How do people develop preventable personality disorders


Personality traits as a disruptive burden (page 12/16)

Anxious avoidant personality disorder, socially inhibited, felt inadequate

With a self-insecure (also: fearful or fearful-avoiding) personality disorder, those affected feel constantly insecure, inferior, tense and worried. At the same time, they constantly long for affection and to be accepted by others. They suffer from constant self-doubt and are overly sensitive to criticism and rejection. Therefore, they often avoid certain situations and activities. They only enter into close relationships with other people if they are sure that they will accept them. In contrast to most other personality disorders, those affected suffer from their behavior and often perceive it as a problem themselves.

Jochen is 33 years old and has been working as an accountant for eight years. He got this job straight after graduating from university. He reports that even in his childhood he was a quiet, shy and fearful boy. Little has changed since then. In his job, he usually works by himself, goes out to eat alone during lunch breaks and does not participate when others are talking during the breaks or making jokes in the office. His supervisor describes that Jochen does his job efficiently, but is a bit strange and a quiet loner.

Jochen has hardly any social contacts in his private life either. He hasn't gone to parties, festivities, or dates in five years. He only has contact with his parents and two friends whom he meets occasionally. He spends most of his free time alone - reading, watching TV and daydreaming. Basically, he longs for more contacts and a girlfriend, but is very afraid that new people might reject him.

It always becomes difficult for Jochen when new employees come into the department, which is the case a few times every year. For some time now, a clique has formed in the office that Jochen would like to be a part of. But he is also afraid of it because he is afraid that they might find him boring and that he “has nothing to offer” them. After a while, he himself becomes the target of ridicule: for several weeks he is constantly being poked at by the clique. Eventually, he begins to be absent from work, cannot finish his reports on time, and makes a lot of mistakes at work. He also often suffers from headaches and stomach upsets. Afraid of losing his job, he eventually turns to a therapist.

Transitions to normality - self-insecure personality style (according to Kuhl & Kazén)

People with a self-insecure personality style - which is similar to, but less pronounced, a self-insecure personality disorder - are self-critical and more cautious and reserved. They are sensitive to criticism and rejection and tend to change their own expectations and ideas when other people have different attitudes. Because those affected do not push themselves to the fore, are reliable and try to find a balance in conflicts, they are often recognized by other people.

What are the typical symptoms of a self-insecure personality disorder?

According to the DSM, those affected have a profound pattern of social inhibition and a constant feeling of inadequacy and are overly sensitive to negative assessments. At least four of the following criteria must be met:

  1. Fear of criticism, disapproval or rejection, those affected avoid professional activities that involve closer interpersonal contacts.
  2. They are reluctant to get involved with people if they are not sure that they will be liked.
  3. They behave cautiously, even in intimate relationships, for fear of being embarrassed or ridiculed.
  4. You are very afraid of being criticized or rejected in social situations.
  5. Because of feelings of inadequacy, they are inhibited in new interpersonal situations.
  6. They consider themselves to be socially awkward, personally unattractive and inferior to other people.
  7. You avoid personal risks and new ventures because they could prove shameful.

In the ICD-10, the disorder is described in a very similar way to that in the DSM.

Differentiation from social phobia

A self-insecure personality disorder is similar in many ways to a social phobia. The main difference, however, is that the symptoms here are more profound, persist longer and are more likely to be experienced by those affected as part of their personality. The fears relate to a wide variety of social situations, and self-esteem is very low.

In the case of a social phobia, on the other hand, there are fears in certain specific situations (for example fear of public speaking, insecurity towards strangers). In addition, a social phobia can only arise later in life, is less experienced as part of one's own personality and is often completely regressed through therapy.

How common is a self-insecure personality disorder?

The frequency of self-insecure personality disorder is around one to two percent of the population. Men and women are probably equally affected.

Depression or anxiety disorders often occur at the same time as the disorder. It is also often associated with a dependent or borderline personality disorder.

What are possible causes of insecure personality disorder?

As with the other personality disorders, an interplay of biological, psychological and environmental factors is assumed. Studies suggest that genetically, those affected tend to feel restless, tense, nervous, and easily vulnerable on the inside. If there are also negative psychological or social influences, this can favor the development of the disorder.

