Anxiety Personality Disorder

Anxiety personality disorder is characterized by avoidance of social situations and interactions in which there may be a risk of rejection criticism or humiliation. The diagnosis is made based on clinical criteria. Treatment consists of psychotherapy and the appointment of anxiolytics and antidepressants.

People with anxiety disorder develop an intense sense of inadequacy and cope with the inadequacy by avoiding any situations in which they might be negatively judged.

The reported prevalence of anxiety disorder in the United States varies but the estimated prevalence is about 2.4%. Anxiety disorder is equally common among women and men.

Often accompanied by concomitant diseases . Patients often also found major depressive disorder resistant depressive disorder obsessive-compulsive disorder or anxiety disorder (eg panic disorder  in particular social phobia or social anxiety disorder. They may also have another personality disorder (eg addictive borderline ). Patients with social phobia and anxiety disorder have more severe symptoms and disorders than those with either of these disorders.

Etiology

Research suggests that childhood experiences of rejection and social isolation and the presence of innate traits of social anxiety and avoidance can contribute to the development of anxiety disorder. Avoidance of situations of social interaction was discovered already at the age of about 2 years.

Clinical manifestations

Patients with anxiety disorder avoid social interaction including in work situations for fear of criticism or rejection and in the following situations:

They may refuse to advance in their careers for fear of criticism from colleagues.

They may avoid meeting

They don't make new acquaintances until they are convinced that they like them.

These patients assume that others will be critical and disapproving until rigorous testing proves otherwise. Thus reassurances of support and acceptance are essential for patients with this disorder before entering the group and forming close relationships.

Patients with anxiety disorder shy away from long-term social interactions fearing losing their well-being when interacting with others. Most often these patients live relatively isolated limit their social circle do not have a social environment that can come to the rescue if necessary.

These patients are very sensitive to any minor critical disapproval or ridicule as they constantly think of criticism or rejection. They are alert to any sign of negative reaction in their direction. Their tense anxious appearance can elicit ridicule or banter thereby confirming their lack of self-confidence.

Low self-esteem and feelings of inferiority increase symptoms especially in new social situations. Patients avoid interacting with new people as they feel socially unadapted unattractive and worse than others. As a rule they behave quietly timidly trying to be invisible as they tend to think that everything they say will be refuted by others. They are afraid to talk about themselves so as not to become the object of ridicule and humiliation. They worry that they will be embarrassed or cry in response to criticism.

Patients with anxiety disorder are very reluctant to take personal risks and for the same reasons do not engage in new activities. In such situations they tend to exaggerate the dangers use minimal symptoms or problems to explain their avoidance. Due to their needs for security and stability they prefer a limited lifestyle.

Diagnostics

Clinical criteria Diagnostic and Statistical Manual of Mental Disorders

·        To make a diagnosis of anxiety disorder patients must have

·        A persistent tendency to avoid social contact feel inadequate and be hypersensitive to criticism and rejection

·        This pattern is apparent in the presence of ≥ 4 of the following:

·        Shy away from work assignments that involve interpersonal contact because they fear being criticized or rejected

·        Do not want to mess with people until they are convinced that they are really accepted

·        Are in a close relationship for fear of ridicule or humiliation

·        Overly concerned about the likelihood of criticism or rejection in social situations

·        Symptoms worsen in a new social setting due to feelings of inadequacy

·        Consider themselves socially incompetent unattractive "below" others

·        Are reluctant to take personal risks or take part in new activities due to the likelihood of being embarrassed

In addition it is imperative that symptoms begin to manifest in early adulthood.

Differential diagnosis

Anxiety personality disorder should be differentiated from the following 2 disorders:

Sociophobia : The differences between social anxiety disorder and anxiety disorder are subtle. Anxiety disorder and avoidance are more prevalent in anxiety and avoidance than in social anxiety disorder which is often characteristic of situations in which there is a risk of public humiliation (for example speaking in public performing on stage). However social phobia can include a broader model of avoidance and thus can be difficult to discern. These 2 types of disorder often occur together.

Schizoid Personality Disorder : Both disorders are characterized by social isolation. However patients with schizoid personality disorder are withdrawn because they have no interest in others while patients with anxiety disorder are isolated because of hypersensitivity to possible rejection or criticism.

Other personality disorders may be somewhat similar to anxiety but may differ in intrinsic characteristics (for example the need for caring in addictive personality disorder versus avoidance of rejection and criticism in anxiety disorder).

Treatment

Cognitive behavioral therapy focuses on social skills

·        Supportive psychotherapy

·        Psychodynamic psychotherapy

·        Tranquilizers and antidepressants

·        General treatment for anxiety disorder is similar to treatment for all other personality disorders.

·        Patients with avoidant personality disorder often avoid treatment.

·        Effective therapy for patients with social anxiety disorder and personality disorder includes:

·        Cognitive-behavioral therapy focused on mastering social skills which is carried out in groups

·        Other group therapy if the group consists of patients with similar problems

·        Patients with anxiety personality disorder

·        Individual therapy that supports and helps hypersensitive patients

·        Psychodynamic therapy that focuses on underlying conflicts can be helpful

Effective drug therapy includes selective serotonin reuptake inhibitors (SSRIs) tranquilizers that help reduce anxiety enough to enable patients to engage in new social situations