The Essential Guide to Overcoming Avoidant Personality Disorder

The Essential Guide to Overcoming Avoidant Personality Disorder

This page intentionally left blank

The Essential Guide to Overcoming Avoidant Personality Disorder

MARTIN KANTOR, MD

Q PRAEGER

AN IMPRINT OF ABC-CLIO, LLC Santa Barbara, California • Denver, Colorado • Oxford, England

Copyright 2010 by Martin Kantor, MD

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, except for the inclusion of brief quotations in a review, without prior permission in writing from the publisher.

Library of Congress Cataloging-in-Publication Data

Kantor, Martin.

The essential guide to overcoming avoidant personality disorder / Martin Kantor. p. cm.

Includes bibliographical references and index.

ISBN 978-0-313-37752-5 (hard copy : alk. paper) — ISBN 978-0-313-37753-2 (ebook) 1. Avoidant personality disorder. I. Title.

RC569.5.A93K36 2010 616.85'82—dc22 2009044857

ISBN: 978-0-313-37752-5 EISBN: 978-0-313-37753-2

14 13 12 11 10 1 2 3 4 5

This book is also available on the World Wide Web as an eBook.

Visit www.abc-clio.com for details.

Praeger

An Imprint of ABC-CLIO, LLC

ABC-CLIO, LLC

130 Cremona Drive, P.O. Box 1911

Santa Barbara, California 93116-1911

This book is printed on acid-free paper (S)

Manufactured in the United States of America

To M.E.C.

Hello Martin. For many years I am spiraling deeper into isolation and only yesterday I read about Avoidant PD and discovered I fit on all counts. I am not sure what to do about it. I am scared to talk to people and my memory is weak.

—letter to the author

viii

Contents

Chapter 14

Supportive Therapy

147

Chapter 15

Other Forms of Therapy

159

Chapter 16

The Ideal Therapist

163

Chapter 17

Helping Avoidants Overcome Their Fear of Criticism

171

Chapter 18

Helping Avoidants Overcome Their Low Self-Esteem

179

Chapter 19

Treating Sexual Avoidance: An Overview

185

PART THREE: SELF-HELP

Chapter 20

Overcoming Shyness and Withdrawal

195

Notes

215

Index

223

Pref

reface

Sufferers from avoidant personality disorder (AvPD) fear forming and maintaining relationships because of ongoing, engaging, deep, pervasive, multilayered interpersonal anxiety. This anxiety causes them to have difficulty meeting, connecting with, getting close to, and staying involved with other people. According to Oldham and Morris, the disorder occurs in fully “10 percent of patients of outpatient mental health clinics,” ¹ whereas Dalrymple and Zimmerman have written that “social anxiety disorder (SAD) [including AvPD] is the fourth most common mental disorder in the United States with a lifetime prevalence rate of 12.1%.”²

I believe that even these disquieting statistics underestimate the extent of the problem, with this disorder far more widespread than most patients believe and clinicians acknowledge. This is because avoidants themselves overlook AvPD because they don’t know it exists, or they downplay AvPD because they believe that having social anxiety is somehow shameful. And their therapists, equally misinformed about, or reluctant to recognize, the disorder, dismiss their suffering as normal shyness, reticence, unfriendliness, cliquishness, or as just part of growing up; or, spotting the disorder, they tell their patients that the problem is insignificant or condone it as acceptable, justified, and even romantic. They then offer reassurances that all is well and say that no therapy is necessary, or if it is necessary, it should be for something else entirely.

On their part, researchers often miss the diagnosis because they fold AvPD into borderline personality disorder (BPD). They fail to distinguish the characteristic chronic distancing patterns of AvPD from those of BPD, which consist of a more acute cyclic, intermittent approach-avoidance shifting. Unlike in AvPD, where the distancing is dynamically, if not clinically, resolute, in BPD, overly close intense relationships characteristic of the object hunger-merging phase of the borderline condition are in turn fitfully undone by an equally intense object satiation-emerging phase. As a result, we see the typical borderline tendency to alternate rapidly between overvaluation of and love for, and undervaluation of and disdain for, other people—the all too familiar “come here, go away, I love you.”

More often still, and with even more tragic results, is the widespread proclivity of researchers to subsume the diagnosis of AvPD under the rubric of social phobia and then to report exclusively on social phobia, virtually ignoring AvPD. Thus the PDM, or Psychodynamic Diagnostic Manual, refers to AvPD as “phobic (avoidant) personality disorder.”³ In some ways, avoidants do resemble social phobics, and some therapists believe that they can effectively treat AvPD as if it were a compendium of social phobias, expecting the former to “disappear” when the latter are relieved. But to my way of thinking, the two disorders differ significantly diagnostically and therapeutically, in large measure because they differ structurally. For avoidants, unlike social phobics, are not terrified by specific, discreet, easily identifiable, well-delineated trivial prompts such as having to speak in public, use a public rest room, eat and swallow while being observed, or enter a crowded room where there is a party going on. Instead, they are troubled by a panoply of mostly negative personality traits that have more of an existential than a situational implication. Thus they suffer not from a fear of writing a check in public but from a fear of getting close to others and committing themselves to one someone special. Clearly, to me, while the dynamics of the two disorders overlap, each takes a unique form, with social phobia being a symptom disorder and AvPD being a personality disorder, and with the former being a modified, encapsulated, delimited version of the latter. Thus, though sufferers of both disorders are struggling emotionally with a fear of criticism and humiliation, the one, the social phobic, displays the fear as a need to avoid using a public rest room to urinate, whereas the other, the individual with AvPD, displays it as a global need to avoid not only restrooms, but also “all” rooms with people in them, making the avoidant individual reluctant to enter into life and to do all the things that happy people living normally ordinarily do.

This is a crossover text meant for two audiences. The first is for therapists hoping to properly identify and thoroughly fathom AvPD in preparation for developing a dedicated treatment approach to helping their patients cope with, or fully overcome, its ravages. The second is for sufferers from AvPD hoping to free themselves from their painful shyness and self-destructive distancing so that they may emerge from the dark shadows of isolation and loneliness into the bright light of warm, close, satisfying, loving, lasting relationships. Thus this book can be read in two ways: it is a guide for therapists developing a psychotherapeutic technique suitable for effectively treating AvPD and a manual for sufferers hoping to develop a self-help approach to profitably modify their lives and change their lifestyles, as they come to subdue their irrational fears and newly and more successfully cope with their overwhelming, life-sapping, happiness-destroying interpersonal anxiety.

This page intentionally left blank

PART ONE

DESCRIPTION AND CAUSATION

-<3^3

This page intentionally left blank

CHAPTER 1

Cl assic or Type I Avoidant Personality Disorder

In this chapter, I focus on classic avoidant personality disorder (AvPD), a disorder whose individuals, as Fenichel noted in 1945, suffer from “social inhibitions consisting of a general shyness [that may lead to withdrawal] from any social contact [because] they anticipate possible criticisms.”¹ I start with a summary of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV ) criteria for AvPD, then add a summary of criteria formulated by Francis and Wi-diger, Benjamin, Horney, me, and the American Psychological Association Help Center.

