Social stigma

From Wikipedia, the free encyclopedia

Social stigma is the disapproval of, or discrimination against, a person based on perceivable social characteristics that serve to distinguish them from other members of a society. Social stigmas are commonly related to culture, gender, race, and health.

Description

Stigma is a Greek word that in its origins referred to a type of marking or tattoo that was cut or burned into the skin of criminals, slaves, or traitors in order to visibly identify them as blemished or morally polluted persons. These individuals were to be avoided particularly in public places.

Social stigmas can occur in many different forms. The most common deal with culture, gender, race, illness and disease. Individuals who are stigmatized usually feel different and devalued by others.

Stigma may also be described as a label that associates a person to a set of unwanted characteristics that form a stereotype. It is also affixed. Once people identify and label your differences others will assume that is just how things are and the person will remain stigmatized until the stigmatizing attribute is undetectable. A considerable amount of generalization is required to create groups, meaning that you put someone in a general group regardless of how well they actually fit into that group. However, the attributes that society selects differ according to time and place. What is considered out of place in one society could be the norm in another. When society categorizes individuals into certain groups the labeled person is subjected to status loss and discrimination. Society will start to form expectations about those groups once the cultural stereotype is secured.

Stigma may affect the behavior of those who are stigmatized. Those who are stereotyped often start to act in ways that their stigmatizers expect of them. It not only changes their behavior, but it also shapes their emotions and beliefs. Members of stigmatized social groups often face prejudice that causes depression (i.e. deprejudice). These stigmas put a person's social identity in threatening situations, like low self-esteem. Because of this, identity theories have become highly researched. Identity threat theories can go hand-in-hand with labeling theory. 

Members of stigmatized groups start to become aware that they aren't being treated the same way and know they are probably being discriminated against. Studies have shown that "by 10 years of age, most children are aware of cultural stereotypes of different groups in society, and children who are members of stigmatized groups are aware of cultural types at an even younger age."

Main theories and contributions

Émile Durkheim

French sociologist Émile Durkheim was the first to explore stigma as a social phenomenon in 1895. He wrote:

Imagine a society of saints, a perfect cloister of exemplary individuals. Crimes or deviance, properly so-called, will there be unknown; but faults, which appear venial to the layman, will there create the same scandal that the ordinary offense does in ordinary consciousnesses. If then, this society has the power to judge and punish, it will define these acts as criminal (or deviant) and will treat them as such.

Erving Goffman

Erving Goffman was one of the most influential sociologists of the twentieth century. He described stigma as a phenomenon whereby an individual with an attribute which is deeply discredited by his/her society is rejected as a result of the attribute. Goffman saw stigma as a process by which the reaction of others spoils normal identity.

More specifically, he explained that what constituted this attribute would change over time. "It should be seen that a language of relationships, not attributes, is really needed. An attribute that stigmatizes one type of possessor can confirm the usualness of another, and therefore is neither creditable nor discreditable as a thing in itself."

In Goffman's theory of social stigma, a stigma is an attribute, behavior, or reputation which is socially discrediting in a particular way: it causes an individual to be mentally classified by others in an undesirable, rejected stereotype rather than in an accepted, normal one. Goffman, a noted sociologist, defined stigma as a special kind of gap between virtual social identity and actual social identity:

Society establishes the means of categorizing persons and the complement of attributes felt to be ordinary and natural for members of each of these categories. [...] When a stranger comes into our presence, then, first appearances are likely to enable us to anticipate his category and attributes, his "social identity" [...] We lean on these anticipations that we have, transforming them into normative expectations, into righteously presented demands. [...] It is [when an active question arises as to whether these demands will be filled] that we are likely to realize that all along we had been making certain assumptions as to what the individual before us ought to be. [These assumed demands and the character we impute to the individual will be called] virtual social identity. The category and attributes he could in fact be proved to possess will be called his actual social identity. (Goffman 1963:2).

While a stranger is present before us, evidence can arise of his possessing an attribute that makes him different from others in the category of persons available for him to be, and of a less desirable kind--in the extreme, a person who is quite thoroughly bad, or dangerous, or weak. He is thus reduced in our minds from a whole and usual person to a tainted, discounted one. Such an attribute is a stigma, especially when its discrediting effect is very extensive [...] It constitutes a special discrepancy between virtual and actual social identity. Note that there are other types of [such] discrepancy [...] for example the kind that causes us to reclassify an individual from one socially anticipated category to a different but equally well-anticipated one, and the kind that causes us to alter our estimation of the individual upward. (Goffman 1963:3).

The stigmatized, the normal, and the wise

Goffman divides the individual's relation to a stigma into three categories:

1. the stigmatized are those who bear the stigma;
2. the normals are those who do not bear the stigma; and
3. the wise are those among the normals who are accepted by the stigmatized as "wise" to their condition (borrowing the term from the homosexual community).

The wise normals are not merely those who are in some sense accepting of the stigma; they are, rather, "those whose special situation has made them intimately privy to the secret life of the stigmatized individual and sympathetic with it, and who find themselves accorded a measure of acceptance, a measure of courtesy membership in the clan." That is, they are accepted by the stigmatized as "honorary members" of the stigmatized group. "Wise persons are the marginal men before whom the individual with a fault need feel no shame nor exert self-control, knowing that in spite of his failing he will be seen as an ordinary other." Goffman notes that the wise may in certain social situations also bear the stigma with respect to other normals: that is, they may also be stigmatized for being wise. An example is a parent of a homosexual; another is a white woman who is seen socializing with a black man. (Limiting ourselves, of course, to social milieus in which homosexuals and blacks are stigmatized). 

Until recently, this typology has been used without being empirically tested. A 2012 study showed empirical support for the existence of the own, the wise, and normals as separate groups; but, the wise appeared in two forms: active wise and passive wise. Active wise encouraged challenging stigmatization and educating stigmatizers, but passive wise did not.

Ethical considerations

Goffman emphasizes that the stigma relationship is one between an individual and a social setting with a given set of expectations; thus, everyone at different times will play both roles of stigmatized and stigmatizer (or, as he puts it, "normal"). Goffman gives the example that "some jobs in America cause holders without the expected college education to conceal this fact; other jobs, however, can lead to the few of their holders who have a higher education to keep this a secret, lest they be marked as failures and outsiders. Similarly, a middle class boy may feel no compunction in being seen going to the library; a professional criminal, however, writes [about keeping his library visits secret]." He also gives the example of blacks being stigmatized among whites, and whites being stigmatized among blacks.

Individuals actively cope with stigma in ways that vary across stigmatized groups, across individuals within stigmatized groups, and within individuals across time and situations.

The stigmatized

The stigmatized are ostracized, devalued, scorned, shunned and ignored. They experience discrimination in the realms of employment and housing. Perceived prejudice and discrimination is also associated with negative physical and mental health outcomes. Young people who experience stigma associated with mental health difficulties may face negative reactions from their peer group. Those who perceive themselves to be members of a stigmatized group, whether it is obvious to those around them or not, often experience psychological distress and many view themselves contemptuously.

