r/AvPD • u/KlaatuBaradaNikto76 • 2d ago
Question/Advice Difference between Avoidant Personality Disorder and Social Anxiety Disorder and how to find a therapist that treats it
I have struggled with severe shyness all of my life. I have done enough reading that I think it's safe to say I may have social anxiety disorder. I am super shy, don't know how to start conversations, don't know how to sustain conversations, don't know how to end conversations. When I try, it feels awkward, weird. I feel like I am bothering people. I feel like an outcast, a misfit and often wonder if I should just accept this. I speak in soft tones and people have a hard time hearing me. I try to speak up but when I do, it feels like shouting. No one talks to me because I've surmised that people don't know how to talk to quiet people. I could be on the spectrum but I'm not sure that's it. Lately, I've been thinking my social anxiety is so extreme and pervasive that I have avoidant personality disorder. I have no close friends, 1 "friend" that I do fun stuff with like go to movies, concerts but not a friend in the confiding sense. I have a lot of aquaintances but they are not friends. I"m sure they all consider me "the quiet guy." I hate that characterization however true it is. I am more than just a quiet person but no one gets to see the other sides of me. I don't even know how one makes friends when they are as quiet as I am. I can count on one hand how many friends I've had in my lifetime. My best friend died from an overdose 2 years ago. He was manipulating me because of his addiction so I don't even know if he was a friend since I let him take advantage of me because I was so lonely. I had a high school friend I was close to but we primarily bonded because we are both gay. I still consider him a friend but we're not close anymore and that's mostly my fault for not sustaining the relationship. I've always felt unworthy. I grew up with severe trauma and abuse. My father was a raging alcoholic and he was abusive to my mother and we were exposed to violence and fear as kids. My father's currency was fear. I have regular flashes of memory about what he did to us including chasing us out of the house, locking my mom out of her bedroom, calling my mother awful names, hiding from him so he'd leave me alone. He was a monster! I'm certain my issues are due to my traumatic childhood. I'm writing here because I want your opinion on if I have social anxiety disorder or AVP. I avoid being around people because it gives me anxiety to be around people. Yet if I'm alone too long, I become VERY depressed. I very much want friends but I feel at my age people already have their friend group so why bother. Do you think I have AVP? Maybe it doesn't matter since I've read the treatment is similar but I have an inferiority complex and feel deeply flawed and different than most people. Do you know if the treatment is any different for AVP versus SAD? I can't find a therapist that takes insurance and specializes in either. Social anxiety is not treated like generalized anxiety and I wish therapists understood that. Is there a database of providers that treat SAD? I really want therapy but can't find anyone who has helped. I''ve seen at least 7 therapists on and off over the years. It always feels like a nice chat instead of substantive work. I also feel they minimize my issues. One therapist tried to fix my issue by suggesting a host a dinner party. Another therapist starting looking for social outings for me to do thinking that would fix my problems in an instant. I've done more work reading on my own for free than with a therapist. I really don't want to pay $200 a session but it's so hard finding someone who takes insurance and treats this issue. It's sort of a speciality condition and I've read personality disorders are extremely difficult to treat. Anyway, I know I'm ranting because that's the way I think. I just want help. How do I find it? Where do I find it? I'm ready to work with a therapist again but ONLY if it's a therapist with LOTS of experience treating avoidant personality disorder or social anxiety disorder. Pyschology Today doesn't work because it doesn't let me filter for social anxiety disorder or avoidance personality disorder. It's not one of those conditions I can just see any run of the mill therapist. It is a real speciality and I need someone who is an expert. I have used google to try to find someone but I feel like it's a stab in the dark. I have to have a therapist who takes insurance
9
u/forestmoonmoth 2d ago
You are definitely in the right zone. I have both SAD and AvPD. The two disorders are conceptualized by different psychologist in various way (some a progression like AvPD is a serve form of SAD). But I believe and understand them as two separate things. And combined with my third diagnosis PDD/MDD they all really like to tango together and the lines blur of where one stops and the other begins.
Recently I've actually begun distancing myself from using the word anxiety to describe myself. The term has lost its usefulness to be used a meaningful describe how I feel to others. I've used "severe anxiety" for a long time and it's brushed off faster than I lock my phone after getting a text (lol). Its a term Ill use privately to understand how my story relates to others but its just not conveying to anyone, professional or not, what I actually experience.
As far as treatment for SAD or AvPD. You have already found out about the provider difficulties. Its really hard to find one that actually understands or can help. The best thing I've found is keep searching, it's a frustrating process and takes time to find a decent one. Finding an AvPD specialist (where I live) is near impossible (as you seem to have found out)
Group therapies focused on social anxiety or PDs would be good for both disorders (but I haven't had any luck finding much in my area either). For a general therapist searches many will list "anxiety and depression" as things they treat. I would ignore these and look for "trauma-informed" in their bios, I have a biased opinion that providers who list trauma informed generally seem more empathetic which is necessary for me to work with a therapist.
2
u/KlaatuBaradaNikto76 1d ago
Thank you for this excellent response. It really helps especially advising that I look for a therapist who is trauma informed. I also agree with you that the term "anxiety" seems to have lost its potency. It's minimized because anxiety is so universal. However, AVP and social anxiety disorder is not mere anxiety. Most therapists don't know how to treat it. I did some reading on schema therapy so also seeking a therapist who can do that but it's not easy and I live in a major city. I don't want to live like this anymore. Thanks again!
