In this post, we will be looking at the book Disorders of Personality: Introducing a DSM/ICD Spectrum from Normal to Abnormal again, but this time looking at Malignant Self-Regard, a relatively new psychological concept, and I’ll be correlating them from my own experience with AvPD and lack of expertise in psychology.

In a study, AvPD and Malignant Self-Regard were found to often come together. “In a clinical context, exploration of self-concept in individuals with AVPD has led the authors of the present review to conclude that an MSR is likely also often present in AVPD. Hence, it is of interest that when the malignant self-regard questionnaire was tested across a range of personality disorder traits, AVPD loaded highly (alongside vulnerable narcissistic PD) on one of the two factors identified, and this association was relevant even after controlling for depression and self-esteem. The authors of that study considered whether social anxiety and avoidance may be an important aspect of MSR. However, it is equally possible that the “sense of personal inadequacy” in AVPD is more than just low self-esteem and may have a malignant aspect.” (Lampe & Malhi, 2018)

Due to its relative newness and the lack of interest in AvPD by many professionals, this is a concept many may not have heard that can be useful in understanding how someone with AvPD views themselves in self-destructive ways.

Introduction to Malignant Self-Regard

First let’s start with what Malignant Self-Regard (MSR) is. MSR was more originally used to explain an alternate form of Narcissistic Personality Disorder called Vulnerable Narcissism. It also is used to explain some forms of PDs that have been dropped in the DSM through the years such as Masochistic Personality Disorder and Depressive Personality Disorder. Malignant Self-Regard looks at personality disorders, but rather than through the lens of traits as they usually are looked at, instead is focused on interpersonal relations. “…trait and symptom models of personality and psychopathology have often been criticized for their lack of attention to the dynamic interplay of internal psychological processes and to the situationally driven, yet temporally stable, aspects of personality. Westen even noted that what clinicians find most helpful in assessing personality pathology is not the DSM but rather the opportunity to interpret the continuities and discontinuities between patients’ reports about their interaction with others and actual observations of their behavior (including how they interact with the clinician).” (Huprich, 2014)

This is especially important to AvPD due to how it functions in relationship to people.

“MSR addresses a number of these issues, as it focuses upon a self-system that becomes activated under conditions of criticism or of seeking out love, care, or acceptance.” (Huprich, 2014)

“Moreover, MSR involves activating feelings of sadness, frustration, and anger, which reliably and predominantly occur in certain contexts…”(Huprich, 2014)

“MSR may be viewed as a type of self-structure that is prone to heightened activation during interpersonal contexts that evoke concerns about how the self is being viewed by others. Though MSR is mainly about self-definition, it is implicitly a process involving interpersonal relatedness. Specifically, a person with MSR wishes or desires to be interpersonally related but is blocked or thwarted by the thoughts, feelings, and processes mentioned above. In this organizational framework, the influence of the other person on the individual’s sense of self is powerful, leaving the individual vulnerable to the judgments of others and with a deeper desire to be cared for. From a developmental framework, descriptions of masochistic, self-defeating, depressive, and vulnerably narcissistic personalities all describe experiences with caregivers who are inconsistent in their praise and validation of the child’s experience. Consequently, normal needs for attention to, and appreciation of, developmentally appropriate accomplishments go unattended, leading the child to turn inward in order to make sense of these unrecognized needs.” (Huprich, 2014)

Here we see two interesting things mentioned about interpersonal relationships. One, the person with MSR wishes to be related to others but thwarted in this, leaving them with a heightened sensitivity to others judgment. Two, they desire to be cared for, showing a form of unrequited dependency toward others’ opinions. This is tied to a history of being neglected and given inconsistent care, and the person’s response is to turn inward to find this. So, the person with MSR finds their relatedness to others thwarted and instead looks within to find a way to correct this. This relates back to the fundamental formative years and relating to caring figures. This is covered earlier in the article with what it calls an overemphasis in self-definition.

“With regard to depressive and narcissistic personalities, Blatt suggested that both personality styles are the product of an overemphasis in self-definition, with depressive and narcissistic personalities having difficulties in a developmental stage described as cooperation-alienation, which falls in between Erikson’s initiative-guilt and industry inferiority stage.” (Huprich, 2014)

Erikson’s stages are an old psychology model that looks at the stages of human development from being a baby until death, looking at clusters of ages as a time of when certain things develop properly or do not. For intiative-guilt, initiative is the positive development whereas an overly active sense of guilt is the negative. Or, if a child learns a healthy way of adapting to the world nor not. Similarly, industry is the positive and inferiority the negative.

