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Avoidant Personality and Social Anxiety: What’s the Difference?

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The silhouette of a person standing in a field of yellow mustard flowers.Social anxiety and avoidant personality disorder share some common features, but they are separate mental health conditions. Because the two conditions appear similar in many ways, it’s not uncommon for people to mistake one for the other.

Sometimes simply getting help is more important than having a specific diagnosis. But some people also find it beneficial to know what’s affecting them. In some cases, the best approach to treatment differs for separate mental health issues, so misdiagnosis can affect treatment and make it harder for a person to improve.

Social anxiety, or social phobia, is a specific type of anxiety characterized by a fear of social situations. People with social anxiety worry about embarrassing themselves in public or doing something that will cause others to judge them negatively. It’s fairly common for people to feel nervous about doing something embarrassing in public, but the feelings of fear and anxiety that occur with social phobia can become so distressing they cause difficulty at work, school, or other parts of daily life. About 75% of people with social anxiety are between the ages of 8 and 15 when diagnosed.

Avoidant personality disorder is a cluster C personality disorder. Personality disorders are a specific kind of mental health issue where patterns of thought and behavior affect daily life, and those with personality disorders often experience difficulty in professional and personal life because they have a hard time understanding other people and common situations.

Levana Slabodnick, LISW-S, a therapist in Columbus, Ohio, notices one difference between social anxiety and avoidant personality may lie in how a person views their own experience. She explains, “A fundamental difference between social anxiety disorder and avoidant personality disorder relates to how the sufferer perceives their own pain. Those with anxiety understand on a basic level that their anxiety is irrational and that the world doesn’t judge them as harshly as they judge themselves. Those with APD, on the other hand, lack this insight. They hold deep rooted feelings of insecurity and worthlessness that they believe to be factual.”

People with avoidant personality often feel socially awkward and inferior to others. They tend to be very sensitive to criticism and rejection and often avoid making friends or participating in social events unless they are sure of their welcome. Feelings of shame or self-loathing are more strongly associated with avoidant personality than social anxiety. This condition is not often diagnosed in children, though it often develops in childhood.

Avoidant Personality Disorder vs. Social Anxiety

Social anxiety and avoidant personality share an intense fear of being embarrassed or judged in social situations. People might describe a person with either condition as shy, timid, awkward, or fearful.

Fear associated with these conditions can present in many ways, such as:

  • Avoiding social situations
  • Avoiding interactions with strangers
  • Low self-esteem
  • Shyness or timidity around other people
  • Isolation from others or complete social withdrawal

Debate over whether avoidant personality is a more severe type of social anxiety exists among mental health experts. According to the fifth edition of the DSM, these issues are often diagnosed together and can overlap to the point where they might seem like different presentations of the same concern. But while avoidant personality typically involves patterns of avoidance in most or all areas of life, social anxiety may only involve avoidance in a few specific situations. The DSM continues to categorize them separately.

Debate over whether avoidant personality is a more severe type of social anxiety exists among mental health experts.

The two issues continue to share similarities when it comes to risk factors. Genetic and environmental factors can contribute to the development of either condition. Avoidance can be a learned response. People might begin to avoid social situations after a negative experience, for example. Being shy as a child can also increase the likelihood a person will go on to develop social anxiety or avoidant personality, though being shy does not necessarily mean a person will develop either issue for certain.

Experiencing abuse, trauma, bullying, or other negative events in childhood can increase risk for both social anxiety and avoidant personality. But neglect, particularly physical neglect, is a significant risk factor for avoidant personality. A 2015 study comparing the two conditions found that having disinterested caregivers, feeling rejected by caregivers, or not having enough affection in childhood was more common in people with avoidant personality.

Certain risk factors do differ between the two conditions:

  • Some research has suggested avoidant personality may be more likely when someone’s physical appearance changes after illness.
  • Research suggests brain structure may contribute to anxiety. If your amygdala, which is believed to help regulate your response to fear, is very active, you may experience greater anxiety in certain situations than other people do.
  • Having a parent or sibling with social anxiety makes it 2-6 times more likely a person will develop the condition, according to the DSM-5.

Should I Get Treatment for Social Anxiety or APD?

Therapy is generally recommended for both avoidant personality and social anxiety. Only a mental health professional can diagnose mental health issues. If you think you might have symptoms of either avoidant personality or social anxiety, making an appointment with a qualified therapist or counselor can be a good place to start.

