What do you think would be some better internal indicators for AvPD?
i while ago, i posted my own rewritten criteria for avpd. the point of it was pretty much to create a set of criteria that focuses on the internal aspects of avpd, not just the outward presentation.
the first section of it is what i would consider the core internal features of avpd, the psychological patterns that make it what it is:
view of self as inadequate, socially inept, personally unappealing, incompetent, inferior to others, or otherwise "wrong" in some way.
prominent fear of negative evaluation (i.e. being criticized, embarrassed, disapproved of, rejected).
general life dissatisfaction associated with the perceived presence of negative evaluation.
hypervigilance to possible signs of negative evaluation. tendency to perceive neutral or even positive responses as negative. may have difficulty paying attention to the situation at hand due to a preoccupation with searching for and preventing such signs.
heightened emotional sensitivity to perceived negative evaluation. intense emotional distress/dysregulation upon experiencing perceived negative evaluation, characterized primarily by feelings of shame and potentially activating a fight/flight/freeze/fawn arousal response.
the third section also is completely made up of internal indicators, and many of the associated features are internal experiences as well, if you’d like a more extensive list. i hope that helps!
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this is 100% a thing, and my understanding is that it’s a feature of the DSM, not a bug. does that mean i agree with it? definitely not, it’s one of my big complaints about the DSM, but i do think it’s done purposefully.
because the thing is, the DSM is a diagnostic manual. the point of it isn’t really to describe the inner workings of a disorder, it’s to lay out a way for clinicians to identify that disorder in someone else from an outside point of view. of course, a clinician is never going to be able to read their patient’s mind to see exactly what’s going on in there, so the DSM offers behavioral indicators that (supposedly) correspond to what’s going on in the patient’s head. that’s why i get so annoyed by resources that explain a diagnosis by listing the diagnostic criteria; they don’t provide a full or accurate picture of how a given disorder actually works because how it works isn’t the focus of the DSM in the first place.
obviously, there are a few flaws in this strategy. first, it assumes that an internal experience will always present externally in a specific way, which obviously isn’t true. even most clinicians who use the DSM will acknowledge that that isn’t true, but they’re still using a resource that doesn’t have a good way to deal with the fact that the same internal experience can look wildly different on the outside depending on who’s experiencing it. it also runs on the assumption that a patient can’t tell you what they’re experiencing — that may be true of some patients who either don’t realize that their experience isn’t “normal” or who aren’t in a mental state where they can do that kind of self-reflecting, but it’s not true of all patients (or even most) and i don’t like that it encourages clinicians to not just talk to their patients instead of relying on outside indicators that may or may not mean what the DSM says they do. third, the way they pick which behaviors will be the markers for a given diagnosis is very clearly rooted in biases about those diagnoses, and i think approaching it from an inside-out perspective where the inner experiences of the patient are the foundation of it would allow for a lot more compassion. i doubt it would be set up the way it is if so many clinicians weren’t allergic to just…talking to their patients to better understand them. fourth, it assumes the clinician has a solid understanding of how each disorder functions and just needs help with how to consistently identify it in the real world, when in reality, most clinicians really only have a solid understanding of a handful of the most common ones. it’s supposed to be a diagnostic manual, but when a clinician really has no knowledge of the thing they’re dealing with outside of its DSM checklist, that diagnostic information is treated as the be all end all of the disorder when that’s not what it should be.
i’m reminded of a man i talked to at work who told me about how it says on his record that he has auditory hallucinations even though he doesn’t because the doctors saw him talking to himself and just assumed he was responding to voices when he wasn’t. i’m also reminded of my own experience with a psychiatrist who decided my biggest issue was anxiety based on the fact that she observed me bouncing my leg and playing with my hair throughout our appointments. while i do have anxiety, she completely missed that those particular behaviors weren’t anxiety-related at all — they were stims. in both cases, it’s pretty clear how clinicians will use their understanding of what certain behaviors mean to decide what a patient must be experiencing instead of asking the patient themselves, because that’s the kind of impersonal deduction that the DSM encourages with the way it describes diagnoses, and how that leads to them getting things wrong.
at the end of the day, the DSM doesn’t care about our internal experiences. it cares about making it as easy and seemingly scientific as possible to put labels on us based on what kind of weird we are on the outside. it’s a tool for categorizing us, not for truly understanding us.