In an early stage of being a kid, a child starts interacting with other children and playing. They learn initiative during this phase, but too much control or a stressful environment can make them pull back. This can lead to guilt.

“Too much guilt can make the child slow to interact with others and may inhibit their creativity. Some guilt is, of course, necessary; otherwise the child would not know how to exercise self-control or have a conscience.” (McLeod, 2018)

Industry-Inferiority continues this. “It is at this stage that the child’s peer group will gain greater significance and will become a major source of the child’s self-esteem. The child now feels the need to win approval by demonstrating specific competencies that are valued by society and begin to develop a sense of pride in their accomplishments.

If children are encouraged and reinforced for their initiative, they begin to feel industrious (competent) and feel confident in their ability to achieve goals. If this initiative is not encouraged, if it is restricted by parents or teacher, then the child begins to feel inferiour, doubting his own abilities and therefore may not reach his or her potential. If the child cannot develop the specific skill they feel society is demanding (e.g., being athletic) then they may develop a sense of inferiourity.” (McLeod, 2018)

Here we are talking about two things, peer relationships and guardian relationships. Peer relationships can be negative, and guardian relationships can be controlling, neglectful, and/or abusive. Guardian relationships in this case matter most because they set the fundamental relationship views of the person. Let’s look further at a relationship between two PDs covered in MSR.

“Cooper has perhaps most clearly articulated the relationship of narcissism and masochism to the individual’s personality structure. He describes how narcissistic-masochistic personalities can be understood through four major themes:

– a desire to be victimized, to have another be in control (which relates to the qualities of their object-relatedness)

– accepting or pursuing pain at the expense of recognizing positive affective experiences (which relates to their experience and management of affect)

– a readiness to succumb to guilt and depression after defeat (which relates to the nature of their superego)

– self-centered satisfaction that others do not suffer as much as they do (which relates to their narcissistic needs)”

We can look at some of these points through this developmental stages. The desire to have another in control can be a manifestation of this early developmental inconsistencies. The readiness to succumb to guilt and depression after defeat is a big correlation here for the negative coping side. In the intitiative-guilt and industry-inferiority continuum this shows a strong falling on the guilt and inferiority side. Inferiority itself is tied to as well to shame in which inferiority expresses itself actively through feelings of shame.

With the points on desire to be victimized and self-centered satisfaction that they suffer more than others, you see them stuck in these attitudes of self-defeat and taking it on as part of their identity. Others have control over their inability to achieve, not themselves, and it is others who cause harm. Others become a target of spite to continue a scapegoat for their unmet needs.

“”their unconscious aim is not the consciously claimed fantasy of restoration of a loving and caring mother; it is the fantasized control over a cruel and damaging mother.” These patients are not willing to relinquish their sense of being hurt and wounded, as it requires them to recognize dependent and positive aspects of a relationship. Similarly, relinquishing a sense of being wounded would mean that they do not deserve justice for their psychological injuries.” (Huprich, 2014)

An important thing here to note is the continuation of an attitude as a part of the narrative of injury. They were substantially harmed, and therefore need a sense of justice toward it, but it becomes interpreted in a twisted way. They cannot conceive a properly caring guardian and it could admit their dependency toward a harmful guardian. But as mentioned before in inconsistent caring, they both are cared for and uncared for. This causes a confusion leading to a heightened inward turn into the self to deal with it. You have a child which is cared for, but inconsistently so that it creates intense emotional problems. They are unable to handle the inconsistency, neither able to completely reject the guardian or accept them as loving. They are unable to handle it, but have no good outward way to change or influence the situation. This forms into ‘overemphasis in self-definition’ as mentioned previously where the child turns inward to deal with this and makes the self more important than it was when interpreting the situation. This also leads to a possible distancing and the simultaneous desire to be cared for.

We see this in the case of an example of a vulnerable narcissist: “For instance, Cooper describes a male patient who engaged in a provocative discussion with his wife over a comment she had made earlier in the day. Though she had apologized and the patient had accepted her apology, the patient obsessed about being aggrieved and wanted her to understand the damage she had inflicted. When the wife eventually became frustrated with his attacks, she threatened to leave, only for the patient to feel depressed and defeated for bringing up the issue in the first place.” (Huprich, 2014)

The connection between the outer acceptance of apology never met the inner, and the patient became obsessed with the damage it did so he attacked her. When she was fed up, his response was a defeatist attitude. This is part of the intitiative-guilt as above. The patient out of an entirely internal frustration not communicated to his wife attacked his wife, and when it did not work and their initiative failed, they gave up and felt defeated.

