A CASE OF Avoidant Personality Disorder
By: THEODORE MILLON
et al.
Notes:
(1) Numbers mark aspects of the case most consistent with DSM
criteria as follow, and
do not necessarily indicate that the
case “meets” diagnostic criteria in this respect.
(2) Patient's name has been changed in respect to
confidentiality, and name mentioned is not of a real existent person.
Case of Sean
A
first-year college student, Sean hardly associated with anyone. In the clinical
interview, he seemed to want to make contact, but he frequently stuttered,
causing him to retreat in embarrassment. Otherwise, he expressed almost no
emotion.
His
second computer programming course was the immediate . Though
he was fluent in several computer languages, his professor wanted the students
to work in groups, to collaborate in building chunks of a single large project.
Sean
was scared. “I try to work on it, but I can’t concentrate.” His voiced shrank
to a whisper. “They’re g . . g . . going to think I’m an idiot.”
(1) His solution was to drop the class, though he had an A
average going into this, the last assignment of the semester.
(4) In fact, his grades were exceptional overall.
Nevertheless, Sean could report no friends, and confessed, “I’m lousy at
meeting people. I guess I think they won’t like me or something. I’m awkward.
(2) I’m a clutz. I just don’t have many qualities others
are interested in, I guess. But I’m great with computers.”
(6)
In
the first several sessions of therapy, he seemed to be holding back, as if he
were looking for what a therapy client should do, in order not to disappointment expectations for progress. These transference
issues were difficult to discuss at first, though eventually they led to a
breakthrough, whereby Sean was able to see the link between present and past,
and began to express his emotions more freely. (3)
Sean’s
problems had their origin with his father, an aggressive and financially
successful physician, noted for authoring a breakthrough surgical procedure.
His mother was a shy woman who had worked as a high school teacher before they
were married. From birth, he was an unusual baby. He cried incessantly and
failed to develop a coherent schedule of feeding and sleeping. Worse, he was
easily upset, and cried at the sight of anyone other than his mother.
From
the start, Sean’s father had little tolerance for his son. When he found out
that Sean, now age 7, was afraid of the dark, he locked his son in the pitch black basement for hours, until the crying stopped.
As Sean grew up, he failed to meet developmental milestones as fast as his older brother, thus disappointing his father again
and again. Even his younger brother outgrew him. In physical education class, he was always picked last for teams. He dreaded
coming up to bat, and he dreaded that the ball might somehow find its way to him. The other kids called him simply “The runt.”
Sean’s
performance in school, though below that of his older brother, was nevertheless
well above average. Even so, his father joked that the other boys would go on to good medical schools and Sean would go
to nursing school. As Sean himself was acutely aware, his anxiety about
measuring up to the other boys in his programming group had its origin in the
many unfavorable comparisons he suffered at home.
DSM-IV Criteria
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:(1) avoids occupational activities that involve significant interpersonal contact, because of fears of
criticism, disapproval, or rejection
(2) is unwilling to get involved with people unless certain of being liked
(3) shows restraint within intimate relationships because of the fear of being shamed or ridiculed
(4) is preoccupied with being criticized or rejected in social situations
(5) is inhibited in new interpersonal situations because of feelings of inadequacy
(6) views self as socially inept, personally unappealing, or inferior to others
(7) is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
References
(1) Personality Disorders in Modern Life, second edition,
2000, 2004 by John Wiley & Sons, Inc.
(2)Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition. Copyright
1994 American Psychiatric Association.
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