Avoidant personality disorder: Definition, clinical and neurobiological profiles, differential diagnosis and therapeutic framework

The present personality disorder, disciplined by the DSM-V [1], in cluster C, is characterized by a penetrating pattern of behaviour of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluations towards oneself and the tendency to avoid social interactions. Most individuals sometimes use avoidance to relieve anxiety or to prevent diffi cult situations. Avoiding personality disorder, on the other hand, is characterised by a pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative assessments. People with this disorder are concerned about being ridiculed by others, rejected or criticised. This leads them to avoid social situations in which they have to interact with others by limiting the normal development of social skills over time. People with personality avoidance disorder generally live in isolation, spectators of a world in which they would like to take part but which is too scary for them. They tend, in fact, to think that they are not good enough, that they can be rejected or hurt, that others do not like them, that they are unattractive and socially inadequate. These thoughts lead to high states of anxiety in social situations, such as work, friends, intimate relationships, which they tend to avoid carefully for fear of being ridiculed, criticized and rejected. The pre-eminent condition is “social distress and anxiety” and a marked tendency to lead a routine life that shelters these people from the potential risks of novelty. In order to live positive and gratifying sensations, even if temporary, the avoiders cultivate solitary interests and activities. Finally, social withdrawal confi rms their personal sense of social inadequacy, in an apparently endless spiral. People with avoidant personality disorder often consider themselves socially incapable or unattractive on a personal level and avoid social interactions for fear of being ridiculed, humiliated or objects of dislike. Despite the diffi culties and strong inhibitions, however, people with this disorder would like to have social relationships; unlike other personality disorders in which the person avoids interaction but at the same time is not interested in it. However, the avoidance disorder is diagnosed at the beginning of adulthood even though the symptoms usually exist from childhood; it is no coincidence that strong associations have been found with emotional neglect, particularly rejection by one or both parents, or perceived rejection by the peer group [2-8]. Abstract


Defi nition and general profi les
The present personality disorder, disciplined by the DSM-V [1], in cluster C, is characterized by a penetrating pattern of behaviour of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluations towards oneself and the tendency to avoid social interactions. Most individuals sometimes use avoidance to relieve anxiety or to prevent diffi cult situations. Avoiding personality disorder, on the other hand, is characterised by a pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative assessments. People with this disorder are concerned about being ridiculed by others, rejected or criticised. This leads them to avoid social situations in which they have to interact with others by limiting the normal development of social skills over time. People with personality avoidance disorder generally live in isolation, spectators of a world in which they would like to take part but which is too scary for them. They tend, in fact, to think that they are not good enough, that they can be rejected or hurt, that others do not like them, that they are unattractive and socially inadequate. These thoughts lead to high states of anxiety in social situations, such as work, friends, intimate relationships, which they tend to avoid carefully for fear of being ridiculed, criticized and rejected. The pre-eminent condition is "social distress and anxiety" and a marked tendency to lead a routine life that shelters these people from the potential risks of novelty. In order to live positive and gratifying sensations, even if temporary, the avoiders cultivate solitary interests and activities. Finally, social withdrawal confi rms their personal sense of social inadequacy, in an apparently endless spiral. People with avoidant personality disorder often consider themselves socially incapable or unattractive on a personal level and avoid social interactions for fear of being ridiculed, humiliated or objects of dislike.
Despite the diffi culties and strong inhibitions, however, people with this disorder would like to have social relationships; unlike other personality disorders in which the person avoids interaction but at the same time is not interested in it.
However, the avoidance disorder is diagnosed at the beginning of adulthood even though the symptoms usually exist from childhood; it is no coincidence that strong associations have been found with emotional neglect, particularly rejection by one or both parents, or perceived rejection by the peer group [2][3][4][5][6][7][8]. accepted. In particular, the need to bond with parents "prone to rejection" makes the person affected by the disorder "hungry" for relationships, but his great desire gradually develops into a defensive "shell" of self-protection against repeated parental criticism. Many others, on the contrary, claim to have had problems with ultra-protective parents that prevented him from developing his own personality [9][10][11][12][13][14][15][16].

The neural correlates
The

Clinical profi les
With reference to the disorder in question, it should fi rst be considered that in many cases there is an "avoidance style" rather than a real personality disorder: the substantial difference between the two conditions is determined by assessing how deeply these affect the normal "functioning" and performance of the individual in daily life. Think of a "bridge" between the healthy and the pathological. The avoidance style is found on the end of the healthy part, while the avoidance of personality disorder lies on the unhealthy part [3].
The characteristics of the avoiding style of personality are 2) It is reluctant to enter into a relationship with people unless it is certain of pleasure. more diffi cult to solve problems [18][19][20][21][22][23][24][25][26][27][28][29], especially in terms of psychotherapy and for understanding the differences between awareness of one's clinical condition and the awareness of wanting to obtain a benefi t by changing one's dysfunctional habits and behaviour [30,31].

Treatments profi les
The cognitive-behavioural treatment for avoidance personality disorder works in the fi rst instance on the analysis of dysfunctional, distorted and inaccurate automatic thoughts, which are the basis of the disorder. These thoughts, once identifi ed and shared with the patient, are challenged through refutation and replaced with new, more functional thoughts.
For example, suppose that the patient strongly believes that he or she is inferior to others and that others would like him or her to leave the company where he or she works. The

Conclusions
The recent interest of the academic world for this disorder echoes the need for further investigation, especially in terms of neurobiological and psychopharmacological elements, able to better explain the internal relations with this disorder and to fi nd the best strategic solutions to solve, according to a multifactorial approach, the problems described by patients.