Letting any potential counselors know your particular symptoms and describing your specific experience can help them decide whether they’re qualified to help you. Not every therapist has experience treating every mental health condition, but an ethical therapist will always let you know if they think another therapist might be more helpful.

Social anxiety is often treated with cognitive behavioral therapy (CBT). This therapy helps you identify thoughts that cause distress and affect you negatively. Once you identify them, you learn how to change them. You can do CBT alone, but some people find group therapy helpful.

Exposure-based CBT is a specific approach to CBT where you slowly expose yourself to feared situations. This approach often involves skills practice or role-playing techniques, both of which can help people get more comfortable interacting with others in the safe space of therapy.

According to a 2015 study, performing random acts of kindness for others led to a decrease in symptoms of social anxiety in study participants after 4 weeks.

While therapy can have great benefit, sometimes social anxiety doesn’t improve right away. If you are working with a counselor and still experience significant difficulty in your daily life, a psychiatrist may recommend medication, such as:

Anxiety medication can help relieve some symptoms of social anxiety, but it’s a good idea to continue with therapy at the same time, as therapy helps you learn how to cope with what you’re experiencing. This can have a more lasting effect on your symptoms.

Many people believe personality disorders are not treatable, but this isn’t the case. They can be difficult to treat, especially if you’ve had symptoms for a long time. But therapy can still be very helpful. People with avoidant personality often seek treatment when they experience loneliness and distress as a result of being unable to participate in social events.

Research has shown people with avoidant personality may do better in therapy if they have the support of family members.

Any kind of talking therapy can be helpful for avoidant personality. CBT is commonly used to treat this condition, but other helpful approaches include family and group therapy. Research has shown people with avoidant personality may do better in therapy if they have the support of family members. Group therapy can help people learn how to develop relationship and communication skills in a safe space, and it’s often recommended for treating personality disorders.

There’s no specific medication used to treat avoidant personality. However, antidepressants and anti-anxiety medications may help relieve some severe symptoms.

Conclusion

Social anxiety and avoidant personality have some similarities, and some approaches to treatment may be similar. Regardless of which condition you have, therapy can help. It’s important to reach out for help if you’re struggling with social situations. When social anxiety or avoidant personality go untreated, complications like depression, isolation, and substance abuse can develop. Some people may experience significant loneliness and distress.

Talking to a therapist can help you get a diagnosis. But you’ll also begin to learn ways to cope with the feelings you experience and explore methods of overcoming these feelings. Therapy can help you become more used to the company of others. In time, you may find it easier to participate in social situations.

If you need help finding a counselor in your area, our therapist directory is a good place to start. Remember, you aren’t alone!

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association. 103-110.
  2. Anxiety disorders. (2017, December 15). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders
  3. Avoidant personality disorder. (2017, November 20). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9761-avoidant-personality-disorder
  4. Eikenaes, I., Egeland, J., Hummelen, B., & Wilberg, T. (2015, March 27). Avoidant personality disorder versus social phobia: The significance of childhood neglect. PLoS One, 10(5). doi: 10.1371/journal.pone.0122846
  5. Kvarnstorm, E. (2016, April 6). Avoidant personality disorder goes beyond social anxiety. Bridges to Recovery. Retrieved from https://www.bridgestorecovery.com/blog/avoidant-personality-disorder-goes-beyond-social-anxiety
  6. Lampe, L. (2016). Avoidant personality disorder as a social anxiety phenotype: Risk factors, associations and treatment. Current Opinion in Psychiatry, 29(1), 64-69. doi: 10.1097/YCO.0000000000000211
  7. Personality disorders. (2016, September 23). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463
  8. Smith, K. (2018, November 19). Avoidant personality disorder. Retrieved from https://www.psycom.net/avoidant-personality-disorder
  9. Social anxiety disorder (social phobia). (2017, August 29). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561
  10. Trew, J. L., & Alden, L. E. (2015, June 5). Kindness reduces avoidance goals in socially anxious people. Motivation and Emotion, 39(6), 892–907. Retrieved from https://link.springer.com/article/10.1007/s11031-015-9499-5

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When Life Continues: Recovering from a Suicide Attempt

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A man observes the city at dawnIf you or a loved one is in crisis, you can call the National Suicide Prevention Lifeline at 1-800-273-8255.

Surviving a suicide attempt can lead to a range of intense emotions and feelings. Many people report feeling a new sense of hope or believing they survived for a reason. Others might feel renewed hopelessness or begin to have thoughts of making another attempt. Some people feel love and compassion from friends and family. Others might feel increasingly alone.

