Distancing: Avoidant Personality Disorder

Having read this book after considering the reviews here, I have to say the critical reviews I found were unfair and misleading. Perhaps those readers were threatened more by the content than truly disappointed in the book itself. There are few available and accessible books on this topic, let alone ones which examine the avoidant personality from a psychoanalytic view. Kantor's work provides a concise, well-organized examination of the avoidant personality and is useful both to those seeking to understand and better love the distant person in their life, as well as to avoidants themselves. I am thrilled with this work and so glad I ordered it despite negative reviews!

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:~~~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of APD, each of which requires a different psychotherapeutic approach.Type I avoidants, the classic avoidants, are withdrawn. There are two subtypes of withdrawn avoidants.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.~~~

I bought this book because I myself have a relative with avoidant tendencies and wanted to learn as much as I could about AvPD. I certainly learned a lot from this thorough, well-written, reader-friendly book, including that my relative is indeed avoidant, that she is not alone, and that there is help for her available (too many of my relative's therapists failed to make the diagnosis and if they made it didn't really know what to do to cure her of the problem ) I did become suspicious that the few reviewers complaining that this book is mostly about gay men were overreacting, so I counted up the examples (about 250) and how many of them were actually about gay men (20), which is about 1 in 10, which is representative of the proportion of gays to straights in the general population. To me, the examples were right on, and illustrative of the author's technical points, helping to explain even the more difficult among them. Another criticism, that the traits cited as representative seemed to be too nonspecific, comes down to what I think is the failure of the reviewers to distinguish between a trait (symptom) and a diagnosis (syndrome). Sure, a lot of the behaviors cited were nonspecific, but the author never said that because an avoidant behaves as X that behaving as X means the individual is an avoidant. Highly recommended, and with few to no reservations.

This book has been the only book I could find about the topic of avoidant personality disorder. There are many books that are written about the other personality disorders, but most only speak very briefly on avoidants. This book has a lot of information that is difficult to find anywhere else. As a matter of fact, the information itself is different then what can be found from other resources such as the internet. This book can be confusing to someone without a good grasp on what personality disorders are. For people familiar with PDs this book will provide a wealth of new information that goes beyond common knowledge of avpd.