I feel like a lot of the personality disorder criteria in the DSM-5 focuses on the outward appearance of the disorder rather than what the person with the disorder is actually feeling. Npd and aspd are what I’m thinking of as examples right now, so let’s go over those first. People with any sort of personality disorder, feel free to chime in and add any thoughts you may have on how the DSM-5 represents your disorder.
Npd’s symptoms in the DSM-5 are listed as:
A persistent pattern of grandiosity, need for admiration, and lack of empathy
An exaggerated, unfounded sense of their own importance and talents (grandiosity)
Preoccupation with fantasies of unlimited achievements, influence, power, intelligence, beauty, or perfect love
Belief that they are special and unique and should associate only with people of the highest caliber
A need to be unconditionally admired
A sense of entitlement
Exploitation of others to achieve their own goals
A lack of empathy
Envy of others and a belief that others envy them
Arrogance and haughtiness
The focus is on how other people might see someone with the disorder rather than what someone with the disorder might feel. As someone with npd, the main symptom of the disorder is lack of self-esteem. Someone with npd very well might experience or do these things BECAUSE of a lack of self-esteem, but I feel like the lack of self-esteem isn’t focused on enough for how much it impacts everything else. Honestly I’d go as far as to say it’s the very root of the disorder (y’know, besides trauma. But the low self-esteem is caused by trauma so, you get what I mean).
Now, I don’t personally have aspd myself, but from what I’ve heard from people with the disorder (people with aspd feel free to chime in), anhedonia is pretty much the biggest symptom? But if you look at the criteria it’s…
A persistent disregard for the rights of others
Disregarding the law, indicated by repeatedly committing acts that are grounds for arrest
Being deceitful, indicated by lying repeatedly, using aliases, or conning others for personal gain or pleasure
Acting impulsively or not planning ahead
Being easily provoked or aggressive, indicated by constantly getting into physical fights or assaulting others
Recklessly disregarding their safety or the safety of others
Consistently acting irresponsibly, indicated by quitting a job with no plans for another one or not paying bills
Not feeling remorse, indicated by indifference to or rationalization of hurting or mistreating others
And again, it’s not like people with aspd CAN’T experience or do these things BECAUSE of their anhedonia, but I really feel like that should be emphasized. Anhedonia isn’t even LISTED as a symptom. But when I listen to people with aspd talk about their experiences, the most commonly talked about symptom is generally feeling extreme boredom constantly, aka anhedonia. Again, people with aspd feel free to correct me and or add any thoughts you may have.
Looking at the criteria now, I see the same sort of issue with stpd (though I see this issue to an extent in the criteria for every personality disorder). I don’t have stpd myself so if you do, feel free to correct me or add anything, but I swear to god if I have to see the word “odd” or “eccentric” or “peculiar” one more fucking time. WHAT DOES THAT MEAN!!!!! The definition of those words is going to be different from person to person. It literally feels like they’re saying “I have diagnosed you with ABNORMAL disorder.” Like…please be more specific, I’m begging. What do you mean by ODD? What classifies “odd” behavior?
Anyways, that’s my little rant. I just wanted to see what other pd havers thought about it???
