Why It’s Important to Thrive and Not Just Survive

We Spend a significant amount of time as doctors monitoring for adverse outcomes. 

We use the absence of disease as an indicator of health. 

But the mere absence of disease is not enough to proclaim good health. 

If we only monitor for the absence of disease, we miss the things that are most important in our patients’ daily lives. 

The things I’ve found to be most important in my life, and often lacking in my patient’s lives are…

Being happy, having a sense of purpose and meaning, and having good relationships which are sometimes ignored if overt signs and symptoms of disease are not present. 

Being “well” is a state of complete mental, physical, and social wellbeing. 

Having a purpose in life is associated with reduced mortality risk, so is life satisfaction. Things like loneliness and social isolation are associated with increased mortality.

When these needs are met people not only live longer but they live with intention. 

Let’s Look beyond the absence disease 

 

The Loneliness Epidemic and Avoidant Personality Disorder 

Although loneliness has always been a friend of mine (Backstreet boys 1997), there is an epidemic of loneliness across all age groups. 

We live in a world where we are all more connected with each other through technological advances and social media, yet people feel more disconnected than ever. 

The COVID-19 pandemic did make this any better, 36% of all Americans, including 61% of young adults and 51% of mothers with young children feel loneliness is a significant problem in their lives. 

The question is are people feeling lonely because they are suffering from avoidant personality disorder?

Epidemiology

The prevalence of APD is 2.36% in the general population, and it appears to occur equally in males and females. 

Definitions and Criteria for diagnosis

Let’s start with a definition of what avoidant personality disorder is and how it can impact a person’s life. 

This is part of the cluster C personality disorders often thought of as the anxious/fearful personality disorders. These individuals experience excessive social anxiety, severe feelings of inferiority and inadequacy, and while they desire close relationships, they avoid the feared stimulus instead living in self-imposed social isolation. 

Other key criteria include: 

-patterns of social inhibition 

-hypersensitivity to rejection or criticism 

-it must be present by early adulthood 

This affects all areas of life and should be a pervasive pattern. It’s not something that is isolated or situational.  

DSM-5 Criteria: 4 out of 7 are required to make a diagnosis 

  1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection. 
  2. Unwilling to engage in relationships unless they are certain of being liked. (They will look for social cue or indicators of interest before committing and often attempt to read other minds) 
  3. Shows restraint in relationships for fear of being ridiculed or shamed 
  4. You are preoccupied with being criticized or rejected 
  5. The person is inhibited in new interpersonal situations because of feelings of inadequacy 
  6. The person will view themselves as socially inept, inferior to others, or unappealing to others. 
  7. The person is reluctant to take personal risks for fear of embarrassment 

It’s important to keep in mind this diagnosis is largely unchanged since DSM-III and are primarily viewed through a psychoanalytic lens. The key difference between avoidant personality disorder and social anxiety is these feelings are pervasive throughout the person’s life, where in social anxiety they are limited to social situations. Although some believe these are the same disorder with many of the criteria overlapping. Avoidant patients tend to read more into things and are constantly looking for any indication from others that supports their theory that they are defective or inadequate. 

Other personality disorders can have rejection sensitivity and sensitivity to criticism, this is often seen in narcissistic personality disorder. We are all sensitive to criticism in certain situations it’s not necessarily pathological. 

Treatment: 

This largely focuses on psychotherapy and sometimes medication if other comorbid psychiatric disorders are identified. Some of the psychotherapy techniques that are effective include social skills training, cognitive behavioral therapy, and exposure therapy. These are also good cases for psychoanalysis if the person can commit to that form of therapy. 

Conclusion :

Could Some of the Loneliness people are experiencing be due to avoidant personality disorder?

-Possibly, but it’s only going to be a small percentage considering the prevalence of avoidant personality disorder is 2.36%. 

-Loneliness has many contributing factors and encouraging people to spend less time connecting digitally and more time connecting face to face is a good place to start. 

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