Internet Mental Health

ANXIOUS (AVOIDANT) PERSONALITY DISORDER


PSYCHIATRIC DUTY TO WARN: Both President Trump and Vladimir Putin have severe Personality Disorders





Internet Mental Health Quality of Life Scale (Client Version)

Internet Mental Health Quality of Life Scale (Therapist Version)

Big 5 Factors Of Mental Illness And Code For This Disorder
(The "6th Big Factor" of Mental Health, "Physical Health", Is Coded Normal or Green)


  • Individuals with Avoidant Personality Disorder are chronically prone to anxiety, are socially anxious and avoidant, and attempt to manage anxiety in ways that limit and constrict their lives.

  • Since childhood or adolescence, was socially withdrawn due to lack of confidence, pessimism, fear of rejection, and feelings of inferiority.

  • Social anxiety disorder (social phobia) and Avoidant Personality Disorder have similar symptoms, genetics, and treatment response.

  • Thus Avoidant Personality Disorder is a more persistent and generalized form of Social Anxiety Disorder (social phobia).

  • Not due to a medical or substance use disorder.

Prediction

    Can last for years or be lifelong

Problems

Occupational-Economic Problems:

  • Causes significant impairment in academic, occupational and/or social functioning

  • Avoids work activities that involve significant interpersonal contact because of fear of criticism or rejection

Detached (Detachment):

    Avoidance:

  • Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection

  • Is inhibited in new interpersonal situations because of her feelings of inadequacy

  • Is unwilling to get involved with people unless she is certain of being liked

Negative Emotions (Negative Emotion):

    Social Anxiety:

  • Shows restraint within intimate relationships because of her fear of being shamed or ridiculed

  • Is preoccupied with being criticized or rejected in social situations

  • Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

  • Views herself as socially inept, personally unappealing, or inferior to others



Explanation Of Terms And Symbols

Internet Mental Health Quality of Life Scale (Client Version)

Internet Mental Health Quality of Life Scale (Therapist Version)


SAPAS Personality Screening Test

Individuals with this disorder would answer "Yes" to the red questions:

      In general, do you have difficulty making and keeping friends?
      Would you normally describe yourself as a loner?
      In general, do you trust other people?
      Do you normally lose your temper easily?
      Are you normally an impulsive sort of person?
      Are you normally a worrier?
      In general, do you depend on others a lot?
      In general, are you a perfectionist?

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Click Here For Free Diagnosis

Limitations of Self-Diagnosis

Self-diagnosis of this disorder is often inaccurate. Accurate diagnosis of this disorder requires assessment by a qualified practitioner trained in psychiatric diagnosis and evidence-based treatment.

However, if no such professional is available, our free computerized diagnosis is usually accurate when completed by an informant who knows the patient well. Computerized diagnosis is less accurate when done by patients (because they often lack insight).

Example Of Our Computer Generated Diagnostic Assessment

Avoidant (Anxious) Personality Disorder 301.82

This diagnosis is based on the following findings:
  • Fears rejection hence avoids social activities at work or school (still present)

  • Is unwilling to get involved with people unless certain of being liked (still present)

  • Fears being shamed or ridiculed hence withholds showing affection (still present)

  • Is preoccupied with being criticized or rejected in social situations (still present)

  • Is inhibited in new interpersonal situations because of feelings of inadequacy (still present)

  • Views herself as socially inept, personally unappealing, or inferior to others (still present)

  • Is unusually reluctant to take personal risks because of her fear of embarrassment (still present)

Treatment Goals:

  • Goal: stop avoiding social activities.
    If this problem persists: She will continue to avoid social and occupational activities that involve significant interpersonal contact. Offers of job promotions may be declined because the new responsibilities might result in criticism from co-workers.

  • Goal: increase socialization.
    If this problem persists: She will continue to avoid joining group activities or making new friends unless there are repeated and generous offers of support and nurturance.

  • Goal: show more affection.
    If this problem persists: She will continue to find interpersonal intimacy difficult, although she will be able to establish intimate relationships if there is assurance of uncritical acceptance. She may act with restraint, and withhold intimate feelings for fear of being exposed, ridiculed, or shamed.

  • Goal: become less sensitive to rejection.
    If this problem persists: She will continue to be preoccupied with being criticized or rejected in social situations. If someone is even slightly disapproving or critical, she may feel extremely hurt.

  • Goal: be less inhibited in new social situations.
    If this problem persists: She will continue to be shy, quiet, inhibited, and "invisible" in new social situations.

  • Goal: stop feeling socially inept, personally unappealing, or inferior to others.
    If this problem persists: She will continue to feel socially inept, personally unappealing, or inferior to others.

  • Goal: overcome fear of embarrassment by taking more personal risks.
    If this problem persists: She will continue to be unusually reluctant to take personal risks or to engage in any new activities because these may prove embarrassing. Hence her lifestyle might become very restricted.


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Anxious [Avoidant] Personality Disorder F60.6 - ICD10 Description, World Health Organization

Anxious [Avoidant] Personality Disorder is characterized by feelings of tension and apprehension, insecurity and inferiority. There is a continuous yearning to be liked and accepted, a hypersensitivity to rejection and criticism with restricted personal attachments, and a tendency to avoid certain activities by habitual exaggeration of the potential dangers or risks in everyday situations.

ICD-10 International Personality Disorder Examination Screening Questions

  • I usually feel tense or nervous.

  • I feel awkward or out of place in social situations.

  • I won't get involved with people until I'm certain they like me.

  • I worry a lot that people may not like me.

  • A lot of things seem dangerous to me that don't bother most people.

  • I keep to myself even when there are other people around.

ICD-10 Diagnostic Criteria (For Research)

    A. The general criteria of personality disorder must be met:

    • Evidence that the individual's characteristic and enduring patterns of inner experience and behavior deviate markedly as a whole from the culturally expected and accepted range (or 'norm').

    • The deviation must manifest itself pervasively as behavior that is inflexible, maladaptive, or otherwise dysfunctional across a broad range of personal and social situations (i.e. not being limited to one specific 'triggering' stimulus or situation).

    • There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behavior.

    • There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence.

    • The deviation cannot be explained as a manifestation or consequence of other adult mental disorders.

    • Organic brain disease, injury, or dysfunction must be excluded as possible cause of the deviation.

    B. At least four of the following must be present:

    • Persistent and pervasive feelings of tension and apprehension.
        (E.g., "I usually feel tense or nervous.")

    • Belief that oneself is socially inept, personally unappealing, or inferior to others.
        (E.g., "I feel awkward or out of place in social situations.")

    • Excessive preoccupation about being criticized or rejected in social situations.
        (E.g., "I worry a lot that people may not like me.")

    • Unwillingness to get involved with people unless certain of being liked.
        (E.g., "I won't get involved with people until I'm certain they like me.")

    • Restrictions in lifestyle because of need for security.
        (E.g., "A lot of things seem dangerous to me that don't bother most people.")

    • Avoidance of social or occupational activities that involve significant interpersonal contact, because of fear of criticism, disapproval or rejection.
        (E.g., "I keep to myself even when there are other people around.")

Avoidant Personality Disorder - Diagnostic Criteria, American Psychiatric Association

  • An individual diagnosed with Avoidant Personality Disorder needs to show at least 4 of the following criteria:

    • Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection.

    • Is unwilling to get involved with people unless she is certain of being liked.

    • Shows restraint within intimate relationships because of her fear of being shamed or ridiculed.

    • Is preoccupied with being criticized or rejected in social situations.

    • Is inhibited in new interpersonal situations because of her feelings of inadequacy.

    • Views herself as socially inept, personally unappealing, or inferior to others.

    • Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

  • This enduring pattern of inner experience and behavior must deviate markedly from the expectations of the individual's culture.

  • This enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

  • This enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Social Anxiety Disorder (Social Phobia) - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with social anxiety disorder (social phobia) needs to meet all of the following criteria:

  • Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech). Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.

  • The individual fears that she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).

  • The social situations almost always provoke fear or anxiety. Note: In children, the fear or anxiety may be experienced by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.

  • The social situations are avoided or endured with intense fear or anxiety.

