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Weme AV, Sørensen KD, Binder PE. Agency in avoidant personality disorder: a narrative review. Front Psychol 2023; 14:1248617. [PMID: 37790232 PMCID: PMC10543493 DOI: 10.3389/fpsyg.2023.1248617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Objectives Avoidant personality disorder (AvPD) is a highly prevalent personality disorder, especially in clinical settings, yet scarcely researched. People diagnosed with AvPD have severe impairments in functioning and suffer greatly, yet we still lack meta-analytic evidence for therapy and only a few RCTs are conducted. Patient factors are the most important for outcome in therapy, in general. Lack of agency might be a core deficit in people diagnosed with AvPD. Their conditions might be improved if we understand their agency better. We review previous research regarding psychological mechanisms and interpersonal relationships that facilitate or hinder agency in AvPD in daily life and psychotherapy. Methods Summarizing original literature in a narrative review with reflexive thematic analysis. Results People diagnosed with AvPD seem to have significant impairments in their sense of agency due to a lack of emotional awareness, an overweight of inhibiting vs. activating emotions, and difficulties regulating emotions. Difficulties also seem related to high levels of attachment avoidance and fear, creating strong ambivalence in social needs, in addition to a strong tendency to subordinate to others. A weak sense of self with a poor narrative, self-doubt, and harsh self-critique makes a reflexive and intentional stand increasingly difficult for these people. Conclusion This review gives a clinically meaningful understanding of core strengths and deficits in the personality functioning of AvPD that can help clinicians map out important therapeutic work, identify barriers to client-agency in therapy, and work through relational difficulties in the therapeutic alliance.
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Affiliation(s)
- Andrea Varga Weme
- Group Therapy Team, Voss Outpatient District Psychiatric Unit NKS Bjørkeli AS, Voss, Norway
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Kristine Dahl Sørensen
- Group Therapy Team, Aust-Agder Country Outpatient Psychiatric Unit, Sørlandet Hospital, Arendal, Norway
| | - Per-Einar Binder
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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Zahl KE, Pedersen G, Eikenaes IUM, Stänicke LI, Wilberg T, Baltzersen ÅL, Pettersen MS, Hummelen B, Arnevik E, Johansen MS, Hartveit Kvarstein E. Avoidant and borderline personality disorder patients during the first Covid-19 wave in Norway - a survey-based comparison of therapy changes and patients' accommodations. Nord J Psychiatry 2022; 77:336-344. [PMID: 35984379 DOI: 10.1080/08039488.2022.2110614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Patients with personality disorders (PDs) often have insecure attachment patterns and may be especially vulnerable to abrupt treatment changes. Patients with borderline PD (BPD) are often considered vulnerable to treatment interruption due to chronic fear of abandonment. Nonetheless, other PDs are poorly investigated. In the first Covid-19 wave in Norway, in-person treatment facilities and group treatments were strongly restricted from March 12th until May/June 2020. OBJECTIVES To examine and compare changes in outpatient treatment for patients with avoidant (AvPD) and BPD during the first Covid-19 wave in Norway, and patients' reactions to these changes. METHODS The study is based on a cross-sectional survey distributed to 1120 patients referred to 12 different PD treatment units on a specialist mental health service level within the Norwegian Network for Personality Disorders. The survey included questions on treatment situation, immediate reactions, and changes during the crisis. From 133 responders (response rate 12%), 40 patients reported BPD and 30 AvPD as diagnosis. RESULTS All patients were followed up from their therapist after March 12th. Almost all patients in both groups expressed satisfaction under the new circumstances. Both groups experienced the same regularity as before, but more AvPD patients reported less than weekly consultations. AvPD patients reported more negative feelings about changes in therapy, and missed the therapy and group members more than the BPD group. CONCLUSION After the lockdown, BPD patients received a closer follow-up than AvPD patients, and the latter reported more negative feelings related to change in their treatment situation.
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Affiliation(s)
- Kjell-Einar Zahl
- District Psychiatric Center Follo, Group Therapy Section, Akershus University Hospital, Lørenskog, Norway
| | - Geir Pedersen
- Department for National and Regional Functions, Division of Mental Health and Addiction, NETWORK for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingeborg Ulltveit-Moe Eikenaes
- Department for National and Regional Functions, Division of Mental Health and Addiction, National Advisory Unit for Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
| | - Line Indrevoll Stänicke
- Department of Psychology, University of Oslo, Oslo, Norway.,Nic Waals Institute, Lovisenberg Deacon Hospital, Oslo, Norway
| | - Theresa Wilberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department for Research and Innovation, Division of Mental Health and Addiction, Section for Treatment Research, Oslo University Hospital, Oslo, Norway
| | - Åse-Line Baltzersen
- Department for National and Regional Functions, Division of Mental Health and Addiction, National Advisory Unit for Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Mona Skjeklesaether Pettersen
- Department for National and Regional Functions, Division of Mental Health and Addiction, NETWORK for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Norwegian Centre for E-health Research, Troms, Norway
| | - Benjamin Hummelen
- Department for Research and Innovation, Division of Mental Health and Addiction, Section for Treatment Research, Oslo University Hospital, Oslo, Norway
| | - Espen Arnevik
- Department for Research and Innovation, Division of Mental Health and Addiction, Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
| | - Merete Selsbakk Johansen
- Department for National and Regional Functions, Division of Mental Health and Addiction, Outpatient Clinic for Specialized Treatment of Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
| | - Elfrida Hartveit Kvarstein
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department for National and Regional Functions, Division of Mental Health and Addiction, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
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