Although the experience of being stigmatized may take a toll on self-esteem, academic achievement, and other outcomes, many people with stigmatized attributes have high self-esteem, perform at high levels, are happy and appear to be quite resilient to their negative experiences.

There are also "positive stigma": it is possible to be too rich, or too smart. This is noted by Goffman (1963:141) in his discussion of leaders, who are subsequently given license to deviate from some behavioral norms, because they have contributed far above the expectations of the group. This can result in social stigma.

The stigmatizer

From the perspective of the stigmatizer, stigmatization involves, threat, aversion and sometimes the depersonalization of others into stereotypic caricatures. Stigmatizing others can serve several functions for an individual, including self-esteem enhancement, control enhancement, and anxiety buffering, through downward-comparison—comparing oneself to less fortunate others can increase one's own subjective sense of well-being and therefore boost one's self-esteem.

21st century social psychologists consider stigmatizing and stereotyping to be a normal consequence of people's cognitive abilities and limitations, and of the social information and experiences to which they are exposed.

Current views of stigma, from the perspectives of both the stigmatizer and the stigmatized person, consider the process of stigma to be highly situationally specific, dynamic, complex and nonpathological.

Gerhard Falk

German born sociologist and historian Gerhard Falk wrote:

All societies will always stigmatize some conditions and some behaviors because doing so provides for group solidarity by delineating "outsiders" from "insiders".

Falk describes stigma based on two categories, existential stigma and achieved stigma. He defines existential stigma as "stigma deriving from a condition which the target of the stigma either did not cause or over which he has little control." He defines Achieved Stigma as "stigma that is earned because of conduct and/or because they contributed heavily to attaining the stigma in question."

Falk concludes that "we and all societies will always stigmatize some condition and some behavior because doing so provides for group solidarity by delineating 'outsiders' from 'insiders'". Stigmatization, at its essence is a challenge to one's humanity- for both the stigmatized person and the stigmatizer. The majority of stigma researchers have found the process of stigmatization has a long history and is cross-culturally ubiquitous.

Link and Phelan stigmatization model

Bruce Link and Jo Phelan propose that stigma exists when four specific components converge:

1. Individuals differentiate and label human variations.
2. Prevailing cultural beliefs tie those labeled to adverse attributes.
3. Labeled individuals are placed in distinguished groups that serve to establish a sense of disconnection between "us" and "them".
4. Labeled individuals experience "status loss and discrimination" that leads to unequal circumstances.

In this model stigmatization is also contingent on "access to social, economic, and political power that allows the identification of differences, construction of stereotypes, the separation of labeled persons into distinct groups, and the full execution of disapproval, rejection, exclusion, and discrimination." Subsequently, in this model the term stigma is applied when labeling, stereotyping, disconnection, status loss, and discrimination all exist within a power situation that facilitates stigma to occur.

Differentiation and labeling

Identifying which human differences are salient, and therefore worthy of labeling, is a social process. There are two primary factors to examine when considering the extent to which this process is a social one. The first issue is that significant oversimplification is needed to create groups. The broad groups of black and white, homosexual and heterosexual, the sane and the mentally ill; and young and old are all examples of this. Secondly, the differences that are socially judged to be relevant differ vastly according to time and place. An example of this is the emphasis that was put on the size of forehead and faces of individuals in the late 19th century—which was believed to be a measure of a person's criminal nature.

Linking to stereotypes

The second component of this model centers on the linking of labeled differences with stereotypes. Goffman's 1963 work made this aspect of stigma prominent and it has remained so ever since. This process of applying certain stereotypes to differentiated groups of individuals has attracted a large amount of attention and research in recent decades.

Us and them

Thirdly, linking negative attributes to groups facilitates separation into "us" and "them". Seeing the labeled group as fundamentally different causes stereotyping with little hesitation. "Us" and "them" implies that the labeled group is slightly less human in nature, and at the extreme not human at all. At this extreme, the most horrific events occur.

Disadvantage

The fourth component of stigmatization in this model includes "status loss and discrimination". Many definitions of stigma do not include this aspect, however these authors believe that this loss occurs inherently as individuals are "labeled, set apart, and linked to undesirable characteristics." The members of the labeled groups are subsequently disadvantaged in the most common group of life chances including income, education, mental well-being, housing status, health, and medical treatment. Thus, stigmatization by the majorities, the powerful, or the "superior" leads to the Othering of the minorities, the powerless, and the "inferior". Where by the stigmatized individuals become disadvantaged due to the ideology created by "the self," which is the opposing force to "the Other." As a result, the others become socially excluded and those in power reason the exclusion based on the original characteristics that led to the stigma.

Necessity of power

The authors also emphasize the role of power (social, economic, and political power) in stigmatization. While the use of power is clear in some situations, in others it can become masked as the power differences are less stark. An extreme example of a situation in which the power role was explicitly clear was the treatment of Jewish people by the Nazis. On the other hand, an example of a situation in which individuals of a stigmatized group have "stigma-related processes" occurring would be the inmates of a prison. It is imaginable that each of the steps described above would occur regarding the inmates' thoughts about the guards. However, this situation cannot involve true stigmatization, according to this model, because the prisoners do not have the economic, political, or social power to act on these thoughts with any serious discriminatory consequences.

'Stigma allure' and authenticity

Sociologist Matthew W. Hughey explains that prior research on stigma has emphasized individual and group attempts to reduce stigma by 'passing as normal', by shunning the stigmatized, or through selective disclosure of stigmatized attributes. Yet, some actors may embrace particular markings of stigma (e.g.: social markings like dishonor or select physical dysfunctions and abnormalities) as signs of moral commitment and/or cultural and political authenticity. Hence, Hughey argues that some actors do not simply desire to 'pass into normal' but may actively pursue a stigmatized identity formation process in order to experience themselves as causal agents in their social environment. Hughey calls this phenomenon 'stigma allure'.

The Six Dimensions of Stigma

While often incorrectly attributed to Goffman the "Six Dimensions of Stigma" were not his invention. They were developed to augment Goffman's two levels – the discredited and the discreditable. Goffman considered individuals whose stigmatizing attributes are not immediately evident. In that case, the individual can encounter two distinct social atmospheres. In the first, he is discreditable—his stigma has yet to be revealed, but may be revealed either intentionally by him (in which case he will have some control over how) or by some factor he cannot control. Of course, it also might be successfully concealed; Goffman called this passing. In this situation, the analysis of stigma is concerned only with the behaviors adopted by the stigmatized individual to manage his identity: the concealing and revealing of information. In the second atmosphere, he is discredited—his stigma has been revealed and thus it affects not only his behavior but the behavior of others. Jones et al. (1984) added the "six dimensions" and correlate them to Goffman's two types of stigma, discredited and discreditable. 