  • The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.

  • The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

  • The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functiioning.

  • The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

  • The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

  • If another medical condition (e.g., Parkinson's disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clarly unrelated or is excessive.

Empirically Derived Taxonomy for Personality Diagnosis: Avoidant Personality Disorder

(This section uses an alternative classification system to that of the American Psychiatric Association)

These individuals:
  • Are chronically anxious.

  • Ruminate, dwelling on problems or replaying conversations in their minds

  • Are more concerned with avoiding harm than pursuing desires, and their choices and actions are unduly influenced by efforts to avoid perceived dangers.

  • Are prone to feelings of shame and embarrassment.

  • Are shy and self-conscious in social situations and to feel like an outcast or outsider.

  • Are often socially awkward and tend to avoid social situations because of fear of embarrassment or humiliation.

  • Are inhibited and constricted and have difficulty acknowledging or expressing desires.

  • May adhere rigidly to daily routines, have trouble making decisions, or vacillate when faced with choices.

  • Their anxiety may find expression through a variety of channels, including panic attacks, hypochondriacal concerns (e.g., excessive worry about normal aches and pains), or somatic symptoms in response to stress (e.g., headache, backache, abdominal pain, asthma).


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Diagnostic Features

Avoidant (Anxious) Personality Disorder is a condition characterized by extreme shyness, feelings of inadequacy, and sensitivity to rejection. These individuals feel inferior to others. This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. This diagnosis should be used with great caution in children and adolescents for whom shy and avoidant behavior may be appropriate (e.g., new immigrants)

Individuals with Avoidant Personality Disorder grow up with excessive social anxiety and withdrawal. They have a longstanding pattern of shyness, feelings of inferiority, and hypersensitivity to rejection/embarrassment. The core features of this disorder are: (1) negative emotion (anxiousness (fear of rejection/embarrassment)), and (2) detachment (withdrawal, intimacy avoidance, and anhedonia [decreased ability to feel pleasure]). This disorder is only diagnosed if: (1) it begins no later than early adulthood, (2) these behaviors occur at home, work, and in the community, and (3) these behaviors lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning. Avoidant Personality Disorder should not be diagnosed if its symptoms can be better explained as due to another mental disorder, Substance Use Disorder, or another medical condition.

Like all personality disorders, Avoidant Personality Disorder is a deeply ingrained and enduring behavior pattern, manifesting as an inflexible response to a broad range of personal and social situations. This behavior represents an extreme or significant deviation from the way in which the average individual in a given culture relates to others. This behavior pattern tends to be stable.

The social anxiety and withdrawal (shyness) of individuals with this disorder often starts in infancy or childhood. Most children grow out of their shyness. However, for some individuals during adolescence, this shyness develops into an intense fear of rejection/embarrassment which would be diagnosed as social anxiety disorder (social phobia). By early adulthood, if this social phobia increases still further; the individual would be diagnosed as having Avoidant Personality Disorder. Social anxiety disorder (social phobia) and Avoidant Personality Disorder have similar symptoms, genetics, and treatment response. Thus Avoidant Personality Disorder is a more persistent and generalized form of Social Anxiety Disorder (social phobia).

Course

This disorder is usually worse earlier in life and often improves in middle age. This avoidant behavior often starts in infancy or childhood with shyness, isolation, and fear of strangers and new situations. Unfortunately, for some, this avoidant behavior persists and intensifies into adulthood; thus they become diagnosed with this disorder.

Complications

Individuals with Avoidant Personality Disorder have few close friends, but are very dependent on them. They are described by others as being "shy", "timid," "lonely," and "isolated". Their occupational functioning may also suffer because they avoid social situations that are important for job advancement.

Comorbidity

Personality disorders are an overlooked and underappreciated source of psychiatric morbidity. Comorbid personality disorders may, in fact, account for much of the morbidity attributed to axis I disorders in research and clinical practice. "High percentages of patients with schizotypal (98.8%), borderline (98.3%), avoidant (96.2%), and obsessive-compulsive (87.6%) personality disorder and major depressive disorder (92.8%) exhibited moderate (or worse) impairment or poor (or worse) functioning in at least one area."
Some other disorders frequently occur with this disorder:

    Non-Personality Disorders

            Depressive Disorders:
      • Persistent Depressive Disorder (Dysthymia)
            Anxiety Disorders:
      • Social Anxiety Disorder (Social Phobia)

    Personality Disorders

            Dependent Personality Disorder

            Schizoid Personality Disorder

Associated Laboratory Findings

No laboratory test has been found to be diagnostic of this disorder.

Prevalence

The prevalence of Avoidant Personality Disorder is about 2.4% of the general population. The male to female ratio is 1:1.

Controlled Clinical Trials Of Therapy

Click here for a list of all the controlled clinical trials of therapy for this disorder.

Psychotherapy

Avoidant Personality Disorder is a very common disorder; yet there is surprisingly little research on the effectiveness of its treatment. There are few randomized controlled clinical trials on psychotherapy for this disorder. One study found that cognitive behavioral therapy (graduated exposure) was partially effective. The same study showed that brief dynamic therapy was ineffective. Older studies showed that social skills training was an effective treatment, but no new studies on social skills training have been published since 1994.

Pharmacotherapy

There are currently no medications approved by the FDA to treat this disorder. Vitamins and dietary supplements are ineffective for all Personality Disorders.

A Dangerous Cult


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Rating Scales

Avoidant-Dependent Traits

Individuals with Avoidant Personality Disorder have an active desire for friendships, but it is constrained by a fear of rejection. Thus they form relationships with others only if they believe they will not be rejected. Loss and rejection are so painful that these individuals would rather be lonely than risk rejection. They usually have feelings of inadequacy, hypersensitivity to criticism, and an excessive need for reassurance.

Lack Of Social Skills In Personality Disorders

There are social skills that are essential for healthy social functioning. Individuals with Avoidant Personality Disorder lack the essential social skills of self-confidence, optimism, and belonging. They lack intimacy and sociabililty (that are also lacking in individuals with schizoid personality disorder).

Social Skills That Are Lacking In Avoidant Personality Disorder

SOCIAL SKILL AVOIDANT PERSONALITY NORMAL
Self-Confidence Feeling inferior or shy Having a good opinion of one's self and abilities; socially confident and out-going
Optimism Pessimism or expecting the worst Having a positive outlook on life; expecting a good outcome; hopeful
Belonging Fearing rejection by others Feeling liked and accepted by friends, and included in their group; not fearing rejection
Intimacy Intimacy avoidance Wanting close friendships or intimate romantic relationships
Sociability Social withdrawal Friendly; interested in social contacts and activities


Avoidant, borderline, and dependent personality disorders are closely related and can be thought of as forming a "low emotional stability cluster" of personality disorders. On personality testing, these three disorders all have low emotional stability scores.

Social Skills That Are Lacking In The "Low Emotional Stability Cluster" Of Personality Disorders

PERSONALITY DISORDER LACKING LACKING LACKING
Avoidant Personality Self-Confidence (instead has feeling inferior or shy) Optimism (instead has pessimism or expecting the worst) Belonging (instead has fearing rejection by others)
Dependent Personality Independence (instead has dependence on others) Extraversion (instead has submissiveness) Peacemaking (instead has inability to handle conflict)
Borderline Personality Emotional Stability (instead has emotional instability) Stable Self-Image (instead has unstable self-image) Stable Relationships (instead has intense, chaotic relationships)

A Emotionally Stable Life (Emotional Stability)

How does one live a Emotionally Stable life?

One approach to answering this question is to study the behavior of individuals who live anxious, emotionally unstable lives. Could the opposite of their maladaptive behavior define how to live a Emotionally Stable life?

Research has shown that anxiety and emotional instability highly correlates with low scores on the emotional stability personality dimension. The personality disorders that have the lowest scores on the emotional stability personality dimension are the Avoidant, Dependent, and Borderline Personality Disorders.

Could the opposite of the personality traits seen in the Avoidant, Dependent, and Borderline Personality Disorders be a clue as to how to live a Emotionally Stable life? If so, the right side of the following table would define a calm, emotionally stable life. (This table uses DSM-5 diagnostic criteria.)


