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Section 9
Social Avoidant Personality Disorder

Question 9 | Test | Table of Contents

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In the last section, we discussed three steps in treating OCD clients. These are identification; exposure; and self-talk.

Previously, in section 6, we discussed agoraphobia and its developments.

In this section, we will examine three other social avoidant behaviors more extreme than agoraphobia, which are social phobia; social skills deficit; and dysmorphophobia.

Three Social Avoidant Behaviors

♦ Behavior #1 - Social Phobia
The first social avoidance results from social phobia. This is a phobia characterized by anxiety arising from fears of embarrassment or humiliation in social situations. Clients feel that they are being pressured to perform in some way and are terrified of slipping up. Performance anxiety can also be categorized as a social phobia, however, this goes far beyond stage fright.

Clients with a performance phobia are unable to make any kind of public appearance for fear of embarrassment. Also, socially phobic clients have difficulty in looking another person in the eyes and will often look away. Many of these socially phobic clients report an unusual shyness in early puberty and increase in severity later in life.

Cynthia, a thirty year old client of mine, described her social phobia, "Through college, I did not like to walk into the campus snackshop alone unless I knew there was someone there I could sit with. I have always been surprised to find myself nervous in some public situations which I had successfully handled many times before. It was as if I were "internally different," rather than the situation around me being different. More recently, negative feedback from some persons in authority about my personality have made what always was and is a real but at least partially manageable problem, an almost unmanageable one in some circumstances."

♦ Behavior #2 - Social Skills Deficits
The second social avoidance is known as social skills deficits. Social skills deficits refer to the anxiety and difficulty some people have in forming superficial or intimate relationships when these are sought and desired. This type of avoidance may also be known as social inadequacy, avoidant personality disorder, and extreme shyness. 

According to a study done at the Maudsley Hospital in London, clients with social dysfunction reported their avoidance as "lifelong." Sixty-one percent reported having no friends or social contacts in high school. They also reported having difficulty in initiating and maintaining social interactions and friendships. Their most frequent activities were visiting bars in which they could drink in undisturbed isolation. 

In any kind of social situation, they reported feeling awkward, silly, or ridiculed, even if this really wasn’t the case. Interestingly, more of the male clients in the study with social skills deficits were either the first born or only child in their families. 

♦ Technique:  Problems and Solutions
Kyle was a 34 year old client of mine who had been diagnosed with social skills deficits.  Kyle reported that he had never had sexual intercourse and even the thought of him being a virgin gave him great anxiety.  He still lived at home with his parents, because he felt that living on his own was too much responsibility. 

Kyle stated, "Whenever I’ve tried to break away from home, I start feeling panicked about how I’m going to get food, how will I pay the bills, and if someone will try to rob me.  I feel that if I have my own place, it will just bring everyone else in and I don’t want that."  To help Kyle move past his anxiety over getting his own apartment, I asked him to make a list of "Problems and Solutions."  For each problem that Kyle could think of, I asked him to write down a solution.  One of his problems was:  "Having people invade my life." 

His solution to this problem was, "I do not have to let everyone in, but I should only let in those people I feel comfortable around."  After making his list, Kyle felt slightly less anxious about living on his own.

♦ Behavior #3 - Dysmorphophobia
In addition to social phobia and social skills deficit, the third social avoidance is dysmorphophobia. This disorder, though also causing the sufferers to take up a life of reclusion, has a different source. Also known as monosymptomatic hypochondriasis, these clients find some defect on a particular place on their body that is not noticeable to others.

In some cases, this disorder can amount to a delusion and can even involve several parts of the body.  Some clients exhibit symptoms of schizophrenia which is the source of the delusions. However, for many clients there is no evidence for a schizophrenic disorder nor any other psychotic phenomena. Dysmorphophobic clients do not have a negative self-image, such as those clients with anorexia nervosa. Many times, simple avoidance of the social situations that they fear do not lessen their anxiety.

Often, these somatic complaints involve bodily odor or the belief that some parts of the body are too small or large. Dysmorphophobic clients will start to believe that those around them notice their defect and subsequently talk about it behind their backs. This is what causes the reclusive behavior in dysmorphophobia sufferers. Plastic surgery to amend the problem does little to lessen the anxiety.

In this section, we presented three social avoidant behaviors that are more extreme than agoraphobia, which are social phobia; social skills deficit; and dysmorphophobia.

In the next section, we will examine three characteristics of childhood agoraphobia, which are development of agoraphobia in childhood and adolescence; separation anxiety; and early exposure.

- Robin, M., Ph.D, & Balter, R., Ph.D. (1995). Performance Anxiety: Overcoming your Fear in the Workplace, Social Situations, Interpersonal Communications, and the Performing Arts. Holbrook, MA: Adams Media Corporation.
Reviewed 2023

Peer-Reviewed Journal Article References:
Beeney, J. E., Stepp, S. D., Hallquist, M. N., Scott, L. N., Wright, A. G. C., Ellison, W. D., Nolf, K. A., & Pilkonis, P. A. (2015). Attachment and social cognition in borderline personality disorder: Specificity in relation to antisocial and avoidant personality disorders. Personality Disorders: Theory, Research, and Treatment, 6(3), 207–215.

Gadassi, R., Snir, A., Berenson, K., Downey, G., & Rafaeli, E. (2014). Out of the frying pan, into the fire: Mixed affective reactions to social proximity in borderline and avoidant personality disorders in daily life. Journal of Abnormal Psychology, 123(3), 613–622.

Hourani, L., Tueller, S., Kizakevich, P., Strange, L., Lewis, G., Weimer, B., Morgan, J., Cooney, D., & Nelson, J. (2018). Effect of stress inoculation training with relaxation breathing on perceived stress and posttraumatic stress disorder in the military: A longitudinal study. International Journal of Stress Management, 25(S1), 124–136. 

Loo, L.-M., Prince, J. B., & Correia, H. M. (2020). Exploring mindfulness attentional skills acquisition, psychological and physiological functioning and well-being: Using mindful breathing or mindful listening in a nonclinical sample.Psychomusicology: Music, Mind, and Brain. Advance online publication. 

Lotfalian, S., Spears, C. A., & Juliano, L. M. (2020). The effects of mindfulness-based yogic breathing on craving, affect, and smoking behavior. Psychology of Addictive Behaviors, 34(2), 351–359.

Torvik, F. A., Welander-Vatn, A., Ystrom, E., Knudsen, G. P., Czajkowski, N., Kendler, K. S., & Reichborn-Kjennerud, T. (2016). Longitudinal associations between social anxiety disorder and avoidant personality disorder: A twin study. Journal of Abnormal Psychology, 125(1), 114–124.

QUESTION 9
What are three social avoidant behaviors more extreme than agoraphobia? To select and enter your answer go to Test.

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