Psychoanalysis and behavior therapy see causes in childhood

From the perspective of psychoanalysis, a pejorative and unemotional behavior on the part of the parents or a tendency to ridicule their children contribute to the development of the disorder. This behavior leads to the fact that those affected devalue themselves, develop no self-esteem and tend to negative and self-critical thoughts.

Cognitive behavioral therapy also sees a cause of the problem in the fact that those affected repeatedly experienced rejection and criticism in their childhood. As a result, they have developed a negative self-image and negative thought patterns about themselves. For fear of devaluation, from now on they avoid friendships and all kinds of social contacts. As a result, they develop poor social skills, feel inadequate in many situations, and become more and more withdrawn over time.

Treatment of insecure personality disorders

Psychotherapeutic approaches

Self-insecure personality disorder is primarily treated with psychotherapy, and this can often be of great help to those affected. Because many suffer from their behavior, they are often willing to start therapy on their own and work particularly well there. Methods similar to those used in the treatment of social phobia and other anxiety disorders are used in therapy.

With a self-insecure personality disorder, however, long-term psychotherapy is often necessary in order to achieve sufficient changes.

Possible problems in psychotherapy and possible solutions

A problem in therapy can be that patients fear that they are not really liked and accepted or that the therapist will reject them. As a result, they often begin to avoid therapy sessions or stop therapy altogether. It is therefore important to build a good therapeutic relationship in which the therapist is appreciative, empathetic, and supportive.

It is often more difficult for those affected than for patients with a social phobia to get involved in therapy measures or to initiate changes. They often have pronounced fears and self-doubts and do not dare to engage in certain therapy methods. Therapy should therefore be proceeded in small steps and patients should be given enough time to decide on a therapeutic measure for themselves.

Psychoanalytic and deep psychology-based therapy

In the case of a self-insecure personality disorder, both long-term psychoanalytic therapy and short-term depth psychological therapy can be used. It is seen as helpful if the "transference" between therapist and patient is made an issue in therapy - that is, the relationship between therapist and patient is used to uncover and change typical problems and insecurities in relationships. In addition, the biographical developmental conditions of the disorder can also be processed during the course of therapy.

Cognitive behavioral therapy

Cognitive behavioral therapy is considered to be the most effective therapeutic approach in treating the disorder. At the beginning of the therapy, the patients are first informed about the causes, typical symptoms and consequences of social fears and self-insecurity, which is also known as psychoeducation.

An important part of the therapy is the training of social skills. It can boost patients' self-esteem and teach them skills that will help them cope better with various social situations. For this purpose, specific instructions, behavioral exercises and role plays with video feedback are often used.

Working on unfavorable thought patterns can help to change negative perceptions of those affected about themselves and their environment. In doing so, they learn to question general negative points of view (for example, “I am incapable” or “I am unattractive”) and to replace them with more positive and differentiated points of view. Furthermore, the therapy works on changing typical everyday problems of the patient.

Patients can also learn to change physical symptoms of their anxiety and insecurity, such as sweating or flushing. In the paradoxical intervention, they are supposed to observe these symptoms closely and deliberately induce or exacerbate them. In most cases, this leads to habituation and a decrease in anxiety. Confrontation with various anxiety situations can also help to reduce anxiety.

If those affected already feel significantly more self-confident and have acquired new social skills, later in therapy they can be encouraged to think about longer-term goals in their life and ways to achieve them.

Group therapy

In group therapy, patients can practice dealing with social situations together with like-minded people. So social skills training can be carried out well in a group. The behavior of the other group participants can serve as a model on which the patients can learn new behaviors (e.g. more self-confident demeanor). In the group they can exchange their experiences, give each other support and learn to deal with feedback from other people and to give feedback themselves (e.g. praise or constructive criticism).

Therapy with psychotropic drugs

In some cases, antidepressants are used to accompany psychotherapy. They can help reduce patient anxiety and discomfort. In most cases, however, no long-term improvements can be achieved with drugs alone.