    Avoidant Personality Disorder The Opposite Of Avoidant Personality Disorder
    Avoidance: Sociability:
    Avoids occupational activities that involve significant interpersonal contact, because of her fear of criticism, disapproval, or rejection Doesn't avoid occupational activities that involve significant interpersonal contact, because of any fear of criticism, disapproval, or rejection
    Is unwilling to get involved with people unless she is certain of being liked Is willing to get involved with people even if she is uncertain of being liked
    Shows restraint within intimate relationships because of her fear of being shamed or ridiculed Is not reluctant in intimate relationships because of any fear of being shamed or ridiculed
    Is preoccupied with being criticized or rejected in social situations Doesn't worry excessively about being criticized or rejected in social situations
    Social Anxiety: Self-Confidence:
    Is inhibited in new interpersonal situations because of her feelings of inadequacy Is not inhibited in new interpersonal situations because of any feelings of inadequacy
    Views herself as socially inept, personally unappealing, or inferior to others Does not view herself as socially inept, personally unappealing, or inferior to others
    Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing Is not reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
    Dependent Personality Disorder The Opposite Of Dependent Personality Disorder
    Dependency: Independence:
    Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others Can make everyday decisions without an excessive amount of advice and reassurance from others
    Needs others to assume responsibility for most major areas of her life Assumes responsibility for most major areas of her life
    Has difficulty expressing disagreement with others because of her fear of loss of support or approval Can express disagreement with others
    Has difficulty initiating projects or doing things on her own No difficulty initiating projects or doing things on her own
    Goes to excessive lengths to obtain nurturance and support from others Does not go to excessive lengths to obtain nurturance and support from others
    Feels uncomfortable or helpless when alone because of her exaggerated fears of being unable to cope Feels comfortable when alone
    Urgently seeks another relationship as a source of care and support when a close relationship ends Does not urgently seek another relationship as a source of care and support when a close relationship ends
    Is unrealistically preoccupied with fears of being left to take care of herself Is not preoccupied with fears of being left to take care of herself
    Borderline (Emotionally Unstable) Personality Disorder The Opposite Of Borderline (Emotionally Unstable) Personality Disorder
    Emotional Instability: Emotional Stability:
    Rapidly shifting emotions Stable emotions
    Inappropriate, intense anger or difficulty controlling anger Good anger control
    Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior No suicidal behavior, gestures, or threats, or self-mutilating behavior
    Chronic feelings of emptiness Has meaning and purpose to her life
    Impulsivity: Caution:
    Potentially self-damaging impulsivity (e.g., spending, sex, substance abuse, reckless driving, binge eating) No potentially self-damaging impulsivity
    Unstable, Intense, Chaotic Relationships: Stable Relationships:
    Unstable and intense 'love-hate' relationships Stable, close, long-lasting interpersonal relationships
    Frantic efforts to avoid real or imagined abandonment Can calmly cope with real or imagined abandonment
    Markedly and persistently unstable self-image or sense of self Stable self-image; positive sense of herself

An Anxious, Emotionally Unstable Life (Low Emotional Stability)

How does one live an anxious, emotionally unstable life?

The following table summarizes the personality traits of individuals with Avoidant, Dependent and Borderline Personality Disorder. Individuals with these low emotional stability personality disorders have marked anxiety or emotional instability. (This table uses ICD-10 diagnostic criteria.)

    The Most Anxious and Emotionally Unstable Personality Traits Examples
    Avoidant Personality Traits:
    Persistent and pervasive feelings of tension and apprehension. "I usually feel tense or nervous."
    Belief that oneself is socially inept, personally unappealing, or inferior to others. "I feel awkward or out of place in social situations."
    Excessive preoccupation about being criticized or rejected in social situations. "I worry a lot that people may not like me."
    Unwillingness to get involved with people unless certain of being liked. "I won't get involved with people until I'm certain they like me."
    Restrictions in lifestyle because of need of security. "A lot of things seem dangerous to me that don't bother most people."
    Avoidance of social or occupational activities that involve significant interpersonal contact, because of fear of criticism, disapproval or rejection. "I keep to myself even when there are other people around."
    Dependent Personality Traits:
    Encouraging or allowing others to make most of one's important life decisions. "I let others make my big decisions for me."
    Subordination of one's own needs to those of others on whom one is dependent, and undue compliance with their wishes. "I find it hard to disagree with people if I depend on them a lot."
    Unwillingness to make even reasonable demands on the people one depends on. "I don't ask favors from people that I depend on a lot."
    Feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself. "I usually feel uncomfortable or helpless when I'm alone."
    Preoccupation with fears of being left to take care of oneself. "I worry about being left alone and having to care for myself."
    Limited capacity to make everyday decisions without an excessive amount of advice and reassurance from others. "I often seek advice or reassurance about everyday decisions."
    Borderline Personality Traits:
    A marked tendency to quarrelsome behavior and to conflicts with others, especially when impulsive acts are thwarted or criticized "I argue or fight when people try to stop me from doing what I want."
    A marked tendency to act unexpectedly and without consideration of the consequences "I take chances and do reckless things."
    Liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions "Sometimes I get so angry I break or smash things."
    Difficulty in maintaining any course of action that offers no immediate reward "I don't stick with a plan if I don't get results right away."
    Unstable and capricious mood "I'm very moody."
    Disturbances in and uncertainty about self-image, aims and internal preferences (including sexual) "I can't decide what kind of person I want to be."
    Liability to become involved in intense and unstable relationships, often leading to emotional crises "I get into very intense relationships that don't last."
    Excessive efforts to avoid abandonment "I go to extremes to try to keep people from leaving me."
    Recurrent threats or acts of self-harm "A number of times, I've threatened suicide or injured myself on purpose."
    Chronic feelings of emptiness "I often feel empty inside."

Core Behaviors Of The Negative Emotion Cluster Of Personality Disorders

Charles Darwin In 1842 With His Eldest Son

Charles Darwin is one of the most influential figures in human history; yet he suffered from Avoidant Personality Disorder. Darwin was eminent as a naturalist, geologist, biologist, and author; and is best known for his explanation of human and animal evolution. However, he so feared public speaking that his friends had to deliver many of his lectures. Likewise, Darwin would not attend public debates of his theories, in that controversy upset him so. For years, he delayed publishing his greatest work, "The Origin Of The Species", because he feared the controversy it would generate. When he died, Darwin was so well-respected that he was buried in Westminster Abbey, close to Isaac Newton. Darwin is an excellent example of how a person can rise above their personality disorder.

Parental Behaviors Which Increase The Risk Of Developing A Personality Disorder

Research has shown that genetic, environmental, and prenatal factors all play important roles in the development of personality disorder. Research has also shown that low parental affection and harsh parenting increase the risk of a child later developing a personality disorder.

"Low affection" was defined as: low parental affection, low parental time spent with the child, poor parental communication with the child, poor home maintenance, low educational aspirations for the child, poor parental supervision, low paternal assistance to the child's mother, and poor paternal role fulfillment. "Harsh parenting" was defined as: harsh punishment, inconsistent maternal enforcement of rules, frequent loud arguments between the parents, difficulty controlling anger toward the child, possessiveness, use of guilt to control the child, and verbal abuse.


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Treatment Guidelines


Setting Goals In Therapy

    Questions To Ask When Setting Goals

    In The Past Week:
    • WHO: was your problem?

    • EVENT: what did he/she do?

    • RESPONSE: how did you respond to that event?

    • OUTCOME: did your response help?

    • TRIGGER: what did you do that could have triggered this problem?

    • GOAL: what life skill(s) do you have to work on? (from checklist)

    Example Of Setting Goals In Interviewing A Person With Avoidant Personality Disorder

    In The Past Week:
    • WHO: was your problem?
      "There's a woman in my office I'd like to date."

    • EVENT: what did he/she do?
      "I tried to ask her out on a date, but before I could ask she had to leave."

    • RESPONSE: how did you respond to that event?
      "I felt so embarrassed that I was at such a loss for words when I was trying to ask her out on a date."

