The Essential Guide to Overcoming Avoidant Personality Disorder

Notes

PREFACE

1. Oldham, J. M., & Morris, L. B. (1995). New personality self-portrait: Why you think, work, love, and act the way you do. New York: Bantam Books, p. 200.

2. Dalrymple, K., & Zimmerman, M. (2007, October). Social anxiety disorder and comorbid depression; challenges in diagnosis and treatment. Psychiatric Times, p. 27.

3. PDM Task Force. (2006). Psychodynamic diagnostic manual. Silver Spring, MD: Alliance of Psychoanalytic Organizations, p. 54.

CHAPTER 1

1. Fenichel, O. (1945). The psychoanalytic theory of neurosis. New York: W. W. Norton, p. 180.

2. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author, pp. 662-665.

3. Quality Assurance Project. (1991). Treatment outlines for avoidant, dependent and passive-aggressive personality disorders. Australian and New Zealand Journal of Psychiatry, 25, p. 410.

4. Francis, A., & Widiger, T. A. (1987). A critical review of four DSM-III personality disorders. In G. L. Tischler (Ed.), Diagnosis and classification in psychiatry. New York: Cambridge University Press, p. 280.

5. Millon, T. (1981). Disorders of personality: DSM-III: Axis II. New York: John Wiley, p. 313.

6. Benjamin, L. S. (1996). Interpersonal diagnosis and treatment of personality disorders. New York: Guilford Press, p. 293.

7. Portnoy, I. (1959). The anxiety states. In S. Arieti (Ed.), American handbook of psychiatry. New York: Basic Books, p. 316.

8. PDM Task Force. (2006). Psychodynamic diagnostic manual. Silver Spring, MD: Alliance of Psychoanalytic Organizations, p. 55.

9. Gabbard, G. O. (1992, Spring). Psychodynamics of panic disorder and social phobia. Bulletin of the Menninger Clinic, 56(Suppl. A), p. A8.

10. APA Help Center. (n.d.). Painful shyness in children and adults. Retrieved June 7, 2009, from http://www. apahelpcenter.org/featuredtopics/feature. php?id=5&ch=1, p. 1.

11. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author, pp. 662-665.

12. Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: W. W. Norton, p. 267.

13. Quality Assurance Project. (1991). Treatment outlines for avoidant, dependent and passive-aggressive personality disorders. Australian and New Zealand Journal of Psychiatry, 25, p. 410.

14. Millon, T., & Davis, R. D. (1996). Disorders of personality DSM-IVand beyond. New York: John Wiley, p. 154.

15. Freud, S. (1924). The economic problem in masochism. In J. D. Sutherland (Ed.) & J. Riviere (Trans.), Collected papers (Vol. 2). London: Hogarth Press, pp. 266-267.

16. Freud, S. (1957). Some character-types met with in psycho-analytic work. In J. D. Sutherland (Ed.) & J. Riviere (Trans.), Collected papers (Vol. 4). London: Hogarth Press, pp. 324-325.

17. Benjamin, L. S. (1996). Interpersonal diagnosis and treatment of personality disorders. New York: Guilford Press, p. 293.

18. Hagey, L. M. (2009, January 21). Review of Distancing. Amazon.com. Retrieved October 23, 2009, from http://www.Amazon.com/Distancing-Avoidant-Personality-Disorder-Expanded/product-reviews/027597829X/ ref=cm_cr_dp_hist_2?ie=UTF8showViewpoints0&filterBy=addTwoStar.

19. Hagey, L. M. (2007, September 10). Review of Forever Flashlight—9” Shake Electromagnetic Induction. Amazon.com. Retrieved October 23. 2009, from http://www.amazon.com/Forever-Flashlight-Shake-Electromagnetic-Induction/dp/B00027U880/ref=cm=cr-mr-title

20. Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: W. W. Norton, p. 216.

21. Fenichel, O. (1945). The psychoanalytic theory of neurosis. New York: W. W. Norton, p. 169.

22. Millon, T. (1981). Disorders of personality: DSM-III: Axis II. New York: John Wiley, p. 313.

23. Francis, A., & Widiger, T. A. (1987). A critical review of four DSM-III personality disorders. In G. L. Tischler (Ed.), Diagnosis and classification in psychiatry. New York: Cambridge University Press, p. 278.

24. Beck, A. T. (1999). Prisoners of hate: The cognitive basis of anger, hostility, and violence. New York: HarperCollins, p. 273.

25. Millon, T., & Davis, R. D. (1996). Disorders of personality DSM-IVand beyond. New York: John Wiley, p. 253.

26. Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: W. W. Norton, p. 57.