There are six dimensions that match these two types of stigma:

1. Concealable – extent to which others can see the stigma
2. Course of the mark – whether the stigma's prominence increases, decreases, or terminated
3. Disruptiveness – the degree to which the stigma and/or others' reaction to it impede social interactions
4. Aesthetics – the subset of others' reactions to the stigma comprising reactions that are positive/approving or negative/disapproving but represent estimations of qualities other than the stigmatized person's inherent worth or dignity
5. Origin – whether others think the stigma is present at birth, accidental, or deliberate
6. Peril – the danger that others perceive (whether accurately or inaccurately) the stigma to pose to them

Types

In Unraveling the contexts of stigma, authors Campbell and Deacon describe Goffman's universal and historical forms of Stigma as the following.

• Overt or external deformities - such as leprosy, clubfoot, cleft lip or palate and muscular dystrophy.
• Known deviations in personal traits - being perceived rightly or wrongly, as weak willed, domineering or having unnatural passions, treacherous or rigid beliefs, and being dishonest, e.g., mental disorders, imprisonment, addiction, homosexuality, unemployment, suicidal attempts and radical political behavior.
• Tribal stigma - affiliation with a specific nationality, religion, or race that constitute a deviation from the normative, i.e. being African American, or being of Arab descent in the United States after the 9/11 attacks.

Deviance

Stigma occurs when an individual is identified as deviant, linked with negative stereotypes that engender prejudiced attitudes, which are acted upon in discriminatory behavior. Goffman illuminated how stigmatized people manage their "Spoiled identity" (meaning the stigma disqualifies the stigmatized individual from full social acceptance) before audiences of normals. He focused on stigma, not as a fixed or inherent attribute of a person, but rather as the experience and meaning of difference.

Gerhard Falk expounds upon Goffman's work by redefining deviant as "others who deviate from the expectations of a group" and by categorizing deviance into two types:

• Societal deviance refers to a condition widely perceived, in advance and in general, as being deviant and hence stigma and stigmatized. "Homosexuality is therefore an example of societal deviance because there is such a high degree of consensus to the effect that homosexuality is different, and a violation of norms or social expectation".
• Situational deviance refers to a deviant act that is labeled as deviant in a specific situation, and may not be labeled deviant by society. Similarly, a socially deviant action might not be considered deviant in specific situations. "A robber or other street criminal is an excellent example. It is the crime which leads to the stigma and stigmatization of the person so affected." The physically disabled, mentally ill, homosexuals, and a host of others who are labeled deviant because they deviate from the expectations of a group, are subject to stigmatization- the social rejection of numerous individuals, and often entire groups of people who have been labeled deviant.

Stigma communication

Communication is involved in creating, maintaining, and diffusing stigmas, and enacting stigmatization. The model of stigma communication explains how and why particular content choices (marks, labels, peril, and responsibility) can create stigmas and encourage their diffusion. A recent experiment using health alerts tested the model of stigma communication, finding that content choices indeed predicted stigma beliefs, intentions to further diffuse these messages, and agreement with regulating infected persons' behaviors.

Challenging

Stigma, though powerful and enduring, is not inevitable, and can be challenged. There are two important aspects to challenging stigma: challenging the stigmatisation on the part of stigmatizers, and challenging the internalized stigma of the stigmatized. To challenge stigmatization, Campbell et al. 2005 summarise three main approaches.

1. There are efforts to educate individuals about the non-stigmatising facts and why they should not stigmatise.
2. There are efforts to legislate against discrimination.
3. There are efforts to mobilize the participation of community members in anti-stigma efforts, to maximize the likelihood that the anti-stigma messages have relevance and effectiveness, according to local contexts.

In relation to challenging the internalized stigma of the stigmatized, Paulo Freire's theory of critical consciousness is particularly suitable. Cornish provides an example of how sex workers in Sonagachi, a red light district in India, have effectively challenged internalized stigma by establishing that they are respectable women, who admirably take care of their families, and who deserve rights like any other worker. This study argues that it is not only the force of rational argument that makes the challenge to the stigma successful, but concrete evidence that sex workers can achieve valued aims, and are respected by others. 

Stigmatized groups often harbor cultural tools to respond to stigma and to create a positive self-perception among their members. For example, advertising professionals have been shown to suffer from negative portrayal and low approval rates. However, the advertising industry collectively maintains narratives describing how advertisement is a positive and socially valuable endeavor, and advertising professionals draw on these narratives to respond to stigma.

Current research

Research undertaken to determine effects of social stigma primarily focuses on disease-associated stigmas. Disabilities, psychiatric disorders, and sexually transmitted diseases are among the diseases currently scrutinized by researchers. In studies involving such diseases, both positive and negative effects of social stigma have been discovered.

Research on self-esteem

Members of stigmatized groups may have lower self-esteem than those of nonstigmatized groups. A test could not be taken on the overall self-esteem of different races. Researchers would have to take into account whether these people are optimistic or pessimistic, whether they are male or female and what kind of place they grew up in. Over the last two decades, many studies have reported that African Americans show higher global self-esteem than whites even though, as a group, African Americans tend to receive poorer outcomes in many areas of life and experience significant discrimination and stigma.

People with mental disorders

Empirical research on stigma associated with mental disorders, pointed to a surprising attitude of the general public. Those who were told that mental disorders had a genetic basis were more prone to increase their social distance from the mentally ill, and also to assume that the ill were dangerous individuals, in contrast with those members of the general public who were told that the illnesses could be explained by social and environment factors. Furthermore, those informed of the genetic basis were also more likely to stigmatize the entire family of the ill. Although the specific social categories that become stigmatized can vary over time and place, the three basic forms of stigma (physical deformity, poor personal traits, and tribal outgroup status) are found in most cultures and eras, leading some researchers to hypothesize that the tendency to stigmatize may have evolutionary roots.

Currently, several researchers believe that mental disorders are caused by a chemical imbalance in the brain. Therefore, this biological rationale suggests that individuals struggling with a mental illness do not have control over the origin of the disorder. Much like cancer or another type of physical disorder, persons suffering from mental disorders should be supported and encouraged to seek help. Unlike physical disabilities, there is a negative social stigma surrounding mental illness, with those suffering being perceived to have control of their disabilities and being responsible for causing them. "Furthermore, research respondents are less likely to pity persons with mental illness, instead reacting to psychiatric disability with anger and believing that help is not deserved." Although there are effective mental health interventions available across the globe, many persons with mental illnesses do not seek out the help that they need. Only 59.6% of individuals with a mental illness, including conditions such as depression, anxiety, schizophrenia, and bipolar disorder, reported receiving treatment in 2011. Reducing the negative stigma surrounding mental disorders may increase the probability of afflicted individuals seeking professional help from a psychiatrist or a non-psychiatric physician. How particular mental disorders are represented in the media can vary, as well as the stigma associated with each.