    • OUTCOME: did your response help?
      "No, I hate it when I get embarrassed like that and freeze when I'm talking to a woman. That never happens when I'm talking to my male friends."

    • TRIGGER: what did you do that could have triggered this problem?
      "This is the third time I've botched trying to ask this woman out on a date. Everytime I fail, it gets more difficult."

    • GOAL: what life skill(s) do you have to work on? (from checklist)
      "I want to work on: (1) Self-esteem ("having a good opinion of one's self and abilities; feeling capable and of worth"), and (2) Extraversion ("being confident and direct in claiming one's rights or putting forward one's views")."


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Research Shows Acts of Kindness Alleviate Social Anxiety

Avoidant Personality Disorder Self-Help Resources

Improving Positive Behavior

Philosophers for the past 2,500 years have taught that it is very beneficial to start the day with goal-setting, and end the day with a brief review.

This habit of planning your day in the morning, and reviewing your day in the evening, is a time-proven technique for more successful living.

Note: When each of the following videos finishes; you must exit YouTube (by manually closing the window) in order to return to this webpage.



Morning Meditation (5-Minute Video)



Afternoon Meditation (Learn How To Have Healthy Relationships)



Evening Meditation (5-Minute Video)



Life Satisfaction Scale (Video)



Healthy Social Behavior Scale (Video)



Mental Health Scale (Video)




Click Here For More Self-Help



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  • The best summary on bad research is given by Laura Arnold in this TEDx lecture. If you read nothing else about research, you owe it to yourself to watch this short video - it is excellent!

  • The power of asking "what if?"

  • The active placebo effect: 2300 years ago, the Greek Stoic philosophers taught that it is not the objective event, but our subjective judgment about the event, that determines our behavior. The active placebo effect bears witness to this ancient wisdom.

  • Criteria For High Quality Research Studies

  • It is troubling that a recent study found that two-thirds of important psychological research studies couldn't be replicated. High quality research must meet the following criteria:

    • Randomized Controlled Trial:
      Ask: Was the trial randomized? Was the randomization procedure described and was it appropriate? The best research design is to have research subjects randomly assigned to an experimental or control group. It is essential that confounding factors be controlled for by having a control group or comparator condition (no intervention, placebo, care as usual etc.).

    • Representative Sample:
      Ask: Do the research subjects represent a normal cross-section of the population being studied? Many psychological research studies using university students are flawed because their subjects are not representative of the normal population since they are all W.E.I.R.D. (White, Educated, Intelligent, Rich, and living in a Democracy).

    • Single Blind Trial:
      Ask: Was the treatment allocation concealed? It is essential that the research subjects are kept "blind" as to whether they are in the experimental or control group (in order to control for any placebo effects).

    • Double Blind Trial (Better Than Single Blind Trial):
      Ask: Were blind outcome assessments conducted? In a double blind study, neither the research subjects nor the outcome assessors know if the research subject is in the experimental or control group. This controls for both the placebo effect and assessor bias.

    • Baseline Comparability:
      Ask: Were groups similar at baseline on prognostic indicators? The experimental and control groups must be shown to be comparable at the beginning of the study.

    • Confounding Factors:
      Ask: Were there factors, that weren't controlled for, that could have seriously distorted the study's results? For example, research studies on the effectiveness of mindfulness cognitive therapy in preventing depressive relapse forgot to control for whether the research subjects were also simultaneously receiving antidepressant medication or other psychological treatments for depression.

    • Intervention Integrity:
      Ask: Was the research study protocal strictly followed? The research subjects must be shown to be compliant (e.g., taking their pills, attending therapy) and the therapists must be shown to be reliably delivering the intervention (e.g., staying on the research protocol).

    • Statistical analysis:
      Ask: Was a statistical power calculation described? The study should discuss its statistical power analysis; that is whether the study size is large enough to statistically detect a difference between the experimental and control group (should it occur) and usually this requires at least 50 research subjects in the study.

      Ask: Are the results both statistically significant and clinically significant? The results should be both statistically significant (with a p-value <0.05) and clinically significant using some measure of Effect Size such as Standardized Mean Difference (e.g., Cohen's d >= 0.33). The summary statistics should report what percentage of the total variance of the dependent variable (e.g., outcome) can be explained by the independent variable (e.g., intervention). In clinical studies, the study should report the number needed to treat for an additional beneficial outcome (NNTB), and the number needed to treat for an additional harmful outcome (NNTH).

        Number Needed To Benefit (NNTB): This is defined as the number of patients that need to be treated for one of them to benefit compared with a control in a clinical trial. (It is defined as the inverse of the absolute risk reduction.) Note: Statistically, the NNTB depends on which control group is used for comparison - e.g., active treatment vs. placebo treatment, or active treatment vs. no treatment.

        Number Needed To Harm (NNTH): This is defined as the number of patients that need to be treated for one of them to be harmed compared with a control in a clinical trial. (It is defined as the inverse of the absolute increase in risk of harm.)

        Tomlinson found “an NNTB of 5 or less was probably associated with a meaningful health benefit,” while “an NNTB of 15 or more was quite certain to be associated with at most a small net health benefit.”

      Ask: Does the researcher accept full responsibility for the study's statistical analysis? The researcher should not just hand over the study's raw data to a corporation (that may have $1,000 million invested in the study) to do the statistical analysis.

    • Completeness of follow-up data:
      Ask: Was the number of withdrawals or dropouts in each group mentioned, and were reasons given for these withdrawals or dropouts? Less than 20% of the research subjects should drop out of the study. The intervention effect should persist over an adequate length of time.

    • Handling of missing data:
      Ask: Was the statistical analysis conducted on the intention-to-treat sample? There must be use of intention-to-treat analysis (as opposed to a completers-only analysis). In this way, all of the research subjects that started the study are included in the final statistical analysis. A completers-only analysis would disregard those research subjects that dropped out.

    • Replication of Findings:
      Ask: Can other researchers replicate this study's results? The research study's methodology should be clearly described so that the study can be easily replicated. The researcher's raw data should be available to other researchers to review (in order to detect errors or fraud).

    • Fraud:
      Ask: Is there a suspicion of fraud? In a research study, examine the independent and dependent variables that are always measured as a positive whole number (e.g., a variable measured on a 5-point Likert-type scale ranging from "1 = definitely false to 5 = definitely true" etc.). For each of these variables, look at their sample size (n), mean (M) and standard deviation (SD) before they undergo statistical analysis. There is a high suspicion of fraud in a study's statistics:

      • If the M is mathematically impossible (online calculator): This is one of the easiest ways to mathematically detect fraud. The mean (M) is defined as "the sum (Sum) of the values of each observation divided by the total number (n) of observations". So: M = Sum/n. Thus: (Sum) = (M) multiplied by (n). We know that, if a variable is always measured as a positive whole number, the sum of these observations always has to be a whole number. For these variables to test for fraud: calculate (M) multiplied by (n). This calculates the Sum which MUST be a positive whole number. If the calculated Sum isn't a positive whole number; the reported mean (M) is mathematically impossible - thus the researcher either cooked the data or made a mistake. A recent study of 260 research papers published in highly reputable psychological journals found that 1 in 2 of these research papers reported at least one impossible value, and 1 in 5 of these research papers reported multiple impossible values. When the authors of the 21 worst offending research papers were asked for their raw data (so that its reliability could be checked) - 57% angrily refused. Yet such release of raw data to other researchers is required by most scientific journals. (Here is an example of a research paper filled with mathematically impossible means.)

      • If the SD is mathematically impossible (online calculator): When researchers fraudulently "cook" their data, they may accidently give their data a mean and standard deviation that is mathematically impossible for a (normally distributed) strictly positive variable (because the "cooked" M and SD would mathematically require the strictly positive variable's range of data to include negative numbers). For a normally distributed sample of size of 25-70, this occurs when the SD is greater than one-half of the M; for a sample size of 70+, this occurs when the SD is greater than one-third of the M [using these formulas].

      • If the SD/M is very small (i.e., the variable's standard deviation is very small compared to the mean suggesting data smoothing).