27. Fenichel, O. (1945). The psychoanalytic theory of neurosis. New York: W. W. Norton, p. 169.

28. Freud, S. (1957). The most prevalent form of degradation in erotic life (from Contributions to the psychology of love). In J. D. Sutherland (Ed.) & J. Riviere (Trans.), Collected papers (Vol. 4). London: Hogarth Press, p. 215.

29. Francis, A., & Widiger, T. A. (1987). A critical review of four DSM-III personality disorders. In G. L. Tischler (Ed.), Diagnosis and classification in psychiatry. New York: Cambridge University Press, p. 280.

CHAPTER 2

1. PDM Task Force. (2006). Psychodynamic diagnostic manual. Silver Spring, MD: Alliance of Psychoanalytic Organizations, pp. 55-56.

2. Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: W. W. Norton, p. 306.

3. Coleman, E. (1992). Is your patient suffering from compulsive sexual behavior? Psychiatric Annals, 22, 320-325.

4. Thompson, C. (1959). An introduction to minor maladjustments. In S. Arieti (Ed.), American handbook of psychiatry. New York: Basic Books, pp. 239-240.

5. Berne, E. (1964). Games people play. New York: Grove Press, p. 126.

6. Beatty, M. (1987). Codependent no more: How to stop controlling others and start caring for yourself. Center City, MN: Hazelden.

CHAPTER 3

1. Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: W. W. Norton, p. 351.

CHAPTER 4

1. Fenichel, O. (1945). The psychoanalytic theory of neurosis. New York: W. W. Norton, p. 169.

2. Freud, S. (1957). The most prevalent form of degradation in erotic life (from Contributions to the psychology of love). In J. D. Sutherland (Ed.) and J. Riviere (Trans.), Collected papers (Vol. 4). London: Hogarth Press, p. 212.

3. Ibid., p. 203.

4. Jones, E. (1953-1957). The life and works of Sigmund Freud (Vols. 1-3). New York: Basic Books, p. 2.299.

1. Berne, E. (1964). Games people play. New York: Grove Press, p. 14.

2. Millon, T. (1981). Disorders of personality: DSM-III: Axis II. New York: John Wiley, p. 313.

CHAPTER 6

1. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author, p. 396.

2. Ballenger, J. (1991). Masters in psychiatry. Kalamazoo, MI: Upjohn,

PP. ^4-5.

3. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author, p. 410.

4. PDM Task Force. (2006). Psychodynamic diagnostic manual. Silver Spring, MD: Alliance of Psychoanalytic Organizations, p. 54.

5. Anthony, M. M., & Swinson, R. P (2000). Shyness & social anxiety workbook: Proven techniques for overcomingyour fears. Oakland, CA: New Harbinger, p. 16.

6. Rettew, D. C. (2000). Avoidant personality disorder, generalized social phobia, and shyness: Putting the personality back into personality disorders. Harvard Review of Psychiatry, 8, 283-297.

7. PDM Task Force. (2006). Psychodynamic diagnostic manual. Silver Spring, MD: Alliance of Psychoanalytic Organizations, p. 55.

8. Millon, T., & Davis, R. D. (1996). Disorders of personality: DSM-IVand beyond. New York: John Wiley, p. 274.

9. Reich, W. (1949). Character analysis. New York: Orgone Institute Press, p. 44.

10. Millon, T., & Davis, R. D. (1996). Disorders of personality: DSM-IV and beyond. New York: John Wiley, p. 274.

11. Benjamin, L. S. (1996). Interpersonal diagnosis and treatment of personality disorders. New York: Guilford Press, p. 291.

12. Ibid., p. 298.

13. Ibid., p. 290.

14. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author, p. 654.

CHAPTER 7

1. Millon, T. (1981). Disorders of personality: DSM-III: Axis II. New York: John Wiley, pp. 313-314.

2. Beck, A. T. (1990). Psychotherapy of an avoidant personality [Audiotape]. New York: Guilford Press.

3. Berne, E. (1964). Games people play. New York: Grove Press, p. 126.

1. Burns, D. D., & Epstein, N. (1983). Passive-aggressiveness: A cognitive-behavioral approach. In R. D. Parsons & R. M. Wicks (Eds.), Passive-aggressiveness: Theory and practice. New York: Brunner/Mazel, p. 75.

2. Ibid.

CHAPTER 9

1. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd rev. ed.). Washington, DC: Author, p. 61.

2. Millon, T. (1981). Disorders of personality: DSM-III: Axis II. New York: John Wiley, p. 318.

3. Benjamin, L. S. (1996). Interpersonal diagnosis and treatment of personality disorders. New York: Guilford Press, pp. 292-293.

