What Is APD?

As someone with acute Exposure Anxiety as a major part of my autism, I was used to chemistry-driven involuntary avoidance, diversion, retaliation responses taking over my behaviour and communication whenever my adrenaline drenched overaroused emotional state triggered the fight/flight responses when others initiated and triggered my oversensitised ‘invasion’ alarm. This Exposure Anxiety (EA) was so severe and entrenched it developed to a secondary level so I not only was triggered into involuntary avoidance, diversion, retaliation responses when responding in fight/flight mode to the initiations of others but progressively also when I too desperately wanted to initiate something for myself- be that getting a drink, something to eat, going to the loo, getting a coat or taking one off, staying in a room or leaving it etc and I could usually do what I DIDN’T want to do at the time but generally not the thing I DID want to do. I found strategies around the EA rules of ‘can’t do it as myself’, ‘by myself’ or ‘for myself’ (of course being prompted counts as ‘doing as someone else’ but doesn’t lead to independance in EA) and how to use the yes=no/no=yes mechanism to actually get relatively functional even if these strategies made me seem just as difficult to comprehend as the problem itself. (this is all written about in Exposure Anxiety; The Invisible Cage )

Recently, Chris and I visited two ‘high functioning’ friends diagnosed with ASD (diagnosed with Aspergers ). One of them also has Avoidant Personality Disorder. At a glance, on the surface APD looks a bit like EA, but where EA has nothing to do with confidence (one can be full of confidence and have severe EA), APD severely effects confidence. Where EA causes a range of involuntary behaviours, APD is a bit different. Where those with EA often desperately try to challenge the often impossible and self defeating confines of the invisible cage of EA (sometimes with self injurious results) , those with APD by it’s nature may, through no fault of their own, be lacking motivation to challenge their condition. Though their behaviour often draws attention and is generally mistaken for attention seeking, EA is generally made worse through overt directly confrontational praise and encouragement and those with it are often most productive when there is no ‘threat’ of praise or attention (though they can constantly force others to prompt them). Those with APD, on the other hand, may need that encouragment constantly, even dependantly.

What was interesting was that whilst APD isn’t generally recognised until late childhood, it is possible that it goes overlooked or hidden in early childhood and it is fairly possible to imagine that misunderstood APD could compound the developmental and information processing issues inherent in autism. If this is so, its important to be informed about what it is so the right environmental approach can be used with those it most fits with. Something like ABA, for example, would likely need to be modified or exchanged for something more fitting where APD or EA compounded or underlied the person’s autism. It’s important that even though I have never had APD, to recognise that there is no one thing called autism and that understanding APD may hold some solutions for others. In case its of use to others who may also have both APD and and autism-spectrum condition, here’s some info on it (albeit rife with words like ‘disorder’, ‘abnormal’ etc).

bye for now… Donna Williams www.donnawilliams.net

here’s an article from the web on APD:

Here are the diagnostic criteria for Avoidant Personality Disorder (APD), taken from the DSM-IV and the ICD-10 World Health Organization classification.

US definition European definition
The symptoms of APD may appear to overlap with those of Generalized Social Anxiety, and many people with SA will be able to relate to the description below.

What is SA?
Introduction
More information
Treatments
Definitions
» Social anxiety
» Avoidant Personality

Opinions vary as to where SA ends and APD begins, although with APD the emphasis is perhaps more on deeply ingrained thought patterns and beliefs, than actual anxiety.

Diagnostic Criteria

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, present in a variety of contexts, as indicated by four (or more) of the following:

– avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection

– is unwilling to get involved with people unless certain of being liked

– shows restraint within intimate relationships because of the fear of being shamed or ridiculed

– is preoccupied with being criticized or rejected in social situations

– is inhibited in new interpersonal situations because of feelings of inadequacy

– views self as socially inept, personally unappealing, or inferior to others

– is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

Associated Features

– Depressed Mood

– Anxious/Fearful/Dependent Personality

Differential Diagnosis

Social Phobia, Generalized Type; Panic Disorder With Agoraphobia; Dependent Personality Disorder; Schizoid Personality Disorder; Schizotypal Personality Disorder; Paranoid Personality Disorder; Personality Change Due to a General Medical Condition; symptoms that may develop in association with chronic substance use.

Diagnostic and Statistical Manual, Fourth Version, 1994 © American Psychiatrists Association

Personality disorder characterized by at least three of the following:

(a) persistent and pervasive feelings of tension and apprehension

(b) belief that one is socially inept, personally unappealing, or inferior to others

(c) excessive preoccupation with being criticized or rejected in social situations

(d) unwillingness to become involved with people unless certain of being liked

(e) restrictions in lifestyle because of need to have physical security

(f) avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection.

Associated features may include hypersensitivity to rejection and criticism.

Personality Disorders

A personality disorder is a severe disturbance in the characterological constitution and behavioural tendencies of the individual, usually involving several areas of the personality, and nearly always associated with considerable personal and social disruption.

Personality disorder tends to appear in late childhood or adolescence and continues to be manifest into adulthood. General diagnostic guidelines applying to all personality disorders are presented below; supplementary descriptions are provided with each of the subtypes.

Diagnostic Guidelines

Conditions not directly attributable to gross brain damage or disease, or to another psychiatric disorder, meeting the following criteria:

(a) markedly dysharmonious attitudes and behaviour, involving usually several areas of functioning, e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;

(b) the abnormal behaviour pattern is enduring, of long standing, and not limited to episodes of mental illness;

(c) the abnormal behaviour pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;

(d) the above manifestations always appear during childhood or adolescence and continue into adulthood;

(e) the disorder leads to considerable personal distress but this may only become apparent late in its course;

(f) the disorder is usually, but not invariably, associated with significant problems in occupational and social performance.

For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations. For diagnosing most of the subtypes listed below, clear evidence is usually required of the presence of at least three of the traits or behaviours given in the clinical description.

The ICD-10 Classification of Mental and Behavioural Disorders World Health Organization, Geneva, 1992 – © 1992 by World Health Organization.