      • If the SD's are almost identical (i.e., the variables have different means but almost identical standard deviations).

      • If the 4th digit of the values of the variables aren't uniformly distributed - since each should occur 10% of the time (Benford's Law).

      • If the researcher is legally prevented from publishing negative findings about a drug or therapy because that would violate the "nondisclosure of trade secrets" clause in the research contract (i.e., it is a "trade secret" that the drug or therapy is ineffective - hence this can not be "disclosed"). Approximately half of all registered clinical trials fail to publish their results.

      • If the researcher refuses to release his raw data to fellow researchers (so that they can check its validity). In order to be published in most scientific journals, a researcher must promise to share his raw data with fellow researchers. Thus a researcher's refusal to do so is almost a sure indicator of fraud.

      • If the research study's data contradicts the study's own conclusions - surprisingly, this often occurs.

  • Calling Bullshit In The Age of Big Data - "Bullshit is language, statistical figures, data graphics, and other forms of presentation intended to persuade by impressing and overwhelming a reader or listener, with a blatant disregard for truth and logical coherence." Reading the syllabus of this university course should be required reading for every student of mental health. This syllabus is absolutely fantastic!

  • Statistical Methods in Psychology Journals: Guidelines and Explanations - American Psychologist 1999

  • Not All Scientific Studies Are Created Equal - video

  • The efficacy of psychological, educational, and behavioral treatment

  • Estimating the reproducibility of psychological science

  • Psychologists grapple with validity of research

  • Industry sponsorship and research outcome (Review) - Cochrane Library

  • 'We've been deceived': Many clinical trial results are never published - (text and video)

  • Junk science misleading doctors and researchers

  • Junk science under spotlight after controversial firm buys Canadian journals

  • Medicine with a side of mysticism: Top hospitals promote unproven therapies - Are some doctors becoming modern witchdoctors?

  • When Evidence Says No, But Doctors Say Yes


  • Cochrane Reviews (the best evidence-based, standardized reviews available)

Research Topics

Avoidant Personality Disorder - Latest Research (2016-2017)


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Which Behavioral Dimensions Are Involved?

Research has shown that there are 5 major dimensions (the "Big 5 Factors") of personality disorders and other mental disorders. There are two free online personality tests that assess your personality in terms of the "Big 5 dimensions of personality". Although not computerized online, the Big Five Inventory (BFI) is a 44-item test often used in personality research.

This website uses these 5 major dimensions of human behavior to describe all mental disorders. (This website adds one more dimension, "Physical Health", but our discussion will focus on the first 5 major dimensions.)

These major dimensions of human behavior seem to represent the major dimensions whereby our early evolutionary ancestors chose their hunting companions or spouse. To maximize their chance for survival, our ancestors wanted companions who were agreeable, conscientious, intelligent, sociable, emotionally stable, and physically healthy.

Which Dimensions of Human Behavior are Impaired in Avoidant Personality Disorder?

THE POSITIVE SIDE OF THE "BIG 5" PERSONALITY DIMENSIONS THE NEGATIVE SIDE OF THE "BIG 5" PERSONALITY DIMENSIONS DESCRIPTION (Where red = this disorder)
Agreeableness Antagonism       Agreeableness
Conscientiousness Disinhibition       Conscientiousness
Intellect Decreased Intellect       Intellect
Sociability (Extraversion) Detachment       Detachment
Emotional Stability Negative Emotion       Negative Emotion



The 5 Major Dimensions of Mental Illness

The Big 5 Factors or dimensions of mental illness each has a healthy side and an unhealthy side. Thus the Big 5 Factors are: (1) Agreeableness vs. Antagonism, (2) Conscientiousness vs. Disinhibition, (3) Intellect vs. Decreased Intellect, (4) Sociability (Extraversion) vs. Detachment (Introversion), and (5) Emotional Stability vs. Negative Emotion.

In the following lists, the problems that are diagnostic of this disorder are highlighted in red.


Treatment Goals for Individuals With Antagonism

AGREEABLENESS VS. ANTAGONISM
.
Agreeableness (Agreeable)
.
Description: Agreeableness is synonymous with compassion and politeness. Compassion reflects empathy, sympathy, and caring for others. Politeness reflects respect for others. Agreeable people are interested in others, and they make people feel comfortable. The Agreeableness dimension measures the behaviors that are central to the concept of JUSTICE and equality (fair, honest, and helpful behavior - living in harmony with others, neither harming nor allowing harm). Justice is then the public manifestation of love. (This dimension appears to measure the behaviors that differentiate friend from foe.)
Descriptors: Compassionate, polite, warm, friendly, helpful, unselfish, generous, modest.
Language Characteristics: Pleasure talk, agreement, compliments, empathy, few personal attacks, few commands or global rejections, many self-references, few negations, few swear words, few threats, many insight words.
Research: Higher scores on Agreeableness are associated with deeper relationships. *MRI research found that Agreeableness was associated with increased volume in regions that process information about the intentions and mental states of other individuals.
"I am helpful and unselfish with others."
"I have a forgiving nature."
"I am generally trusting."
"I am considerate and kind to almost everyone."
"I like to cooperate with others."
"I don't find fault with others."
"I don't start quarrels with others."
"I am not cold and aloof."
"I am not rude to others."
"I feel other's emotions."
"I inquire about others' well-being."
"I sympathize with others' feelings."
"I take an interest in other people's lives."
"I like to do things for others."
"I respect authority."
"I hate to seem pushy."
"I avoid imposing my will on others."
"I rarely put people under pressure."
.
Antagonism (Antagonistic)
.
Description: Antagonism is synonymous with competition and aggression. Antagonistic people are self-interested, and do not see others positively.
Descriptors: Manipulative, deceitful, grandiose, callous, disrespectful, unfriendly, suspicious, uncooperative, malicious.
Language Characteristics: Problem talk, dissatisfaction, little empathy, many personal attacks, many commands or global rejections, few self-references, many negations, many swear words, many threats, little politeness, few insight words.
.
* Callousness:
"It's no big deal if I hurt other people's feelings."
"Being rude and unfriendly is just a part of who I am."
"I often get into physical fights."
"I enjoy making people in control look stupid."
"I am not interested in other people's problems."
"I can't be bothered with other's needs."
"I am indifferent to the feelings of others."
"I don't have a soft side."
"I take no time for others."
.
* Deceitfulness:
"I don't hesitate to cheat if it gets me ahead."
"Lying comes easily to me."
"I use people to get what I want."
"People don't realize that I'm flattering them to get something."
.
* Manipulativeness:
"I use people to get what I want."
"It is easy for me to take advantage of others."
"I'm good at conning people."
"I am out for my own personal gain."
.
* Grandiosity:
"I'm better than almost everyone else."
"I often have to deal with people who are less important than me."
"To be honest, I'm just more important than other people."
"I deserve special treatment."
.
* Suspiciousness:
"It seems like I'm always getting a “raw deal” from others."
"I suspect that even my so-called 'friends' betray me a lot."
"Others would take advantage of me if they could."
"Plenty of people are out to get me."
"I'm always on my guard for someone trying to trick or harm me."
.
* Hostility:
"I am easily angered."
"I get irritated easily by all sorts of things."
"I am usually pretty hostile."
"I always make sure I get back at people who wrong me."
"I resent being told what to do, even by people in charge."
"I insult people."
"I seek conflict."
"I love a good fight."
.
("Agreeableness vs. Antagonism" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.



