As time goes by, anergia and anhedonia can also appear, as defensive avoidance continues to consume energy that would otherwise be available for relating and diverts it into denying and binding one’s natural /healthy inclinations. Anergia and anhedonia can also appear because second-line defenses develop, bolstering, fixing, and protecting the remoteness. These defenses include hypomanic denial, consisting of resolutely not caring about being loved; inertia in the form of a protective striving for familiarity and sameness; rationalization; identification with the aggressor; and acting out.
RATIONALIZATION
Avoidants who say they want to be alone are often really expressing a fear of connecting. Protesting too much about the splendid nature of isolation, they come to insist (not quite convincingly because of the modest gratification to be obtained from the advantages they list) that “I like being alone because at least my apartment stays straight, I can sleep through without a lover’s snoring, no one stains my upholstery and wall-to-wall rug, and for companionship I have all that anyone needs—my two delightful, loving cats.”
Other rationalizations include the following: 1
seekers, and easily tiring of what they already have, they pursue the unfamiliar, seeking variety as the only spice in their life.
The world is a terrible place, full of terrible people. Examples follow: “Out there I have nothing but bad luck,” “I never met anyone any good in my whole life,” or in extremely unfavorable cases, “There aren’t any people where I live worthy of me.” A sample uninsight-ful/cruel statement made by a woman in a singles bar as to why she would never try meeting people over the Internet follows: “The creeps in here are bad enough; imagine what I’d find if I actually entered the chat rooms.”
I can’t help myself; it’s not my fault. It is true that some avoidants are in fact so anxious and fearful that they cannot help but retreat when faced with the possibility of forming a relationship. But others, whose anxiety and fear are relative, not absolute, could, if they would, struggle against their anxiety, try to relate, and do so successfully. However, they choose not to use willpower to fight their anxiety. Then, out of shame or guilt about being derelict, they say, not “I choose not to,” but “I can’t.”
The grapes are sour. One patient, afraid of women, thought instead, “Who wants one?” and gave as his reason, “After all, insides beneath that lovely exterior make a woman nothing but a well-packaged bag of dirt,” then added, “and anyway, all wives cheat on their husbands.”
A Case Example
A patient had several ways to rationalize his unrelatedness. He announced, “Relationships are really not that important or essential.” He dwelled on what he believed to be the philosophical meaninglessness of everything interpersonal until, as he later suggested, he became so “preoccupied with the sound of one hand clapping that I can’t erupt into spontaneous applause.” He constantly told himself, “What’s the use of trying to meet someone, we are all going to die anyway?” and convinced himself that the world was a terrible place because of life’s little sardonic twists such as, “You can’t get a partner unless you have relationship experience, and you can’t get relationship experience unless you have a partner.”
Too often, other people buy into such rationalizations, thus perpetuating them. An avoidant friend of mine threw her husband, a PhD psychologist, out of the house after three months of marriage. I mentioned to the psychologist that though his ex-wife later said to me that she couldn’t meet anybody new because there were no eligible men where she lived, I thought that what was keeping her back was not her geographical location, but her personal problems (and he should know all about those!). Yet in spite of his recent firsthand negative experience with her, he shot back that her difficulties weren’t created by, but for, her, due to her being stuck living in the boonies—a place where all the men were already married so that the only men you could meet there were either cheating on their wives or complete losers who stay single not because they want to, but because they have no other choice.
A caveat is that it is necessary to distinguish rationalization from its opposite: guilt about being oneself. In rationalization, things that are feared are turned into matters of natural preference. In guilt about being oneself, matters of natural preference are turned into things that are feared. Thus one woman who wanted to remain single but was embarrassed to say so said, instead, “I am an avoidant, and as such too fearful to even try to connect.”
IDENTIFICATION WITH THE AGGRESSOR
In the realm of identification with the aggressor, relying on how the best defense is a good offense, avoidants reject others as a way to defend themselves against being rejected by them. The idea is to put others down before they can do the same thing to you. Theirs is, however, an unfortunate quest for immediate gratification, without concern for collateral damage and long-term consequences, for they overlook how, in the long run, putting others down changes the avoidant in others’ eyes: from a person to be pitied and succored into one to be feared and ignored.
Finally, avoidance can also worsen with the failure of helpful defenses already in place so that avoidants can no longer handle their anxiety adequately. Now we see panic, increased self-monitoring due to spreading fear, and breakthrough depression accompanied by behavioral regression, appearing because avoidants can no longer deny, and finally have to face, their sad predicament—which, for them, becomes one that they feel entirely helpless to change.
CHAPTER 6
Differential Diagnosis
In this chapter, I discuss differentiating avoidant personality disorder (AvPD) from panic disorder, specific phobia, and social phobia, all Axis I disorders, and from borderline personality disorder, an Axis II disorder.
DIFFERENTIATING AVPD FROM PANIC DISORDER/SPECIFIC PHOBIA/SOCIAL PHOBIA
According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), patients with panic disorder have discrete anxiety attacks in “places or situations from which escape might be difficult (or embarrassing).”1 According to Ballenger, these panic attacks commonly lead to avoidance of certain situations “because [the patient] fear[s] that if a panic attack occurred in these settings, it would be embarrassing, frightening, or both.”2
According to the DSM-IV, patients with specific phobia tend to experience “fear[s] that are excessive or unreasonable, cued by the presence or anticipation of a specific object or situation.”3
According to a vast body of literature devoted to “differentiating” AvPD from social phobia, there is no real difference between the two disorders, and AvPD should be subsumed diagnostically under the rubric of social phobia. Thus the Psychodynamic Diagnostic Manual (PDM) calls AvPD “phobic (avoidant) personality disorder”4; Anthony and Swinson state that “avoidant personality disorder is just a more intense form of Social Phobia”5; and Rettew, wondering if it is possible to diagnose one without the other, notes that APD may represent a more severe form of generalized social phobia with respect to levels of symptoms, fear of negative evaluation, anxiety, avoidance, and depression.6