Another thing to keep in mind is how a lack of understanding relationships and other people can form in a PD here. The child wanting to punish the parent and believe themselves a victim means the child does not feel loved and places that above the fantasy for love. This attitude can be conflicting and cause the person not to seek out love, causing the problem to continue. This may be a beginning of confusion surrounding relationships where the child does not understand why they are not getting their needs met. Then, their continual attitude in relationships like this shows their distance from experiencing love. “First, it has been widely suggested that personality pathology fundamentally involves a disruption in the way that individuals view themselves and others—a dynamic interplay of self and others that leads to (mal)adaptation in the social world.” (Huprich, 2014)

Now that we understand how MSR can develop and a little of how it can manifest, let’s get into the traits of it. First of all, there is a fundamental difference between MSR and AvPD traits in their goals. MSR traits deal with temporal but consistent traits activated in social context. The AvPD traits describe the person as a whole. AvPD traits also tend to look at the personality of the person as completed, or the final adult conclusions of the sufferer’s worldviews and the symptoms from it. MSR looks at the mechanisms which can lead to these sorts of traits. Due to this, there will most likely not be many direct 1 to 1 correlations between each, and I will be speculating on how one could lead to another.

General

This part will cover general comparable traits not covered specifically by the traits given in MSR.

[Keep in mind when it says SRA it means AvPD in this context. SRA is something else which includes AvPD, but in this context it’s all taken from a chapter on AvPD. When a quote ends in Huprich means it’s talking about MSR, while Millon is AvPD.]

“MSR may be viewed as a type of self-structure that is prone to heightened activation during interpersonal contexts that evoke concerns about how the self is being viewed by others. Though MSR is mainly about self-definition, it is implicitly a process involving interpersonal relatedness.” (Huprich, 2014)

AvPD also holds an activation process, “The internalized residue of the past that inheres within the mind of SRAs comprises intense, conflict-ridden memories of problematic early relationships. These can be readily reactivated with minimal promptings.” (Millon, 2011)

This reactivation process occurs in relation to the same thing for both, self-regard. How they define themselves(inferior) and how others view them.

“From a developmental framework, descriptions of masochistic, self-defeating, depressive, and vulnerably narcissistic personalities all describe experiences with caregivers who are inconsistent in their praise and validation of the child’s experience. Consequently, normal needs for attention to, and appreciation of, developmentally appropriate accomplishments go unattended, leading the child to turn inward in order to make sense of these unrecognized needs.” (Huprich, 2014)

“SRA personalities tend to be excessively introspective and self-conscious, often perceiving themselves as different from others, and they are unsure of their identity and self-worth. The alienation they feel with others is paralleled, then, by a feeling of alienation from themselves. ” (Millon, 2011)

Perfectionism in the Context of Grandiose Fantasies

People may have difficulty verbalizing their grandiose ideas; verbalization might be viewed as a dangerous activity that opens one up for criticism or rebuke. Alternatively, one may have come to believe that such ideas are arrogant, bad, or “sinful.” For instance, by acknowledging a desire to date an attractive woman and to feel sexually aroused, a man might believe such affect will open him up to disapproval by the woman or by others who might know of such personal desires.” (Huprich, 2014)

This is interesting because it relates to the history of AvPD. Millon describes a history of AvPD where it arised out of an alternative view on Schizoid Personality Disorder. In this history the Schizoid and its alternative form which eventually turned into AvPD were looked at as a construct of aestheticism – people who deny their desires and needs often by seeing their own desires as sinful. (Millon, 2011) You can see this trait in today’s view on AvPD.

“The SRA avoidant’s prime, if not sole, recourse is to break up, destroy, or repress these painful thoughts and the emotions they unleash. These personalities struggle to prevent self-preoccupations and seek to intrude irrelevancies by blocking and making their normal thoughts and communications take on different and less significant meanings. … they attempt to interfere actively with their own cognitions. Similarly, the anxieties, desires, and impulses that surge within them must be also restrained, denied, turned about, transformed, and distorted.” (Millon, 2011)

Rather than being outright repressed like an aesthetic, they are transformed and distorted as well.

