Customer Reviews

Distancing: Avoidant Personality Disorder, Revised and Expanded

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Martin Kantor is a psychiatrist on the staff of the Department of Veterans Affairs Medical Center in East Orange, New Jersey, and has elsewhere written the following summary of Distancing reproduced (and lightly edited) here:

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APD has to date been a misunderstood and neglected entity -- either entirely ignored or confused with another disorder, such as Social Phobia. The purpose of my revised Distancing is to broaden our dynamic understanding of APD, to describe, understand and treat all avoidants, not just those who are shy and social phobic, and to develop a new therapeutic approach to avoidance, one I call Avoidance Reduction.

This is an eclectic method for treating avoidants composed of relevant techniques borrowed from psychoanalytic, cognitive behavioral, interpersonal, existential and supportive therapies. Many clinicians fail to recognize APD, instead diagnosing Social Phobia. Those who do recognize APD emphasize shyness and Social Phobia as its main features. However, these are not basic to all patients with APD. What is basic to APD is not shyness or Social Phobia but a severe and pervasive social and relationship anxiety displayed in a variety of ways. Therefore, there are not one but four subtypes of APD, each of which requires a different psychotherapeutic approach.

Type I avoidants, the classic avoidants, are withdrawn. There are two subtypes of withdrawn avoidants. The first is the shy individual who cannot seem to tolerate, flinches in the face of, and pulls back from any form of social contact. The second suffers from a Social Phobia, which is a delimited pull back from a situation or event that symbolizes relationships, for example, from public speaking or eating in public. Though shy and social phobic avoidants are the main and virtually exclusive focus of today's scientific literature, these avoidants may not even be in a majority, but may represent only the tip of the avoidant iceberg.

Types II and III avoidants, almost entirely ignored by the literature, also suffer from relationship anxiety -- but their relationship anxiety takes the form not of shyness or Social Phobia but of unstable relationships due to a fear of commitment. Type II avoidants shift from relationship to relationship afraid of closeness due to a fear of commitment ("mingle" avoidants such as the perpetual bachelor or femme fatale). They are therefore the opposite of withdrawn. These are hyperrelated individuals who can relate easily, widely and well but have difficulty sustaining the relationships they form. Theirs are unstable relationships, marked by a tendency to abandon relationships before they fully develop, especially when closeness threatens and commitment looms. Type III avoidants form lasting relationships only to disrupt them after months or years of apparent functionality. These are what I call the "seven year itch" avoidants who form what appear to be solid relationships -- only to tire of them after a shorter or longer period of time, then leave them with little warning. That is, they abandon their relationships after some time has passed, and they often do so suddenly and without warning.

Type IV avoidants hide out in a codependent relationship with one person to avoid having healthy relationships with many people. They sink into one relationship to avoid all others. Some are dependent on their family. Others are dependent on a lover with whom they form a merger relationship that protects them from the anxiety associated with relationships outside of the primary relationship.

These are all patients with APD. Their dynamics are remarkably similar. They all require Avoidance Reduction. However, the significant differences in the ways they manifest their avoidance require a different therapeutic emphasis in each case. For example, while exposure techniques may prove useful for Type I shy and social phobic avoidants, they will likely be ineffective for Type II avoidants with a commitment phobia, who are more likely to benefit from insight oriented and cognitive therapy. Effective treatment of APD requires a devoted approach dedicated to reversing the underlying relationship anxiety via Avoidance Reduction. It will be applicable to reduction of avoidance in all its forms.

Avoidance Reduction should focus not only on fear of criticism (the official dynamic explanation of avoidance) but also on the equally important fears of flooding, depletion, and acceptance. Avoidants are not simply afraid of criticism and humiliation -- the only reason for avoidance currently identified in the official literature. They are also afraid of being flooded by feelings they cannot tolerate, and of being depleted should they express these feelings. Most importantly, they fear acceptance as much as they fear rejection because they fear losing their identity and personal freedom.

In practice, Avoidance Reduction involves a pastiche of familiar psychotherapeutic approaches in use today, including psychodynamic, cognitive behavioral, interpersonal, and supportive approaches, selected elements of which are combined for a synergistic effect.

