Why You're So Avoidant ft. Dr. Kirk Honda @PsychologyInSeattle

0:03 for kindness So Close Your Eyes take a few moments to breathe in and breathe out [Music]

0:51 h [Music] [Applause] [Music] oh [Music]

1:48 but I would say on a on a deeper level it's more like when when we say work on yourself that involves all kinds of like things about moving your life forward and they struggle with motivation in these things it's because when I don't think I'm worth it I'm not worth fixing [Music]

2:45 h [Music] oh [Music]

3:42 when you develop empathy and compassion for other people there's going to be room for someone else in the relationship and then this in turn is going to reduce the feeling of being an object now two people can connect and now it's not about getting your needs met in Starvation it's about two human beings forming a [Music] relationship all righty chat let's get started welcome to another healthy gamer GG stream my name is Dr Al kenoa just a reminder that although I'm a psychiatrist nothing we discuss on stream today is intended to be taken as medical advice everything is for

4:28 educational or entertainment purposes only if yall have a medical concern or question please go see a licensed professional um so today we've got a super awesome stream guest who I hope is coming and hopefully nothing fell through um but we are hopefully going to be talking to Dr KK Honda from psychology in Seattle who's an expert on personality disorders so uh you know I have some experience with personality disorders so like I do do deal a lot with more cluster B stuff so for those of you all that aren't familiar with this stuff I do a lot of work with people with sociopathy narcissism and borderline personality disorder those are really like what I I yeah so that's

5:15 kind of where I have a lot more clinical experience and um hopefully today we'll be talking with Dr Honda about avoidant Personality Disorder so I have tons of questions about it we have a couple of posts that we can look at but I think it's something that's actually really relevant to this community um so we'll get hop into that as soon as he shows up but and hopefully this is a de problem on R end like he doesn't have the link or something which sometimes happens um because you know we're still noobs at this but while we're waiting I think we can just uh we can just Vibe um and then yeah we'll see what's going on I'm going to kind of double check into this and make sure that I'm not doing something wrong because sometimes as chat knows I'm a

6:02 Noob um there we go um okay let's see oh here we okay he's here all right great okay hey Dr Honda oh uh can you count to 10 for me are you muted by chance okay hold on I think it's me what yeah I can hear you fine say something count to 10 perfect okay let me just fix this overlay and then um let's dive in so

6:48 we're going to see if this hopefully Works crossing our fingers oh and hold on we got this there we we go we fixed it all right hey Dr Honda how are you um I just got to fix sound so count to 10 for me one last time one two three four five six seven eight n perfect thank you so much so um I just did our intro just a reminder to everyone that uh Dr Honda is also a medical professional but nothing he is going to say today qualifies as medical advice anything that youall have a a medical concern or question about please go see a licensed professional sound appropriate Dr Honda absolutely um so I

7:35 was just telling people that you're an expert in avoidant uh in personality disorders uh but do you want to start by just telling us a little bit and I think today we're going to be talking mostly about avoidant personality disorder okay um I love how he says okay so if there are other things that are available cool yeah well we had brainstormed lots of things so yeah I uh I sort of mini prepped a lot of things this morning but yeah yeah do you want to tell us a couple of the other things that you kind of thought about or talked about I know we we prepped as you said for a lot of things well yeah we talked about uh skeid personality disorder as well and maybe just about loneliness in general and what can cause isolation

8:21 yeah awesome so that sounds great I'm personally curious because i' I've worked with very few skeid people in my clinical career don't usually come to therapy so right yeah so um I I think I would I would love to hear about that but do you want to tell us a little bit about kind of who you are um where people can find you on the internet yeah uh I have had a podcast in YouTube channel called psychology in Seattle since 2008 and we do all sorts of things you know podcasts and reaction videos and deep Dives and lots of things yeah that's I've been a therapist and a professor since the late 90s wow so so you were doing podcasting before it was

9:07 cool yeah I don't know why but I was yeah no one was listening but I was doing it anyway and and what what kind of um stuff can people expect on your podcast yeah you know I have a hard time elevator speeching it because on one hand we'll do a deep dive on a personality disorder for example and I'll talk I'll research for 6 months and talk for 12 hours and it'll be from several different angles and I will feel like it is a mini dissertation or I will react to love is blind and just go what was that and I've never diagnosing from afar but I am using it as a launching pad to talk about relationships and attachments and conflict resolution

9:55 infidelity that kind of stuff or I'm talking with one of my co-hosts that who are all really good friends of mine and sometimes were're reacting or we're uh responding to emails or we're talking about a movie we saw you know it when you create uh 20 episodes a week uh you know you got to keep the needle moving and so you make 20 episodes a week I mean it depends on the week but uh but yeah that's insane well yeah but my understanding is you work a lot as well so you know you know the you know the drive to like keep going sure but I I mean you I I I didn't missar you you said per week not per month yeah like

10:42 right now uh Love is Blind season 7 is on and so I always will react to that because it's my favorite reality TV show and so I will put out two episodes a day just for that then there's also the audio okay podcast and stuff so yeah that's that's so cool I I think um so here's I think your Channel's phenomenal and I think part of what I really like about it by the way but I am quite honored I never thought that you would even know who I was and give me the time of day let alone have me on one of your videos so I'm quite honored by this well we can you're very welcome um I I am equally honored uh because you know you've been a pro Professor since the

11:28 90s I was like in elementary school in the 90s so so to have someone of your experience and Just Breath of of stuff is is super cool and and I think um strongly recommend everybody check out your channel and I think it's a really good fit for people in our audience because like you said I think so I think a lot of people come here because they want mental health in different ways right so like sometimes it's a conversation sometimes it's like a deep dive or like dissertation sometimes it's like and I think you do react content incredibly well yeah and so I I think you do a fantastic job of taking things that are entertaining and already people are like watching or into and then you sort of make like learning about