“The fantasies often focus upon means by which to prove oneself worthy and acceptable to others. All three personalities seek a higher level of being in order to avert criticism or rejection by others. Depressive and narcissistic individuals, in particular, are often hard working and high achieving; thus, their perfectionistic strivings are regularly reinforced. Their achievements, however, come at the expense of healthy self regard and a balanced evaluation of others’ ideas, criticism, and feedback—which makes such individuals highly dependent upon others for the maintenance of self-esteem.

Besides their own perfectionistic and grandiose strivings of the self, depressive, masochistic, and vulnerably narcissistic persons often view others through a similar lens and consequently, as noted above, expect perfectly attuned and sensitive responses. Patients can become angry and hurt when others fail to see their accomplishments or when others do not see the ways in which their misattuned reactions hurt the patients. This pattern of object relatedness sets the stage for chronic disappointments, shame, and sadness.” (Huprich, 2014)

With fantasy we see a lot of similarities to AvPD. What is interesting is in the AvPD description it describes fantasies as a means of getting what they need, but in MSR it specifies the MSR person needs grandiose fantasy. You can look at grandiose fantasy as needed as a way of self-protection and distorting one’s desires. “Perfectionistic ideas or desires to achieve a perfected or ideal status are common in individuals with malignant self-regard. A person might believe that an exceptional work product may yield an important promotion or pay raise, or that by being an especially caring and listening partner, the significant other will never become angry or frustrated at him or her. While certain strivings can be logically adaptive and reasonable, others may be placed too high, such that they either are unattainable (which is masochistic and breeds pessimism) or, if attained, may not bring forth the happiness that is desired (i.e., others might not provide the acceptance or praise that is desired, or the accomplishment may be minimized as a “stroke of good luck” or a coincidence).” (Huprich, 2014)

Here we see the fantasy as a way of being invincible, where the person is immune to criticism and negative feedback. This can be self-protective as negative feedback can be viewed as rejecting, something an Avoidant would be avoiding if they interpreted it as such.

“Apart from destroying their inner cognitions, SRAs depend excessively on fantasy and imagination to achieve a measure of need gratification, to build what little confidence they may have in their self-worth, and to work out what few methods they can for resolving conflicts. SRAs experience their feelings deeply and hence must use their daydreams and reveries as a means of dealing with their frustrated affectionate needs and discharging their resentful and angry impulses. But fantasies also prove distressing in the long run because they point up the contrast between desire and objective reality.” (Millon, 2011)

Masochism

“Theoretically, Kernberg explained that the depressive-masochistic personality can deteriorate into a sadomasochistic personality, due to an excessively punitive superego that obfuscates the relationship of self-love and self-hate.” (Huprich, 2014)

“And as Cooper described, the narcissistic masochistic personality is characterized by sadomasochistic object-relatedness, in which unconsciously desired love and approval from the caregiver is disavowed in place of a desire to punish the unavailability of the caregiver.” (Huprich, 2014)

These both show a strong strain of narcissism. Let’s try looking at the general trait first before talking about this.

“Because individuals have experienced early caregivers as inconsistently accepting or validating, they have come to think and know that being cared for and accepted in a relationship is associated with suffering. In fact, showing one’s competencies, strengths, or independence may have actually received more negative attention from caregivers than behaving in ways that were compliant or dependent, even though wanting positive attention for the accomplishment is appropriate. Perfectionistic outcomes or states are ultimately unattainable and, when pursued without modification, lead to masochistic behavioral patterns (e.g., overworking, turning down opportunities for pleasure in order to reach a goal, or substance use or other addictive behaviors that are used to assuage the disappointment with the imperfect self).” (Huprich, 2014)

Here we see an interesting thing, pain and pleasure become blended from others, where approval can be painful and disapproval can bring pleasure. These particular cases reflect the disorders the author is trying to analyze, but it’s not hard to find masochism in AvPD. Setting unobtainable goals and standards is not far from AvPD, as you can see the entire belief system of the Avoidant to be centered around unobtainable goals.

