Distancing: Avoidant Personality Disorder [Hardcover]

Martin Kantor is a psychiatrist on the staff of the Department of Veterans Affairs Medical Center in East Orange, New Jersey, and has elsewhere written the following summary of Distancing reproduced (and lightly edited) here:

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APD has to date been a misunderstood and neglected entity -- either entirely ignored or confused with another disorder, such as Social Phobia. The purpose of my revised Distancing is to broaden our dynamic understanding of APD, to describe, understand and treat all avoidants, not just those who are shy and social phobic, and to develop a new therapeutic approach to avoidance, one I call Avoidance Reduction.

This is an eclectic method for treating avoidants composed of relevant techniques borrowed from psychoanalytic, cognitive behavioral, interpersonal, existential and supportive therapies. Many clinicians fail to recognize APD, instead diagnosing Social Phobia. Those who do recognize APD emphasize shyness and Social Phobia as its main features. However, these are not basic to all patients with APD. What is basic to APD is not shyness or Social Phobia but a severe and pervasive social and relationship anxiety displayed in a variety of ways. Therefore, there are not one but four subtypes of APD, each of which requires a different psychotherapeutic approach.

Type I avoidants, the classic avoidants, are withdrawn. There are two subtypes of withdrawn avoidants. The first is the shy individual who cannot seem to tolerate, flinches in the face of, and pulls back from any form of social contact. The second suffers from a Social Phobia, which is a delimited pull back from a situation or event that symbolizes relationships, for example, from public speaking or eating in public. Though shy and social phobic avoidants are the main and virtually exclusive focus of today's scientific literature, these avoidants may not even be in a majority, but may represent only the tip of the avoidant iceberg.

Types II and III avoidants, almost entirely ignored by the literature, also suffer from relationship anxiety -- but their relationship anxiety takes the form not of shyness or Social Phobia but of unstable relationships due to a fear of commitment. Type II avoidants shift from relationship to relationship afraid of closeness due to a fear of commitment ("mingle" avoidants such as the perpetual bachelor or femme fatale). They are therefore the opposite of withdrawn. These are hyperrelated individuals who can relate easily, widely and well but have difficulty sustaining the relationships they form. Theirs are unstable relationships, marked by a tendency to abandon relationships before they fully develop, especially when closeness threatens and commitment looms. Type III avoidants form lasting relationships only to disrupt them after months or years of apparent functionality. These are what I call the "seven year itch" avoidants who form what appear to be solid relationships -- only to tire of them after a shorter or longer period of time, then leave them with little warning. That is, they abandon their relationships after some time has passed, and they often do so suddenly and without warning.

Type IV avoidants hide out in a codependent relationship with one person to avoid having healthy relationships with many people. They sink into one relationship to avoid all others. Some are dependent on their family. Others are dependent on a lover with whom they form a merger relationship that protects them from the anxiety associated with relationships outside of the primary relationship.

These are all patients with APD. Their dynamics are remarkably similar. They all require Avoidance Reduction. However, the significant differences in the ways they manifest their avoidance require a different therapeutic emphasis in each case. For example, while exposure techniques may prove useful for Type I shy and social phobic avoidants, they will likely be ineffective for Type II avoidants with a commitment phobia, who are more likely to benefit from insight oriented and cognitive therapy. Effective treatment of APD requires a devoted approach dedicated to reversing the underlying relationship anxiety via Avoidance Reduction. It will be applicable to reduction of avoidance in all its forms.

Avoidance Reduction should focus not only on fear of criticism (the official dynamic explanation of avoidance) but also on the equally important fears of flooding, depletion, and acceptance. Avoidants are not simply afraid of criticism and humiliation -- the only reason for avoidance currently identified in the official literature. They are also afraid of being flooded by feelings they cannot tolerate, and of being depleted should they express these feelings. Most importantly, they fear acceptance as much as they fear rejection because they fear losing their identity and personal freedom.

In practice, Avoidance Reduction involves a pastiche of familiar psychotherapeutic approaches in use today, including psychodynamic, cognitive behavioral, interpersonal, and supportive approaches, selected elements of which are combined for a synergistic effect.

My book is for psychotherapists who will be better able to identify, understand and manage APD from the detailed clinical descriptions, illustrative clinical vignettes (including those from real life) and thorough exploration of the psychodynamic, cognitive and interpersonal dynamics of the disorder.

It is also for victims of avoidants who can learn to better manage the people in their lives who snub and otherwise neglect or exploit them.

It is a self help manual for avoidants themselves, for individuals attempting to surmount their relationship anxiety and form close, satisfying, meaningful relationships with others without inordinate fear and regret.

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This book attracted me because I know an avoidant and wanted to understand her. I found the book both interesting and tedious. Kantor does a good job of classifying the various types of AvPD and their symptoms, but lost my attention by his examples and his constant reference to gays. I accept that any relationship may evidence avoidant behavior, but it seems that Kantor particularly enjoyed using a gay psychotherapist as his favorite example. This caused me to read the book primarily as a manual for gay avoidants --- that might be applicable to more general heterosexual relationships.

I also noticed that the examples seemed to focus on urban social life --- parties, decorating, looks, fashion --- conditions that might apply in New York City, but not necessarily Boise, Idaho.

Nevertheless, I found the basic explanation of avoidants and treatments good and thorough. It is fairly clear that avoidants can develop closer relationships --- and this provides hope for those who want to relate to them. Kantor could improve the book, however, by providing better examples.

First of all this book is 265 pages and it should have been less 100. It is the most redundant book I have ever read.

Secondly, it seems to me a very superficial look at avoidant personality disorder. There are some sections of this book that are so superficial he should have left them out altogether. He classifies them into different groups and provides examples (way too many) of what type of behavior exemplifies a particular group. He does not delve into their psychology though. I don't find it useful just to be able to classify someone. I wanted to understand why they think like they do or behave like they do, even if it is theoretical.

Overall, it seems like his objective was to describe avoidants or identify them rather than figure out why they are like they are. It might be somewhat useful to an avoidant person to read the book just because they might recognize themselves in here somewhere.

About 17 pages are devoted to cause (at least 5 of which were examples). This chapter should be the center of the book if you want to understand the disorder, but it was treated superficially as well. Again, he seems to be describing the possible causes without explaining them. You expect some analysis from a psychologist, but he doesn't offer any.