DSM-IV CRITERIA

The essential DSM-IV² criteria for AvPD are as follows:

1. Shyness, timidity, and withdrawal from relationships associated with the willing renunciation of autonomous strivings to avoid the friction and conflict associated with closeness and commitment. (The Quality Assurance Project refers specifically to “fear of commitment”³ and assigns it a central role in the dynamics of avoidance.)

2. A fear of criticism, humiliation, and rejection.

3. Feelings of inadequacy and low self-esteem.

4. Anxiety in new social situations.

5. Hypervigilance and self-consciousness.

6. Social awkwardness due to an off-putting fearful tense demeanor that, in turn, elicits ridicule and derision from others, which confirm self-doubts, leading to further awkwardness, causing others to pull back because they see avoidants not as “fearful of rejection by me,” but as “being rejecting of me.”

NON-DSM-IV CRITERIA

Frances and Widiger

Francis and Widiger go beyond the DSM-IV view of AvPD as the product of a sensitivity to and fear of interpersonal rejection in the form of criticism and humiliation by others to offer further reasons for social anxiety:

1. A fear of flooding and losing control of various impulses due to overstimulation, for example, the fear that forbidden, even revolting, romantic or hostile impulses are about to erupt— disturbing inner peace or even completely shattering internal equanimity.

2. An associated fear of experiencing “uncomfortable body sensations” such as tremulousness.

3. A fear of failure, accompanied by a paradoxical (masochistic) fear of success.⁴

Millon/Benjamin/Horney

These observers emphasize the generally downplayed role freefloating and reactive anger play in the distancing process. Millon describes an “avoidant-passive-aggressive mixed personality”⁵; Benjamin speaks of the avoidant’s tendency to become too readily “indignant”⁶; and Horney, according to Portnoy, notes that “the major possibilities of anxiety come to be [not only] rejection or disapproval by others [but also] hostile impulses from within the self.”⁷

Kantor

I propose the following as basic criteria:

1. Self-criticism due to self-condemnation by a harsh, unforgiving, shaming conscience, causing one to become guilty over legitimate desires and ordinary (but to the avoidant extraordinarily shameful), interpersonal foibles.

2. Annoyance with others over the most trivial things, for example, “every time he dries himself he uses a new towel, running up my laundry bill, and that in a recession!”

3. A masochistic desire to be hurt by suffering relationally.

4. A fear that acceptance and closeness will interfere with doing the “me” things avoidants really want to do and thoroughly enjoy doing like a man’s watching the TV shows he likes or a woman’s becoming fully emancipated both personally and professionally.

5. A fear of acceptance and closeness due to a fear that these will “swallow avoidants up whole,” leading to a loss of boundaries and a compromised identity due to becoming overly dependent on, and subject to the full control of, others.

6. Relational idealism consisting of a disdain for relationships that appear to be imperfect, originating in excessive expectations of oneself and others, associated with excessive pridefulness and a hypermorality that too narrowly defines what is and what is not “biblically” correct and so relationally permissible.

7. A fear of depletion due to a fear of letting go with others to the point of significantly dissipating one’s life energy.

8. The excessive use of relational defenses. (The Psychodynamic Diagnostic Manual, or PDM, lists, in addition to the defense of phobic withdrawal/avoidance the defenses of symbolization, displacement, projection, and rationalization.⁸)

9. Covalent characterological features, including histrionic (oe-dipal) rivalry that buries the potential for closeness, intimacy, and commitment under competitive struggles with others—as Gabbard notes, “entailing an aggressive demand for complete attention . . . associated with a wish to scare away or kill off all rivals . . . [with the competitiveness] interwoven with a sense of shame”⁹; obsessive fretting about the correctness and propriety of one’s interpersonal actions—with obsessive overworry about the consequences of making even minor relational mistakes associated with a hypermorality that leads to viewing one’s ordinary humanity, including, or especially, one’s acceptable sexuality, as shameful and sinful; paranoid suspiciousness about the negative things others are, or might be, thinking; depressive alarmism and pessimism that nothing will ever work out as hoped and planned for and the worrisome fear that if all is not already lost, it soon will be; excessive “don’t make waves” passivity, accompanied by a paradoxical fear of passivity and so a need to be on constant alert and continuously active to assure always being in complete control of everything about one’s relationships; extreme dependence possibly leading to a codependent relationship with one person to avoid having to relate to any and all others; narcissism characterized by constant pulse taking, for example, “how you make me feel,” that implies an unempathic lack of concern about “how I make you feel”; neophilia—a need for newness associated with easy boredom with the old; and neophobia—a fear of newness, leading to a need for sameness, creating a fear of change and progress.

10. Fear of being different from equally avoidant peers, as if being different from them means defying them, and so becoming a nonavoidant pariah in what is perceived to be, and ultimately too often actually is, one’s avoidant society.

The American Psychological Association Help Center

1. Canceling social events at the last moment.

2. Avoiding situations that provide positive social interaction.

3. Few or no friends.

4. Avoidance of activities that are otherwise pleasurable.

5. Passivity, pessimism, and low self-esteem.

6. Excessive computer use that is not social in nature and without face-to-face contact with others.¹⁰

I next offer a more detailed discussion of the some of the previously mentioned criteria.

DSM-IV CRITERIA

1. DSM-IV: Shyness, timidity, and withdrawal.¹¹ Avoidants are shy, timid, introverted, withdrawn, socially inhibited individuals anxiously desirous of relating but conflicted about doing so due to a fear of getting close and committing to others.

Unlike schizoid individuals, who have a severely reduced capacity for relationships, avoidants can relate and are both unable and unwilling to relinquish relationships completely and definitively. As Sullivan suggests, the problem is that their “intimacy need[s] collide with the need for security”¹² so that they feel frustrated and pull back as selfprotection becomes more urgent than self-fulfillment.

2. DSM-IV: Fear of criticism, humiliation, and rejection. Avoidants are fearful of what other people think partly based on hypersensitivity and a proneness to exaggerate the dangers of a negative evaluation. They avoid taking personal risks because they fear being exposed, ridiculed, and shamed, for example, for crying or blushing publicly. (As the Quality Assurance Project says, “an extreme interpersonal sensitivity to perceived rejection” and a tendency to interpret ordinary slightly negative human interactions as rejection leads avoidants to see “developing involvement with others as hazardous.”¹³)

A Case Example

An avoidant man, expecting too much from the world, overlooked how some rejection is simply part of life’s give and take, and instead, expecting life to always be fair, rewarding, and complete, became highly vulnerable to even minor signs of life’s inherent unfairness and imperfections. Regularly expecting relational successes, he would panic when they were not forthcoming, pull back, give up, and cry, “Never again.” Too, regularly expecting relational miracles, he would go to mingles events/singles resorts and share singles homes in country resorts, and surf the Internet for dates, thinking, “Tonight, I will connect for sure,” then, even though he knew intellectually and from experience that he could not count on connecting every night, he would let one night’s failure or one turndown become a commentary on how he was completely wasting his time because no one would ever love him. His motto soon became, “It’s better to have never loved at all than to have innocently loved, then been rejected for having done so.”