In the music industry, specifically in the genre of hip-hop or rap, those who speak out on mental illness are heavily criticized. However, according to a The Huffington Post article, there's a significant increase in rappers who are breaking their silence on depression and anxiety.

Addiction and substance use disorders

Throughout history, addiction has largely been seen as a moral failing or character flaw, as opposed to an issue of public health. Substance use has been found to be more stigmatized than smoking, obesity, and mental illness. Research has shown stigma to be a barrier to treatment-seeking behaviors among individuals with addiction, creating a "treatment gap". Research shows that the words used to talk about addiction can contribute to stigmatization, and that the commonly used terms of "abuse" & "abuser" actually increase stigma. Behavioral addictions (i.e. gambling, sex, etc.) are found to be more likely to be attributed to character flaws than substance-use addictions. Stigma is reduced when Substance Use Disorders are portrayed as treatable conditions. Acceptance and Commitment Therapy has been used effectively to help people to reduce shame associated with cultural stigma around substance use treatment.

Mental illness, Taiwan

In Taiwan, strengthening the psychiatric rehabilitation system has been one of the primary goals of the Department of Health since 1985. Unfortunately, this endeavor has not been successful and it is believed that one of the barriers is social stigma towards the mentally ill. Accordingly, a study was conducted to explore the attitudes of the general population towards patients with mental disorders. A survey method was utilized on 1,203 subjects nationally. The results revealed that the general population held high levels of benevolence, tolerance on rehabilitation in the community, and nonsocial restrictiveness. Essentially, benevolent attitudes were favoring the acceptance of rehabilitation in the community. It could then be inferred that the belief (held by the residents of Taiwan) in treating the mentally ill with high regard, somewhat eliminated the stigma.

Epilepsy, Hong Kong

Epilepsy, a common neurological disorder characterised by recurring seizures, is associated with various social stigmas. Chung-yan Gardian Fong and Anchor Hung conducted a study in Hong Kong which documented public attitudes towards individuals with epilepsy. Of the 1,128 subjects interviewed, only 72.5% of them considered epilepsy to be acceptable; 11.2% would not let their children play with others with epilepsy; 32.2% would not allow their children to marry persons with epilepsy; additionally, employers (22.5% of them) would terminate an employment contract after an epileptic seizure occurred in an employee with unreported epilepsy. Suggestions were made that more effort be made to improve public awareness of, attitude toward, and understanding of epilepsy through school education and epilepsy-related organizations.

In the media

In the early 21st century, technology has a large impact on the lives of people in multiple countries and has become a social norm. Many people own a television, computer, and a smart phone. The media can be helpful with keeping people up to date on news and world issues and it is very influential on people. Because it is so influential sometimes the portrayal of minority groups affects attitudes of other groups toward them. Much media coverage has to do with other parts of the world. A lot of this coverage has to do with war and conflict, which people may relate to any person belonging from that country. There is a tendency to focus more in the positive behaviour of one's own group and the negative behaviours of other groups. This promotes negative thoughts of people belonging to those other groups, reinforcing stereotypical beliefs.

"Viewers seem to react to violence with emotions such as anger and contempt. They are concerned for the integrity of the social order and show disapproval of others. Emotions such as sadness and fear are shown much more rarely." (Unz, Schwab & Winterhoff-Spurk, 2008, p. 141)

In a study testing the effects of stereotypical advertisements on students, 75 high school students viewed magazine advertisements with stereotypical female images such as a woman working on a holiday dinner, while 50 others viewed non stereotypical images such as a woman working in a law office. These groups then responded to statements about women in a "neutral" photograph. In this photo a woman was shown in a casual outfit not doing any obvious task. The students that saw the stereotypical images tended to answer the questionnaires with more stereotypical responses in 6 of the 12 questionnaire statements. This suggests that even brief exposure to stereotypical ads reinforces stereotypes.(Lafky, Duffy, Steinmaus & Berkowitz, 1996)

Effects of education, culture

The aforementioned stigmas (associated with their respective diseases) propose effects that these stereotypes have on individuals. Whether effects be negative or positive in nature, 'labeling' people causes a significant change in individual perception (of persons with disease). Perhaps a mutual understanding of stigma, achieved through education, could eliminate social stigma entirely. 

Laurence J. Coleman first adapted Erving Goffman's (1963) social stigma theory to gifted children, providing a rationale for why children may hide their abilities and present alternate identities to their peers. The stigma of giftedness theory was further elaborated by Laurence J. Coleman and Tracy L. Cross in their book entitled, Being Gifted In School, which is a widely cited reference in the field of gifted education. In the chapter on Coping with Giftedness, the authors expanded on the theory first presented in a 1988 article. According to Google Scholar, this article has been cited at least 110 times in the academic literature.

Coleman and Cross were the first to identify intellectual giftedness as a stigmatizing condition and they created a model based on Goffman's (1963) work, research with gifted students, and a book that was written and edited by 20 teenage, gifted individuals. Being gifted sets students apart from their peers and this difference interferes with full social acceptance. Varying expectations that exist in the different social contexts which children must navigate, and the value judgments that may be assigned to the child result in the child's use of social coping strategies to manage his or her identity. Unlike other stigmatizing conditions, giftedness is a unique because it can lead to praise or ridicule depending on the audience and circumstances. 

Gifted children learn when it is safe to display their giftedness and when they should hide it to better fit in with a group. These observations led to the development of the Information Management Model that describes the process by which children decide to employ coping strategies to manage their identities. In situations where the child feels different, she or he may decide to manage the information that others know about him or her. Coping strategies include: disidentification with giftedness, attempting to maintain a low visibility, or creating a high-visibility identity (playing a stereotypical role associated with giftedness). These ranges of strategies are called the Continuum of Visibility.

Stigmatising attitude of narcissists to psychiatric illness

Arikan found that a stigmatising attitude to psychiatric patients is associated with narcissistic personality traits.

Abortion

While abortion medicine is very common in western society, women rarely disclose their use of such services, and providers are also subject to stigma.

Stigmatization of Prejudice

Cultural norms can prevent displays of prejudice as such views are stigmatized and thus people will express non-prejudiced views even if they believe otherwise (preference falsification). However, if the stigma against such views is lessened, people will be more willing to express prejudicial sentiments. For example, following the 2008 economic crisis, anti-immigration sentiment seemingly increased amongst the US population when in reality the level of sentiment remained the same and instead it simply became more acceptable to openly express opposition to immigration.

Social exclusion

From Wikipedia, the free encyclopedia

Social exclusion, or social marginalisation, is the social disadvantage and relegation to the fringe of society. It is a term used widely in Europe and was first used in France. It is used across disciplines including education, sociology, psychology, politics and economics.

Social exclusion is the process in which individuals or people are systematically blocked from (or denied full access to) various rights, opportunities and resources that are normally available to members of a different group, and which are fundamental to social integration and observance of human rights within that particular group (e.g., housing, employment, healthcare, civic engagement, democratic participation, and due process).

