Academic journal article International Journal of Psychology and Psychological Therapy

Links between Childhood Experiences and Avoidant Personality Disorder Symptomatology

Academic journal article International Journal of Psychology and Psychological Therapy

Links between Childhood Experiences and Avoidant Personality Disorder Symptomatology

Article excerpt

Avoidant personality disorder (AVPD) is a relatively common personality disorder (PD) with a prevalence of 1.4 to 6.6% in the general population (Ekselius, Tillfors, Furmark, & Fredrikson, 2001; Jackson & Burgess, 2000). AVPD is marked by long-term patterns of behaviour intended to avoid personal attachments (both intimate and superficial), together with the desire for loving relationships (Stravynski, Elie, & Franche, 1989). Individuals with AVPD experience significant distress and social impairment (Robin, Cohan, Hambrick, & Albano, 2007), tend to devalue themselves, and suffer apprehension about possible ridicule and rejection from others (Stravynski et al., 1989). Avoidant personality disorder is associated with low global functioning, high interpersonal problems, and reduced quality of life (Wilberg, Karterud, Pedersen, & Urnes, 2009). In addition, comorbidity with other DSM-IV-TR Axis I or II disorders is high (Feske, Perry, Chambless, Renneberg, & Goldstein, 1996; Herbert, Hope, & Bellack, 1992). The debilitating behaviours expressed in individuals with AVPD, coupled with high rates of comorbidity, underscore the need for a better understanding of the developmental pathology. Despite suggestions that childhood experiences are pertinent to the development of AVPD (Benjamin, 1993; Millon, 1981), the role of these factors remains relatively unexplored. Accordingly, the current study examined associations between reported childhood maltreatment, teasing, and parental bonding with adult AVPD symptomatology, whilst controlling for the potential influence of depressive and anxiety symptomatology.

Individuals suffering with AVPD are frequently diagnosed with comorbid depression and/or anxiety. Skodal et al. (1999) found that as many as 35.2% of individuals with AVPD were also diagnosed with major depressive disorder. With respect to anxiety disorders, in particular, generalised social phobia (GSP), reported comorbidity ranges widely between 25% to nearly 100% (Rettew, 2000). Indeed, some evidence suggests that AVPD may represent a more severe form of GSP with regards to social phobia symptoms and types of impairment (Holt, Heimberg, & Hope, 1992). Further evidence suggests current anxiety and/or depression may influence recall of childhood experiences (Lewinsohn & Rosenbaum, 1987). Together, these findings suggest substantial overlap between features of depression and anxiety with AVPD. In addition to the literature demonstrating substantial symptomatic overlap and comorbidity of AVPD with other disorders, some research has also investigated the relevance of adverse childhood experiences for development of AVPD.

The relevance of childhood maltreatment to the development of AVPD symptoms has been acknowledged by numerous studies (i.e., Battle et al., 2004; Carr & Francis, 2009b), demonstrating some support particularly for the role of childhood emotional abuse, emotional neglect, and sexual abuse in the development of adult AVPD symptoms. For example, Battle et al. (2004) found that individuals with a PD reported more exposure to childhood abuse or neglect than individuals with major depressive disorder. Carr and Francis (2009b) examined whether early maladaptive schemas mediated the relationship between childhood experiences and AVPD symptoms in 178 non-clinical participants. They found AVPD symptomatology was significantly related to childhood emotional abuse, emotional neglect, sexual abuse, and physical neglect. These results are consistent with those of Gibb, Wheeler, Alloy, and Abramson (2001) who found emotional maltreatment (a combination of emotional abuse and neglect) was directly related to elevated AVPD symptoms. Sullivan, Bulik, Carter, and Joyce (1995) also found sexual abuse to be significantly associated with AVPD. Another clinical study found individuals with AVPD reported higher levels of childhood trauma (in particular, physical and emotional abuse) compared to depressed individuals (Rettew et al. …

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