My book is for psychotherapists who will be better able to identify, understand and manage APD from the detailed clinical descriptions, illustrative clinical vignettes (including those from real life) and thorough exploration of the psychodynamic, cognitive and interpersonal dynamics of the disorder.

It is also for victims of avoidants who can learn to better manage the people in their lives who snub and otherwise neglect or exploit them.

It is a self help manual for avoidants themselves, for individuals attempting to surmount their relationship anxiety and form close, satisfying, meaningful relationships with others without inordinate fear and regret.

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This book attracted me because I know an avoidant and wanted to understand her. I found the book both interesting and tedious. Kantor does a good job of classifying the various types of AvPD and their symptoms, but lost my attention by his examples and his constant reference to gays. I accept that any relationship may evidence avoidant behavior, but it seems that Kantor particularly enjoyed using a gay psychotherapist as his favorite example. This caused me to read the book primarily as a manual for gay avoidants --- that might be applicable to more general heterosexual relationships.
I also noticed that the examples seemed to focus on urban social life --- parties, decorating, looks, fashion --- conditions that might apply in New York City, but not necessarily Boise, Idaho.
Nevertheless, I found the basic explanation of avoidants and treatments good and thorough. It is fairly clear that avoidants can develop closer relationships --- and this provides hope for those who want to relate to them. Kantor could improve the book, however, by providing better examples.

First of all this book is 265 pages and it should have been less 100. It is the most redundant book I have ever read.

Secondly, it seems to me a very superficial look at avoidant personality disorder. There are some sections of this book that are so superficial he should have left them out altogether. He classifies them into different groups and provides examples (way too many) of what type of behavior exemplifies a particular group. He does not delve into their psychology though. I don't find it useful just to be able to classify someone. I wanted to understand why they think like they do or behave like they do, even if it is theoretical.

Overall, it seems like his objective was to describe avoidants or identify them rather than figure out why they are like they are. It might be somewhat useful to an avoidant person to read the book just because they might recognize themselves in here somewhere.

About 17 pages are devoted to cause (at least 5 of which were examples). This chapter should be the center of the book if you want to understand the disorder, but it was treated superficially as well. Again, he seems to be describing the possible causes without explaining them. You expect some analysis from a psychologist, but he doesn't offer any.

Clinicians, researchers, and students seeking a clear picture of what AvPD looks like and how it functions will find no such depiction in this book. "Distancing" is less fact than it is poetry and fantasy. Kantor relies on pop-psychology ideals and strays lightyears away from the actual, accepted DSM-IV-R criteria for the disorder.

There are virtually NO empirical data given to support Kantor's claims. Instead, he heavily emphasizes Freudian writings (esp. "Totem and Taboo") and uses them as "sufficient" justification for his own conclusions. In fact, nearly a third of his references are from Freud; other references include fictional works such as "Madame Bovary." The bulk of Kantor's "data" derives from a handful of idiosyncratic individual cases, rather than from systematic examination of the AvPD-diagnosed population. Science is all but absent from this book.

Kantor's books on AvPD cannot be used as reliable tools for identifying, describing, or treating AvPD. His over-reliance on the outdated psychoanalytic/psychodynamic schools of thought and his outright avoidance of solid scientific data severely limit his ability to provide anything more than a minsinformed and stereotypical caricature of the disorder.

Kantor is clearly out of touch with the scientific community. The psychiatric and psychological literatures are in desperate need of a solid, in-depth examination of AvPD; this book isn't it. If you still want to read this book, get it at the library. You'll quickly learn it's not worth the fifty-some dollars you'd spend.

I bought this book because I myself have a relative with avoidant tendencies and wanted to learn as much as I could about AvPD. I certainly learned a lot from this thorough, well-written, reader-friendly book, including that my relative is indeed avoidant, that she is not alone, and that there is help for her available (too many of my relative's therapists failed to make the diagnosis and if they made it didn't really know what to do to cure her of the problem ) I did become suspicious that the few reviewers complaining that this book is mostly about gay men were overreacting, so I counted up the examples (about 250) and how many of them were actually about gay men (20), which is about 1 in 10, which is representative of the proportion of gays to straights in the general population. To me, the examples were right on, and illustrative of the author's technical points, helping to explain even the more difficult among them. Another criticism, that the traits cited as representative seemed to be too nonspecific, comes down to what I think is the failure of the reviewers to distinguish between a trait (symptom) and a diagnosis (syndrome). Sure, a lot of the behaviors cited were nonspecific, but the author never said that because an avoidant behaves as X that behaving as X means the individual is an avoidant. Highly recommended, and with few to no reservations.