Alienation or disenfranchisement resulting from social exclusion can be connected to a person's social class, race, skin color, religious affiliation, ethnic origin, educational status, childhood relationships, living standards, or appearance. Such exclusionary forms of discrimination may also apply to people with a disability, minorities, LGBTQ+ people, drug users, institutional care leavers, the elderly and the young. Anyone who appears to deviate in any way from perceived norms of a population may thereby become subject to coarse or subtle forms of social exclusion.

The outcome of social exclusion is that affected individuals or communities are prevented from participating fully in the economic, social, and political life of the society in which they live. This may result to a resistance in form of demonstrations, protests, or lobbying from the excluded people.

Overview

Most of the characteristics listed in this article are present together in studies of social exclusion, due to exclusion's multidimensionality. 

Another way of articulating the definition of social exclusion is as follows:

Social exclusion is a multidimensional process of progressive social rupture, detaching groups and individuals from social relations and institutions and preventing them from full participation in the normal, normatively prescribed activities of the society in which they live.

In an alternative conceptualization, social exclusion theoretically emerges at the individual or group level on four correlated dimensions: insufficient access to social rights, material deprivation, limited social participation and a lack of normative integration. It is then regarded as the combined result of personal risk factors (age, gender, race); macro-societal changes (demographic, economic and labor market developments, technological innovation, the evolution of social norms); government legislation and social policy; and the actual behavior of businesses, administrative organizations and fellow citizens.

Individual exclusion

The marginal man...is one whom fate has condemned to live in two societies and in two, not merely different but antagonistic cultures....his mind is the crucible in which two different and refractory cultures may be said to melt and, either wholly or in part, fuse.

Social exclusion at the individual level results in an individual's exclusion from meaningful participation in society. An example is the exclusion of single mothers from the welfare system prior to welfare reforms of the 1900s. The modern welfare system is based on the concept of entitlement to the basic means of being a productive member of society both as an organic function of society and as compensation for the socially useful labor provided. A single mother's contribution to society is not based on formal employment, but on the notion that provision of welfare for children is a necessary social expense. In some career contexts, caring work is devalued and motherhood is seen as a barrier to employment. Single mothers were previously marginalized in spite of their significant role in the socializing of children due to views that an individual can only contribute meaningfully to society through "gainful" employment as well as a cultural bias against unwed mothers. When the father's sole task was seen as the breadwinner, his marginalization was primarily a function of class condition. Solo fatherhood brings additional trials due to society being less accepting of males 'getting away with' not working and the general invisibility/lack of acknowledgement of single fathers in society. Acknowledgement of the needs participatory fathers may have can be found by examining the changes from the original clinical report on the father’s role published by the American Academy of Pediatrics in May 2004. Eight week paternity leave is a good example of one social change. Child health care providers have an opportunity to have a greater influence on the child and family structure by supporting fathers and enhancing a father's involvement.

More broadly, many women face social exclusion. Moosa-Mitha discusses the Western feminist movement as a direct reaction to the marginalization of white women in society. Women were excluded from the labor force and their work in the home was not valued. Feminists argued that men and women should equally participate in the labor force, in the public and private sector, and in the home. They also focused on labor laws to increase access to employment as well as to recognize child-rearing as a valuable form of labor. In some places today, women are still marginalized from executive positions and continue to earn less than men in upper management positions.

Another example of individual marginalization is the exclusion of individuals with disabilities from the labor force. Grandz discusses an employer's viewpoint about hiring individuals living with disabilities as jeopardizing productivity, increasing the rate of absenteeism, and creating more accidents in the workplace. Cantor also discusses employer concern about the excessively high cost of accommodating people with disabilities. The marginalization of individuals with disabilities is prevalent today, despite the legislation intended to prevent it in most western countries, and the academic achievements, skills and training of many disabled people.

There are also exclusions of lesbian-gay-bisexual-transgender (LGBT) and other intersexual people because of their sexual orientations and gender identities. The Yogyakarta Principles require that the states and communities abolish any stereotypes about LGBT people as well as stereotyped gender roles.

Isolation is common to almost every vocational, religious or cultural group of a large city. Each develops its own sentiments, attitudes, codes, even its own words, which are at best only partially intelligible to others.

Community exclusion

Many communities experience social exclusion, such as racial (e.g., black) (e.g., Untouchables or Low Castes or Dalits in Indian Caste System ) and economic (e.g., Romani) communities. 

One example is the Aboriginal community in Australia. Marginalization of Aboriginal communities is a product of colonization. As a result of colonialism, Aboriginal communities lost their land, were forced into destitute areas, lost their sources of livelihood, and were excluded from the labor market. Additionally, Aboriginal communities lost their culture and values through forced assimilation and lost their rights in society. Today various Aboriginal communities continue to be marginalized from society due to the development of practices, policies and programs that "met the needs of white people and not the needs of the marginalized groups themselves". Yee also connects marginalization to minority communities, when describing the concept of whiteness as maintaining and enforcing dominant norms and discourse. Poor people living in run-down council estates and areas with high crime can be locked into social deprivation.

Other contributors

Social exclusion has many contributors. Major contributors include race, income, employment status, social class, geographic location, personal habits and appearance, education, religion and political affiliation.

Global and structural

Globalization (global-capitalism), immigration, social welfare and policy are broader social structures that have the potential to contribute negatively to one's access to resources and services, resulting in the social exclusion of individuals and groups. Similarly, increasing use of information technology and company outsourcing have contributed to job insecurity and a widening gap between the rich and the poor. Alphonse, George & Moffat (2007) discuss how globalization sets forth a decrease in the role of the state with an increase in support from various "corporate sectors resulting in gross inequalities, injustices and marginalization of various vulnerable groups" (p. 1). Companies are outsourcing, jobs are lost, the cost of living continues to rise, and land is being expropriated by large companies. Material goods are made in large abundances and sold at cheaper costs, while in India for example, the poverty line is lowered in order to mask the number of individuals who are actually living in poverty as a result of globalization. Globalization and structural forces aggravate poverty and continue to push individuals to the margins of society, while governments and large corporations do not address the issues (George, P, SK8101, lecture, October 9, 2007).

Certain language and the meaning attached to language can cause universalizing discourses that are influenced by the Western world, which is what Sewpaul (2006) describes as the "potential to dilute or even annihilate local cultures and traditions and to deny context specific realities" (p. 421). What Sewpaul (2006) is implying is that the effect of dominant global discourses can cause individual and cultural displacement, as well as an experience of "de-localization", as individual notions of security and safety are jeopardized (p. 422). Insecurity and fear of an unknown future and instability can result in displacement, exclusion, and forced assimilation into the dominant group. For many, it further pushes them to the margins of society or enlists new members to the outskirts because of global-capitalism and dominant discourses (Sewpaul, 2006).