Sensitivity to rejection frequently results in defensive outbursts meant to destroy what could otherwise easily have been a viable relationship.

Case Examples

A patient stormed out of the house after telling his wife he was leaving her because one day, instead of being there to greet him when he came home from work, she had gone out to do some errands and forgot to leave a note saying where she was, “forcing me to come home to an empty house, causing me to feel ‘you left me and so you don’t love me,’ throwing me into a panic about having to stay home by myself for who knows how long, thinking, ‘I did something wrong, this is my comeuppance, and as a result I am always going to be completely alone, and in this, such a hostile, world.’ ”

A patient kept the same routine for months or years—eating in the same restaurant every night and ordering the same food and drinks night after night, meal after meal. He did that until one “fateful day” he changed restaurants on a slim, slightly paranoid pretext because he felt that his “waiter hustled me for drinks, and served me baked potatoes today that were smaller than the baked potatoes he served me yesterday.”

A music critic, preoccupied with “who is being mean to me, ” interpreted any opinion that differed from his own as putting him down in a critical way. When others corrected his mispronunciations, he thought that they were calling him stupid and uneducated for misspeaking. When people expressed any neediness at all to him, he interpreted that as their criticizing him for not giving them what they wanted. A globally anxious protective removal grew out of these negative misinterpretations and led to misunderstandings and arguments that became his reason to permanently rupture even relationships that had, until then, otherwise been going well.

3. DSM-IV: Feelings of inadequacy and low self-esteem. Avoidants feel inadequate; see themselves as socially inept, unappealing, or inferior; and assume that others view them the same way. Hence they have an undue need for certainty and security and, before they extend themselves to others, require that others pass stringent tests indicating that they will always act in an obviously supportive and nurturing manner. Avoidants also withdraw because they feel unworthy of being liked, making it unlikely that they will expect/ask others to like and accept them. (Avoidants can, however, be intimate when they know that assurance of uncritical acceptance is forthcoming.)

A Case Example

A gay patient withdrawing from a suitable partner as a form of self-apology said, “The new man in my life is a vice president of a large media company here in Chicago. The person that introduced us said he was just looking for an average guy, but I was concerned when he got into his Mercedes and all I have is an old Honda. In other words, he lives a much higher lifestyle than I do, and I am worried that I will not be able to keep up with him. He is also very good looking, and I am just average in looks and make a lot less than he does. But we seem to be hitting it off so far: no sex or anything like that—just enjoying each other’s company and I actually like him, to date anyway. I just work as a welder in a large construction company, but I am not after his money or anything. My friends say I am worrying about nothing. Still, I’m going to drop him because I would rather live poor and be happy than force myself on someone I feel I am unworthy of.”

4. DSM-IV: Anxiety in new social situations. Excessive security needs along with doubts about relational certainty in both personal and occupational contexts cause avoidants to become highly anxious in unfamiliar situations, as, for example, when attending large parties.

Although the DSM-IV emphasizes that many avoidants are most fearful of strange, unfamiliar surroundings, where they know nobody or are just meeting new people, some avoidants actually function best with strangers like waitresses, for they see them as safe because they are comfortably remote and predictably unavailable.

A Case Example

One timid avoidant, though shy with friends and family, was bold and forceful with waiters and coat check girls—for as strangers, they were unlikely to expect anything from him beyond the superficialities. He was able to feel positively about women he merely passed on the street, but with women he really liked and got to know, to use his own words, when he “got past first base” and was “in a position to score,” he “completely froze up.”

5. DSM-IV: Hypervigilance and self-consciousness. Avoidants always have one eye open to what others think. They tensely appraise others’ movements and expressions to see if others approve of what they are saying and doing, only to avoid others because they become convinced that others believe the avoidant has done, or is about to do, something wrong.

Their vigilance promotes an excessively rich fantasy life, as they frantically appraise the movements and expressions of others, conjuring up the bad things others might be thinking and doing from slim stuff, thence creating complex, fantasized, fearful scenarios, especially about being alone and its lonely consequences. They routinely have dreams about potential or actual social loss, for example, “I call you on your cell phone but no one answers, you were there in the room with me a minute ago, but now you have simply disappeared; and clearly you don’t want me anymore because you find me disgusting, which is why you are telling me to get out.”

Often their dreams express avoidant fantasies symbolically, as when they dream of running stuck in place, not being able to move forward, or of waiting for the bus that never comes, then when it does come, it turns out to be the wrong bus or, if the right bus, it goes to the wrong place, or to a dangerous place where one gets mugged or killed. This symbolic expression often takes on a surrealistic cast. For example, a man dreamed of a street at the end of which was a welcoming bar with welcoming neon lights, friendly music, and warm grog. One side of the street was brightly lit, and the other was completely dark. Unable to traverse the lit side, he could only traverse the side that was dark. This side, however, held too many terrors and dangers for him to seriously contemplate making the attempt. So he cowered and held back, effectively freezing in place.

6. DSM-IV: Social awkwardness. Avoidants can seem off-putting to others who misinterpret their fearful, tense demeanor as rejecting so that others withdraw, often after ridiculing and deriding the avoidant, confirming the avoidant’s self-doubts.

A Case Example

A potential lover took a long bus trip to be with a patient of mine. As the bus pulled in, the lover-to-be, from inside the bus, saw my patient waiting for him at the bus station and waved him a gusty hello, only to have my patient respond by going into a panic, thinking, “That big wave turned me off, I am suspicious of people who are just too eager to see me.” My patient then adopted a body posture that, virtually oozing remoteness, retreat, and rejection, broadcast his clear regret that an actual meeting was imminent.

SOME NON-DSM-IV CRITERIA

Fear of Flooding

According to Millon and Davis, avoidants must “avoid everything which might arouse their emotions [and] seek as far as possible to avoid and deaden all stimulation from the outside.”¹⁴ Many come to fear that if they attempt to get close, their positive/romantic impulses will erupt, flooding them and threatening their emotional security and structural integrity and, if men, making them feel and look feminine, and, if women, making them feel and look weak.

