COMPARISON: Avoidant Personality Disorder vs BPD

[BPDFamily.com]

Can anyone share some information on Avoidant personality disorder, and its comorbid relationship with BPD? I have read it co occurs in between 14% & 43% [depending on who's study]. What are the effects, and behaviors that come with this combination? Does this explain any of the silent treatment?

[Marvin Martian]

Can anyone share some information on Avoidant personality disorder, and its comorbid relationship with BPD? I have read it co occurs in between 14% & 43% [depending on who's study]. What are the effects, and behaviors that come with this combination? Does this explain any of the silent treatment?

[beyondbelief]

While they may be comorbid, I don't think it is the main cause of silent treatment.  My X was probably near the middle of the extravert introvert spectrum and she would go silent for weeks on end but ONLY TOWARDS ME.  An avoidant PD tends to not to want to be around almost everyone due to lack of social skills.  Beyond my personal experience it seems the vast majority of people here seem to report getting the silent treatment from their pwBPD.

I think APD would tend to occur more often in the low functioning pwBPD.

[Skip]

When asking differential questions about multiple personality disorders, it is important to understand why you are asking the question and how you intend to use the information. Without this perspective and focus, the data may be overwhelming, confusing and misleading.  For example... .

~ if your child is not responding to therapy, it makes sense to look more carefully into the possibility that the wrong personality disorder was diagnosed or whether there are comorbid (multiple) personality disorders at play.

~ If you are trying to get along better with your wife, it's not as important to pinpoint the specific disorder or analyze the comorbidity as it is to recognize and fully understand the problem behaviors and how to constructively deal with them.  

~ If you are recovering from a failed relationship, the important thing is often to understand which behaviors were pathologic (mental illness) and which were just the normal run of the mill problems common to failing/failed relationships - there is often a bias to assign too much to the "pathology" and not enough to common relationship problems, or the issues we created by our own behaviors.

It's important to know that the distinctions are not all that neat and tidy. In a 2008 study, comorbidity with another personality disorder was very high at 74% (77% for men, 72% for women).  This is one reason why there is controversy around the DSM classifications of Personality Disorders - there is so much overlap it is confusing even to professionals - personality disorders are real, but they are not easily or neatly defined.

Comorbid w/BPD-------------- Paranoid Schizoid Schizotypal Antisocial Histrionic Narcissistic Avoidant Dependent OCD More info

Men----------- 17% 11% 39% 19% 10% 47% 11% 2% 22%

Women------- 25% 14% 35% 9% 10% 32% 16% 4% 24%

Some helpful hints for sorting through this.

• General and Specific There are definitions for "personality disorder" as a category and then there are definitions for the subcategories (i.e., borderline, narcissistic, antisocial, etc.).  Start with the broader definition first.  Keep in mind that to be a personality disorder, symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder - - the history of symptoms can be traced back to adolescence or at least early adulthood - - the symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life. Symptoms are seen in at least two of the following areas: thoughts (ways of looking at the world, thinking about self or others, and interacting), emotions (appropriateness, intensity, and range of emotional functioning), interpersonal functioning (relationships and interpersonal skills), or impulse control

• Spectrum Disorders  An extremely important aspect of understanding mental disorders is understanding that there is a spectrum of severity. A spectrum is comprised of relatively "severe" mental disorders as well as relatively "mild and nonclinical deficits".  Some people with BPD traits cannot work, are hospitalized or incarcerated, and even kill themselves.  On the other hand, some fall below the threshold for clinical diagnosis and are simply very immature and self centered and difficult in intimate relationships.

• Comorbidity Borderline patients often present for evaluation or treatment with one or more comorbid axis I disorders (e.g.,depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa). It is not unusual for symptoms of these other disorders to mask the underlying borderline psychopathology, impeding accurate diagnosis and making treatment planning difficult. In some cases, it isn’t until treatment for other disorders fails that BPD is diagnosed.  Complicating this, additional axis I disorders may also develop over time.  Because of the frequency with which these clinically difficult situations occur, a substantial amount of research concerning the axis I comorbidity of borderline personality disorder has been conducted. A lot is based on small sample sizes so the numbers vary.  Be careful to look at the sample in any study -- comorbidity rates can differ significantly depending on whether the study population is treatment seeking individuals or random individuals in the community.  Also be aware that comorbidity rates  are generally lower in less severe cases of borderline personality disorder.

• Multi-axial Diagnosis  In the DSM-IV-TR system, technically, an individual should be diagnosed on all five different domains, or "axes." The clinician looks across a large number of afflictions and tries to find the best fit.  Using a single axis approach, which we often do as laymen, can be misleading -- looking at 1 or 2 metal illness and saying "that's it" -- if you look at 20 of these things, you may find yourself saying "thats it" a lot.     A note in the DSM-IV-TR states that appropriate use of the diagnostic criteria is said to require extensive clinical training, and its contents “cannot simply be applied in a cookbook fashion”.