4. Rosenthal, E. (1992, August 18). Troubled marriage? Sibling relations may be at fault. New York Times, pp. C1, C9.

5. Millon, T. (1981). Disorders of personality: DSM-III: Axis II. New York: John Wiley, p. 320.

6. Ballenger, J. (1991). Masters in psychiatry. Kalamazoo, MI: Upjohn, p. 4.

7. Millon, T. (1981). Disorders of personality: DSM-III: Axis II. New York: John Wiley, pp. 316-317.

8. Galvin, R. (1992, March-April). The nature of shyness. Harvard Magazine, 94, pp. 41, 43.

CHAPTER 10

1. Oldham, J. M., & Morris, L. B. (1995). New personality self-portrait: Why you think, work, love, and act the way you do. New York: Bantam Books, 2001.

2. Millon, T., & Davis, R. D. (1996). Disorders of personality: DSM-IVand beyond. New York: John Wiley, pp. 321-324.

3. Ibid., pp. 282-284.

4. Anthony, M. M., & Swinson, R. P. (2000). Shyness & social anxiety workbook: Proven techniques for overcoming your fears. Oakland, CA: New Harbinger, pp.100-101.

5. Benjamin, L. S. (1996). Interpersonal diagnosis and treatment of personality disorders. New York: Guilford Press, p. 302.

CHAPTER 11

1. Quality Assurance Project. (1991). Treatment outlines for avoidant, dependent and passive-aggressive personality disorders. Australian and New Zealand Journal of Psychiatry, 25, p. 405.

2. Millon, T. (1981). Disorders of personality: DSM-III: Axis II. New York: John Wiley, p. 324.

1. Beck, A. T. (1999). Prisoners of hate: The cognitive basis of anger, hostility, and violence. New York: HarperCollins, p. 54.

2. Ibid., pp. 252-254.

3. Rapee, R. M. (1998). Overcoming shyness and social phobia: A step-by-step guide. Northvale, NJ: Jason Aronson.

4. Quality Assurance Project. (1991). Treatment outlines for avoidant, dependent and passive-aggressive personality disorders. Australian and New Zealand Journal of Psychiatry, 25, pp. 404-405.

5. Anthony, M. M., & Swinson, R. P. (2000). Shyness & social anxiety workbook: Proven techniques for overcomingyour fears. Oakland, CA: New Harbinger, pp.193-219.

6. Benjamin, L. S. (1996). Interpersonal diagnosis and treatment of personality disorders. New York: Guilford Press, pp. 304-305.

7. Rapee, R. M. (1998). Overcoming shyness and social phobia: A step-by-step guide. Northvale, NJ: Jason Aronson, p. 76.

8. Auden, W. H. (n.d.). The more loving one. Retrieved July 9, 2009, from http://www.poets.org/viewmedia.php/prmMID/15550

9. Haley, personal communication, 1961.

CHAPTER 13

1. Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: W. W. Norton, p. 302.

2. Fromm-Reichmann, F. (1960). Principles of intensive psychotherapy. Chicago: University of Chicago Press, p. 34.

3. Millon, T., & Davis, R. D. (1996). Disorders of personality: DSM-IVand beyond. New York: John Wiley, p. 283.

4. Mitchell, J. (2008, November 4). A 65th birthday tribute to Joni Mitchell. Wall Street Journal, p. D7.

CHAPTER 14

1. Benjamin, L. S. (1996). Interpersonal diagnosis and treatment of personality disorders. New York: Guilford Press, p. 302.

2. Pinsker, H. (1997). A primer of supportive therapy. Hillsdale, NJ: Analytic Press, p. 162.

CHAPTER 15

1. Bandura, A. (n.d.). Observational learning. Retrieved July 22, 2009, from http://en.wikipedia.org/wiki/Observational_Learning

2. Buggey, T. (n.d.). A picture is worth . . . Video self-modeling applications at school and home. Retrieved July 9, 2009, from http://education.ucsb.edu/ autism/JPBI-abstracts/JPBIv9n3su07.htm

3. Beavers, W. R. (1982). Indications and contraindications for couples therapy. Psychiatric Clinics of North America: Marital Therapy, 5, p. 474.

4. Benjamin, L. S. (1996). Interpersonal diagnosis and treatment of personality disorders. New York: Guilford Press, p. 305.

5. Gabbard, G. O. (1992). Psychodynamics of panic disorder and social phobia. Bulletin of the Menninger Clinic, 56(Suppl. A), p. A8.

6. Marshall, J. R. (1992). The psychopharmacology of social phobia. Bulletin of the Menninger Clinic, 56(Suppl. A), pp. 42-49.

