are extremely sensitive and it may be extremely difficult to open the patient mind once closed, who has a very stringent safety test. Also, the therapist has to help the patient decide to change the pattern of selecting only few relationships. Blocking maladaptive patterns, such as unrestrained trashing each partner in a couples therapy with an avoidant personality disorder patient. The most difficult one is to strengthen the will to give up ongoing maladaptive behavior, such as giving up safety and withdrawal behaviors. Benjamin (1993) says understanding alone is about as useful to the avoidant as trying to talk to a non-swimmer who nearly in a shipwreck into becoming a Navy SEAL, so it is better to help them learn new patterns gradually. With his proposed treatments, Benjamin (1993) recommends adding another criterion in the DSM an avoidant patient occasionally has outbursts of indignant rage over humiliation. As the avoidant personality disorder patient is offended or humiliated, the ball of anger against rejection and degradation, which the patient constantly tried to restrain, may strike back with an angry attack against the offender with great indignation. This makes the avoidant to feel the fear of losing control of the anger one keeps hidden with me (Benjamin, 1993).

Conclusion
Avoidant personality Disorder is often ignored and overlooked, because this disorder does not cause anyone to be hospitalized. Furthermore, the person himself or herself diagnosed with the disorder is unlikely to be dramatic about the disorder and have a tendency to be so withdrawn that no one pay much attention to him or her enough to recognize theres an alarming problem. However, if left untreated or ignored, the diagnosed individuals may hurt themselves and his or loved ones, or incur other psychological disorders. Psychotherapies for avoidant personality disorder are recommended by various experts, but before any of these can be effective, it is important to give the disorder the attention it deserves and to understand the causes and symptoms of these disorders thoroughly.