A Case Example

One patient gave up playing the piano, though, in fact, he played well and others enjoyed listening. He did this because he couldn’t tolerate all the adulation he received when he performed in public. For him, playing in public was shamefully exhibitionistic, a showing off, with “crescendos, moderatos, and other expressions of feeling one step removed from having sex out in the open.” He also convinced himself that when he played, others snickered, so that by playing, he made a complete fool of himself. For him, then, avoidance was a way to detach from others to proclaim, “I am in full control of myself and emotionally and physically intact, just like the artist Joseph Cornell, who sensibly died a virgin because he feared that if he had sex, it would destroy his artistic ability.”

Masochism

Avoidants withdraw not only because they fear losing when they want to win, but also because they fear winning because they need to lose. Freud, in his 1924 paper “The Economic Problem in Masochism,” spoke of individuals who needed to be punished and to suffer due to an unconscious sense of guilt that plays an extensive part in their social lives. These individuals are unable to tolerate the possibility of gratification, so they provoke their own criticisms and abandonments by “do[ing] something inexpedient, act[ing] against [their] own interests, ruin[ing] the prospects which the real world offers [them and risking the] possibility] of destroying [their] own existence in the world of reality.”¹⁵ In his 1915 paper “Some Character-Types Met with in Psychoanalytic Work,” Freud described individuals “wrecked by success,” who fell “ill precisely because a deeply-rooted and long-cherished wish has come to fulfillment [and they can] not endure . . . bliss.” “Illness follows close upon wish fulfillment, and [leads to] annihilation of ] all enjoyment of it.”¹⁶

Thus these avoidants, anxious not only about the possibility of rejection, but also about the possibility of acceptance, arrange to be rejected by selecting distant, unavailable people to relate to, or people with a fatal flaw, such as those who dislike them or those who are already taken because they are married. They have rescue fantasies in which they long to bring around situations they know to be inherently nonviable, then focus all their efforts on doing so, even when, or really because, they are convinced that these efforts are virtually certain to come to naught. This way, they see to it that they waste their valuable time, and that way, they provide themselves with yet another reason to be avoidant.

A Case Example

A gay man uninterested in dating people who were available to him wrote to me, “There is not much action in my town and since most of the gays are in the closet meeting people is very difficult. I have taken your advice—I do not frequent bars and of course, I never drank. I am still single. I have had a few flings, but they were just that, flings. I am still very serious about meeting someone and establishing a monogamous relationship. But I can’t seem to meet the right person. Maybe I am simply not receptive enough. Or it’s because I seem to have a propensity for being attracted to divorced or soon-to-be divorced men with children, who may or may not be homosexual. I suspect that they are, but nothing seems to happen. I really think that I am wasting my time.”

I have treated a number of women who form hopeless romantic relationships with married men, consciously expecting them to divorce their wives and spend the rest of their lives with them, all the while unconsciously knowing that a good deal of their attraction is less to the man than to the man’s unavailability.

Readiness to Anger

Benjamin notes that anger plays a significant role in the psychogenesis of AvPD, saying, “Usually [avoidants] restrain this aspect [of their avoidance],” but there are times when it breaks through and they tend “to become indignant about alleged humiliations.” Benjamin adds, “I believe that the DSM should add angry outbursts to the description of AVD [because] occasionally AVDs will identify with their humiliating and rejecting family members, and become quite commanding and judgmental themselves.”¹⁷

Here is an excerpt from a negative “review” on Amazon.com of Distancing, my earlier book on AvPD, with the review a missile that I believe hints at the irrational anger (she got the facts wrong, perhaps having read only enough to make her mad) just alluded to:

The most redundant book I have ever read . . . very superficial . . . some sections . . . are so superficial he should have left them out altogether . . . provides examples (way too many) . . . does not delve into their psychology [for only] 17 pages are devoted to cause (at least 5 of which are examples) . . . you expect some analysis from a psychologist [sic], but he doesn’t offer any.¹⁸

Here is the heading of another Amazon.com review written by the same person:

This flashlight sucks.¹⁹

Sullivan notes that avoidance is called out by prolonged severe hostility, the disjunctive nature of “malevolence,” the feeling that “once upon a time everything was lovely, but that was before I had to deal with people.”²⁰ Fenichel suggests that avoidance is an anger equivalent—appearing “on occasions where others would feel rage.”²¹ Millon describes an avoidant-passive-aggressive mixed personality and notes that a threat equal to personal humiliation or social rejection is the avoidant’s own aggressive impulses, for avoidants “bind anger” by withdrawing to protect themselves “against humiliation and loss.”²² Frances and Widiger note that in some dynamic models, avoidants and passive-aggressives are placed side by side as both “likely to be higher on hostility [than dependents].”²³ Beck notes that “the avoidant personality stays poised to attack.”²⁴

I believe that avoidance, among other things, is a way to say, “I fear you because I fear your making me mad.” I also believe that avoidant hostility is partly defensive: both a way to avoid getting close and a method for maintaining one’s (shaky) self-esteem by pulling down the standing of others through disparagement and ridicule.

A Case Example

An avoidant woman pursued a cyberrelationship with a man from Germany, who at first told her that he was royalty, only to later confess, somewhat ashamedly, and to her consternation, that he “picked up waste materials to be moved from here to there on a dispersing truck.” “Nevertheless,” as she put it, she agreed to welcome him to the United States. But after he promised to cross the Atlantic to visit her, he made one excuse after another for not being able to come, for example, “I can’t get time off from my job.” Eventually, however, he made the trip and, as she said, “turned out to be a great guy after all.” That is precisely when she picked a fight with him, condemning him for his bad grammar and complaining about his using too many towels, always taking a new one instead of reusing the old ones until they absolutely had to be washed. She justified her feelings and subsequent actions on the correct but trivial grounds that any lover of hers should have known without having to be told that doing the laundry took time and effort and ran up the electricity bill. But in actuality, she had become angry with him as her way to get what she wanted: that he pack his bags, stomp out the door, and take the first available flight back to Germany.

Avoidants often get angry when others won’t welcome them and let them become as dependent on them as they (secretly) want to be.

Some Case Examples

A housewife saved her money for months to travel to the big city to attend a salon for a complete makeover. Her husband, more dependent on her than he admitted, disliked her leaving him even for the day because he saw that as her rejecting him and even suspected, without reason, that she might be meeting a secret lover. As he put it, “You wouldn’t be making yourself over for me, I never cared how you look.” Upon her return, instead of telling her, “You look beautiful,” he launched into a tirade, displacing his own angry disappointment about how she had left him onto their cat, who, according to him, acted “pissed off because you left her alone all day.”

A patient, feeling rejected because her next-door neighbors did not invite her over to join them for a barbecue, got back at them by condemning them for letting their ivy grow onto her fence. Shortly afterward, the next-door neighbors’ child was sitting quietly in her own yard, watching the birds over the fence feed at the feeder in the patient’s yard. Because the child was part of “that family that had caused me great harm and left me bereft and depleted by not including me in their festivities,” the patient yelled at the kid, “Stop watching my birds, and stop it right now!”