With the prevailing notion of globalization, we now see the rise of immigration as the world gets smaller and smaller with millions of individuals relocating each year. This is not without hardship and struggle of what a newcomer thought was going to be a new life with new opportunities. Ferguson, Lavalette, & Whitmore (2005) discuss how immigration has had a strong link to access of welfare support programs. Newcomers are constantly bombarded with the inability to access a country's resources because they are seen as "undeserving foreigners" (p. 132). With this comes a denial of access to public housing, health care benefits, employment support services, and social security benefits (Ferguson et al., 2005). Newcomers are seen as undeserving, or that they must prove their entitlement in order to gain access to basic support necessities. It is clear that individuals are exploited and marginalized within the country they have emigrated (Ferguson et al., 2005).

Welfare states and social policies can also exclude individuals from basic necessities and support programs. Welfare payments were proposed to assist individuals in accessing a small amount of material wealth (Young, 2000). Young (2000) further discusses how "the provision of the welfare itself produces new injustice by depriving those dependent on it of rights and freedoms that others have…marginalization is unjust because it blocks the opportunity to exercise capacities in socially defined and recognized way" (p. 41). There is the notion that by providing a minimal amount of welfare support, an individual will be free from marginalization. In fact, welfare support programs further lead to injustices by restricting certain behaviour, as well the individual is mandated to other agencies. The individual is forced into a new system of rules while facing social stigma and stereotypes from the dominant group in society, further marginalizing and excluding individuals (Young, 2000). Thus, social policy and welfare provisions reflect the dominant notions in society by constructing and reinforcing categories of people and their needs. It ignores the unique-subjective human essence, further continuing the cycle of dominance (Wilson & Beresford, 2000).

Unemployment

Whilst recognizing the multi-dimensionality of exclusion, policy work undertaken at European Union level focuses on unemployment as a key cause of, or at least correlating with, social exclusion. This is because in modern societies, paid work is not only the principal source of income with which to buy services, but is also the fount of individuals' identity and feeling of self-worth. Most people's social networks and sense of embeddedness in society also revolve around their work. Many of the indicators of extreme social exclusion, such as poverty and homelessness, depend on monetary income which is normally derived from work. Social exclusion can be a possible result of long-term unemployment, especially in countries with weak welfare safety nets. Much policy to reduce exclusion thus focuses on the labour market:

• On the one hand, to make individuals at risk of exclusion more attractive to employers, i.e. more "employable".
• On the other hand, to encourage (and/or oblige) employers to be more inclusive in their employment policies.

The EU's EQUAL Community Initiative investigated ways to increase the inclusiveness of the labour market. Work on social exclusion more broadly is carried out through the Open Method of Coordination (OMC) among the Member State governments.

Religion

Some religious traditions recommend excommunication of individuals said to deviate from a religious teaching, and in some instances shunning by family members. Some religious organisations permit the censure of critics. 

Across societies, individuals and communities can be socially excluded on the basis of their religious beliefs. Social hostility against religious minorities and communal violence occur in areas where governments do not have policies restricting the religious practise of minorities. A study by the Pew Research Center on international religious freedom found that 61% of countries have social hostilities that tend to target religious minorities. The five highest social hostility scores were for Pakistan, India, Sri Lanka, Iraq, and Bangladesh. In 2015, Pew published that social hostilities declined in 2013, but Harassment of Jews increased.

Social inclusion

Social inclusion, the converse of social exclusion, is affirmative action to change the circumstances and habits that lead to (or have led to) social exclusion. The World Bank defines social inclusion as the process of improving the ability, opportunity, and dignity of people, disadvantaged on the basis of their identity, to take part in society. The World Bank's 2019 World Development Report on The Changing Nature of Work suggests that enhanced social protection and better investments in human capital improve equality of opportunity and social inclusion.

Social Inclusion ministers have been appointed, and special units established, in a number of jurisdictions around the world. The first Minister for Social Inclusion was Premier of South Australia Mike Rann, who took the portfolio in 2004. Based on the UK's Social Exclusion Unit, established by Prime Minister Tony Blair in 1997, Rann established the Social Inclusion Initiative in 2002. It was headed by Monsignor David Cappo and was serviced by a unit within the department of Premier and Cabinet. Cappo sat on the Executive Committee of the South Australian Cabinet and was later appointed Social Inclusion Commissioner with wide powers to address social disadvantage. Cappo was allowed to roam across agencies given that most social disadvantage has multiple causes necessitating a "joined up" rather than a single agency response. The Initiative drove a big investment by the South Australian Government in strategies to combat homelessness, including establishing Common Ground, building high quality inner city apartments for "rough sleeping" homeless people, the Street to Home initiative and the ICAN flexible learning program designed to improve school retention rates. It also included major funding to revamp mental health services following Cappo's "Stepping Up" report, which focused on the need for community and intermediate levels of care and an overhaul of disability services. In 2007 Australian Prime Minister Kevin Rudd appointed Julia Gillard as the nation's first Social Inclusion Minister.

In Japan, the concept and term "social inclusion" went through a number of changes over time and eventually became incorporated in community-based activities under the monikers hōsetsu (包摂) and hōkatsu (包括), such as in the "Community General Support Centres" (chiiki hōkatsu shien sentā 地域包括支援センター) and "Community-based Integrated Care System" (chiiki hōkatsu kea shisutemu　地域包括ケアシステム).

Consequences

Health

In gay men, results of psycho-emotional damage from marginalization from a heteronormative society, suicide, and drug addiction.

Scientists have been studying the impact of racism on health. Amani Nuru-Jeter, a social epidemiologist at the University of California, Berkeley and other doctors have been hypothesizing that exposure to chronic stress may be one way racism contributes to health disparities between racial groups. Arline Geronimus, a research professor at the University of Michigan Institute for Social Research and a professor at the School of Public Health, and her colleagues found that psychosocial associated with living in extreme poverty can cause early onset of age-related diseases. The 2015 study titled, "Race-Ethnicity, Poverty, Urban Stressors, and Telomere Length in a Detroit Community-based Sample" was conducted in order to determine the impact of living conditions on health and was performed by a multi-university team of social scientists, cellular biologists and community partners, including the Healthy Environments Partnership (HEP) to measured the telomere length of poor and moderate-income people of White, African-American and Mexican race.

In 2006, there was research focused on possible connections between exclusion and brain function. Studies published by both the University of Georgia and San Diego State University found that exclusion can lead to diminished brain functioning and poor decision making. Such studies corroborate with earlier beliefs of sociologists. The effect of social exclusion have been hypothesized in various past research studies to correlate with such things as substance abuse and addiction, and crime.

Economics

The problem of social exclusion is usually tied to that of equal opportunity, as some people are more subject to such exclusion than others. Marginalisation of certain groups is a problem in many economically more developed countries, including the United Kingdom and the United States, where the majority of the population enjoys considerable economic and social opportunities.