7. Rapee, R. M. (1998). Overcoming shyness and social phobia: A step-by-step guide. Northvale, NJ: Jason Aronson, p. 116.

CHAPTER 17

1. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author, p. 662.

2. Keating, C.J. (1984). Dealing with difficult people. Ramsey, NJ: Paulist Press, p. 150.

3. Freud, S. (1957). Certain neurotic mechanisms in jealousy, paranoia and homosexuality. In J. D. Sutherland (Ed.) & J. Riviere (Trans.), Collected papers (Vol. 2). London: Hogarth Press, pp. 232-243.

4. Franklin, B. (n.d.). BrainyQuote. Retrieved October 26, 2009, from http://www.brainyquote.com/quotes/quotes/b/benjaminfr151684.html

CHAPTER 18

1. Beck, A. T. (1999). Prisoners of hate: The cognitive basis of anger, hostility, and violence. New York: HarperCollins, p. 251.

2. Ibid., p. 53.

CHAPTER 19

1. PDM Task Force. (2006). Psychodynamic diagnostic manual. Silver Spring, MD: Alliance of Psychoanalytic Organizations, p. 128.

CHAPTER 20

1. Oldham, J. M., & Morris, L. B. (1995). New personality self-portrait: Why you think, work, love, and act the way you do. New York: Bantam Books and Morris, p. 201.

2. Winter, D. A. (n.d.). The internet encyclopaedia of personal construct psychology: Fixed-role therapy. Retrieved July 22, 2009, from http://www.pcp-net. org/encyclopaedia/fixed-role-ther.html

3. New introductory lectures on psycho-analysis. (n.d.). Answers.com. Retrieved October 22, 2009, from http://www.answers.com/topic/new-introductory-lectures-on-psycho-analysis

4. Mitchell, J. (2008, November 4). A 65th birthday tribute to Joni Mitchell. Wall Street Journal, p. D7.

5. Anthony, M. M., & Swinson, R. P. (2000). Shyness & social anxiety workbook: Proven techniques for overcomingyour fears. Oakland, CA: New Harbinger, p. 78.

ex

Acceptance, 208

Acquired sexual avoidance, 48-50 Action oriented therapeutic approach, 113

Addiction, 88

Adolescent turmoil, 40

Advice to patients, 150-55

Affairs, extramarital, 160, 190

Aggressive personality disorder, 83-84

Aggressor, identification with, 16,

59-60, 174-75

American Psychological Association Help Center, 6

Analytic dimension of therapy, 112 Anergia, 58 Anger, 13-15, 202-3 Anhedonia, 58

Animals, comparisons to, 107-8 Antagonistic individuals, avoiding, 152-53

Anxiety, 9, 148, 149, 199-200 Appearance, physical, 212-13 Asexuality, 45-47 Assertiveness, 18, 174-75 Avoidance: accepting, as last resort, 161-62; as avoidant defense, 16; avoidant personality disorder, 42-44; avoidant personality traits, 41-42; creation in therapy, 167-68; healthy, 37-39, 156, 182, 197-98; normal, 39-41, 198

Avoidance reduction overview, 111-21; choosing best approach for specific patients, 118-21; cognitive-behavioral therapy, 114-16; existential approach, 117; family therapy, 117-18; interpersonal approach, 116; psychodynamically oriented psychotherapy, 113-14; supportive therapy, 116-17 Avoidant disorder of childhood and adolescence, 99-102 Avoidant personality disorder: avoidant personality traits versus, 41-42; cognitive-behavioral aspects,

93-97; comorbidity, 71-92; course, 57-60; development, 99-108; differential diagnosis, 61-69; overview, 42-44; self-help, 195-214. See also specific types and therapies

Avoidant personality traits, 41-42

Behavioral therapy, 137-42; graded exposure, 138-40; joint/group exposure, 142; journaling, 141; manipulation, 140; motivation, enhancing, 141; non-avoidant philosophy, injecting, 140; overview, 112; paradoxical therapy, 140-41; patience, urging, 141; relaxation techniques, 142; right-brain activity, 142; role-playing, 135, 140; sexual avoidance reduction, 188-89; social skills training, 137; as supplemental treatment, 165-66; treatment of avoidant personality disorder and social phobia, 65. See also Cognitive-behavioral therapy

Biological factors, 106-7

Bisexuality, 88- 89

Borderline personality disorder,

66 - 69

Boredom, 212

Case examples: aggressive personality disorder, 83-84; anger, readiness to, 14-15; anxiety in new social situations, 9; avoidant disorder of childhood and adolescence, 99-102; bisexuality, 89; borderline personality disorder, 67-69; cognitive-behavioral therapy,