Angry avoidants often express their rage by getting others to act out for them. It was pets for the patient who kept a half-dog, half-wolf that he didn’t discourage from snarling at passers-by, and for the man who let his dog off the leash so that it might wander about upon, soil, and uproot his neighbor’s lawns and gardens. It was his spouse for the man who maintained the outward appearance of being the “perfectly delightful one,” while he egged his wife on to be the troublemaker of the family. It was her children for the avoidant who publicly played the role of “pillar of the community,” while privately encouraging her sons to cut the neighbor’s flowers (by wishing aloud for a certain bouquet) and to shout antigay epithets (by criticizing homosexuals within the children’s hearing range). It was underlings for the boss who used them to live out his own petty, interpersonal antagonisms, taking A into his confidence, telling A that B had made nasty comments to him about A behind A’s back, then saying to B that A had made nasty comments to him about B behind B’s back, getting both A and B fighting. It was colleagues for an employee who provoked fights among his coworkers by misquoting them: “repeating” their passing comments out of context and with the qualifiers left out, subtly changing their remarks from positive to negative in the telling. It was patients for a therapist who, unable to get the divorce he longed for, fulfilled his own wishes in fantasy by encouraging his patients to leave their spouses, when instead, he should have been encouraging them to at least try to smooth things over and attempt reconciliation.

Excessive Relational Idealism

Avoidants, as exacting individuals overly idealistic about relationships, will, before they agree to get involved with someone, demand that the relationship meet certain, usually impossible, conditions. Only they soon discover that their self-imposed irrational, impractical, and overly perfectionistic standards are unachievable, so they pull back in disappointment and withdraw to avoid injury to their pride.

Excessive Defensiveness

Avoidance is not a static, but an active, dynamic condition—what Millon and Davis call an “active detachment,”²⁵ that is, one with important defensive components. Sullivan describes avoidance as a “somnolent detachment,” the protective dynamism “called out by inescapable and prolonged anxiety.”²⁶ In equating avoidance with inhibited function, Fenichel views avoidance as the product of a tendency to neutralize wishes with “countercathexes,” that is, with equal but opposite forces. Fenichel also notes that “analysis always shows that the specifically avoided situations or the inhibited functions have unconsciously an instinctual (sexual or aggressive) significance. It is this instinctual significance against which [avoidance, that is, the defense of avoidance] really is directed. What is avoided is an allusion either to a temptation for the warded-off drive or to a feared punishment or both.”²⁷ Therefore some observers, emphasizing how the avoidant inhibits important aspects of living to reduce (social) anxiety, suggest that the term inhibited personality could substitute for the term avoidant personality disorder.

Avoidant detachment is made up of the following defenses, among others:

Identification with the aggressor. Avoidants create expected losses actively to handle the possibility of experiencing unexpected losses passively, for example, “I fear your rejecting me” becomes “I reject you to avoid being rejected by you.”

Masochism. Self-sacrificing, self-abnegating, and self-punitive responses are an avoidant’s way to counter forbidden desire. Avoidants commit a kind of social suicide to punish themselves for what they consider to be their unacceptable instinctual urges. They suffer now to avoid suffering even more later.

Repression. Repression is the avoidant’s way to detoxify anxious thoughts and feelings by suppressing them, then acting as if they no longer exist.

Displacement. Many avoidants find it advantageous to express their avoidance indirectly by expressing it symbolically. For example, instead of actually staying away from someone, they “merely” avoid shaking hands and so touching the person.

Intellectuatization. Avoidants frequently disguise avoidant compulsion as avoidant philosophy, for example, their “philosophy of splendid isolation” is in fact a rationalized fearfulness of connecting. Regression. Avoidants act like children to avoid having to act like adults. Many deliberately if unconsciously revive old negative childhood fears and actual past traumas to discourage adult interaction, often almost deliberately hanging on to ancient painful parental attachments so that they can view anyone available as forbidden because they are “just like my mother and father.”

Also regressive is the typical avoidant tendency to too readily form conditioned responses so that they can reflexively shrink from a new situation because it elicits an old displeasure. Regression also accounts for avoidants’ too readily forming transference responses that facilitate their viewing present relationships in the light of troublesome relationships from the past and present so that they can respond to people as if they are old problematic parents, rival siblings, difficult childhood friends or enemies, or one or more other of their current bête noires.

Associated Characterological Problems

Obsessionalism. Avoidants are worrisome individuals, brooders with one eye always wide open to the potentially negative consequences of everything they say and do to others, and others to them. They are often rigid, inflexible people who, stuck in routine, have difficulty adapting to unexpected life changes. Also, ambivalent about relationships, instead of settling in to a given relationship, they do and undo it: attempting to relate, becoming anxious, pulling back, then trying again either with the same person or with someone different, ad infinitum. Thus an obsessional avoidant went to New York City, had a successful career and lived a sophisticated lifestyle, gave it up to get married and move to the suburbs, got a dog, and had children, when, unhappy about and bored with being a housewife, she hired nannies to help care for her children so that she could resume working at something “more gratifying than just being a homemaker.” Her outside work then gave her the money she needed to become independent of her husband, and her independence gave her the emotional foundation she needed to get a divorce, whereupon she returned home to her birthplace and family, which, as she now believed, she should never have left in the first place.

Paranoia. Avoidants are hypervigilant individuals who fear something bad can or will happen to them unawares, “when they are not looking.” They take impersonal matters far too personally and see rejections that are not there as a clear and present danger, or actual attack. A difficulty with basic trust leads them to become highly skeptical of everyone, convinced that no one will show them any goodwill whatsoever, and certain that either they will trust everyone and get burned, or trust no one and get dumped.

Passivity/dependency (fear of being assertive). Avoidants fear selfassertion because they believe that being assertive means being aggressive. Peers, teachers, entertainers, religious leaders, and media all seem to be warning them that assertion, like dissent, means not being “healthily individualistic and productively rivalrous,” but “aggressively killing off the competition.”

Narcissism. Avoidants tend to be pulse takers who think more about how they feel than of how they make others feel, for example, “I fear what you do to me,” not “I worry about what my pulling back from you might do to you.”

Depression. Avoidants tend to be depressed individuals with intense negative moods that often commence when someone does not compliment them adequately or rejects them openly. In the absence of daily praise, they experience full and permanent stroke deprivation, associated with a sense of hopelessness about ever winning in the relationship game. They hold the pessimistic view that when it comes to relationships, there is no sense even trying since there is little chance of ever succeeding. Depressive cognitions prevail, particularly the tendency to think catastrophically in the “for want of a nail the ship was lost” mode, so that they readily come to believe that any sign of disinterest in them constitutes a turndown, a turndown a rejection, and a rejection an epochal tragedy.