Other emotions might include:

  • Relief, or being glad the attempt failed
  • Disappointment or confusion
  • Embarrassment and shame
  • Fatigue, lethargy, or general overwhelm
  • Anger

Whatever feelings you experience, it’s essential to work with a counselor trained in helping people recover from suicide attempts. Healing from a suicide attempt is possible, though recovery time may vary depending on different factors. According to Tamara Hill, MS, NCC, CCTP, LPC, “Recovery is possible with planning, but recovery should be multi-dimensional.”

Getting Help After a Suicide Attempt

One of the first steps in recovering from a suicide attempt is seeking health care. It’s important to get medical attention for any physical injuries or illness related to the attempt. A mental health professional will talk to you at the hospital to see how you’re feeling and whether you’re still at risk for suicide. If you’re already working with a therapist, the hospital can contact them.

If you’re still in crisis or your doctor or counselor is concerned for your safety, they may recommend you remain in the hospital as a patient until your suicide risk has decreased. People at high risk for suicide who don’t want to be admitted to the hospital may be hospitalized involuntarily for a few days. This isn’t common. It’s only likely to happen if your care providers believe you are very likely to attempt suicide again very soon. You may not want to stay in the hospital, but if you plan to make another attempt, remaining somewhere safe is a good idea.

It’s important that you prioritize your healing and spend time with people who can offer support. Some of your loved ones may need time to work through their own feelings, but you can only be responsible for your own recovery. Once you’re home, your friends and family may ask questions you aren’t sure how to answer. Suicide is a topic that’s still surrounded by stigma, so it can be difficult to talk about what you experienced.

Remember that you don’t have to share anything you don’t want to. If you want to talk to your loved ones but need more time, let them know you’re still sorting through your feelings. Your counselor can help you work through what to say if you’re struggling to find the right words.

You’ve just experienced something very traumatic. Your family and friends may be affected by your decision to attempt suicide. Some people may say thoughtless or hurtful things out of grief or fear. It’s important that you prioritize your healing and spend time with people who can offer support. Some of your loved ones may need time to work through their own feelings, but you can only be responsible for your own recovery.

How Long Does It Take to Recover from a Suicide Attempt?

Recovery from attempted suicide can take time. The amount of time may depend on several factors, including the level of social/emotional support you have and how you continue to work through the challenges affecting your mental health.

Recovery typically happens in stages. A study published in the Journal of Clinical Nursing lists five common phases of recovery:

  1. A person realizes that they still have business in life and/or that they don’t want to die.
  2. A person becomes aware that they need to seek help from others, such as professionals or loved ones.
  3. A person re-encounters stress and hardship in their life.
  4. A person adjusts their behavior to better cope with life’s challenges.
  5. A person accepts that there are good and bad parts to life and begins to invest in their own well-being.

The same study suggests recovery is often nonlinear. People often move back and forth between stages of self-awareness, adjustment, and acceptance. A person may feel average one day, stressed the next, and then hopeful the third.

Self-care is an important part of recovery.

  • You can take care of yourself physically by getting enough sleep, taking any medications your doctor or psychiatrist prescribed, making time for physical activity, and eating nourishing foods.
  • Activities such as listening to music, writing in a journal, or working with your hands or body can help you feel better emotionally.
  • Many people find yoga and meditation to be both emotionally and physically beneficial.

These things can all have a positive impact on recovery.

Therapy for Suicide Recovery

In many cases, the triggers leading to a suicide attempt don’t go away after the attempt. If you were working with a therapist before attempting suicide but therapy wasn’t helping, consider trying a new approach to treatment. Not every approach works for every person. Talk with your therapist about what’s working and what isn’t. If there’s a new concern in your life that’s adding stress, try to address this in therapy so you can develop ways to cope.

Check in frequently with your therapist, and be honest about what you’re feeling. Your therapist’s job is to help you, and they are trained to do so with compassion and without judgment.Another important component of therapy after a suicide attempt is developing your crisis/safety plan. According to Hill, this plan might include, “triggers, warning signs of evident regression in health, and a concrete plan of coping skills to use to avoid hospitalization or suicide attempts.” Hill goes on to emphasize the importance of societal support, which might include “addresses to local groups, registration information to educational seminars, and websites to local organizations that support suicide recovery.”

Your therapist can help you develop a safety plan. Check in frequently with your therapist, and be honest about what you’re feeling. Your therapist’s job is to help you, and they are trained to do so with compassion and without judgment.

