Psychiatr. pro Praxi, 2004; 4: 179-185

Vyhýbavá porucha osobnosti - diagnostika a kognitivně-behaviorální terapie

Mgr. Petra Houbová1, doc. MUDr. Ján Praško CSc1,3,2,4, PhDr. Marek Preiss1
1 Psychiatrické centrum Praha, 3. LF UK, Praha
2 Centrum neuropsychiatrických studií, Praha
3 Psychiatrická klinika FN a LF UP, Olomouc
4 3. LF UK, Praha

Keywords: avoidant personality disorder, diagnostics, pharmacotherapy, cognitive-behavioral therapy, cognitive schemas, group psychotherapy.

Published: December 31, 2004  Show citation

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Houbová P, Praško J, Preiss M. Vyhýbavá porucha osobnosti - diagnostika a kognitivně-behaviorální terapie. Psychiatr. praxi. 2004;9(4):179-185.

Vyhýbavá porucha osobnosti se projevuje trvalými rysy sociální přecitlivělosti, inhibicí, vyhýbáním se sociálním situacím a pocity méněcennosti. Tito lidé mají výrazný strach navázat osobní vztahy, protože se necítí bezpeční v kontaktu s druhými nebo nejsou schopni vyjádřit svoje pocity. Tato porucha se zdá být extrémní variantou základních osobnostních rysů introverze a neuroticismu. Tyto vrozené rysy se mohou posílit hyperprotektivitou a nadměrnou kritikou vychovatelů v dětství. Běžné dětské zážitky - odmítnutí, výsměchu, ponížení nebo shození druhými jsou pro takto zranitelné lidi devastující. Vyhýbavá porucha osobnosti se objevuje u 1-2% osob v populaci, ale až u 5-25% klinických pacientů. Lidé trpící vyhýbavou poruchou osobnosti vyhledávají léčbu spíše pro příznaky úzkosti, zejména pro sociální fobie, nebo pro depresi. Nácvik sociálních dovedností a expoziční léčba se zdá být pro tyto lidi velmi užitečnou. Ke snížení celkové úzkostnosti mohou pomoci také antidepresiva.

Evasive personality disorder - diagnosis and cognitive-behavioral therapy

Avoidant personality disorder shows pervasive patterns of social hypersensitivity, inhibition, timidity and inadequacy. These persons may have a strong desire to develop close, personal relationships but feel too insecure to approach others or to express their feelings. This disorder appears to be an extreme variant of the fundamental personality traits of introversion and neuroticism. These inheritant traits might be exacerbated further in childhood through overprotection and excessive cautiousness. The normal child experiences of rejection, denigrating, embarrassment and devaluation, will be particularly devastating to the persons who is already lacking of self-confidence or is temperamentally passive, inhibited, or introverted. Avoidant personality disorder may be diagnosed in only 1-2% of the general population, but as much as 5-25% of patients in clinical setting.

Patients with avoidant personality disorder initially seek treatment for symptoms of anxiety, particularly social phobia, or depression. Social skills training, exposure therapy to feared social situations has been shown to be useful in the treatment of this disorder. Many persons with avoidant personality disorder will respond to antidepressants.

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