Neophilia and neophobia. Avoidants paradoxically display both neo-philiac and neophobic traits. As neophiles, they are always seeking new people because they are easily bored with the old. Some become serial daters who, as Freud notes, show “a lack of stability in object-choice [evidenced by a] ‘craving for stimulus’ ” that is the product of a need to have an “endless series of substitute objects, none of which can ever give full satisfaction.”²⁸ As neophobes, avoidants seek not newness, but familiarity. They fear being unprepared and taken by surprise with their defenses down. So instead of trying new situations, they strive for sameness, as Frances and Widiger note, avoiding rejection by retreating into routines with the same few old friends, “going to the same restaurant, the same table, and eating the same entrée.”²⁹

Identification with One’s Peers/Society

Avoidants are often most attracted to friends, family, and society who are avoidogenics, that is, avoidance makers encouraging avoidance in others and having an especially devastating impact on avoidants as individuals already prone to shyness. Avoidogenics typically embrace and advance in-vogue avoidant philosophies such as religious (biblical) damnation for positive/sexual feelings; the Beatles’ exhortation to not trust anyone over 30; Zen philosophies of withdrawal aimed at reducing personal anxiety by the expedient of removing oneself from others and the world; and “do-your-own-thing” philosophies that overstress the importance of freedom, independence, and individuality, while fretfully condemning even the relatively modest submission and deindividuation that are in fact necessary to form close, loving relationships. Avoidants who do obeisance to this avoidant crowd come to view committed long-term relationships as the essence of boorish and uncool, and antithetical to their only true and meaningful goals in life—to be free of encumbrances (“a man thing”) and to be fully emancipated (“a woman thing”).

For one avoidant, embracing the belief that all intimacy is troublesome dependency was her way to be politically correct and so to gain approval from her equally avoidant peers. Hoping to belong if she accepted her group’s avoidant ideals, she went along when the group proclaimed, “Never cling too hard, it makes you into an invasive vine that only grows well with support from the very people it will ultimately strangle.” She, like so many other people today, clung to this avoidant philosophy because she valued her reputation with others over her satisfaction with herself.

Case Examples

A patient, after having gone to a great deal of trouble and expense to move from the “crowded large city in which I live to a small town with fewer inhabitants where I can have less contact with people,” could do no better than complain about the daytime noise in his new home— the leaf blowers, the gas company repairing the mains, and the like, really because they were the accoutrements of life and living. To “get

away from all the oppressive activity,” he moved again, this time to a farmhouse surrounded by acres of land and enclosed by a high fence to keep intruders out—only to move still again to an even more remote place in the desert because “on the farm, I’m frightened by the shadows in the woods at night.”

After years of being unemployed, he took a job working in the mail room of the post office. He took that particular job, even though it was “beneath him,” because it allowed him to have as little contact as possible with coworkers whose minor slights and rejections he took so personally that after arriving home after a day’s work, he began to brood about who said, meant, and did what to him. Unable to sleep at night, he was too tired to function effectively the next day and so unable to fully concentrate on his work. As a result, he became so distraught that he called out sick the day after, only to become so guilty for calling out sick that, once again, he was unable to sleep at night and had to call out sick the day after that, as well. Eventually, he became a secretive, isolated, sullen, and uncooperative worker who was diagnosed as having “burnout” and put on temporary disability leave. In response, he quit his job so that he could once again be able to live the lonely, completely isolated life he really had always dreamed of for himself.

A patient manifested a fear of commitment in his occupational life as a dreamy restlessness and desire for change whenever things were going well professionally so that he quit one perfectly good job after another and moved on, rationalizing his behavior as “for more money” or “for better working conditions”—ultimately illusory. A doctor, he kept many licenses in different states in case he wanted to relocate, and for a long time wouldn’t buy the house or apartment he wanted, and instead rented one so that he wouldn’t be tied down to one spot. Whenever he did move, he found that the old job he had left behind was as or more worthy than the new one. Though he recognized this after the fact, the recognition had no effect on his future behavior so that he continued to look at ads and apply for new positions. Of course, with each new job, the same difficulties arose, for his avoidant tendencies reasserted themselves, and he felt a new urgency to move on.

In his personal life, he suffered from a severe fear of commitment that took the form of intense object love alternating with a consuming desire to “get away from them all.” One night, he had the following dream. After waiting in a restaurant for his take-out order, and noting with mixed pleasure and envy the many generations all working under the same roof in splendid cooperation, he heard himself begging his wife to “throw him out” so that he could be alone. In his waking life, he had mixed feelings about his wife and their marriage (he was later actually to get a divorce). These took the form of an obsessive fear that his (consciously) beloved wife would get into a fatal car crash. Associated were a series of escapist distancing fantasies and behaviors involving shopping alone; going alone on vacations to exotic places or to a remote shack in the woods with a warm fire and steamy kettle; reading escapist books on exploring the Antarctic; traveling Through the Looking Glass and going “Over the Rainbow”; wandering alone through the seaside mists listening to the fog horn; taking trains by himself north, to isolated places, or to distant stations at the end of the line, not because of the pretty, interesting, or welcoming things he might find there, but because there, in his private, remote Oz, he would be as far away from home base as possible; taking fantasized trips in time to an imagined better past or future; and taking fantasized trips in person assuming another identity such as that of a troubadour in the Middle Ages playing ancient music alone in the woods, or that of an archaeologist who uncovered the past, not so that he could study, but so that he could live in it.

He once decided to actually buy a shack in the woods. He couldn’t wait to go there every weekend, and even went in winter, using as his excuse, “I have to water my plants.” However, when he got there, he promptly panicked because now he was all alone with nothing to do. So he called all his friends in the city just to make contact with other human beings and drank in local bars just to be where other people were, although he hated drinking and disliked the people in the bars as well as the contact he had with them, for as he saw it, they were “all predictably superficial and limited.” So he sold the lonely country shack and bought an apartment in the city, only to find that he constantly dreamed of the splendid times he had when alone in his house in the wilds—of the pleasures of getting into his car in the middle of winter, the cold snow everywhere; driving to the bars with their warm, welcoming lights, sounds, and people and wonderful, body-strengthening food and soul-building drink; and of the times when he was isolated, in his “beautiful digs,” with its beautiful furnishings, “living in sin” (as an acquaintance once put it) “with the wall board.”

A woman lived at home with her parents, being the good, dutiful, but resentfully compliant daughter who drew a magic circle around herself, letting the family in, keeping a few friends whom she saw occasionally, and having an occasional blind date, but accepting no close intimates into her life. She mainly filled her days with impersonal interests such as collecting things and attending craft shows. While sometimes she complained about being lonely and isolated, at other times, she insisted that she was enjoying her life fully because she was living it exactly the way she believed she wanted to. When she tried “to fight the good fight attempting to relate,” she was only able to do so with difficulty and deficit. Thus she occasionally went to singles bars, mixers, and parties, only, once she got there, to function below par, standing off completely by herself or speaking only to the person she came in with. She might complain that she was dissatisfied with the narrowness of her life, but would then regularly add that however hard she tried to change her luck, she could never seem to do any better and truly “get lucky.”

