Specialized Treatment for Patients with Severe Avoidant Personality Disorder: Experiences from Scandinavia

Abstract
Avoidant personality disorder (AvPD) is a common and heterogeneous disorder. In spite of this, few studies have focused
on treatment, and treatment guidelines have not been developed. In Scandinavian countries many patients with low levels of
AvPD are treated sufficiently in private practices or in briefer psychiatric treatments, often for anxiety or depression. However,
patients with higher levels of personality dysfunction are often not helped sufficiently by such treatments. In this paper we
describe a longer and more intense treatment for severe AvPD based on a combination of Mentalization-Based Group Psychotherapy
and Metacognitive Interpersonal Individual Therapy. This treatment has been piloted in Norway and Denmark,
and we provide a case example of a successful treatment of a patient, “Julie” treated at Stolpegaard Psychotherapy Centre in
Denmark. Based on our review of the literature and experiences from the pilot studies, we also provide some observations
and general guidelines about important aspects of treatment of severe AvPD.
Keywords Avoidant personality disorder · Mentalization · Metacognition · Specialized treatment · Anxious personality ·
Detached personality