Abnormal Psychology

Personality Disorders 619

Understanding Fearful/Anxious Personality Disorders

Virtually nothing is known about the neurological bases of fearful/anxious per-

sonality disorders, but the apparent similarity between these disorders and anxiety

disorders might indicate that the amygdala is involved. At present, however, this

is merely inference and speculation. In contrast, psychological factors associated

with these disorders have been identifi ed. In particular, fear and anxiety underlie the

three fearful/anxious disorders. Temperament—specifi cally being high in the dimen-

sion of harm avoidance—can contribute to the development of one of these disor-

ders, especially avoidant personality disorder (Joyce et al., 2003; Taylor, Laposa, &

Alden, 2004). In fact, many of the factors related to social phobia are also involved

in avoidant personality disorder, which makes sense, given the overlap in the symp-

toms of the two disorders. For instance, people with social phobia are also high in

the dimension of harm avoidance (Marteinsdottir et al., 2003). Moreover, people

with both disorders have similar negative beliefs about themselves in relation to

other people and avoid social situations for fear of embarrassing themselves (Meyer,

2002; Morey et al., 2003).

Cognitive and behavioral factors are thought to contribute to all three fearful/

anxious personality disorders, as outlined in Table 13.27. For all three, patients

avoid situations that lead to discomfort and anxiety: With avoidant personality

disorder, patients avoid social situations; with dependent personality disorder, they

avoid making decisions and having responsibility; and with obsessive-compulsive

personality disorder, they avoid making mistakes and experiencing strong emotions.

The avoidance perpetuates the cognitive distortions because the patients’ fears go

unchallenged (Beck, Freeman, & Davis, 2004; Farmer & Nelson-Gray, 2005).

Finally, social factors also contribute to these personality disorders. These fac-

tors include anxious or avoidant attachment style, which may have arisen in child-

hood as a result of particular interaction patterns with parents (Gude et al., 2004;

Pincus & Wilson, 2001).

Treating Fearful/Anxious Personality Disorders

As for most other personality disorders, there is little research on the treatment of

fearful/anxious personality disorders, and what research there is has focused primar-

ily on avoidant personality disorder. The fi ndings suggest that the treatment that is

effective with social phobia—CBT that uses exposure to avoided stimuli as well as

Table 13.27 • Maladaptive Views, Beliefs, and Strategies of Individuals

with Fearful/Anxious Personality Disorders

Personality Disorder View of Self View of Others Main Beliefs Main Strategies

Avoidant Socially inept,

incompetent,

vulnerable to rejection

Critical, demeaning,

superior

“I may get hurt.”

“If people know the ‘real’ me, they will

reject me.”

“It’s terrible to be rejected, put down.”

“I can’t tolerate unpleasant feelings.”

Avoid evaluative situations and

unpleasant thoughts or feelings

Dependent Needy, weak, helpless,

incompetent

Idealized as nurturant,

supportive, competent

“I am helpless.”

“I need people to survive, to be happy.”

Cultivate relationships in which

dependence is accepted

Obsessive-Compulsive Responsible,

accountable,

fastidious, competent

Irresponsible, casual,

incompetent, self-

indulgent

“I must not err.”

“I know what’s best.”

“Details are crucial.”

“People should do better, try harder.”

Perfectionism, control,

criticism, punishment, thinks in

terms of “shoulds”

Source: Beck, Freeman, & Davis, 2004, pp. 21, 36, 48–49.