“The SRA personality is hyperalert to the most subtle feelings and intentions of others… ‘sensitizers,’’ acutely perceptive observers who scan and appraise every movement and expression… it floods them with excessive stimuli and distracts them from attending to many of the ordinary yet relevant features of their environment… extraordinarily sensitive to the subtleties of tone and feeling, hyperalert to the meaning of emotive utterances, such as voice inflections and facial grimaces, as well as possessing an infallible ear for vocal cadences and nuances, especially those which are judgmental or potentially derogatory. ” (Millon, 2011)

“The pervasive sense of unease and disquiet is what is most observable… evince[ing] a constant timorous and restive state, overreacting to innocuous experiences, hesitant about relating to events that may prove personally problematic, and anxiously judging these events as signifying ridicule or rejection from others.” (Millon, 2011)

The avoidant in a sensitizer to the thing which causes them pain, making them interpret painful situations into things which are innocuous. In desiring to be around people, the beliefs and behaviors of AvPD cause it to be painful. This makes their desires unobtainable, and you can see therefore a possible masochism develop from this where the pleasure of intimacy brings pain, and pain of loneliness brings pleasure.

Problematic management of angry and aggressive emotions

“Kernberg was especially insightful when he characterized narcissistic personalities as having a fundamental problem with aggression. Similar concerns have been expressed about depressive and masochistic personalities. Across all PDs, at a very basic level, anger arises early in the context of interpersonal relationships when caregivers do not provide empathic attunement to, and recognition of, the child’s basic needs. Children internalize quite early that self-strivings, needs, and wishes are not consistently recognized and that they may even be discouraged or punished when they experience such desires. They learn to dislike that part of themselves that seeks to be recognized and gratified—which sets in motion an insidious process of self-sequestration, self-attack, and inner turmoil. Others are needed and clearly wanted, but they are anticipated to be disappointing, shortsighted, and incapable of adequately meeting one’s needs. As a consequence, the self is attacked for wanting such things in the first place. Anger becomes self-directed. The process is insidious and malignant.” (Huprich, 2014)

“Of equal threat is the SRA’s own aggressive and affectional impulses. These are especially distressing since these persons fear that their own behaviors may prompt others to reject and condemn them. Much intrapsychic energy is devoted to mechanisms that deny and bind these inner urges.” (Millon, 2011)

“Perhaps the most important aspect of malignant self-regard is the identification and management of underlying anger. As noted above, individuals with inconsistent parenting or support engage in behaviors meant to demonstrate their goodness, acceptability, or likeability. Yet, such action frequently covers up underlying anger and frustration toward others who have not provided the desired attention, acceptance, and validation. Anger often remains inwardly directed, usually in the form of self-critical thoughts and hypersensitive self-focus. Part of the energy from this anger is directed toward achievement and acceptance. It is difficult for individuals who are so self-focused to admit that they want or need attention or approval from others. Their anger at others can and is felt, and if it continues, it evokes feelings of guilt, especially since the hypersensitive self-focus has identified so many problems of which the person is aware and conscious—problems that outweigh the magnitude of the anger and disappointment evoked by unmet relational needs.” (Huprich, 2014)

“SRAs find no solace and freedom within themselves. Having internalized the pernicious attitude of self-derogation and deprecation to which they were exposed in earlier life, they not only experience little reward in their accomplishments and thoughts but find instead shame, devaluation, and humiliation. In fact, they may feel more pain being alone with their despised self than with the escapable torment of others. The immersion of self in the individual’s own thoughts and feelings is the more difficult experience because a person cannot physically avoid the self, cannot walk away, escape, or hide from his or her own being. … these persons suffer constantly from painful thoughts about their pitiful state, their misery, and the futility of being themselves. Efforts that are even more vigilant than those applied to the external world must be expended to ward off the painful ideas and feelings that well up within them. It is their entire being that has become devalued, and nothing about them escapes the severe judgment of self-derision.” (Millon, 2011)

In the MSR case it’s about an inability to manage anger, while with AvPD it’s about an inability to handle fear. They are both very similar in how they end up blaming themselves and direct most anger towards themselves. One can see these as interconnected, though. For example, the avoidant’s crutch on avoidance as a coping mechanism turns a lot of anger into fear and vice-versa.