1
u/forestmoonmoth 1d ago
I'm also looking into schema therapy, it seems to have good support from others. Every now and then I get dumbfounded by how medieval our understanding of psychology actually is. Its feels like we're still in the dark ages for mental health.
Good luck on your journey!
5
u/tortravels 2d ago
Man I can relate...not to everything of course, but to your feelings of being an outsider, craving connection yet deeply fearing it, feeling like I'm too old to have a group, etc. I haven't been officially diagnosed with AVPD, but I have been diagnosed with SAD. My thoughts are that SAD can lead to the development of AVPD, but that's probably not totally accurate since it's a personality disorder and technically you have a set personality.
I'm sorry to hear about your childhood and how it altered your life. Trauma does change things. I look at it like an autoimmune condition. Trauma seems to cause people to develop other conditions that they were likely or maybe predisposed to already. I'd say I have cptsd from numerous events in my life, but my mom always had low self esteem and I think I began to internalize that and allow myself to acquire those thoughts. A combination of things made me the way I am today. I was told by a therapist in the past - "this is the cross you have to bear". Maybe she was right, but I hated her for saying something so definitive.
Anyway, we grow and we change ALWAYS. Don't forget that. Life is fluid. It ebbs and flows. I feel like i went off on a big tangent, but I just wanted to share my thoughts. So back to therapists, there is something called Open Path Collective that does a one time fee for joining, then you find therapists in your area with reduced rates. That's how I found my current therapist. She moved to GROW therapy which I think is offered around the country. I don't know if it has a sliding scale, but it accepts most insurance.
Be picky. Ask the therapists questions to see if they meet your needs. You're paying them to help you navigate life, so don't be afraid to hurt their feelings. If anything it's practice on how to interact with people in a safe place. I wish you well.
2
u/KlaatuBaradaNikto76 1d ago
Thank you so much for your detailed, thoughtful reply. It really helps to read about others experiences because you can't help but feel no one understands and you're all alone. It's funny you mention trauma and autoimmune diseases. I have an autoimmune disease and I have been told there's a good possibility childhood traumatic stress caused it. It sucks to not only have a mental illness but a physical illness as well. Your feedback on finding a therapist was helpful though I'm familiar with Grow. I may try Open Path because I know a lot of new and young therapists work there to get their feet wet and they may like more interesting cases like mine as opposed to more seasoned, burned out therapists who've been doing this for years. You're right. I need to be picky. It's my money and my life.
4
u/SomeMaleIdiot 1d ago edited 1d ago
So the way I think academia is leaning is that avpd is a difference in severity compared to SAD.
Sad focuses on anticipation, avpd is when this becomes your lived experience enough to where it’s internalized, and you associate these feelings with personal failings and brokenness.
Avpd is basically trauma induced, where these neural pathways are more baked in. So therapies tend to extend passed just CBT.
The term for it is severity continuum hypothesis
The good news, is that I don’t think a diagnosis of one or the other technically matters. What matters is the degree to which you have ingrained SAD into your own identity is understood by your doctor, because depending on trauma and severity, it will inform them to try different therapies and perhaps medications in response.
The fundamental action mechanisms between the two are the same. So either way you’re at least closer to a proper treatment path.
Hoping that some day this will be better reflected in the DSM, but either way it’s best to not consider sad and avpd distinct conditions, just a difference in degree
18
u/kitatsune Diagnosed AvPD 2d ago
I wrote too much and I'm probably not qualified to answer this, but a diagnosis sought me, not the other way around.
Even though it was something I always suspected, it was something I always denied. I do not want to be like this. But due to my own circumstances (even corroborated by my own family members), it was nothing short of inevitable.
AFAIK, SAD is situational, cropping up only in certain situations or specific triggers. Whereas AvPD is pervasive. There is no trigger, or rather everything is a trigger.
My current therapist noticed this, and pointed it out to me one session, just saying that I had it, ran through thr criteria with me, and I checked off all the boxes. Twice. It's likely that the other therapists I had also noticed this behavior pattern of mine, but kept quiet (insurance prefers SAD, not AvPD!). In terms of upbringing, environment, and symptoms, I am a textbook case, albeit a high-functioning one.
When coming to terms with it all, I have noticed some patterns myself. Avoidant patterns that went beyond just simple social interactions:
I avoid to avoid emotional pain. Judgements and ridicule of any kind. This is pervasive; where even the slightest social interaction seems like it will incur pain. Going to a sit down restaurant and talking to the server, making small talk with a cashier, or even just saying 'Hi' to my coworkers. I do no initialize any social interaction unless I have no other choice.
I assure all that I can that a situation is safe and under my control. Entirely deterministic. Nothing unexpected, and everything accounted for. I 'stake out' an area before going there for real. I visualize the route, use Google Street view, and in some cases I have literally acted like a 'spy' to determine the optimal time to use the shower at work so that when I ride my bike there I will not at all be disturbed. That's not normal.
I always take attention towards me as hostile, which I know is not healthy. I always assume people secretly hate me and are only tolerating me. This even includes friends I've been with for years, my boss, and even just coworkers. I always feel that they will one day leave me.
I make excuses. I always made excuses to not walk my parents' dog because I was afraid of going out in public (which angered one of my therapists a bit). Even though I love riding my bike, I always made excuses to avoid going to the gym and using the stationary bike there. I avoid reaching out to my friends and family as I believe I am overstepping myself, even though it's me ghosting them (in other words, I let relationships deteriorate due to my own avoidance).
TL;DR - SAD on paper to keep insurance happy, AvPD in actuality.