115; cognitive therapy, 134-35; criticism, humiliation, and rejection, fear of, 7-8, 176-77; depression, 73-74; dissociative personality disorder, 78-80; DSM-IV criteria, 7-8, 9, 11; false equivalencies, 95; family therapy, 117-18; flooding, fear of, 11; healthy avoidance, 37-38; identification with peers/ society, 19-28; inadequacy and low self-esteem, feelings of, 9; interpersonal therapy, 144-45; masochism, 12-13, 86-87; non-DSM-IV criteria, 11, 12-13,

14-15, 19-28; normal avoidance, 40-41; obsessive-compulsive personality disorder, 75-77; parental relationships, early, 102-5; posttraumatic stress disorder, 81-82; psychodynamically oriented psychotherapy, 124, 127-31; push techniques, 164-65; rationalization, 59-60; sexual avoidance, acquired, 49-50; sexual avoidance, innate/essential, 45-47; sexual avoidance development, 51-52; sexual avoidance psychodynamics, 53; sexual avoidance treatment, 185-86, 187-88; social awkwardness, 11; social phobia,

63-64, 64-65; supportive therapy, 149-50; Type Ila avoidants, 30-33; Type Ilb avoidants, 34-36 Catastrophic thinking, 96-97, 136 Cats, comparisons to, 107 “Certain Neurotic Mechanisms in Jealousy, Paranoia, and Homosexuality” (Freud), 173 Changes, real-life, 202 Charactering armoring, 62 Characterological problems, associated, 17-19

Classic avoidant personality disorder. See Type I avoidant personality disorder

Cleansing prohibitions, and sexual avoidance, 48-49, 50 Codependency, 36 Cognitive-behavioral aspects, 93-97; catastrophic thinking, 96-97; false equivalencies, 94-95; negative thinking, 95; overgeneralizing, 96; projective thinking, 93-94 Cognitive-behavioral therapy, 133-42; behavioral therapy, 137-42; cognitive therapy, 133-37; graded exposure, 138-40; joint/group exposure, 142; journaling, 141; manipulation, 140; motivation, enhancing, 141; non-avoidant philosophy, injecting, 140; overview, 114-16; paradoxical therapy, 140-41; patience, urging, 141; relaxation techniques, 142; right-brain activity, 142; roleplaying, 135, 140; social skills training, 137

Cognitive errors, 144, 209 Cognitive restructuring, in sexual avoidance reduction, 189 Cognitive therapy, 112, 133-37. See also Cognitive-behavioral therapy Commitment, fear of, 20-21; dreams, 20 -21

Comorbidity, 71-92; addiction, 88; aggressive personality disorder,

83-84; bisexuality, 88-89; depression, 71, 73-74; dissociative personality disorder, 78-81; grief, 74; hysterical (histrionic) personality disorder, 77-78; masochism, 71, 85-88; mixed personality disorder, 89-92; narcissism, 82; obsessive-compulsive personality disorder, 71, 74-77; paranoia, 71, 72; paraphilia, 82; passive-aggression, 83; passive-dependent personality disorder, 84-85; posttraumatic stress disorder, 81-82 Competitive/normal jealousy, 173 Consensual validation, 151 Constructive criticism, 177 Consultative action, taking, 206-7 Control, 77, 94, 103, 148 Counteridentification, with healthy, nonavoidant parents, 104-5 Counterphobia, healthy, 156 Counterphobic avoidants. See Type II avoidant personality disorder Counterphobic defenses, 126 Course of avoidant personality disorder, 57-60; identification with aggressor, 59-60; rationalization, 58 - 60

Criteria. See DSM-IV criteria; Non-DSM-IV criteria Criticism: anxiety over, 200;

constructive, 177; fear of, 7-8,

171; global, 175; helping avoidants overcome fear of, 171-77; inuring yourself to, 209; of patients by therapists, 167; responding to in a healthier way, 173-76; supportive therapy for dealing with, 148-49 Critics: characteristics, 171-72; manipulating, 175-76. See also Criticism

Daughters, sexual avoidance development in, 52 Dedicated therapeutic approach, 111

Defenses, 16-17, 126, 156-57 Delayed ejaculation, 55, 188 Delusional jealousy, 173 Denial, healthy, 156 Depression, 18, 57-58, 71, 73-74 Development, 99-108; avoidant disorder of childhood and adolescence, 99-102; biological factors, 106-7; cognitive errors and, 97; evolutionary factors,

107-8; nonparental relationships, early, 105-6; normal avoidance as part of, 40; parental relationships, early, 102-5; psychological issues, early, 99-105; trauma, early,

102

Diagnostic and Statistical Manual of Mental Disorders, fourth edition.