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Hi. After following a hyperfixation rabbit hole (thank you, ADHD and Autism) I have been wondering if I have AvPD. I've been obsessively researching it for a while now, and it would make a lot of sense for the struggles i've been facing that just aren't really explained by my other diagnoses but also aren't really *normal* per se, but I'm scared I'm wrong or just looking for something else to be "wrong" (i put wrong in quotes bc i dont think any disability/mental illness is actually something wrong, but that's how a lot of the people around me perceive it) with me so I feel like my suffering is more valid. My thoughts and hang ups are this:
I feel like my avoidance isn't severe enough to qualify (also me: hasn't made a follow-up appointment with either my neurologist or psychiatrist bc the idea of making the phone call "wrong" is crushing; changes the time I eat lunch so I don't have to either ask to sit with the people I know would let me sit with them bc they consider me or a friend or have them see me sitting alone even tho I literally like them and want them to be my friends; still haven't applied for my college housing accoms that I literally need bc I'm too scared i'll get turned down; feels crushing embarrassment even existing in the same space as my roommate; has a grand total of 1 friend)
It could just be my social anxiety/autism/agoraphobia. I feel like none of these really explain how deeply I feel rejection (my best friend was too busy to eat dinner with me like we usually do bc finals season and I nearly threw up bc of how much it hurt, and I ended up in tears for almost an hour) or just how crushingly embarrassing I find being perceived by others/existing to be (I literally can't make phone calls unless I'm locked in my dorm without my roommate there because I feel like people will judge me for doing a normal human activity like answering my mom's phone call; can't brush my teeth in the morning bc what if people see and only do it at night when most of the dorm hall is asleep), the constant reassurance I need from people (I'm constantly asking my best friend (only friend really) if I'm annoying them/too much work/going to get left by them/actually welcome to hang out with them).
I also wonder if my self-esteem is too high since I know low self-esteem is a key part of AvPD? I don't feel like I'm inferior academically/intelligence wise, hell I'm kind of arrogant in that respect, but also feel like I'm not good enough/interesting enough/pretty enough/funny enough for someone to want to be around me and have struggled with suicidal ideation because of it. I sometimes (by that I mean almost weekly) have meltdowns where I end up just wallowing in my own self-hatred for hours and ignoring people's texts/my homework bc I feel like i'm not good enough to have friends/long term partners.
I'm also not particularly quiet when I *am* in social situations. I tend to blurt out whatever's on my mind, even though I immediately regret it 99.9999% of the time, and my ADHD impulsivity results in me interrupting people a lot even tho it makes me feel like a horrible person. I always feel like I've overshared to everyone (tho my best friend, the only person I can be around all the time and not have a meltdown, says I actually under-share and should open up more to people).
I don't have any childhood trauma that could have caused it, at least I don't think? Like. My parents are amazing, they've always been there for me emotionally and physically. I was kind of bullied in pre-school through elementary school (people would take stuff from my bag and throw it and make me "fetch like a dog," I was really short so they'd hold stuff out of my reach) and never really had friends in middle school, just these three girls who let me hang out with them when I was around but would ignore my texts a lot, not invite me places they were going, etc, and after I moved away just before high school i didn't really bother to try making friends bc even tho i was lonely it just didn't seem like it was worth it bc they wouldn't like me anyway and I was just gonna go to college soon and they'd leave me then but none of that's really traumatizing?
I don't know. I feel like it really fits but also like if it were actually a big enough problem to qualify as a personality disorder my therapist would have caught it by now? And I'm scared to bring it up bc if she thinks i'm wrong i'll probably never want to talk to her again bc i'd be so embarrassed. Sorry, this was really long. If you actually read all of this, I guess I just want to ask if you think it's even possible I could have it.
i'll give you the short answer first: yes, it's absolutely possible that you could have it. i can't tell you if you do or not, but i can tell you that all of the doubts you mentioned are things i've personally struggled with while figuring my avpd out.
i'll put a much more in-depth answer addressing each of your concerns under the cut:
I'm scared I'm wrong
here's the thing: being wrong doesn't hurt anyone. people will act like researching your own potential diagnoses and coming to the wrong conclusion is the end of the world, but the reality is, there's very little actual harm that could come from a self-misdiagnosis.
with a clinical diagnosis, if the doctor is wrong, that could end with consequences like taking the wrong medication or doing therapies that do more harm than good to you. but just doing your own research and coming to your own conclusion? the worst that happens is you use the wrong word for a while and then eventually realize it doesn't fit as well as you thought it did, or you ask a doctor about it and they decide it's not a good fit and (if they're a good doctor) help guide you toward a more accurate explanation of what you're experiencing. either way, there's no harm done!
or just looking for something else to be "wrong" with me so I feel like my suffering is more valid
here's the thing: whether avpd is the answer or not, you're suffering. and if you're suffering and you want to better understand why that's happening, you're allowed to do that! your suffering is valid whether there's a name attached to it or not, but that doesn't mean it's wrong to want a name for it. it's only natural to want to understand why you feel the way you do and find people like you.
and if you're worried about a "psychology student syndrome" kind of thing – that you might just be projecting symptoms onto yourself that you don't really experience – the best thing you can do for that is to take some time to really look at yourself and your life and see if you see those things taking place. don't worry about if they're "as bad" as other people's; if you see examples of those things in your life and you're suffering because of them, that's all it takes to know you're genuinely experiencing it.
