History of the AvPD Diagnosis | The Avoidant Zone

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Avoidant personality disorder is a relatively recent diagnosis when compared to other diagnostic labels, but the collection of behaviors and experiences we call AvPD has been written about since long before it was given that name. The following timeline chronicles the process of AvPD becoming a diagnosis and gaining that name.

Timeline of the Development of the AvPD Diagnosis

1911

In Dementia Praecox or the Group of Schizophrenias, Eugen Bleuler described different ways that schizophrenia may develop. Describing one possible early stage of schizophrenia, Bleuler talked about a group of patients who showed the following characteristics:

Intentionally shunning "any contact with reality"
Experiencing such intense emotional states that they felt the need to "avoid everything which might arouse" those emotions
Appearing outwardly apathetic as a result of this avoidance, despite internally having incredibly strong reactions

This description is significant for two reasons: it can be considered the first description of the mental state we now call avoidant personality disorder, and it foreshadows the connections currently being researched between AvPD and the schizophrenia spectrum.

1923

In The Psychopathic Personalities, Kurt Schneider proposed the existence of 10 "psychopathic personalities" (what we would now think of as personality disorders), including the asthenic personality. While some characteristics of the asthenic personality aren't particularly relevant to AvPD, the description did include the following similar traits:

Paying an unusual amount of attention to and overthinking their inner experiences, causing their emotions to feel less genuine and their relationships to feel "lifeless and void"
Being unable to relax after reacting to an experience, prolonging the situation or continuing to experience a "disturbed emotional undertow" following the event

Additionally, Schneider describes the insecure self-distrusting personality. This personality also includes some traits similar to those we now recognize as AvPD:

"Deeply rooted" insecurity and lack of self-confidence
Tendency to blame themselves for "anything that goes wrong"
Consistently feeling dissatisfied with themselves
Hiding these inner experiences from the outside world

1925

Before the avoidant personality was recognized as its own unique entity, the patterns we new call avoidant and schizoid personality disorders were generally talked about as one in the same, with both often being referred to as "schizoid".

Ernst Kretschmer was the first to differentiate between two unique patterns within the schizoid label when, in Physique and Character, he described the anaesthetic schizoid (analagous to what we now call schizoid PD) and the hyperaesthetic schizoid (analagous to what we now call AvPD0. The description of the hyperaesthetic schizoid included the following characteristics:

Constant self-analysis and comparison; continual internal conflict
Nervousness, excitability, unstable moods, anxiety, and sensitivity
Shy, timid, or distrusting behavior
Behaving "as if [they were] pushed into [themselves]"
Outwardly silent, but inwardly tense as a result of pent-up negative emotions which can't be expressed
Seeking to avoid and numb any external stimulation as much as possible

Kretschmer's description of the hyperaesthetic type is one of the most comprehensive precursors to the AvPD label, covering many of the important characteristics of AvPD.

1931

In Psychopathic Personalities, Eugen Kahn describes what he calls the passive autist, another category which strongly resembles AvPD:

Separation from themselves as well as from others
Inability to assert themselves
Primary goal is self-protection, particularly protection of their self-esteem and emotions
Belief that their personality is weak and constantly threatened
Refusal to take action or face the threats of the outside world
Preference for living in isolation, detached from and therefore protected from life

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