• Don't become an Amateur Psychologist or Neurosurgeon  While awareness is a very good thing, if one suspects a mental disorder in the family it is best to see a mental health professional for an informed opinion and for some direction - even more so if you are emotionally distressed yourself and not at the top of your game. 

I hope this helps keep it in perspective.  

Skippy



DIFFERENCES|COMORBIDITY: Overview of Comorbidity

Additional discussions... .

Personality Disorders

Borderline and Paranoid Personality Disorder

Borderline and Schzoid/Schizotypal Personality Disorder

Borderline and Antisocial Personality Disorder

Borderline and Histrionic Personality Disorder

Borderline and Narcissistic Personality Disorder

Borderline and Avoidant Personality Disorder

Borderline and Dependent Personality Disorder

Borderline and Obsessive Compulsive Personality Disorder

Borderline and Depressive Personality Disorder

Borderline and Passive Aggressive Personality Disorder

Borderline and Sadistic Personality Disorder

Borderline and Self Defeating Personality Disorder

Other

Borderline PD and Alcohol Dependence

Borderline PD and Aspergers

Borderline PD and Attention Deficit Hyperactivity Disorder

Borderline PD and BiPolar Disorder

Borderline PD and Dissociative Identity Disorder

Borderline PD and P.T.S.D.

Borderline PD and Reactive Attachment Disorder (RAD)

[K. Salters-Pedneault, Ph.D.]

You are right that the comorbidity rates between avoidant PD and BPD range wildly depending on the study population (that 43% figure is from treatment seeking samples, whereas its about 14% in community samples).

Although I haven't seen data on this, the clinical lore is that people with BPD tend to become more avoidant as they get older because they start to lose hope that they can have healthy relationships. No research that I know of on this though.

I wrote a brief article on this: www.BPD.about.com/od/relatedconditions/a/Borderline-And-Avoidant-Personality-Disorder.htm.

Hope this helps,

Dr. S-P

K. Salters-Pedneault, Ph.D.

Clinical Psychologist

www.nathancenter.org

The DSM-IV defines avoidant personality disorder as "a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation... ." In addition, an individual must have four or more additional signs or symptoms, including avoidance of social interactions due to fears of criticism, preoccupation with rejection, inhibition in unfamiliar social situations, and low self-worth.

People with APD might be described as being extremely shy, socially anxious, self-conscious, and self-critical. This pattern of behavior rises to the level of a clinical disorder when it significantly interferes with relationships, occupation, or other important domains in life.

How Often do Borderline and Avoidant Personality Co-Occur?

The research findings about the co-occurrence of borderline and avoidant personality vary depending on the characteristics of the study sample. In a treatment sample (i.e., a sample of individuals with BPD who were in treatment, 43 percent of patients with BPD also met the diagnostic criteria for APD. In another study that used a community sample, about 14 percent of people who met BPD criteria in their lifetime also met criteria for APD in their lifetime (see Skip's post).

Why do APD and BPD Occur Together So Frequently?

We don't know why so many people with BPD also meet criteria for APD, but experts have speculated about two main causes for this comorbidity. First, BPD and APD share a key symptom: both are associated with intense fear of criticism and rejection. It may be that having this trait increases an individual's chances of meeting criteria for both disorders.

In addition, it may be that people with BPD have such intense emotional pain in their relationships that a subset may withdraw from relationships altogether in order to reduce this pain.

[mitti]

While they may be comorbid, I don't think it is the main cause of silent treatment.

I agree. I think silent treatment is mostly about punishing you, hence passive aggressive, whereas I get the feeling that APDs rather choose solitude as a form of protection.

[Beach_Babe]

I agree. I think silent treatment is mostly about punishing you, hence passive aggressive, whereas I get the feeling that APDs rather choose solitude as a form of protection.

interesting... .my BP alternated between avoidant (i.e: not leaving house for days on end/ simple interaction with someone at the grocery store could send into  panic) and gregarious (i.e: life of the party) behavior.

[Starting_Over]

My psychologist has told me that I have a mix of avoidant and dependent traits ( I was only surprised by the dependent traits). I have never had issues with using silent treatment on people. I might slow down how often I contact people if I feel like I am being a burden.  I think that a diagnosis of both avpd and BPD would have to do with the thought processes going on in the individual. I am really sure what it would look like, because  avpd makes you feel like you are worthless and everything is your fault... .whereas BPD makes people feel like they are the centre of the universe.

I have heard that some BPD sufferers do misidentify as avoidant, because they have become hermits. However, that is just the external picture of what having avpd is.