She feared starting and maintaining intimate relationships because she was highly fearful of rejection. Partly this was because she was a perfectionist, who, when it came to relationships, failed to accept that any rejection was part of life’s give-and-take, and otherwise expected too much positivity in a world full of negativity. Partly it was because her self-esteem was extremely low so that she would anticipate rejections that might never arise and take those that actually occurred much too seriously—because for her, a rejection meant that her greatest fear had come true: that no one could ever love her because she was completely unlovable. Often even a mild rejection led to a catastrophic reaction, where she panicked, pulled back, gave up, and cried, “Never again.” A doctor once diagnosed her as having a depersonalization disorder. Fearing acceptance because it could only lead to rejection, when faced with the “danger,” as she saw it, of being embraced by other people and getting close to them, she would go into a trancelike state that reminded her of a rabbit freezing in the headlights of a car, so that her trance, meant to be protective, instead turned out to be self-destructive. For in her trance, she shrugged men off with a “yeah, sure,” put them off by acting silly and giggly, or drove them away by becoming preoccupied and remote—her mind wandering to other things, even (perversely) going from a present satisfactory contact with a real person to a future affair with a mysterious stranger. Particularly when introduced to someone she really liked, she became defensively hazy, actually fainted, or even called on one of her multiple personalities to save her—one of the alter egos she reverted to temporarily at times of danger—created by suppressing parts of her old personality, by borrowing new personality parts through identification with someone she admired, or by becoming once again like her old self: the rebel she had once been but was no longer. Only later, after she had eliminated any possibility of a serious involvement, did she come to her senses, wonder what she was thinking about at the time, and “kick herself” for allowing the one that got away to escape. Then she pressured herself to “go out and meet someone new,” only to start the entire pathological cycle once again.

An avoidant woman consulted me because of her inability to “meet the man of my dreams.” She sought treatment for being so shy with men that it had become difficult for her to get close to the men in her family, to make male friends at and outside of work, and to get beyond accepting a first date with a man to be able to go out with him a second time. As a result, she feared, and with reason, that she would never fulfill her wish to get married, have children, and live a “normal life with a husband and kids in the suburbs.”

Just having wishful thoughts about marriage frightened her. She first thought, “I better get serious and start looking for a husband, for after all, I’m not getting any younger.” Then she took that back with, “Marriage isn’t right for everyone, and it may not be right for me. I think I would be much better off single, being able to come and go as I please, and beholden to nothing and no one. As far as I am concerned, the single life is not only just as good and valid as the married life, in many ways it is even better. I really enjoy being single, and just having a few good friends. I actually prefer that to having a husband, because with friends you can beat a path out of the relationship whenever you want to—and without a lot of stupid paper work.”

Often the normal travails of dating left her feeling severely depressed. For example, when a man was just a few minutes late for a date, she convinced herself that that was the end of the relationship, for he had died in a car accident, and “there goes my last chance to get married.” Because the nice things men said to and did for her eluded her completely, she saw even a highly positive relationship with a man as entirely negative and would break off the relationship precipitously and without explanation. Part of the problem was that feeling she deserved no better, she picked men who were unavailable, either because they played hard to get or because they were already married. Then she complained that relationships with men could never amount to much or go anywhere, so that her fate was only to be hurt, abused, and alone, her sole source of love coming from tearful, caring, concerned friends and family rushing to her side and rescue, pitying her, and taking her under their wing, to nurture her and salve her wounds.

Soon she became paranoid as well as depressed. She began imagining that even a man’s compliments were criticisms, so that when a man told her that she looked great one day, she thought that he was actually telling her that she looked terrible the day before. She convinced herself that all men were just out to seduce and abandon her: planning to take advantage of her sexually and financially before dumping her precipitously. Serious feelings of jealousy also began to plague her. When a date was just a few minutes late, she convinced herself that he was not going to come at all because he was out with someone he liked better. So his being late was his way to send her a message that he would soon leave her for another woman, and she would be all alone in life now and forever. She even became jealous when a date looked at another woman on the street just to make sure he would not run into her, spoke to another woman at a party, said more than hello, looked as if he were enjoying himself, got excited not bored like she thought he ought, did not look uncomfortable as if he couldn’t wait to get away, and said more to the woman than (she was almost actually counting his words) he said to her all day. Once she became jealous of a boyfriend’s having close friends at work, even though he was only going out to lunch with his buddies. She panicked if she called him at work and he didn’t answer the phone, for then she started worrying about “what he might be up to.” She even started writing down where his odometer was set to make certain that he wasn’t making extra trips on the side to see another woman. She began to demand that he be avail-able/accountable to her at all times so that she could keep tabs on him 24 hours a day because “since all men are secretive, you never know.” Ultimately, she even came to believe that she could read his mind and pick up the negative signals he was sending her. She then confronted him with her imaginations. There would be a fight, and should he try to defend himself, that meant that he was defiantly challenging her. So she pulled back permanently, believing that he was not only being unfaithful to her, but that he was also lying about it.

Men were sometimes able to get beyond these relational impediments by handling her “therapeutically,” only to come up against an even more distressing problem: boredom that tempted her to break off what had finally become a working relationship so that she could move on and look for someone else. A little into what had, in spite of all, become a positive encounter, a pervasive sense of aching dullness impelled her to give up, move on, and meet a new man, for “every day with the same man was just going to be the same old, same old, tired experience for the rest of my long, troubled life.” Her need to move on became so pressing that she completely forgot how painful it was to have to look for someone new: having to reexperience all those terrible letdowns and disappointments where all she could salvage were a pleasurable self-pitying feeling and (a progressively dimming) hope for better luck next time. There were times when she gave up on all men completely, feeling that she would willingly undergo the lesser pain of permanent isolation to avoid suffering what was for her the greater pain of the vast emptiness predictably associated with being connected.

In therapy, we focused on how a measure of her “boredom” with the old was a defense against her fear of being controlled. Thus she was reluctant to make plans with any man in advance, even a dinner date, because she feared she would not be able to “wriggle out from under.” When a man called her and invited her over for “dinner this Saturday,” she accepted, only to feel trapped and cornered, so she added, “I will call if anything comes up,” leaving the man wondering, with reason, if she would actually make it over at the appointed time, and thinking, “Maybe I better back out first so that I don’t save the date only to have her cancel out on me at the last minute, leaving me with no plans for the big night.” Feeling trapped, she longed for her space and started thinking about how wonderful it would be to sit at home by herself “surrounded by the things I love, like my valuable collection of lovely appliqued teacups that fill the shelves in what used to be my basement bar (no longer working because all the china on the shelves left no room for liquor).” She might contemplate having a man over to sip from her cups, but afterward, she would ask herself, “How am I going to get out of this?” and cancel the engagement with only a few minute’s notice using a flimsy excuse, such as claiming she had caught a cold or had a last-minute family emergency.

