Young adulthood is marked by important periods of social connection. From meeting new friends in college to building rapport with colleagues at a first job, relationships made during these years shape careers and future, lifelong relationships. But for individuals who struggle with social anxiety, even the smallest day-to-day interactions can feel overwhelming, even painful, and stand in the way of opportunity and well-being.
In this article, we’ll be delving into two diagnoses we treat at The Dorm, Social Anxiety Disorder (SAD) and Avoidant Personality Disorder (AVPD), both of which can impact a young person’s quality of life and ability to thrive in relation with others.
In the following interview, one of our clinicians at The Dorm speaks with Ed Maletic, LCSW, Clinical Supervisor of The Dorm UWS, to break down differences between these disorders, and share treatment modalities that have helped so many within our community learn to thrive socially. Today, our clients report +32% improvement in peer social acceptance as a result of our care, marked by a decrease in feelings of social rejection, and increased feelings of social belonging.
Key Article Takeaways
First, what is social anxiety disorder (SAD)?
Ed Maletic, LCSW: Think of SAD as a fight or flight response that is activated in situations that are specifically localized to social settings. People with SAD might feel extremely anxious in large groups or big social settings and often worry about how others perceive them.
This can manifest as being overly attentive or having elements of neuroses during interactions with people.
The Dorm Clinician: Building on that explanation, SAD is centered around fear of socializing and being around others, such as fear of judgment, inadequacy, saying the wrong thing in social interactions, and embarrassment. These fears can be amplified and grow to be out of proportion to the actual situation. People with SAD may:
- Feel that their lives are “closing in”
- Establish fears about going out
- Feel a reduction in anxiety from not going out which then reinforces avoidance behaviors
What is avoidant personality disorder (AVPD)?
The Dorm Clinician: Personality disorders are different in their etiology, and the avoidance is often times larger than in cases of SAD (which are centralized to social settings). AVPD is a fear that extends beyond social situations, reaching most things in their life and is deeply connected to a person’s sense of identity. Individuals with AVPD may not realize they have the disorder or recognize their experiences as symptoms. Often rooted in insecure attachments established during childhood, this lack of awareness makes them believe their behavior is just part of who they are, rather than a treatable condition.
Ed: People with AVPD may get very fixated on having to make decisions and put an immense amount of pressure on themselves, which results in inaction and ultimately interferes with activities of daily living (ADLs) and general well-being.
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What are the important differences between SAD and AVPD?
It is important to remember that there are distinct differences behind these disorders which impacts how they are experienced and also treated.
Below are the main differentiators:
- SAD is an axis I disorder, which can be considered ego dystonic, meaning the symptoms associated with the disorder are incongruent with the individual’s self-image and identity.
- AVPD is an axis II disorder, which is considered ego syntonic, as the symptoms of the disorder are deeply ingrained throughout the individual’s sense of self.
The Dorm Clinician: While the overlap in symptomatology can seem similar, SAD is much more common than AVPD. If you have social anxiety, you likely have insight or awareness that something isn’t right due to the impact on your social connections, whereas with AVPD, your feelings are deeply ingrained in the way you think and act.
Ed: Social anxiety disorder is about social contexts specifically. Avoidant personality disorder can be related to any form of making decisions. We often see individuals with AVPD demonstrate:
- Strong feelings of inadequacy
- Extreme reactions and sensitivity to criticism
- Deep-set fears of intimacy and vulnerability
- Reluctance to take risks and try new things, especially if it involves any form of social/personal interaction
What are the best treatment modalities for young adults with SAD or AVPD?
SAD is known to respond really well to exposure therapy, as habituation results in a reduction in symptomatology. At The Dorm, this process is guided by a licensed/credentialed clinician as part of individual therapy and/or clinical coaching.
An example might be working with a client on practicing social exposures on a micro scale i.e. saying hello and making small talk with our Clubhouse receptionist or asking a store clerk where to find an item. Eventually, a client will work their way up to more nuanced and longer social engagements, such as joining a meal with friends or speaking with family about one’s needs.
AVPD may be harder to detect, as there may be a lack of insight into personality disorders but one-on-one individual therapy and skills coaching support is generally always beneficial for this profile of individual.
Regardless of diagnosis, however, group therapy is one of the most profound and effective treatment modalities for young people with any type of social anxiety. because it allows individuals to safely practice social skills learned in treatment with other people, and gradually gain confidence and competence in a collective milieu.
Some group therapy offering that help these clients at The Dorm include:
- Artful Communication Group: A psycho-educational and process-oriented communication group where clients are challenged to explore communication dynamics at home, at work, and in social situations. Social anxiety, as well as communication skill-building, is stressed as a focal point of group discussions. Role play and homework assignments are done regularly to support progress.
- Social Skills Group: The Social Skills Group is co-educational and facilitated by two licensed clinicians. Clients are given a monthly budget and can pick social activities on a weekly basis that fall within the budget. They are challenged to practice and utilize the social skills they have been learning in one-on-one therapy and groups and receive feedback from group facilitators and peer groups.
- Various Social Groups: The Dorm has a number of social skill-building groups that are run by clinicians but in a more relaxed environment, such as walking group, cooking group, themed game and movie nights, and social groups. These settings are less ‘intensive’ than dedicated groups or one-on-ones and help clients become more comfortable socializing while doing shared activities. In particular, cooking groups allow clients to learn about meal etiquette and how to hold a conversation over the course of a lunch or dinner which is a transferable skill to other areas of life.
Why is community and socialization important for young adults with SAD or AVPD?
In addition to structured group therapy, the day-to-day community experience at The Dorm brings an invaluable opportunity to put social skills learning in therapy to the test in all manner of situations.
- The Clubhouse: At The Dorm, we have a community-oriented treatment milieu with a clubhouse at each location where clients can be found talking between therapeutic sessions, making lunch, playing games or studying. A licensed or credentialed clubhouse community manager is present to facilitate peer connection and encourage clients to drop their cell phones so they can interact with one another. This is an intentional step towards addressing aspects of social functioning that may be impaired.
- Clubs: We offer a number of clubs that allow for peer-to-peer connection based on shared interests, such as book club, music club, and horticulture club.
When left untreated, both SAD and AVPD can be paralyzing and isolating. However, with proper care, support and time, any young person can learn how to cope with their condition and live a fulfilling, connected life.
Thank you both for your insights, contributions, and valuable advice!
At The Dorm, we are always available to answer any questions you may have. Please reach out to us today to learn more about our services pertaining to both social anxiety disorder and avoidant personality disorder.
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