Treatment Goals for Individuals With Disinhibition

CONSCIENTIOUSNESS VS. DISINHIBITION
.
Conscientiousness (Conscientious)
.
Description: Conscientiousness is synonymous with being self-disciplined, industrious and orderly. The Conscientiousness dimension measures the behaviors that are central to the concept of SELF-CONTROL - organizing and controlling one's behavior in order to achieve one's goals. (This dimension appears to measure the behaviors that differentiate behavioral order and inhibition from chaos and disinhibition.)
Descriptors: Industrious, self-disciplined, rule-abiding, organized
Language Characteristics: Many positive emotion words (e.g. happy, good), few negative emotion words (e.g. hate, bad), more perspective, careful to check that information is conveyed correctly, straight to the point, formal, few negations, few swear words, few references to friends, few disfluencies or filler words, many insight words, not impulsive.
Research: Higher scores on Conscientiousness predict greater success in school and at work. *MRI research found that Conscientiousness was associated with increased volume in the lateral prefrontal cortex, a region involved in planning and the voluntary control of behavior.
"I do a thorough job. I want everything to be 'just right'. I want every detail taken care of."
"I am careful."
"I am a reliable hard-worker."
"I am organized. I follow a schedule and always know what I am doing."
"I like order. I keep things tidy."
"I see that rules are observed."
"I do things efficiently. I get things done quickly."
"I carry out my plans and finish what I start."
"I am not easily distracted."
.
Rigid Perfectionism (Excessive Conscientiousness)
.
"Even though it drives other people crazy, I insist on absolute perfection in everything I do."
"I simply won't put up with things being out of their proper places."
"People complain about my need to have everything all arranged."
"People tell me that I focus too much on minor details."
"I have a strict way of doing things."
"I postpone decisions."
.
Disinhibition (Disinhibited)
.
Description: Disinhibition is synonymous with being distractible, impulsive and disorganized.
Descriptors: Distractible, impulsive, irresponsible, disorganised, unreliable, careless, forgetful
Language Characteristics: Few positive emotion words, many negative emotion words, less perspective, less careful, more vague, informal, many negations, many swear words, many references to friends (e.g. pal, buddy), many disfluencies or filler words, few insight words, impulsive.
.
* Irresponsibility:
"I've skipped town to avoid responsibilities."
"I just skip appointments or meetings if I'm not in the mood."
"I'm often pretty careless with my own and others' things."
"Others see me as irresponsible."
"I make promises that I don't really intend to keep."
"I often forget to pay my bills."
.
* Impulsivity:
"I usually do things on impulse without thinking about what might happen as a result."
"Even though I know better, I can't stop making rash decisions."
"I feel like I act totally on impulse."
"I'm not good at planning ahead."
.
* Distractibility:
"I can't focus on things for very long."
"I am easily distracted."
"I have trouble pursuing specific goals even for short periods of time."
"I can't achieve goals because other things capture my attention."
"I often make mistakes because I don't pay close attention."
"I waste my time ."
"I find it difficult to get down to work."
"I mess things up."
"I don't put my mind on the task at hand."
.
* Reckless Risk Taking:
"I like to take risks."
"I have no limits when it comes to doing dangerous things."
"People would describe me as reckless."
"I don't think about getting hurt when I'm doing things that might be dangerous."
.
* Hyperactivity:
"I move excessively (e.g., can't sit still; restless; always on the go)."
"I'm starting lots more projects than usual or doing more risky things than usual."
.
* Over-Talkativeness:
"I talk excessively (e.g., I butt into conversations; I complete people's sentences)."
"Often I talk constantly and cannot be interrupted."
.
* Elation:
"I feel much more happy, cheerful, or self-confident than usual."
"I'm sleeping a lot less than usual, but I still have a lot of energy."
.
("Conscientiousness vs. Disinhibition" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.



Treatment Goals for Individuals With Decreased Intellect

Intellect vs. Decreased Intellect
.
Intellect (Open-Minded)
.
Description: Intellect (or "Openness To Experience") is synonymous with being open-minded and creative. The Intellect dimension measures the behaviors that are central to the concept of WISDOM - having experience, knowledge, and good judgment. (This dimension appears to measure the behaviors that differentiate open-minded from close-minded individuals.) Open-minded people are usually creative, sophisticated, intellectual, curious and interested in art.
Descriptors: Receptive to new ideas, curious, imaginative, creative, unconventional
Language Characteristics: Many positive emotion words (e.g. happy, good), high meaning elaboration, more perspective, politeness, few self-references, complex sentence constructions, few causation words, many inclusive words (e.g. with, and), few third person pronouns, many tentative words (e.g. maybe, guess), many insight words (e.g. think, see), few filler words and within-utterance pauses, stronger uncommon verbs.
Research: Higher scores on Intellect are associated with greater creativity and general intelligence. *MRI research found that Intellect did not have any significant correlation with the volume of any localized brain structure.
Relationship To General Intelligence: Research has shown that Intellect can be separated into 2 factors: Openness and Intellect. Intellect was independently associated with general intelligence (g) and with verbal and nonverbal intelligence about equally. Openness was independently associated only with verbal intelligence.
Example: This video shows how we see what we want to see. What we pay attention to (or what we believe about the world) blinds us to reality. (Exit YouTube after first video.)
"I am original, and come up with new ideas."
"I am curious about many different things."
"I am quick to understand things."
"I can handle a lot of information."
"I like to solve complex problems."
"I have a rich vocabulary."
"I think quickly and formulate ideas clearly."
"I enjoy the beauty of nature."
"I believe in the importance of art."
"I love to reflect on things."
"I get deeply immersed in music."
"I see beauty in things that others might not notice."
"I need a creative outlet."
.
Decreased Intellect (Closed-Minded)
.
Description: Decreased Intellect (or "Closed To Experience") is synonymous with being closed-minded and uncreative. Decreased Intellect is associated with narrow-mindedness, unimaginativeness and ignorance.
Descriptors: Narrow-minded, conservative, ignorant, simple
Language Characteristics: Few positive emotion words, low meaning elaboration, less perspective, less politeness, few positive emotion words, many self-references, simple sentence construction, many causation words (e.g. because, hence), many third person pronouns, few tentative words, few insight words, many filler words and within-utterance pauses, milder verbs.
.
"I prefer work that is routine."
"I have difficulty understanding abstract ideas."
"I think slowly."
"People find it hard to follow my logic or understand my thoughts."
"I avoid philosophical discussions."
"I avoid difficult reading material."
"People find it hard to follow my logic or understand my thoughts."
"I have few artistic interests."
"I seldom notice the emotional aspects of paintings and pictures."
"I do not like poetry."
"I seldom get lost in thought."
"I seldom daydream."
.
Cognitive Impairment
.
* Memory Impairment:
"I have difficulty learning new things, or remembering things that happened a few days ago."
"I often forget a conversation I had the day before."
"I often forget to take my medications, or to keep my appointments."
.
.
* Impaired Reasoning:
"My judgment or ability to solve problems isn't good."
"I have difficulty understanding abstract ideas."
"I think slowly."
"People find it hard to follow my logic or understand my thoughts."
.
Psychoticism
.
Description: Psychoticism is the state of being psychotic or of being predisposed to develop psychosis.
Descriptors: Unusual beliefs and experiences, eccentricity, perceptual dysregulation.
.
* Eccentricity:
"I often have thoughts that make sense to me but that other people say are strange."
"Others seem to think I'm quite odd or unusual."
"My thoughts are strange and unpredictable."
"My thoughts often don’t make sense to others."
"Other people seem to think my behavior is weird."
"I have several habits that others find eccentric or strange."
"My thoughts often go off in odd or unusual directions."
.
* Unusual Beliefs and Experiences:
"I often have unusual experiences, such as sensing the presence of someone who isn't actually there."
"I've had some really weird experiences that are very difficult to explain."
"I have seen things that weren’t really there."
"I have some unusual abilities, like sometimes knowing exactly what someone is thinking."
"I sometimes have heard things that others couldn’t hear."
"Sometimes I can influence other people just by sending my thoughts to them."
"I often see unusual connections between things that most people miss."
.
* Perceptual Dysregulation:
"Things around me often feel unreal, or more real than usual."
"Sometimes I get this weird feeling that parts of my body feel like they're dead or not really me."
"It's weird, but sometimes ordinary objects seem to be a different shape than usual."
"Sometimes I feel 'controlled' by thoughts that belong to someone else."
"Sometimes I think someone else is removing thoughts from my head."
"I have periods in which I feel disconnected from the world or from myself."
"I can have trouble telling the difference between dreams and waking life."
"I often 'zone out' and then suddenly come to and realize that a lot of time has passed."
"Sometimes when I look at a familiar object, it's somehow like I'm seeing it for the first time."
"People often talk about me doing things I don't remember at all."
"I often can't control what I think about."
"I often see vivid dream-like images when I’m falling asleep or waking up."
.
("OPENNESS TO EXPERIENCE vs. BEING CLOSED TO EXPERIENCE" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.