Desire Approval and Acceptance from Others

“Though individuals may appear focused upon themselves (hypersensitive self-focus) and preoccupied with achievements and performance (related to perfectionism and self-criticism), they ultimately are doing such acts in order to attain approval or acceptance from others, which is necessary to help buffer their fragile self-regard. Thus, they frequently engage others in ways to demonstrate their competency or exhibit their strengths and skills, though often without much conscious awareness of how dependent they are upon others.While they do receive acceptance and recognition in several domains, it is irregularly received. A tension state is created (often unconsciously), in which the desire for approval and acceptance is in conflict with self-strivings that will not go away and are more consciously experienced. The subsequent thoughts are focused on achievement and performance but not on the desire to be recognized or understood by others.” (Huprich, 2014)

Avoidant behavior is focused upon the same, but often in the negative. This is shown in fear of rejection. Or, perhaps it shows to be negative on the outside, and on the inside it is just like MSR, where there is a desire for achievement and love, but they find themselves always failing due to avoidance and an inability to handle things, causing an intensification of a negative self-regard and self-image, leading to more avoidance. Avoidance and fearful responses rather than depressive responses we see in depressive personalities lead to the avoidant being defined by fear of the negation of their desires, and a lack of awareness surrounding the desire below the fear of their being taken away.

For example, someone wants a friend and meets someone. They avoid that person out of fear that they will screw it up. They then feel that person must hate them. Rather than it being about their desire for approval and acceptance, they become obsessed with how the situation will end poorly just like all others, and rather than it being about striving for acceptance from another in the mind of the avoidant, all conscious effort forms around avoiding rejection. In this way, AvPD could be interpreted as a fearful and avoidance based version of MSR.

Avoidance takes on a masochistic quality, since avoidance can’t bring about their desire, nor pursuing it. If they avoid things, then they will never get their desire and it will make them feel incompetent. If they pursue their desire, they find themselves in a state of constant fear, reactivating processes which lead to feelings of being rejected. The avoidant stays in a limbo state of being dependent on the views of others at all times, and also desiring independence from others so the pain they feel about others can end. They are unable to achieve either, and avoidance becomes a band-aid solution they stick to over and over along with fantasy. Fantasy as talked about above brings an unrealistic situation in which they can feel themselves being given positive feedback while simultaneously detached from others in the fantasy and denying their own need for positive affirmation from others. It’s possibly a fear process which covers up a self-absorbed, ego driven process.

Self-Criticism

“Individuals believe that their efforts are not good enough and that someone else will look at their work and judge it as harshly as they do (e.g., “They will see that [small] error in the document and start to question my abilities.”). Similarly, they might view constructive feedback as criticism aimed at themselves and their abilities, despite the feedback being positively framed, with the purpose of enhancing the work, rather than undermining or attacking the person doing the work. As in the example above, individuals might feel inadequate about approaching a person to potentially start a relationship, thereby leading them to criticize themselves for not having the requisite skills (e.g., “I should know how to do this by now.”). This situation can lead to many affects, such as guilt, shame, or anger. Having an “eye” on their faults, they subsequently become more selective about whom they chose to become close to.” (Huprich, 2014)

We see this generally with AvPD. “Privacy is sought and they attempt to eschew as many social obligations as possible without incurring further condemnation. Any event that entails a personal relationship with others, unless it assures uncritical acceptance, constitutes a potential threat to their fragile security.” (Millon, 2011)

Hypersensitive Self-Focus

“Hypersensitive self-focus is a component of self-criticism and perfectionistic tendencies. It involves thinking often about one’s performance, abilities, or qualities in a way that is unduly critical because one falls short of higher accomplishments. This activity has cognitive and affective components, including guilt, shame, depression, or anger, though in some cases, the self-focus might elucidate feelings of pride and joy over one’s accomplishments and successes. However, these positive feelings are not experienced consciously very often. This level of self-directed attention might appear obsessive to others, and the individual who is self-focusing may be unable relinquish it.” (Huprich, 2014)

This is a continuation of the above.

Pessimism

“Because individuals cannot be perfect, and because there are ways in which individuals’ actions or ideas could be improved upon, those who have malignant self-regard are prone to pessimism in their thinking, which can evoke a depressive or slightly angry affect. This kind of thinking is self defeating or masochistic.However, pessimistic thinking might come to be experienced as a necessary part of being approved, accepted, or liked, as it is so often evoked in interpersonal situations. Approval and such experiences come with a cost to one’s self-regard; pessimism develops because no one can expect to be praised or approved of all the time, and because no one acts in ways that are always approved and accepted by others.” (Huprich, 2014)