In philosophy

The marginal, the processes of marginalisation, etc. bring specific interest in postmodern and postcolonial philosophy and social studies. Postmodernism question the "center" about its authenticity and postmodern sociology and cultural studies research marginal cultures, behaviors, societies, the situation of the marginalized individual, etc.

Implications for social work practice

Upon defining and describing marginalization as well as the various levels in which it exists, one must now explore its implications for social work practice. Mullaly (2007) describes how "the personal is political" and the need for recognizing that social problems are indeed connected with larger structures in society, causing various forms of oppression amongst individuals resulting in marginalization. It is also important for the social worker to recognize the intersecting nature of oppression. A non-judgmental and unbiased attitude is necessary on the part of the social worker. The worker must begin to understand oppression and marginalization as a systemic problem, not the fault of the individual.

Working under an anti-oppression perspective would then allow the social worker to understand the lived, subjective experiences of the individual, as well as their cultural, historical and social background. The worker should recognize the individual as political in the process of becoming a valuable member of society and the structural factors that contribute to oppression and marginalization (Mullaly, 2007). Social workers must take a firm stance on naming and labeling global forces that impact individuals and communities who are then left with no support, leading to marginalization or further marginalization from the society they once knew (George, P, SK8101, lecture, October 9, 2007).

The social worker should be constantly reflexive, work to raise the consciousness, empower, and understand the lived subjective realities of individuals living in a fast-paced world, where fear and insecurity constantly subjugate the individual from the collective whole, perpetuating the dominant forces, while silencing the oppressed.

Some individuals and groups who are not professional social workers build relationships with marginalized persons by providing relational care and support, for example, through homeless ministry. These relationships validate the individuals who are marginalized and provide them a meaningful contact with the mainstream.

Juridical concept

There are countries, Italy for example, that have a legal concept of social exclusion. In Italy, "esclusione sociale" is defined as poverty combined with social alienation, by the statute n. 328 (11-8-2000), that instituted a state investigation commission named "Commissione di indagine sull'Esclusione Sociale" (CIES) to make an annual report to the government on legally expected issues of social exclusion.

The Vienna Declaration and Programme of Action, a document on international human rights instruments affirms that "extreme poverty and social exclusion constitute a violation of human dignity and that urgent steps are necessary to achieve better knowledge of extreme poverty and its causes, including those related to the program of development, in order to promote the human rights of the poorest, and to put an end to extreme poverty and social exclusion and promote the enjoyment of the fruits of social progress. It is essential for States to foster participation by the poorest people in the decision making process by the community in which they live, the promotion of human rights and efforts to combat extreme poverty."

Quotations

Social exclusion is about the inability of our society to keep all groups and individuals within reach of what we expect as a society...[or] to realise their full potential.

Whatever the content and criteria of social membership, socially excluded groups and individuals lack capacity or access to social opportunity.

To be "excluded from society" can take various relative senses, but social exclusion is usually defined as more than a simple economic phenomenon: it also has consequences on the social, symbolic field. 

Women of Pakistani, Bangladeshi and Caribbean descent [in Britain] are doing well in schools but are still being penalised in the workplace...80-89% of 16-year-olds from those ethnic groups wanted to work full-time...but they were up to four times more likely to be jobless.

Philosopher Axel Honneth thus speaks of a "struggle for recognition", which he attempts to theorize through Hegel's philosophy. In this sense, to be socially excluded is to be deprived from social recognition and social value. In the sphere of politics, social recognition is obtained by full citizenship; in the economic sphere (in capitalism) it means being paid enough to be able to participate fully in the life of the community.

This concept can be gleaned from considering examples of the "social integration crisis: poverty, professional exclusion or marginalization, social and civic disenfranchisement, absence or weakening of support networks, frequent inter-cultural conflicts", These relate not only to gender, race and disability, but also to crime:

Social exclusion is a major cause of crime and re-offending. Removing the right to vote increases social exclusion by signalling to serving prisoners that, at least for the duration of their sentence, they are dead to society. The additional punishment of disenfranchisement is not a deterrent. There is no evidence to suggest that criminals are deterred from offending behaviour by the threat of losing the right to vote.....(and) the notion of civic death for sentenced prisoners isolates still further those who are already on the margins of society and encourages them to be seen as alien to the communities to which they will return on release.

Avoidant personality disorder

From Wikipedia, the free encyclopedia

Avoidant personality disorder
Synonyms	Anxious personality disorder
Specialty	Psychiatry

Avoidant personality disorder (AvPD) is a Cluster C personality disorder. Those affected display a pattern of severe social anxiety, social inhibition, feelings of inadequacy and inferiority, extreme sensitivity to negative evaluation and rejection, and avoidance of social interaction despite a strong desire for intimacy. The behavior is usually noticed by early adulthood and occurs in most situations.

People with AvPD, often, consider themselves to be socially inept or personally unappealing and avoid social interaction for fear of being ridiculed, humiliated, rejected, or disliked. They generally avoid becoming involved with others unless they are certain they will be liked. As the name suggests, the main coping mechanism of those with AvPD is avoidance of feared stimuli. Childhood emotional neglect (in particular, the rejection of a child by one or both parents) and peer group rejection are associated with an increased risk for its development; however, it is possible for AvPD to occur without any notable history of abuse or neglect.

Some researchers have theorized certain cases of AvPD may occur when individuals with innately high sensory processing sensitivity (characterized by deeper processing of physical and emotional stimuli, alongside high levels of empathy) are raised in abusive ' negligent ' or otherwise dysfunctional environments, which inhibits their ability to form secure bonds with others.

Signs and symptoms

Avoidant individuals often choose jobs of isolation so that they do not have to interact with the public regularly, due to their anxiety and fear of embarrassing themselves in front of others. Some with this disorder may fantasize about idealized, accepting, and affectionate relationships, due to their desire to belong. Individuals with the disorder tend to describe themselves as uneasy ' anxious ' lonely ' unwanted ' and isolated from others. They often feel themselves unworthy of the relationships they desire, so they shame themselves from ever attempting to begin them.

People with AvPD are preoccupied with their own shortcomings and form relationships with others only if they believe they will not be rejected. Loss and social rejection are so painful that these individuals will choose to be alone rather than risk trying to connect with others. They, often, view themselves with contempt, while showing an increased inability to identify traits within themselves that are generally considered as positive within their societies.

• Extreme shyness or anxiety in social situations, though the person feels a strong desire for close relationships
• Heightened attachment-related anxiety, which may include a fear of abandonment
• Substance abuse and/or dependence

Comorbidity

AvPD is reported to be especially prevalent in people with anxiety disorders, although estimates of comorbidity vary widely due to differences in (among others) diagnostic instruments. Research suggests that approximately 10–50% of people who have panic disorder with agoraphobia have avoidant personality disorder, as well as about 20–40% of people who have social anxiety disorder. In addition to this, AvPD is more prevalent in people who have comorbid social anxiety disorder and generalised anxiety disorder than in those who have only one of the aforementioned conditions.