If you have family support (or support from your partner or close friends), consider including them in your recovery plan and therapy if possible. Suicide is a difficult topic, and your family and friends may not know how to talk to you about what happened. They may be working through their own feelings about the attempt. Therapy can provide a safe space for you and your loved ones to share your thoughts—when you’re ready to do so.

Preventing Future Suicide Attempts

Making one suicide attempt is a risk factor for future suicide attempts. A 2014 review of articles looking at suicide found that one in 25 people who are hospitalized for self-harm complete suicide within five years. A 2016 study looking at 1,490 people who attempted suicide found almost 82% of those who didn’t complete their first attempt completed a second attempt within one year.

It’s important to have a crisis plan when recovering from a suicide attempt. This is something you might talk about with your therapist. Your crisis plan might include:

  • A list of what triggers suicidal thoughts or feelings.
  • A list of things that help you cope with triggers.
  • A list (or photos) of your loved ones, pets, and other things that are important to you. These can help you cope in a time of crisis.
  • Names and numbers of people you can reach out to, such as friends, family, your therapist and doctor, or others you trust.
  • Numbers for immediate care, such as the nearest emergency room, a suicide helpline, or other emergency services.
  • A list of steps to keep yourself safe if you are in crisis. For example, you might plan how you could avoid or get rid of items in your house that you could harm yourself with.

It’s also important to seek support from others. Re-establishing connections with people who care for you can have a significant impact on recovery. Different people in your life can help in different ways, so don’t be afraid to reach out to the people who care about you.

It helps to be clear about what you need. For example, if you don’t feel like talking, you could ask family members or close friends if they can keep you company when you’re struggling to cope with difficult feelings. You might say something like, “I don’t want to talk, but I want to distract myself from thinking about hurting myself. Can we go for a walk?”

After surviving a suicide attempt, you may feel lost and uncertain of your next steps. The journey forward may seem long and difficult. But recovery is possible! Take the time you need to heal, and make sure you have social and professional support as you work toward recovery. Remember, you are not alone. There is hope for the future.

References:

  1. After an attempt. (n.d.). American Foundation for Suicide Prevention. Retrieved from https://afsp.org/find-support/ive-made-attempt/after-an-attempt
  2. Bostwick, J. M., Pabbati, C., Geske, J. R., & McKean, A. J. (2016, August 13). Suicide attempt as a risk factor for completed suicide: Even more lethal than we knew. The American Journal of Psychiatry, 173(11), 1094-1100. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2016.15070854
  3. Carrigan, C. G., & Lynch, D. J. (2003). Managing suicide attempts: Guidelines for the primary care physician. The Primary Care Companion to the Journal of Clinical Psychiatry, 5(4) 169-174. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC419387
  4. Carroll, R., Metcalfe, C., & Gunnell, D. (2014, February 28). Hospital presenting self-harm and risk of fatal and non-fatal repetition: Systematic review and meta-analysis. PLoS ONE, 9(2). Retrieved from https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0089944
  5. Chi, M. T., Long, A., Jeang, S. R., Ku, Y. C., Lu, T., & Sun, F. K. (2014). Healing and recovering after a suicide attempt: A grounded theory study. Journal of Clinical Nursing, 23(11-12), 1751-1759. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24251862
  6. Recovering after a suicide attempt. (n.d.). SuicideLine Victoria. Retrieved from https://www.suicideline.org.au/resource/recovering-after-a-suicide-attempt
  7. Sellin, L., Asp, M., Kumlin, T., Wallsen, T., & Gustin, L. W. (2017, February 28). To be present, share and nurture: A lifeworld phenomenological study of relatives’ participation in the suicidal person’s recovery. International Journal of Qualitative Studies in Health and Well-being, 12(1). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5345596
  8. A journey toward health and hope [PDF]. (2015). Substance Abuse and Mental Health Services Administration. Retrieved from https://store.samhsa.gov/system/files/sma15-4419.pdf

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Which Should We Treat First: Mental Illness or Addiction?

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Substance use can alter behaviors, moods, and personalities so severely for people with addiction that without specialized knowledge and experience, it’s difficult to determine underlying causes such as mental illness or trauma.

I credit psychological intervention for pushing me into recovery from alcoholism.

Addiction is a mental illness, but is it one that needs to be treated before anything else? Or should we be stopping people from hitting their addiction bottom and helping them recover from their comorbid conditions concurrently?

