Distancing: Avoidant Personality Disorder, Revised and Expanded

294 Pages·2003·1.24 MB·English

by  Martin Kantor

Distancing:
Avoidant Personality
Disorder, Revised
and Expanded
MARTIN KANTOR
PRAEGER
Distancing

Distancing
Avoidant Personality Disorder,
Revised and Expanded
MARTIN KANTOR
LibraryofCongressCataloging-in-PublicationData
Kantor,Martin.
Distancing:avoidantpersonalitydisorder/MartinKantor.—Rev.andexpanded
p.cm.
ISBN0–275–97829–X(alk.paper)
1.Avoidantpersonalitydisorder. 2.Avoidance(Psychology). 3.Remoteness
(Personalitytrait). I.Title.
RC569.5.A93K35 2003
616.85(cid:1)8—dc21 2003052894
BritishLibraryCataloguinginPublicationDataisavailable.
Copyright(cid:2)2003byMartinKantor
Allrightsreserved.Noportionofthisbookmaybe
reproduced,byanyprocessortechnique,withoutthe
expresswrittenconsentofthepublisher.
LibraryofCongressCatalogCardNumber:2003052894
ISBN:0–275–97829–X
Firstpublishedin2003
PraegerPublishers,88PostRoadWest,Westport,CT06881
AnimprintofGreenwoodPublishingGroup,Inc.
www.praeger.com
PrintedintheUnitedStatesofAmerica
Thepaperusedinthisbookcomplieswiththe
PermanentPaperStandardissuedbytheNational
InformationStandardsOrganization(Z39.48–1984).
10 9 8 7 6 5 4 3 2 1
ToM.E.C.
Letusnotforgetthatthemotivesbehindhumanactionsare
usuallyinfinitelymorecomplicatedandvariousthanweassume
themtobeinoursubsequentexplanations...
—Dostoyevsky,TheIdiot
Contents
Preface ix
PartI:Description 1
1 WhyHasAvoidantPersonalityDisorderReceivedSoLittle
Attention? 3
2 TheLiterature 11
3 TheMentalStatusProfile 33
4 TypesofAvoidants 51
5 HealthyAvoidance 59
6 AvoidantPeople 65
7 SocioculturalManifestations 75
8 Course 77
9 ComorbidDisorders:ComorbiditywithSchizotypal,
Schizoid,andAffectiveDisorders 87
10 ComorbidDisorders:Comorbiditywith“Neurotic”
SpectrumDisorders 101
11 ComorbidDisorders:ComorbiditywithOtherPersonality
Disorders 127
12 Cause:AnOverview 149
viii Contents
PartII:Therapy 167
13 AnOverviewofAvoidanceReduction 169
14 PsychodynamicallyOrientedPsychotherapy 185
15 Cognitive-BehavioralTherapy 195
16 InterpersonalTherapy 207
17 SupportiveTherapy 217
18 Pharmacotherapy 237
19 TherapeuticModificationsforTreatingAvoidants 239
20 TreatingDepressedAvoidants 251
References 267
Index 271
Preface
In today’s world, avoidance, distancing, removal and isolation have be-
come so widespread that people assign greater importance to their pos-
sessions than they assign to their relationships. This is not surprising.
Whatwillstartleus,however,istheextenttowhichlaypersons,clinicians,
and researchers alike have overlooked, misunderstood, or downplayed
avoidance, even though, like sex or hunger, it serves as a primarydeter-
minant of behavior, creates as much interpersonal difficulty as schizoid
remoteness, depressive withdrawal, and borderline ambivalence, and
causesasmuchsocialdistressasignoranceandpoverty.Avoidantsthem-
selves(IusethetermavoidantstorefertopatientswithanAvoidantPer-
sonality Disorder) think they are happy as things stand, or, if they feel
unhappy,blametheirunhappinessontheirstarsorontheirfate.Victims
of avoidants remain convinced that something is wrong with them, and
trytodobetter,whenitistheavoidantwhohastheproblemandshould
betheonemakingtheimprovements.Psychotherapiststreatingavoidants
often have too narrow a view of what causes and constitutesavoidance.
Intherealmofwhatcausesavoidance,theyoftenfocusexclusivelyonthe
avoidant’s fear of criticism, humiliation, and rejection,withoutconsider-
ingotherequallyimportantreasonstobeavoidant,suchastheparanoid
tendency to assume criticism, humiliation and rejection in their absence,
orthehistrionictendencytoragemightilyoverthemostinsignificantand
unimportant of interpersonal events. In the realm of what constitutes
avoidance,theyfocusalmostexclusivelyontwogroupsofavoidants:in-
dividuals who are timid and shy in their relationships, and individuals
with a Social Phobia such as public speakers with stage fright. Virtually