Some studies report prevalence rates of up to 45% among people with generalized anxiety disorder and up to 56% of those with obsessive-compulsive disorder. Posttraumatic stress disorder is also commonly comorbid with avoidant personality disorder.

Avoidants are prone to self-loathing and, in certain cases, self-harm. In particular, avoidants who have comorbid PTSD have the highest rates of engagement in self-harming behavior, outweighing, even, those with borderline personality disorder (with or without PTSD). Substance use disorders are, also, common in individuals with AvPD—particularly in regards to alcohol, benzodiazepines and heroin—and may significantly affect a patient's prognosis.

Earlier theorists proposed a personality disorder with a combination of features from borderline personality disorder and avoidant personality disorder, called "avoidant-borderline mixed personality" (AvPD/BPD).

Causes

Causes of AvPD are not clearly defined, but appear to be influenced by a combination of social, genetic, and psychological factors. The disorder may be related to temperamental factors that are inherited. Specifically, various anxiety disorders in childhood and adolescence have been associated with a temperament characterized by behavioral inhibition, including features of being shy, fearful, and withdrawn in new situations. These inherited characteristics may give an individual a genetic predisposition towards AvPD. Childhood emotional neglect and peer group rejection are both associated with an increased risk for the development of AvPD. Some researchers believe a combination of high-sensory-processing sensitivity coupled with adverse childhood experiences may heighten the risk of an individual developing AvPD.

Subtypes

Millon

Psychologist Theodore Millon notes that because most patients present a mixed picture of symptoms, their personality disorder tends to be a blend of a major personality disorder type with one or more secondary personality disorder types. He identified four adult subtypes of avoidant personality disorder.

Subtype and description	Personality traits
Phobic avoidant (including dependent features)	General apprehensiveness displaced with avoidable tangible precipitant; qualms and disquietude symbolized by repugnant and specific dreadful object or circumstances.
Conflicted avoidant (including negativistic features)	Internal discord and dissension; fears dependence; unsettled; unreconciled within self; hesitating, confused, tormented, paroxysmic, embittered; unresolvable angst.
Hypersensitive avoidant (including paranoid features)	Intensely wary and suspicious; alternately panicky, terrified, edgy, and timorous, then thin-skinned, high-strung, petulant, and prickly.
Self-deserting avoidant (including depressive features)	Blocks or fragments self awareness; discards painful images and memories; casts away untenable thoughts and impulses; ultimately jettisons self (suicidal).

Others

In 1993, Lynn E. Alden and Martha J. Capreol proposed two other subtypes of avoidant personality disorder:

Subtype	Features
Cold-avoidant	Characterised by an inability to experience and express positive emotion towards others.
Exploitable-avoidant	Characterised by an inability to express anger towards others or to resist coercion from others. May be at risk for abuse by others.

Diagnosis

WHO

The World Health Organization's ICD-10 lists avoidant personality disorder as anxious (avoidant) personality disorder (F60.6). 

It is characterized by at least four of the following:

1. persistent and pervasive feelings of tension and apprehension;
2. belief that one is socially inept, personally unappealing, or inferior to others;
3. excessive preoccupation with being criticized or rejected in social situations;
4. unwillingness to become involved with people unless certain of being liked;
5. restrictions in lifestyle because of need to have physical security;
6. avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection.

Associated features may include hypersensitivity to rejection and criticism.

It is a requirement of ICD-10 that all personality disorder diagnoses also satisfy a set of general personality disorder criteria.

APA

The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the APA also has an Avoidant Personality Disorder diagnosis (301.82). It refers to a widespread pattern of inhibition around people, feeling inadequate and being very sensitive to negative evaluation. Symptoms begin by early adulthood and occur in a range of situations. Four of seven specific symptoms should be present, which are the following:

1. Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
2. Is unwilling to get involved with people unless certain of being liked
3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
4. Is preoccupied with being criticized or rejected in social situations
5. Is inhibited in new interpersonal situations because of feelings of inadequacy
6. Views self as socially inept, personally unappealing, or inferior to others
7. Is unusually reluctant to take personal risk or to engage in any new activities because they may prove embarrassing

Differential diagnosis

In contrast to social anxiety disorder, a diagnosis of avoidant personality disorder (AvPD) also requires that the general criteria for a personality disorder are met. 

According to the DSM-5 avoidant personality disorder must be differentiated from similar personality disorders such as dependent, paranoid, schizoid, and schizotypal. But these can also occur together; this is particularly likely for AvPD and dependent personality disorder. Thus, if criteria for more than one personality disorder are met, all can be diagnosed.

There is also an overlap between avoidant and schizoid personality traits and AvPD may have a relationship to the schizophrenia spectrum.

Treatment

Treatment of avoidant personality disorder can employ various techniques, such as social skills training, psychotherapy, cognitive therapy, and exposure treatment to gradually increase social contacts, group therapy for practicing social skills, and sometimes drug therapy.

A key issue in treatment is gaining and keeping the patient's trust, since people with avoidant personality disorder will often start to avoid treatment sessions if they distrust the therapist or fear rejection. The primary purpose of both individual therapy and social skills group training is for individuals with avoidant personality disorder to begin challenging their exaggerated negative beliefs about themselves.

Significant improvement in the symptoms of personality disorders is possible, with the help of treatment and individual effort.

Prognosis

Being a personality disorder, which are usually chronic and long-lasting mental conditions, avoidant personality disorder is not expected to improve with time without treatment. It is a poorly studied personality disorder and in light of prevalence rates, societal costs, and the current state of research, AvPD qualifies as a neglected disorder.

Controversy

There is controversy as to whether avoidant personality disorder (AvPD) is distinct from generalized social anxiety disorder. Both have similar diagnostic criteria and may share a similar causation, subjective experience, course, treatment and identical underlying personality features, such as shyness.

It is contended by some that they are merely different conceptualisations of the same disorder, where avoidant personality disorder may represent the more severe form. In particular, those with AvPD experience not only more severe social phobia symptoms, but are also more depressed and more functionally impaired than patients with generalized social phobia alone. But they show no differences in social skills or performance on an impromptu speech. Another difference is that social phobia is the fear of social circumstances whereas AvPD is better described as an aversion to intimacy in relationships.

Epidemiology

Data from the 2001–02 National Epidemiologic Survey on Alcohol and Related Conditions indicates a prevalence rate of 2.36% in the American general population. It appears to occur with equal frequency in males and females. In one study, it was seen in 14.7% of psychiatric outpatients.

History

The avoidant personality has been described in several sources as far back as the early 1900s, although it was not so named for some time. Swiss psychiatrist Eugen Bleuler described patients who exhibited signs of avoidant personality disorder in his 1911 work Dementia Praecox: Or the Group of Schizophrenias. Avoidant and schizoid patterns were frequently confused or referred to synonymously until Kretschmer (1921), in providing the first relatively complete description, developed a distinction.