Agency in avoidant personality disorder: a narrative review

Area of Science:

• Psychology
• Clinical Psychology
• Personality Disorders

Background:

• Avoidant personality disorder (AvPD) is highly prevalent but under-researched.
• Individuals with AvPD experience significant functional impairments and distress.
• A lack of agency may be a core deficit in AvPD.

Purpose of the Study:

• To review psychological mechanisms and interpersonal factors influencing agency in AvPD.
• To understand how agency is facilitated or hindered in daily life and psychotherapy for AvPD.
• To inform therapeutic interventions by clarifying patient factors in AvPD.

Main Methods:

• Narrative review of original literature.
• Reflexive thematic analysis of existing research.

Main Results:

• AvPD is associated with impaired agency stemming from poor emotional awareness and regulation.
• High attachment avoidance and fear contribute to social ambivalence and subordination.
• A weak sense of self, self-doubt, and harsh self-critique impede intentional action.

Conclusions:

• This review provides clinical insights into AvPD functioning, highlighting strengths and deficits.
• It aids clinicians in identifying therapeutic targets and barriers to client agency.
• Understanding agency is crucial for addressing relational dynamics in the AvPD therapeutic alliance.