What Is Addiction?

Before we can discuss treatment, we need to understand what addiction is and how it is defined. The two major guidelines for diagnosing mental health conditions around the world are the DSM and the ICD. The DSM (Diagnostic and Statistical Manual of Mental Disorders) is the standard diagnostic tool for mental health conditions in the United States and often used in North America. The ICD (International Classification of Diseases) is endorsed by the World Health Organization and often used in Europe.

In the DSM-5, substance abuse and substance dependence are combined under the same name of substance use disorder, which is diagnosed on a continuum. Each substance has its own sub-category, but behavioral addiction is also in the DSM-5, with gambling disorder listed as a diagnosable condition. Other similar entries, such as internet gaming disorder, are listed as needing further research before being formally added as a diagnosis. In the ICD-11 there is a subset of mood disorders called “substance-induced mood disorders,” which are conditions caused by substance use. To qualify for this category, one must not have experienced the mood disorder symptoms prior to substance use.

Hypothetically, a person who has alcohol-induced mood disorder might find health with abstinence alone, but substance use disorders do not occur in a vacuum and no one can go through the experience of addiction without it altering their mind and body, sometimes irreversibly. With enough time, substance-induced disorders change the function of the brain and alter emotion regulation. That doesn’t mean that addiction will cause another mental disorder; addiction is a mental disorder.

Not everyone with an addiction is concurrently experiencing another mental disorder. Substance use can alter behaviors, moods, and personalities so severely for people who are addicted that without specialized knowledge and experience, it’s difficult to determine what, if any, underlying cause is responsible for the changes. Drugs, even those that are prescribed and used as directed, can have side effects that seem to mimic the symptoms of other diagnosable conditions. These effects can also appear if a person is in withdrawal. Because of this inability to isolate co-occurring conditions, there was a time when it was popular for doctors and clinicians to first treat substance use disorders before exploring the possibility of other mental illnesses.

That is no longer considered the best approach to care…

So, what is considered the best approach then? Keep reading for more information about therapy to recognize addiction, integrated treatment, the consequences of discriminating against people with substance abuse disorder, and more over at the original article Addiction or Mental Illness: Which Should You Treat First? at The Fix.

Which Should We Treat First: Mental Illness or Addiction?

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With an abundant experience with a diverse client base, spanning age, gender, cultural, religious and lifestyle type and enjoy working with all.

Your First Session!

Your first session is a free two-way assessment, both you and your Counsellor therapist Gareth will establish if you are able to work together. Gareth will appreciate that you may have intense feelings about attending therapy and will work to help you feel at ease. Asking non intrusive questions but gaining an understanding of your issue and what you want to gain from attending Counselling. Gareth will discuss his therapeutic approach, session times, payment, confidentiality, and the cancellation policy with you so you have a clear understanding of the way it works.

Therapy Can Be Provided For Many Types

Counselling near Bolton
Counselling near Bolton Call Gareth Parry on: 07770 635 046

Gareth Parry


 


 

Councelling near Bolton

Counselling near Pontefract

Counselling near Pontefract

Looking for counselling near Pontefract for yourself or someone else? We can help!

Sometimes it is comforting to know that the therapy you receive has the anonymity you seek, where you feel safe and confident to open up to yourself knowing, when, at the end of your session, you aren’t walking out to a street where everybody knows your name.

Connect With A Qualified Counsellor Supporting Pontefract Area!

Counselling near Pontefract

If difficulties from the past, painful experiences in the present or worries about the future leave you feeling distressed or struggling to face day to day life then Counselling with Gareth Parry can provide an opportunity to share, evaluate and challenge your issues in a safe, confidential and non-judgmental space.

Counselling near Pontefract

With an abundant experience with a diverse client base, spanning age, gender, cultural, religious and lifestyle type and enjoy working with all.

Your First Session!

Your first session is a free two-way assessment, both you and your Counsellor therapist Gareth will establish if you are able to work together. Gareth will appreciate that you may have intense feelings about attending therapy and will work to help you feel at ease. Asking non intrusive questions but gaining an understanding of your issue and what you want to gain from attending Counselling. Gareth will discuss his therapeutic approach, session times, payment, confidentiality, and the cancellation policy with you so you have a clear understanding of the way it works.

Therapy Can Be Provided For Many Types

Counselling near Pontefract
Counselling near Pontefract Call Gareth Parry on: 07770 635 046

Gareth Parry


 


 

Councelling near Pontefract