Treatment Goals for Detachment

SOCIABILITY (EXTRAVERSION) vs. DETACHMENT
.
Sociability (Sociable)
.
Description: Sociability (Extraversion) is synonymous with being enthusiastic and assertive. Assertiveness encompasses traits relating to leadership, dominance, and drive. Enthusiasm encompasses both sociability and the tendency to experience and express positive emotion. Extraverts tend to engage in social interaction; they are enthusiastic, risk-taking, talkative and assertive. The Extraversion dimension measures the behaviors that are central to the concept of SOCIABILITY - seeking and enjoying companionship. (This dimension appears to measure the behaviors that differentiate approach from avoidance.)
Descriptors: Sociable, gregarious, reward-seeking, talkative.
Language Characteristics: Many topics, higher verbal output, think out loud, pleasure talk, agreement, compliment, positive emotion words, sympathetic, concerned about hearer (but not empathetic), simple constructions, few unfilled pauses, few negations, few tentative words, informal language, many swear words, exaggeration (e.g. "I'm really smart" ), many words related to humans (e.g. "man", "pal"). poor vocabulary.
Research: Higher scores on Sociability (extraversion) are associated with greater happiness and broader social connections. *MRI research found that Sociability (extraversion) was associated with increased volume of medial orbitofrontal cortex, a region involved in processing reward information.
"I'm talkative"
"I'm not reserved."
"I'm full of energy."
"I generate a lot of enthusiasm."
"I'm not quiet."
"I have an assertive personality."
"I'm not shy or inhibited."
"I am outgoing and sociable."
"I make friends easily."
"I warm up quickly to others."
"I show my feelings when I'm happy."
"I have a lot of fun."
"I laugh a lot."
"I take charge."
"I have a strong personality."
"I know how to captivate people."
"I see myself as a good leader."
"I can talk others into doing things."
"I am the first to act."
.
Attention Seeking (Excessive Sociability)
.
"I like to draw attention to myself."
"I crave attention."
"I do things to make sure people notice me."
"I do things so that people just have to admire me."
"My behavior is often bold and grabs peoples' attention."
.
Detachment (Detached)
.
Description: Detachment is synonymous with being reserved and quiet.
Descriptors: Withdrawn, anhedonic (pleasureless), intimacy avoiding, detached, shy, passive, solitary, moody
Language Characteristics: Single topic, doesn't think out loud, problem talk, dissatisfaction, negative emotion words, not sympathetic, elaborated sentence constructions, many unfilled pauses, formal language, many negations, many tentative words (e.g. maybe, guess), few swear words, little exaggeration, few words related to humans, rich vocabulary.
.
* Social Withdrawal:
"I don’t like to get too close to people."
"I don't deal with people unless I have to."
"I'm not interested in making friends."
"I don’t like spending time with others."
"I say as little as possible when dealing with people."
"I keep to myself."
"I am hard to get to know."
"I reveal little about myself."
"I do not have an assertive personality."
"I lack the talent for influencing people."
"I wait for others to lead the way."
"I hold back my opinions."
.
* Intimacy Avoidance:
"I steer clear of romantic relationships."
"I prefer to keep romance out of my life."
"I prefer being alone to having a close romantic partner."
"I'm just not very interested in having sexual relationships."
"II break off relationships if they start to get close."
.
* Anhedonia (Lack of Pleasure):
"I often feel like nothing I do really matters."
"I almost never enjoy life."
"Nothing seems to make me feel good."
"Nothing seems to interest me very much."
"I almost never feel happy about my day-to-day activities."
"I rarely get enthusiastic about anything."
"I don't get as much pleasure out of things as others seem to."
.
* Restricted Emotions:
"I don't show emotions strongly."
"I don't get emotional."
"I never show emotions to others."
"I don't have very long-lasting emotional reactions to things."
"People tell me it's difficult to know what I'm feeling."
"I am not a very enthusiastic person."
.
("Sociability vs. Detachment" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.



Treatment Goals for Negative Emotion

EMOTIONAL STABILITY VS. NEGATIVE EMOTION
.
Emotional Stability (Emotionally Stable)
.
Description: Emotional Stability is synonymous with being calm and emotionally stable. The Emotional Stability dimension measures the behaviors that are central to the concept of COURAGE - having calm composure and endurance when confronting adversity. (This dimension appears to measure the behaviors that differentiate safety from danger.)
Descriptors: Calm, even-tempered, peaceful, confident
Language Characteristics: Pleasure talk, agreement, compliment, low verbal productivity, few repetitions, neutral content, calm, few self-references, many short silent pauses, few long silent pauses, many tentative words, few aquiescence, little exaggeration, less frustration, low concreteness.
"I am relaxed, and I handle stress well."
"I am emotionally stable, and not easily upset."
"I remain calm in tense situations."
"I rarely get irritated."
"I keep my emotions under control."
"I rarely lose my composure."
"I am not easily annoyed."
"I seldom feel blue."
"I feel comfortable with myself."
"I rarely feel depressed."
"I am not embarrassed easily."
.
Negative Emotion (Negative Emotions)
.
Description: Degree to which people experience persistent anxiety or depression and are easily upset. (This could be thought of as high threat sensitivity or low stress tolerance.)
Descriptors: Emotionally unstable, anxious, separation-insecure, depressed, self-conscious, oversensitive, vulnerable.
Language Characteristics: Problem talk, dissatisfaction, high verbal productivity, many repetitions, polarised content, stressed, many self-references, few short silent pauses, many long silent pauses, few tentative words, more aquiescence, many self references, exaggeration, frustration, high concreteness.
Research: Lower scores on Emotional Stability are associated with unhappiness, dysfunctional relationships, and mental health problems. *MRI research found that Low Emotional Stability (= Negative Emotion or Neuroticism) was associated with increased volume of brain regions associated with threat, punishment, and negative emotions.
.
* Emotional Instability:
"I get emotional easily, often for very little reason."
"I get emotional over every little thing."
"My emotions are unpredictable."
"I never know where my emotions will go from moment to moment."
"I am a highly emotional person."
"I have much stronger emotional reactions than almost everyone else."
"My emotions sometimes change for no good reason."
"I get angry easily."
"I get upset easily."
"I change my mood a lot."
"I am a person whose moods go up and down easily."
"I get easily agitated."
"I can be stirred up easily."
.
* Anxiety:
"I worry about almost everything."
"I'm always fearful or on edge about bad things that might happen."
"I always expect the worst to happen."
"I am a very anxious person."
"I get very nervous when I think about the future."
"I often worry that something bad will happen due to mistakes I made in the past."
"I am filled with doubts about things."
"I feel threatened easily."
"I am afraid of many things."
.
* Separation Insecurity:
"I fear being alone in life more than anything else."
"I can't stand being left alone, even for a few hours."
"I’d rather be in a bad relationship than be alone."
"I'll do just about anything to keep someone from abandoning me."
"I dread being without someone to love me."
.
* Submissiveness:
"I usually do what others think I should do."
"I do what other people tell me to do."
"I change what I do depending on what others want."
.
* Perseveration:
"I get stuck on one way of doing things, even when it's clear it won't work."
"I get stuck on things a lot."
"It is hard for me to shift from one activity to another."
"I get fixated on certain things and can’t stop."
"I feel compelled to go on with things even when it makes little sense to do so."
"I keep approaching things the same way, even when it isn’t working."
.
* Depressed Mood:
"I have no worth as a person."
"Everything seems pointless to me."
"I often feel like a failure."
"The world would be better off if I were dead."
"The future looks really hopeless to me."
"I often feel just miserable."
"I'm very dissatisfied with myself."
"I often feel like nothing I do really matters."
"I know I'll commit suicide sooner or later."
"I talk about suicide a lot."
"I feel guilty much of the time."
"I'm so ashamed by how I've let people down in lots of little ways."
"I am easily discouraged."
"I become overwhelmed by events."
.
("Emotional Stability vs. Negative Emotion" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.