See DSM-IV criteria Differential diagnosis, 61-69;

borderline personality disorder,

66-69; panic disorder/specific phobia/social phobia, 61-66 Displacement, 16-17 Dissociation, 212

Dissociative personality disorder, 78-81 Dogs, comparisons to, 107-8 Dreams: analyzing, 79-80, 209; commitment, fear of, 20-21; dissociative avoidants, 79-80; early parental relationships,

105; hypervigilance and selfconsciousness, 10; masochistic avoidants, 86; self-help, 209 DSM-IV criteria: anxiety in new social situations, 9; fear of criticism, humiliation, and rejection, 7-8,

171; feelings of inadequacy and low self-esteem, 8-9; hypervigilance and self-consciousness, 10; list of, 3-4; shyness, timidity, and withdrawal, 3, 6-7; social awkwardness, 10-11. See also Non-DSM-IV criteria

Eclectic therapeutic approach, 111-13 “Economic Problem in Masochism, The” (Freud), 11-12

Educative dimension of therapy, 112 Ego-ideals, 15-16, 126, 210-12 Ejaculatio tarda, 55, 188 Emotional charging, in sexual avoidance reduction, 188

Emotionalism, parental criticism about, 103

Empathy, 145

Environmental enhancing, in sexual avoidance reduction, 188 Equivalencies, false, 94-95 Erectile dysfunction, 55 Erotophobia, 48, 50, 51, 52. See also Sexual avoidance Essential sexual avoidance, 45-47 Evolutionary factors, 107-8 Existential approach, 117 Exposure: graded, 138-40; interoceptive, 139; joint/group, 142 Exposure anxiety, 199-200

False equivalencies, 94-95 Family, helpful, 207-8 Family therapy, 117-18, 168-69 Fears: of commitment, 20-21; of control, 94; of criticism, humiliation, and rejection, 7-8,

171; erotophobia, 48, 50, 51, 52; of flooding, 11; neophobia, 18-19; of public speaking, 65, 156, 176; sexual avoidance and, 20-21; social phobia, 61-66, 166; specific phobia, 61; of success, 86-88; supportive therapy for, 149 Fidelity, in committed sexual relationships, 153-54, 191 Fixed role therapy, 202 Flooding, fear of, 11 Forgiveness, 208 Francis and Widiger criteria, 4 Freud, Sigmund, 11-12, 48, 173 Friends, helpful, 207-8

Gambling addiction, 88 Garlic disorders, 64 Global criticism, 175 Goals, setting, 199-200 Graded exposure, 138-40

Grief, 39-40, 74 Group therapy, 160 Guilt: about being oneself, 60; about sexuality, 94; depressed avoidants and, 73; as overresponse, 149; psychodynamically oriented psychotherapy and, 114, 125-26; rationalization versus, 60; reducing, 125-26, 181-82, 186; self-esteem and, 181-82; sexual avoidance reduction and, 186; supportive therapy and, 149

Health, 212-13

Healthy avoidance, 37-39, 156, 182, 197-98

Healthy defenses, 126, 156-57, 204 Healthy denial and counterphobia,

156

Healthy identification, 156-57 Healthy projection, 156 Histrionic personality disorder,

77-78, 157

Hobbies, 142, 167-68 Holistic therapeutic approach, 111-13 Hot red pepper disorders, 64 Humiliation, fear of, 7-8, 171 Hypervigilance and self-consciousness, 10

Hysterical (histrionic) personality disorder, 77-78, 157

Identification: with aggressor, 16, 59-60, 174-75; healthy, 156-57; with peers/society, 19-28 Identity maintenance, 145 Impatience. See Patience Impracticality, 168 Improvement, spontaneous, 57 Inadequacy, feelings of, 8-9 Infantilization, 103-4 Innate/essential sexual avoidance,

45- 47

Insight, 123-25, 186-88, 205-6 Intellectualization, 17, 168 Interoceptive exposure, 139 Interpersonal therapy, 112, 116,

143-45, 159-60

Jealousy, 173

Joint/group exposure, 142 Journaling, 141, 202-2

Kantor criteria, 4-6

Learning, observational, 159 “Love phobia,” 48, 50, 51, 52. See also Sexual avoidance

Madonna complex, 53, 185 Manipulation, 140

Marital/couple therapy, 159-60. See also Interpersonal therapy Marriage, open, 190 Masochism, 11-13, 16, 71, 85-88 Media, 106

Medical curing, in sexual avoidance reduction, 189

Men, sexual avoidance in, 51-52, 53, 55 Millon/Benjamin/Horney criteria, 4 “Mingles” avoidants, 31-32, 33 Mixed personality disorder, 89-92 Motivation, enhancing, 141, 198-200