I don't think that some of the criticism articulated by other readers is valid. First, Kantor's book is not intended as purely academic research material for scientists -- and this is what makes it easy to read and useful for a big audience. The book explicitly addresses persons with AvPD and their "victims", so you shouldn't expect highly academical lingo and math. Some sentences, although questionable from an academic point of view, are worth the book's money for major audiences. Example: "Victims of avoidants remain convinced that something is wrong with them, and try to do better, when it is the avoidant who has the problem and should be the one making the improvements." Great insight, and encouraging for those "victims", who are, unfortunately, part of the AvPD bill, too. I think it's fantastic how Kantor reflects and elaborates on this fact. Second, while there are lots of examples from gay couples and Mr. Kantor may be gay himself, I don't assume that this devaluates the book as there is probably no difference in how AvPD affects homosexual or heterosexual relationships.

I have been an avid fan of the work of Dr. Martin Kantor for quite some time now. This book, Distancing:Avoidant Personality Disorder is one of my favorites of all time, because it not only deals with the obvious factors surrounding the avoidant personality, but it also digs deeper into the more subtle, oft neglected aspects of this malady such as the formation of unstable relationships that are not necessarily due to shyness or fear of social situations, but rather may be simply byproducts of a fear of intimacy and commitment. Dr. Kantor is brilliant in his conversational style . He offers substance for the practicing therapist; help and hope for the patient; and support for the victims of those who suffer from Avoidant Personality Disorder, and who are distressed because they believe they must be doing something wrong. This book should be read by everyone--by those in the mental health profession, by those who suffer from the disorder to varying degrees, and by the rest of us who most likely either know someone, or have had someone in our lives at one time or another who made us miserable by their inability to get close. An indispensable book!

This book has been the only book I could find about the topic of avoidant personality disorder. There are many books that are written about the other personality disorders, but most only speak very briefly on avoidants. This book has a lot of information that is difficult to find anywhere else. As a matter of fact, the information itself is different then what can be found from other resources such as the internet. This book can be confusing to someone without a good grasp on what personality disorders are. For people familiar with PDs this book will provide a wealth of new information that goes beyond common knowledge of avpd.

Well I read it and it took awhile. I found the book helpful although it was a bit difficult to read. I especially liked the fact that Mr. Kantor brought up the need for someone with AvPD to change and not change his enviroment. Although, I don't believe that is entirely correct; the seniment is correct. I really wish there was more on AvPD. Mr. Kantor is correct to assume that there is too little information on the subject. People with this disorder live very difficult lives and probably have had to overcome many obstacles in life such as incredably difficult childhoods. This book expands far beyond the DSM-IV TR explanation of AvPD and I suggest reading the book to anyone who knows someone or is afflicted with the disorder. To the people who wrote the there is too many gay references in this book I say to you that gays are people too and I suggest reading Michael Kantor's other book on Homophobia.

Ordered this book along with the next one...and they are quite the same. Same interviews of the same patience. The essential guide to overcoming AvPD gives vague suggestions on what the Dr. thinks the patient should think to behave as a non- avoidant. As far as where to go and what to do...there is nothing that he offers for starters. He has a strict opinion that almost sounds like he is making fun of the the avoidant...not tasteful at all. I am not suffering from this but my son is and my hopes were high when I ordered these books. Looking for insight and answers to get him the help he needs. I was becoming confused reading these books. I don't care what strange beliefs his patients have...he went on and on about that. Almost like he was trying to fill the pages with something to say...making money as a retired Dr. Not a very good writer. AvPD patience have strange beliefs. They are truly scared and shaken in the presence of others. They have highly sensitive nervous systems and can't just think differently because he thinks they should. I would've liked to hear about people he has helped and that have made progress.