Selective Mutism Articles

I believe I have interacted with more individuals with avoidant personalities than anyone in the world! I’m neither bragging nor complaining. It’s just a fact: It’s my job. As a psychotherapist with more than 35 years’ experience specializing in social anxiety—which is commonly comorbid with avoidant personality disorder—I have treated thousands of people with this issue. The overlap between social anxiety and avoidant personality disorder is clear, with avoidant personality disorder involving “more severe and broader areas of personality dysfunction than social [anxiety].” Indeed, the Diagnostic and Statistical Manual of Mental Disorders-5’s identifies social anxiety as a distinguishing characteristic of Avoidant Personality Disorder: “Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to social situations; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of embarrassment.”² Avoidance results when these feelings become so intolerable that the person goes to often extreme measures to avoid the situations in which they may occur. As the fear of embarrassment, humiliation and shame increases, the person enters into an avoidance vortex from which they feel like they cannot escape. Narcissistic behavior results, dominating their decision making and behavior. I have often referred to avoidant personality as a compulsion because the behavior is so ingrained.

Avoidant personality disorder occurs in an estimated 5.2 percent of the U.S. population annually.³ Social anxiety disorder occurs in 6.8 percent, and within that 6.8 percent, almost 30 percent of cases are considered severe.⁴ Much academic research exists on the comorbidity of social anxiety and avoidant personality disorder; but very little is available to explore the compulsive nature of avoidance. Therefore, I would like to shed some light on the avoidant personality for the benefit of both clinicians and those who are themselves afflicted with this frustrating and debilitating disorder. After all, individuals with avoidant personality are quite skilled at avoiding, which means that (1) the mental health profession as a whole may have limited access to this group and (2) avoidant people themselves may have found few resources out there to help them recognize their own tendencies and relate to others who share them.⁵

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