The general goal of treatment in avoidant personality disorder is improvement of self-esteem and confidence. As the patient's self-confidence and social skills improve, he or she will become more resilient to potential or real criticism by others.
These approaches are usually supportive; the therapist empathizes with the patient's strong sense of shame and inadequacy in order to create a relationship of trust. Therapy usually moves slowly at first because persons with avoidant personality disorder are mistrustful of others; treatment that probes into their emotional state too quickly may result in a more protective withdrawal by
<u the patient. As trust is established and the patient feels "H safer discussing details of his or her situations, he or she ™ may be able to draw important connections between their deeply felt sense of shame and their behavior in social ^ situations. o
£ Cognitive-behavioral therapy
c Cognitive-behavioral therapy (CBT) may be help ful in treating individuals with avoidant personality dis> order. This approach assumes that faulty thinking patterns underlie the personality disorder, and therefore focuses on changing distorted cognitive patterns by examining the validity of the assumptions behind them. If a patient feels he is inferior to his peers, unlikable, and socially unacceptable, a cognitive therapist would test the reality of these assumptions by asking the patient to name friends and family who enjoy his company, or to describe past social encounters that were fulfilling to him. By showing the patient that others value his company and that social situations can be enjoyable, the irrationality of his social fears and insecurities are exposed. This process is known as "cognitive restructuring."
Group therapy may provide patients with avoidant personality disorder with social experiences that expose them to feedback from others in a safe, controlled environment. They may, however, be reluctant to enter group therapy due to their fear of social rejection. An empa-thetic environment in the group setting can help each member overcome his or her social anxieties. Social skills training can also be incorporated into group therapy to enhance social awareness and feedback.
Family or couple therapy can be helpful for a patient who wants to break out of a family pattern that reinforces the avoidant behavior. The focus of marital therapy would include attempting to break the cycle of rejection, criticism or ridicule that typically characterizes most avoidant marriages. Other strategies include helping the couple to develop constructive ways of relating to one another without shame.
The use of monoamine oxidase inhibitors (MAOIs) has proven useful in helping patients with avoidant personality disorder to control symptoms of social unease and experience initial success. The major drawback of these medications is limitations on the patient's diet.
People taking MAOIs must avoid foods containing a substance known as tyramine, which is found in most cheeses, liver, red wines, sherry, vermouth, beans with broad pods, soy sauce, sauerkraut, and meat extracts.
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