We next uncovered how part of her distancing from men was attributable to her anger with them. She rarely expressed this anger with men directly. Mostly she expressed it indirectly and subtly: by becoming remote as her way to quietly say, “You make me mad.”

A great deal of this anger toward men was defensive: her way to seek out negative things about them to give herself the excuse she required to remove herself from their presence. She actively looked for reasons to complain that a man did not love her; didn’t accept her for herself; criticized her for anything she said or did; only saw her weaknesses and ignored her strengths; and subjected her to ridicule. She made certain that she interpreted anything that a man said that wasn’t a compliment as a criticism and that she saw his disagreeing with her as exactly the same thing as his savaging her completely. Humorlessly, she would deliberately take the mildest joke at her expense far too seriously. Once, for example, she confessed to a friend at a dinner party, “I have brittle bones.” She then asked a man seated next to her, “What about your bones, are they bad?” Others at the table, overhearing the exchange, jokingly remarked, “Don’t tell her! Your bones are your business!” So the man she asked, also as a joke, said, “I’ll never tell.” Whereupon she began to sulk aloud: “I told you about my bones, now why won’t you tell me about yours?” And she meant it, and refused ever to speak to that man again.

Her anger was especially fierce when she believed that men were trying to control her—to “get me to do their bidding by roping me into a relationship I am reluctant to pursue”—and when she believed that men thought they were better than she was simply because they were men. Even fiercer still was her anger over the possibility that a close relationship with a man might be compromising her identity—by keeping her from being herself, stifling her right to be free and emancipated, and thwarting her creative urge to do what she wanted without interference by any man. As she put it, “I hate having to change myself around just for men I don’t respect or care about that much anyway. I am an independent woman. For me closeness and intimacy with a man overwhelms, strangles, and pulverizes me into dust. Doesn’t it do that to any woman alive?”

We also discussed how she was too much the relational perfectionist for her own good: a woman who sought the ideal man, while refusing to consider and accept any man who was less than perfect. Thus, before contemplating getting serious with a man, she demanded full compatibility. A man had to be not a calm, stoic type, who thought that all fretting was a waste of time, but as much in touch with his worries as she was. He wasn’t for her unless he was “the sort who gets hysterical over nothing.” Shared interests became much too important for her. Thus she left one viable relationship because “he loves boorish baseball and I love the much more sublime chamber music.” She would also demand full exclusivity right from the start and break off a promising relationship at the first sign that she was just one of several in a man’s affections. Otherwise, she was just “lowering her standards by hanging around with someone beneath me; someone who doesn’t deserve me, or merit my faithful love.”

We profitably identified and worked on two of her counterproductive security maneuvers. The first involved identifying with the aggressor. She would actively abandon men to deal with her fear that they might abandon her. She would also deal with her fear of being devalued by men by actively devaluing them so that it wouldn’t matter if they devalued her. As she put it, “I actually like weak men because they lack power over me: the power to put me down.”

We also worked on her paradoxical fears: that giving herself any breathing room in a relationship would mean that she was going to be abandoned; that retaining her identity in a relationship would result in her being left out in the cold, punished and sacrificed for being an individual by being thrown over for another more cooperative, compliant, conciliatory, and passive woman; and that involvement with a man necessarily meant compromising her career only to find herself not only alone, but also unemployed. Too, we worked on her destructive competitiveness, marked by her need to turn a cooperative relationship into a struggle for power and supremacy. For she saw friendly, cooperative men as rivals, turning a relationship into a contest either over small things, like who would be the one the dog came to first or whose lap the cat always sat on, or over big things, like who was or would be more successful than her professionally. This competitiveness led her to actively rejoice when something bad happened even to a man she liked. For that way, she could win, without feeling guilty about having caused him to lose.

Throughout, and not surprisingly, she complained that she was “dead in bed.” She postponed having her first sexual experience indefinitely because she believed that abstinence alone was conducive or even essential to moral superiority. As she once put it, not entirely humorously, “The only way I can even think of having sex would be in the missionary position, with a Bible in one hand, and a washcloth in the other.”

She saw sex not as lofty or spiritual, but as dirty and animalistic: to the point that she often provoked an argument to avoid having relations. On those few occasions when she actually tried sex, she would stop prematurely because she couldn’t relax, lost sensation, and felt cold. To avoid self-blame, she convinced herself that “I really don’t like how the man looks, or the way he behaves in bed, so it’s best that I see to it that it is over immediately.”

We discovered that much of her sexual difficulty developed out of the early fear that men would hurt her now, as her parents had hurt her when she was a child. She saw all men as father clones, who terrified her the way her father had done when he threatened to whip her if she didn’t “behave” and “cooperate.” All men had also symbolically become her hurtful mother, who never supported and always criticized her, even for a thing and its opposite, such as being messy (for not keeping her room clean) and for being excessively neat (for being a compulsively finicky dresser). Too, she believed that all men would infantilize her the way both her parents did—treating her like a helpless child with no rights or acceptable ideas of her own, yet demanding that she grow up fast so that she wouldn’t be a burden to them forever. Worst of all, as she put it with tears in her eyes, “when, after a good deal of effort, once I managed to tell my parents that in spite of it all, I loved them, they nevertheless remained unmoved. So I never uttered those words to them again. Or to anyone else.”

Unfortunately, she resisted therapy throughout. Rather than admit to being avoidant, she developed a number of rationalizations to normalize her behavior. She transformed fear into disinterest, and disinterest into preference, so that a fear of rejection became a fond desire for personal isolation, and that was “not something we ever need to discuss.”

Ultimately, after a few months, she left treatment, saying that her life wasn’t so bad after all and she didn’t need to waste her money and time working on something that didn’t really amount to much. For, as she put it, almost incredibly, “I am not hurting at all. If I am an avoidant in the first place, it gives me very little grief personally, and no trouble whatsoever professionally.”

Just recently, I heard from her once again. Therapy had worked after it ended, for she could accept treatment from me now that she was no longer struggling with me about “how to think and what to do.” She had gotten married, had a large family, and made a peace with her parents that was, however, imperfect, for “I still resent them for making me an avoidant, causing me to lose so many years out of my life to all the fearful isolation I had to endure all that time, and strictly on their behalf, and account.”

CHAPTER 2

DIFFERENTIATING AVPD FROM BORDERLINE PERSONALITY DISORDER

CHAPTER 9 Development

BEHAVIORAL THERAPY

CHAPTER 18

Notes