I feel like my avoidance isn't severe enough to qualify
it seems like you already know this on some level, but yeah, all of the things you listed after this sentence absolutely sound like some pretty significant avoidance to me. again, i can't tell you if it's avpd or not, but those do sound like the kinds of things i would count toward my own self-diagnosis if it were me.
there's no hard line of how severe your avoidance has to be, or any real way to objectively measure severity in the first place. if those things are getting in the way of you living your life and/or causing you to suffer emotionally, that means they're bad enough to be taken into consideration.
the secret is, almost no one feels like what they're experiencing is bad enough. i've had times in my life where my avoidance literally almost killed me, and i still wonder if it's "bad enough". don't let that imposter syndrome feeling stop you from better understanding your brain and getting the support you need.
It could just be my social anxiety/autism/agoraphobia. I feel like none of these really explain how deeply I feel rejection or just how crushingly embarrassing I find being perceived by others/existing to be, the constant reassurance I need from people.
this feeling was actually exactly what started me on the path that led to me realizing i had avpd. i knew that i was autistic and socially anxious, and i thought for a long time that those explained what i was experiencing, but the more i interacted with people around me who were also socially anxious autistics, the more i realized i was dealing with something none of them seemed to understand.
and all of the things you described – intense emotional dysregulation caused by rejection and embarrassment and needing constant reassurance to function in social situations – are classic avpd things. so i would say, if your gut tells you those things aren't being explained well enough by the words you already have to describe yourself, avpd is definitely worth considering.
I don't feel like I'm inferior academically/intelligence wise, hell I'm kind of arrogant in that respect, but also feel like I'm not good enough/interesting enough/pretty enough/funny enough for someone to want to be around me and have struggled with suicidal ideation because of it. I sometimes (by that I mean almost weekly) have meltdowns where I end up just wallowing in my own self-hatred for hours and ignoring people's texts/my homework bc I feel like i'm not good enough to have friends/long term partners.
hey, you're talking to the guy who's not just avoidant but also a narcissist. avpd can absolutely coexist with being highly confident (or even overconfident) in certain parts of yourself.
it also sounds like that confidence is an exception to the rule. feeling like you're "not X enough" for other people to the point of having self-isolation spirals or suicidal ideation because of it are really common forms of low self-esteem in avpd. if you ever here an avoidant refer to having an "avpd spiral" or "shame spiral", the experience they're talking about is a lot like what you described.
I'm also not particularly quiet when I *am* in social situations. I tend to blurt out whatever's on my mind, even though I immediately regret it 99.9999% of the time, and my ADHD impulsivity results in me interrupting people a lot even tho it makes me feel like a horrible person. I always feel like I've overshared to everyone
the stereotype of avpd is a super shy and quiet person, and some of us definitely are like that (myself included), but not all avoidants are. there are some who mask their avoidance by coming off as incredibly social and talking to people a lot, and others who (like you described) talk a lot even if they don't want to because of other aspects of their neurotype.
i think those feelings of regret and shame that you feel in response to what you're saying are really the important thing here. those internal experiences are much more fundamental to what avpd is than how they present externally, so the fact that you're experiencing them means i definitely wouldn't count avpd out just because you're not as quiet as some of us are.