We see a consummate pessimism toward life in AvPD. “SRAs describe their emotional state as a constant and confusing undercurrent of tension, sadness, and anger. They feel anguish in every direction they turn, vacillating between unrequited desires for affection and pervasive fears of rebuff and embarrassment. Not infrequently, the confusion and dysphoria they experience leads to a general state of numbness. … They have learned to believe through painful experiences that the world is unfriendly, cold, and humiliating, and that they possess few of the social skills and personal attributes by which they can hope to experience the pleasures and comforts of life. They anticipate being slighted or demeaned wherever they turn. They have learned to be watchful and on guard against the ridicule and contempt they expect from others. … And, perhaps most painful of all, looking inward offers them no solace because they find none of the attributes they admire in others. Their outlook is therefore a negative one: to avoid pain, to need nothing, to depend on no one, and to deny desire. Moreover, they must turn away from themselves also, away from an awareness of their unlovability and unattractiveness, and from their inner conflicts and disharmony. Life, for them, is a negative experience, both from without and from within.” (Millon, 2011)

This works as a comparison if we view it as I described before, AvPD being a fear based manifestation of MSR. The avoidant’s crutch on their limited coping mechanisms and beliefs are an outward manifestation of an inner desire for love. The avoidant cannot cope with a view that others are inherently dangerous while also desiring love, and so they seek perfectionist, impossible standards which make them better in the eyes of others while somehow detached from the fearful things they bring.

Guilt, Shame, Inadequacy

“Individuals frequently feel guilty or ashamed over efforts to self-promote, even when it is appropriate. For example, even at a performance review in which their work has been excellent, they may believe that their record is inadequate and not good enough to be valued or appreciated, either by others or by themselves. Either way, guilt, shame, or inadequacy is felt. These feelings may lead them to downplay their strengths or minimize their accomplishments, not only to themselves but to others. In a different context, an individual might find another person attractive and want to get to know him or her better. Such desires might be imbued with a feeling of inadequacy and the belief that “I will look foolish or sound stupid if I try to initiate a discussion with this person.”” (Huprich, 2014)

Here we see a general similarity with feelings of inferiority and lack of confidence in AvPD.

Depression Proneness

“Individuals frequently feel depressed, though not necessarily meeting criteria for major depressive disorder. The depressive affect is activated most often in interpersonal situations in which (1) approval and acceptance are desired (but criticism or disapproval are possible) or (2) the person believes that he or she has fallen short of a desired goal (e.g., a work product that the person believed to be excellent is deemed defective by others). This depressivity may lead to interpersonal withdrawal or some other form of comfort seeking. Otherwise, individuals have a wide range of affect, including happiness and pleasure.” (Huprich, 2014)

With AvPD, since they feel they fall short and are in danger of disapproval at all times, then they often become numbed to the world and avoid.

Conclusion



A major conclusion I came to from this has to do with how a lack of love and inconsistent parenting leads the patient into turning inward to make sense of it. The person with a AvPD has an inability to understand themselves in relationship to others in fundamental ways. These two things seem connected, where it seems the child did not understand their guardian, and had to turn inward to try to understand and interpret their situation. This may have begun the process of a disruption in how they view themselves and others, where they learned to justify neglect, transforming into their own adult views of themselves – self-neglect and self-attacking. Simultaneously, a mistrust of others occurs as their communication has to be filtered through this lens.



The best conclusion for the reader is what can you get from this? In what ways do you relate to MSR? How do you believe it is connected to your own experience? After reading this, it’s best to think about this for a while and write down how you believe it may or may not relate to you. If a lot connects, then it can be very helpful in figuring out what one thinks and believes inside and outside social situations, and how one defines oneself in relation to others.

Cited:

Huprich, S. K. (2014). Malignant Self-Regard: A Self-Structure Enhancing the Understanding of Masochistic, Depressive, and Vulnerably Narcissistic Personalities. Harvard Review of Psychiatry, 22(5), 295–305. doi: 10.1097/hrp.0000000000000019

Lampe, L., Malhi, G.S. (2018) Avoidant personality disorder: current insights. Psychology Research and Behavior Management 11, 55–66 doi:10.2147/PRBM.S121073. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5848673/

McLeod, S. A. (2018, May 03). Erik Erikson’s stages of psychosocial development. Simply psychology: https://www.simplypsychology.org/Erik-Erikson.html

Millon, T. (2011). Disorders of personality: introducing a Dsm/Icd spectrum from normal to abnormal. Hoboken, NJ: John Wiley.