Narcissism, 18, 82 Negative thinking, 95 Negative transference resistances, 120-21, 169-70 Neophilia, 18, 33, 212 Neophobia, 18-19 Niceness, 144

Nonavoidance: advantages of, 199; philosophy, 140, 151; trial forays into, 206

Non-DSM-IV criteria: American Psychological Association Help Center, 6; anger, readiness to, 13-15; associated characterological problems, 17-19; defensiveness, excessiveness, 16-17; flooding, fear of, 11; Francis and Widiger, 4; identification with peers/society, 19-28; Kantor, 4- 6; masochism, 11-13; Millon/Benjamin/Horney, 4; relational idealism, excessive, 15-16. See also DSM-IV criteria Nonparental relationships, early, 105-6

Normal avoidance, 39-41, 198 Normal jealousy, 173

Observational learning, 159 Obsessionalism, 17 Obsessive-compulsive personality disorder, 39, 71, 74-77, 156-57 Onion disorders, 64 Open marriage, 190 Overgeneralizing, 96

Panic disorder, 61 Paradoxical therapy, 140-41 Paranoia: as associated characterological problem, 18; comorbidity, 71, 72; reducing, 183; self-esteem and,

183; supportive therapy for, 157; thinking and, 93-94 Paraphilia, 82

Parents: cognitive errors and, 97; counteridentification with,

104-5; early relationship with, 102-5; excessive control by, 103; infantilization by, 103-4; selfesteem in children and, 180; sexual avoidance development in daughters and, 52; sexual avoidance development in sons and, 51-52; sexual avoidance treatment and,

191

Passive-aggression, 83 Passive-dependent personality disorder, 18, 84-85, 156 Patience, 141, 169, 200 Patients: advice to, 150-55; criticism of, 167; liking and respecting, 147. See also Self-help

PDM (Psychodynamic Diagnostic Manual), 5, 29-30, 187 Peers, early relationships with, 106 Peers/society, identification with, 19-28 Perfectionism, 74-75, 96, 188 Personality changing, in sexual avoidance reduction, 188 Personality traits, avoidant, 41-42 Pets, 167-68

Pharmacotherapy, 112, 160-61 Phobic passes/talismans, 140

Playing the field, as rationalization, 58-59

Positive transference resistances, 120 Positivity, 144, 151, 189-90 Posttraumatic stress disorder, 81-82 Premature ejaculation, 55 Priorities, setting, 200 Profession, selecting, 196 Prognosis, good, 197 Projected jealousy, 173 Projection, 72, 93-94, 156, 204 Psychodynamically oriented psychotherapy, 123-31; basic technique, 123; defenses, unhealthy, 126; ego-ideals, 126; guilt reduction, 125-26; insight, 123-25; marital/ couple therapy, 160; overview, 113-14; secondary gain, 126-27; supplemental techniques, 127-31; transference resistances, 127; treatment of avoidant personality disorder and social phobia, 65-66 Psychodynamic Diagnostic Manual (PDM), 5, 29-30, 187

Psychological disorder styles, 64 Psychological issues, early, 99-105;

avoidant disorder of childhood and adolescence, 99-102; early parental relationships, 102-5; early trauma, 102

Psychopathology, in critics, 172 Public speaking, 65, 156, 176 Push techniques, 163-65

Quality Assurance Project, 3, 7, 123,

137

Rationalization, 58- 60 Reassurance, 148-50, 166-67 Regression, 17 Rejection, fear of, 7-8, 171 Relational idealism, 15-16, 126, 210-12 Relationships: nonparental, early,

105-6; nonworking, 153; parental, early, 102-5

Relaxation techniques, 142 Religious leaders, relationships with, 106 Remedies, ineffective, 165-66

Repression, 17 Resignation defenses, 126 Resistances, 120-21, 127, 169-70,

200, 201

Right-brain activity, creating, 142 Role-playing, 135, 140, 206

Secondary gain, dealing with, 126-27 Self-consciousness, 10 Self-criticism, 172 Self-devaluation, projection of, 94 Self-esteem, 8-9, 179-83, 203, 204 Self-help, 195-214; acceptance, 208; anger, 202-3; boredom, 212; changes, real-life, 202; cognitive errors, 209; consultative action, 206-7; criticism, 209; defenses, healthy, 204; dissociation, 212; dream analysis, 209; forgiveness, 208; friends and family, 207-8; health and appearance, 212-13; healthy/normal avoidances, 19798; helping others become less avoidant, 212; journaling, 200-202; motivation, 198-200; nonavoidance, trial forays into, 206; prevention, 196-97; profession, selecting, 196; prognosis, 197; projection, unhealthy, 204; relational philosophy, 210-12; resistances to improvement, 200, 201; role-playing, 206; self-esteem,