The "Big 5 Factors" of Personality as Shown In Dogs

The same "Big 5 Factors" of personality found in humans can be found in dogs. This makes sense because dogs, like humans, are a social species.



AGREEABLENESS VS. ANTAGONISM
.
Agreeableness ("Friend")
.
Dog is friendly towards unfamiliar people.
Dog is friendly towards other dogs.
When off leash, dog comes immediately when called.
Dog willingly shares toys with other dogs.
Dog leaves food or objects alone when told to do so.
.
Antagonism ("Foe")
.
Dog is dominant over other dogs.
Dog is assertive with other dogs (e.g., if in a home with other dogs, when greeting).
Dog behaves aggressively towards unfamiliar people.
Dog shows aggression when nervous or fearful.
Dog aggressively guards coveted items (e.g., stolen item, treats, food bowl).
Dog is quick to sneak out through open doors, gates.

CONSCIENTIOUSNESS VS. DISINHIBITION
.
Conscientiousness ("Self-Controlled")
.
Dog works at tasks (e.g., getting treats out of a dispenser, shredding toys) until entirely finished.
Dog works hard all day herding or pulling a sleigh (if a "working dog" on the farm or in the snow). *
Dog is curious.
.
Disinhibition ("Disinhibited")
.
Dog is boisterous.
Dog seeks constant activity.
Dog is very excitable around other dogs.

Intellect vs. Decreased Intellect
.
Open To Experience ("Open-Minded")
.
Dog is able to focus on a task in a distracting situation (e.g., loud or busy places, around other dogs).
.
Closed To Experience ("Closed-Minded")
.
Dog is slow to respond to corrections.
Dog ignores commands.
Dog is slow to learn new tricks or tasks.

SOCIABILITY (EXTRAVERSION) vs. DETACHMENT
.
Sociability ("Approach")
.
Dog is attention seeking (e.g., nuzzling, pawing or jumping up on family members looking for attention and physical contact).*
Dog seeks companionship from people.
Dog is affectionate.
.
Detachment ("Avoidance")
.
Dog is aloof.
Dog gets bored in play quickly.
Dog is lethargic.

EMOTIONAL STABILITY VS. NEGATIVE EMOTION
.
Emotional Stability ("Safety")
.
Dog tends to be calm.
Dog is relaxed when greeting people.
Dog is confident.
Dog adapts easily to new situations and environments.
.
Negative Emotion ("Danger")
.
Dog is anxious.
Dog is shy.
Dog behaves fearfully towards unfamiliar people.
Dog exhibits fearful behaviors when restrained.
Dog avoids other dogs.
Dog behaves fearfully towards other dogs.
Dog behaves submissively (e.g., rolls over, avoids eye contact, licks lips) when greeting other dogs.
.
Modified from Jones, A. C. (2009). Development and validation of a dog personality questionnaire. Ph.D. Thesis. University of Texas, Austin.

* New items added by Phillip W. Long MD


Personality Difference Between Dogs and Humans

Dogs and humans are strikingly similar on 4 of the "Big 5 Factors" of personality. However, dogs and humans are quite different on the "Conscientiousness" factor - because the canine brain is designed for hunting, not building. That's why dogs don't build dog houses.

The Brain and the "Big-5 Factors" of Personality In A Social Species

The "Big-5 Factors" of personality represent basic brain functions in social species. For example, when a male approaches a female, the female must: (1) decide whether the male is friend or foe ["Agreeableness"], (2) decide if this represents safety or danger ["Emotional Stability"], (3) decide whether to approach or avoid him ["Sociability"], (4) decide whether to be self-controlled or disinhibited ["Conscientiousness"], and (5) learn from this experience ["Openness to Experience"].

The "Big-5 Factors" of Human and Cat Personality

Cats are a social species, but less social than dogs. Nevertheless, cats also show the "Big 5 Factors" of personality.




The "Big 5" Dimensions of Personality and Personality Disorders

There are two free online personality tests that assess your personality in terms of the "Big 5" dimensions of personality. The following diagram shows the relationship between the "Big 5" dimensions of personality and personality disorders. This diagram is based on the research of Sam Gosling, Jason Rentfrow, and Bill Swann, Gerard Saucier, Colin G. DeYoung, and Douglas Samuel and Thomas Widiger.


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Personality Disorders Scoring Low On Emotional Stability

In personality testing, individuals with Avoidant Personality Disorder often have a low emotional stability test score.


Individuals with Borderline or Dependent Personality Disorders also often score low on the emotional stabillity personality dimension.

Low emotional stability test scores are associated with negative emotion (i.e., anxiety, depression and anger). The following scale lists the emotions and behaviors most associated with emotional stability.

EMOTIONAL STABILITY NEGATIVE EMOTION
Emotional Stability Emotional Instability
Having a stable and predictable mood Over-reacting to events with rapidly changing, intense, unpredictable emotions
Sense of Purpose No Sense of Purpose
Feeling that one’s life has a sense of purpose, direction or meaning; knowing one’s passion Wandering aimlessly through life without purpose, direction, meaning or a passion
Social Stability Social Instability
Having a stable and peaceful social life Unstable and stormy social life; frequently going from one social crisis to another
Self-Appreciation Self-Depreciation
Having a good opinion of oneself; feeling capable and of worth; good self-esteem Having a poor opinion of oneself; feeling worthless or useless; low self-esteem
Optimism Pessimism
Having a positive outlook on life; expecting a good outcome; hopeful; not giving up too easily Having a negative outlook on life; expecting the worst outcome; giving up too easily
Social Support Lack of Social Support
Having friends to turn to in times of need or crisis; having supportive companionship Feeling there is nobody to talk to, or to turn to in times of need or crisis; lacking companionship
Independence Separation Anxiety
Not fearing rejection, being alone, or being temporarily separated from loved ones Fear of abandonment; fear of rejection by, or separation from, significant others
Assertiveness Submissiveness
Being confident to think or express your own ideas or opinions Humble obedience and unassertiveness; frequently seeks advice and reassurance
Peacemaking Difficulty Handling Conflict
Skillfully preventing (or handling) conflict within a group or family Difficulty handling conflict with others

Internet Mental Health: Emotional Stability Scale

Avoidant Personality Disorder Scores Low On Extraversion

In personality testing, individuals with Avoidant Personality Disorder often have a Low Extraversion test score.



HIGH EXTRAVERSION NORMAL EXTRAVERSION LOW EXTRAVERSION (DETACHMENT)
Inappropriately Seductive Intimacy Intimacy Avoidance
Inappropriately seductive or provocative sexual behavior Wanting close, intimate relationships Avoidance of close relationships and intimate sexual relationships
Attention Seeking Friendliness Social Withdrawal
Trying to be the center of attention; being overly dramatic or flamboyant Friendly; interested in social contacts and activities; tendency to approach people Reserved, distant, preference for being alone; tendency to avoid people
Theatrical Self-Dramatization Demonstrativeness Lack of Emotion
Drama Queen; theatrically blows everything out of proportion Expressing one's feelings easily, openly or unreservedly (especially love or affection) Being unemotional, even in normally emotionally arousing situations

Internet Mental Health: Extraversion Scale


Primate Evolution

There appears to be three different ways in which primates have evolved socially:
  • The chimpanzees have evolved to be socially antagonistic, competitive, callous, and manipulative. Chimpanzees are the only primates (apart from humans) that wage organized war. Thus chimpanzee social behavior most closely mirrors the antagonistic behavior of the antisocial-narcissistic-borderline-histrionic cluster of personality disorders.

  • In contrast, the bonobos have evolved to be socially anxious, peaceful, cooperative, and loving. Thus bonobo social behavior most closely mirrors the negative emotion (anxious) behavior of the avoidant-dependent cluster of personality disorders.

  • Another separate evolutionary path was followed by the orangutans. They evolved to become solitary hermits. Thus orangutan social behavior most closely mirrors the detached behavior of the paranoid-schizoid-schizotypal cluster of personality disorders.


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