I don't have any childhood trauma that could have caused it, at least I don't think? Like. My parents are amazing, they've always been there for me emotionally and physically. I was kind of bullied in pre-school through elementary school and never really had friends in middle school, just these three girls who let me hang out with them when I was around but would ignore my texts a lot, not invite me places they were going, etc
first of all, a history of trauma isn't actually required to have avpd. it's often assumed that personality disorders are also trauma disorders because they are often associated with trauma, but there's nothing suggesting that's always the case.
there's also research that has shown some people are born predisposed to avpd. it tends to cluster in families along with social anxiety, suggesting there's some sort of heritable aspect, and some research suggests avpd might start in childhood with a person having a nervous system that's naturally hypersensitive to certain triggers.
it's also important to remember that the kinds of trauma that can lead to something like avpd aren't always things we would look at as obvious trauma. for example, one paper i found said that a possible form of trauma that could lead to avpd is having an overprotective parent – the parent projects their fears onto the child and, despite just trying to keep them safe out of genuine love and care, ends up teaching their child that the world is dangerous. we might not look at that kind of parenting and automatically see it as traumatizing, and it's hard to fault that parent for trying to keep their child safe, bu the result for the child is the same. especially if we are born with more sensitive nervous systems than the average person, things that seem totally mundane could have a significant impact on how our brains develop.
all of that to say, it is possible that the experiences you described –being bullied in school and excluded by your friends – had enough of an impact to cause the struggles you're experiencing now, even if they don't feel like trauma. it's also possible that they're unrelated, because avpd (if that is what you're experiencing) can develop even in the absence of trauma.
I feel like it really fits but also like if it were actually a big enough problem to qualify as a personality disorder my therapist would have caught it by now?
you'd be surprised what therapists don't catch, especially if there's a much more common and less "scary" label (like social anxiety) that can, on the surface, explain away what you're experiencing. i've been seeing my therapist for 8 or 9 years now and she's very aware of my avoidant tendencies, including how much they get in the way of my life, but she still never brought up avpd with me. whether it’s because they just don’t hear about avpd enough to think of it, because they avoid diagnosing personality in general, because they don’t know “do with” avpd and would rather assume it’s something they do know how to handle, or because they think avpd is just another word for severe social anxiety, a lot of therapists will see all the signs of avpd in a patient but never actually bring up avpd as a possibility.
at the end of the day, you know better than anyone how much of a problem these struggles are for you. if you think this really could be the explanation, don't worry about what she did or didn't catch. therapists aren't infallible; they're human, and they can miss things.
I'm scared to bring it up bc if she thinks i'm wrong i'll probably never want to talk to her again bc i'd be so embarrassed
i 100% get that fear. i actually had that happen to me with my therapist – i brought up a few theories of mine to her, she shot them all down, and i ended up stopping our sessions and eventually going to a different therapist for a while because i felt like i couldn't trust her anymore. ultimately, i went back to her (mostly because the second therapist was an incredibly condescending asshole and my parents didn’t know of any other options), but i honestly still haven't brought avpd up to her to this day because of that.
so i can't blame you at all, and it's okay if you feel like you need to work up to bringing this up with her. try doing some more research and getting more confident in your theory so you feel like you can explain it well to her, and maybe even put together a collection of the evidence you have for it – examples of how you feel like you exhibit the symptoms, things like that – so you have something to hand to her instead of having to explain it on the spot. once you've looked into it more on your own, you can reevaluate how confident you feel in the theory and decide if it's time to talk to her.
in the meantime, you could try testing the waters to see how she might respond to you bringing up a theory. there are some therapists who are super against patients doing their own research and having their own ideas about what's going on, so it’s good to know if your therapist is one of those people ahead of time instead of finding out the hard way.
i would also recommend telling her that exact fear if/when you do bring this up to her. that sentiment of "one somewhat negative interaction is all it takes for my embarrassment to be so bad that i can never talk to you again" is a really common thing with avpd, and is one of the reasons a lot of avoidants struggle with therapy. so being honest about that fear can both help her understand that she needs to be cautious in her approach if she does disagree with you and could actually make her more likely to agree.
I guess I just want to ask if you think it's even possible I could have it.
so yeah, like i said at the beginning of this, i think it's very possible that you could have avpd. i can't tell you for sure, but pretty much everything you've described here sounds very familiar to me as an avoidant person, so at the very least i think it's definitely worth looking into further and seeing if it continues to feel accurate as you learn more.
i hope this helps! and whether you end up concluding that you're avoidant or that there's something else going on, i hope you're able to find the understanding and support that you need.
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