203, 204; shyness, 203-4; therapy, evaluating need for, 213-14; transactional insight, 205-6; traumas, 204-5; vicious cycles, 208-9 Self-modeling, video, 159, 165-66 Self-studies, evidence-based, 183 Seven-year itch avoidants, 34-36, 87 Sexual avoidance, 45-55; acquired, 48-50; cautions, 153; description, 45-50; development, 50-52; innate/essential, 45-47; options of last resort, 190-91; paradoxical therapy for, 141; parents and, 191; prevention, 185-86; prognosis, 191-92; psychodynamics, 53-54; specific sexual symptoms, 54-55;

therapeutic errors, 192; treatment, 185-92

Shyness, timidity, and withdrawal, 3, 6-7, 106-7. See also Self-help Siblings, 103, 105 Social anxiety, 148 Social awkwardness, 10-11 Social phobia, 61-66, 166 Social skills training, 137 Society, identification with, 19-28 Somatic complaints, 74 “Some Character-Types Met with in Psychoanalytic Work” (Freud), 12 Sons, sexual avoidance development in, 51-52

Sour grapes, 59 Specific phobia, 61 Stimulation enhancement, in sexual avoidance reduction, 186 Successophobia, 86 - 88 Supplemental approaches, 127-31, 155-57, 165-66

Supportive therapy, 147-57; advice, bad, 155; advice, good, 150-55; liking and respecting patients,

147; overview, 112, 116-17; reassurance, 148-50; supplemental approaches, 155-57 Sympathy, 170

Temperament, inherited, 106-7 Therapy: avoidance creation in,

167-68; cognitive, 112, 133-37; dimensions, 112; evaluating need for, 213-14; family,

117-18, 168-69; fixed role, 202; group, 160; ideal techniques, 163-70; interpersonal, 112, 116, 143-45, 159-60; marital/couple, 159-60; normal avoidance as part of, 41; paradoxical, 140-41; pharmacotherapy, 112, 160-61; technique of last resort, 161-62; video self-modeling, 159, 165-66.

See also Behavioral therapy; Cognitive-behavioral therapy; Psychodynamically oriented psychotherapy; Supportive therapy Thinking: catastrophic, 96-97, 136; errors in, 144, 209; negative, 95; projective/paranoid, 93-94 Third parties, putting between avoidants and critics, 176 Thompson, Clara, 31 Time to meet people, lack of, as rationalization, 58

Timidity, 3, 6-7, 106-7. See also Self-help

Total push techniques, 163-65 Transference resistances, 120-21, 127, 169 -70

Trauma, early, 102, 204-5 Type I avoidant personality disorder, 3-28; DSM-IV criteria, 3-4, 6-11; non-DSM-lV criteria, 4-6, 11-28; push techniques, 165; Type II versus, 29

Type II avoidant personality disorder,

29- 36; Type Ila, 30-34, 165; Type Ilb, 34-36, 165; Type IIc, 36

Type IIa avoidant personality disorder,

30- 34, 165

Type IIb avoidant personality disorder, 34-36, 165

Type IIc avoidant personality disorder, 36

Unhealthy defenses, 126 Unhealthy projection, 204 Unworthiness, projection of, 94

Validation, consensual, 151 Vicious cycles, interrupting, 180-81,

208 -9

Video self-modeling, 159, 165-66

Withdrawal, 3, 6-7, 106-7. See also Self-help

Women, sexual avoidance in, 52, 53

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MARTIN KANTOR, MD, is a Harvard psychiatrist who has been in full private practice in Boston and New York City and active in residency training programs at several hospitals, including Massachusetts General and Beth Israel in New York. He also served as assistant clinical professor of psychiatry at Mount Sinai Medical School and as clinical assistant professor of psychiatry at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School. He is author of 18 other books, including Homophobia: The State of Sexual Bigotry Today (Praeger, 2009); Uncle Sam's Shame: Inside the Veteran's Administration (Praeger, 2008); Lifting the Weight: Understanding Depression in Men: Its Causes and Solutions (Praeger, 2007); The Psychopathy of Everyday Life: How Antisocial Personality Disorder Affects All of Us (Praeger, 2006); Understanding Paranoia: A Guide for Professionals, Families, and Sufferers (Praeger, 2004); Distancing: Avoidant Personality Disorder, Revised and Expanded (Praeger, 2003); Passive-Aggression: A Guide for the Therapist, the Patient, and the Victim (Praeger, 2002); and Treating Emotional Disorder in Gay Men (Praeger, 1999).