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The Prevalence of Avoidant Personality Disorder in People on the Autism Spectrum

According to some professionals in the autism community, Avoidant Personality Disorder (APD) manifests itself more frequently in adults on the autism spectrum compared to the general population. Reasons for this may include:
  • social rejection as a child
  • difficulty cultivating friendships throughout the lifespan
  • being the victim of bullying as a child
  • difficulty maintaining gainful employment due to social skills deficits
  • an over-reliance on parents in adulthood (i.e., “adult-child syndrome”)
  • “learned helplessness” (i.e., the adult believes he/she is fundamentally “flawed” in some way, thus he/she simply gives up and stops trying to “connect with” others in a meaningful way)

APD is characterized by feelings of extreme social inhibition, inadequacy, and sensitivity to negative criticism and rejection. However, the symptoms involve more than simply being shy or socially awkward. APD causes significant problems that affect the ability to interact with others and maintain relationships in day-to-day life.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, an individual diagnosed with APD needs to show at least four of the following criteria:
  1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection
  2. Is inhibited in new interpersonal situations because of feelings of inadequacy
  3. Is preoccupied with being criticized or rejected in social situations
  4. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
  5. Is unwilling to get involved with people unless they are certain of being liked
  6. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
  7. Views self as socially inept, personally unappealing, or inferior to others

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APD symptoms may include a variety of thoughts, feelings and behaviors, for example:
  • avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection
  • avoids physical contact because it has been associated with an unpleasant or painful stimulus
  • belief that one is socially inept, personally unappealing, or inferior to others
  • emotional distancing related to intimacy
  • persistent and pervasive feelings of tension and apprehension
  • extreme shyness or anxiety in social situations, though the person feels a strong desire for close relationships
  • highly self-conscious
  • is unusually reluctant to take personal risk or to engage in any new activities because they may prove embarrassing
  • is unwilling to get involved with people unless certain of being liked
  • lonely self-perception, although others may find the relationship with them meaningful
  • low self-esteem
  • mistrust of others
  • problems in occupational functioning
  • restrictions in lifestyle because of need to have physical security
  • self-critical about their problems relating to others
  • self-imposed social isolation
  • uses fantasy as a form of escapism and to interrupt painful thoughts
  • and in some more extreme cases, agoraphobia

The adult on the autism spectrum may feel as if he is frequently unwelcome in social situations, even when that is not the case. This is because people with APD have a low threshold for criticism and often imagine themselves to be inferior to others. When in social situations, an individual with APD may be afraid to speak up for fear of saying the wrong thing, blushing, stammering, or otherwise getting embarrassed. He may also spend a great deal of time anxiously studying those around him for signs of approval or rejection.

The individual who has APD is aware of being uncomfortable in social situations and often feels socially inept. Despite this self-awareness, comments by others about his shyness or nervousness in social settings may feel like criticism or rejection. This is especially true if he is teased, even in a joking way, about his avoidance of social situations.

APD causes a fear of rejection that often makes it difficult to connect with other people. The affected individual may be hesitant to seek out friendships, unless he is certain that the other person will like him. When he is involved in a relationship, he may be afraid to share personal information or talk about his feelings. This can make it difficult to maintain intimate relationships or close friendships.

As with other disorders, a mental health professional can design a treatment plan that is appropriate for the affected individual. APD treatments vary, but they will likely include talk therapy. If a co-existing condition (e.g., depression, anxiety disorder) is also diagnosed, appropriate medications may also be used.

Other disorders can occur along with APD. Treatments in these cases will be designed to help with the symptoms of each disorder. A few of the conditions that most frequently occur with APD include:
  • Borderline personality disorder, in which adults on the autism spectrum have difficulties in many areas including social relationships, behavior, mood, and self-image
  • Dependent personality disorder, in which these adults rely excessively on others for financial support, advice or to make decisions for them
  • Social phobia, in which the individual experiences overwhelming anxiety and self-consciousness in common social situations

Many APD symptoms are commonly shared among these other conditions, particularly in the case of generalized social phobia. Because of this, the disorders can be easily confused. It may take some time for a mental health professional to make a clear diagnosis and choose the appropriate treatments.

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