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Hi Dr. Saltzman:

First off, thank you for taking the time to read this.

I am a 20 year old male, and I'm at a loss to explain my personality. I am a very social person when it comes to public life and strangers. I can meet anyone and talk to anyone about anything for any time without hesitation. But when I start to notice that a stranger wants to become friends with me, I back off. I make sure to do almost anything to keep my private life private. Thus I have just one friend; with whom who I don't hang out with that much either. And I usually stay at home where I feel comfortable.

I am socially considered an "attractive" male (although I don't like saying, nor thinking about this). I am attracted to females. But I try my best to alter my cosmetic appearance so that I appear less attractive. And if that doesn't work, and a female (at school or work) becomes interested in me, (as a friend, or worse, even more than a friend), I also try to do anything to never see or talk to her again (so far very successfully). I don't go out. And in the rare instances that I'm forced to, I am comfortable in open crowded public places (outdoors), but in enclosed places with a lot of people (like an indoor shopping mall, club, restaurant), I'm very nervous (even around people I've known for a long time like family). And when I talk to strangers I am much more comfortable talking to people 2, 3, even 4 times my age, than compared to peers. I consider myself pretty intelligent (once again I don't like bragging), and much more mature than my peers. I sometimes feel like I'm a 45 year old in my 20 year old body.

The only possible explanation for some of this is that I moved to this country when I was six (which I remember as being pretty tough on me), and I moved every year to a new location for the next four years. I'm thinking this early experience might have caused damage in being able to form normal social, long-term relationships. But I could be wrong. Thanks for you help.

Gratefully signed,

(Please do not disclose my name).

ask dr-robert ask psychologist todos santos ask psychologist dr robert saltzman

dr-robert: Thank you for writing. As I understand your letter, you are OK being with others as long as you are able to keep them at a distance, but that as soon as things begin to feel intimate at all, you move to cut off further communication, or at least to discourage it. I understand further that this behavior manifests with everyone, even with trusted members of your family, but that it is particularly strong in regard to women who might find you sexually attractive.

I do not think your early experience of moving to "this country" (you don't say which) would be a cause for your wanting to avoid social situations which begin to feel intimate unless that experience was remarkably traumatic, having involved, for example, prolonged separation from your parents or other important figures which felt to you like a rejection. And, in any case, trying to discover causes and antecedents for your problem is probably not the best form of treatment for what seems to be a rather classic case of what is called "Avoidant Personality Disorder."

It is commonly believed that biological factors, including heredity as well as prenatal maternal factors, set the foundation for avoidant personality disorder, which then comes into being in forms shaped and mitigated by environmental factors. Probably the strongest environmental factor in this complex personality disorder is frequent or intense rejections of the child by parental figures, since such rejections crush children's natural energy and optimism, leaving instead attitudes of self-deprecation, inadequacy, and feelings of social isolation. Then, in later life, such people avoid activities that involve significant interpersonal contact because of fears of criticism, disapproval or rejection which, seeming to be an extension of the trauma of earlier parental rejection, would be intolerable. Intimate relationships of all kinds are particularly problematical because the more intimate the connection, the greater the fear of being shamed, ridiculed, or considered inadequate in regard to private matters, and so often people suffering from avoidant personality disorder isolate themselves all the more as things threaten to become more intimate. Some psychologists also believe that avoidant personality can arise as a strategy for managing strong ambivalent or negative feelings toward sex and sexuality, and your letter suggests that this may be a factor in your case.

It is particularly important to get treatment for this problem as soon as possible, because avoidant personality disorder tends to worsen with time, leaving sufferers more and more isolated. Also, this disorder tends with time to become more resistant to treatment. Therefore, I urge you to begin looking for a competent psychotherapist immediately.

Although antidepressant medications often are used in treatment for avoidant personality in order to reduce sensitivity to rejection, the main treatment modality, in my opinion, should be long-term psychotherapy, particularly cognitive/behavioral therapy aimed at reducing sensitivity to shame and rejection, and working at assuaging sexual fears. Certainly this problem should never be treated with medication alone. An older, experienced professional with a commitment to, and talent for, unconditional acceptance of the client would be the best choice, in my opinion, in selecting a therapist, and I suspect you might do better with a man than with a women as your therapist.

I hope this helps.

Be well.

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page last modified February 28, 2006

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