12:13 psychology Psychiatry and mental health like fun and in a more packageable way so strongly recommend everybody check out Dr Honda's Channel yeah I kind of fell into it at the beginning of the pandemic I was bored like everyone else during the initial days of the lockdown and I had heard of this show that everyone was talking about called called love is buy and I never watched reality TV uh but I'm sitting there with my wife and I'm like well we have a less of time to kill so I started watching it and I found myself actually liking the show and bothering my wife with like no no no they shouldn't be doing that they should try this thing you know and I was and I was like maybe I should stop bothering my wife and I should just bother the internet with this and then I didn't think anyone would watch but sort of

12:59 blew up and then you know here I am yeah that's cool but yeah it is along those lines of like finding things that people are already interested in because you know I've been podcasting since 2008 trying to uh break through the SEO on some level and whenever people would find me they would say I can't you know you need a better SEO or something because I just you know I I finally found your content and you've been doing this for so long well the trick is is if you sort of jump into the stream of uh content that people are already Googling then you have a greater chance of actually coming across people's feeds so I I think we have some people uh uh on our team who I think understand that stuff really well and they're super awesome yeah and so so

13:44 let's let's dig into Personality Disorder so can you start by just telling us um what is a personality disorder yeah well it's complicated and even when I explain this to students I will tell them and hope that they believe me that me describing a personality disorder and even having gone through a few courses studying personality disorders and other disorders they're not really going to get it until you actually know the academic side the research DSM criteria and hear it from an expert and hear all the vignettes but also experiencing the individual if if you out there have had someone in your life

14:32 close to you or you are someone that has a personal store or thinks that you do then you have a much greater chance of understanding but if you don't have someone to reference or you have an experience it yourself it it'll even if you think you get it you know I'm just speaking for my own personal experience uh it it's hard to grasp but the easiest way I can describe it is that it is a a disorder in perception and I don't usually hear it described this way but I find which makes me wonder if I'm off Bas in some way but I find that all personality disorders aside from antisocial which is kind of an anomaly depending on how you look at it but all the other personality disorders have

15:19 pathologically distorted perceptions mean you know like a common personality sorder that people might know about is borderline and so with this personal disorder the distorted perception is that people are about to ban and be at any given moment even when they're not so it's not delusional it's not hallucinating it's not psychotic but it's borderline psychotic which is why it has that name in that the individual is convinced of Abandonment and reacts accordingly even when there's no evidence of that or extremely limited evidence like someone doesn't text you back right away and you are triggered and you become convinced with other personality disorders it's a different

16:05 core pathological perceptual Distortion related to the relational traumas that were chronic in early childhood okay so that's that's the shortest way I can describe personality disorders sure so so what what is the what happens in avoidant personality disorder yeah so I always find that with any personality just for my own sake I will um understand it through its hypothesized and frequently found uh early relational trauma and then once you understand that then to me it all kind of fits together because like again with like borderline if you just read the criteria it looks kind of like a

16:50 jumble of behavior observations but when you understand that it all generates from an abandonment trauma then it's like oh okay so with a personality disorder the childhood trauma is that on you know Baseline is and really this is true for all personality disorders is there's General abuse and neglect that is present and lack of Attunement so the child uh because you know all children go through bad things and have bad moments but if they don't have someone to turn to that is safe that can listen to them attune to them and and help them then left to their own devices to come up with their own defenses against that fear and and uh and and danger and

17:36 threat so so as and that's similar and that's the same with avoidant personal disorder as that there's some sort of neglect and abuse often it's neglect but the second feature of the childhood ongoing relational trauma is that the child is made to feel excessively afraid of social situations which of course makes sense right but this can um look a lot lot of different ways right it can look some obvious ways where you have a child who is uh uh you know and it can be subtle you can have a you can have parents who you know maybe there's conflict there's divorce maybe the parents aren't the best parents in the world but you don't characterize your parents as the worst but they're not really there for you and when you were 2

18:22 years old and you had a a pain or a fear or a boredom or a joy your parents just weren't there maybe they were avoidant themselves maybe they were depressed maybe they were working too much maybe your family was experiencing War trauma or something but anyway so there's some sort of neglect and then the parents are trying to get you to go to daycare or to preschool and they push you into it and they don't have a good approach to it and your experience in that preschool or in that daycare was not pleasant um and when you get and that can that's very common but then when the child comes home or gets picked up by the parents the parents again don't attune and they

19:10 don't listen and they don't notice and so the child learns that they're alone in the world and they cannot uh uh turn to other people and that there's a constant threat of being humiliated and rejected and it develops into this perceptual Distortion which brings it a you know to a higher degree than social anxiety because you know we have regular social anxiety jump in for a second please yeah so this is awesome oh thanks love it so um I I I wanted because you're covering a ton of good stuff so I I wanted to first of all make sure that I really understood this because I have never heard personality disorders described in this way before okay um and I struggled

19:56 a lot with learning about personality and personality disorders during residency training um so I'm going to just repeat back so you said so I I I think it's really interesting because when I when we look at like some personality disorders when I look at something like let's say BPD or or something like that there's there's more Frank or overt abuse right so there's like a very high history of physical abuse or sexual abuse for people who develop borderline personality disorder um and the way that I think about personality disorder I think about non-personality or maybe we'll get to this in a little bit but I I think about personality disorders is is very similar to what you're saying in terms of it shapes the way that your brain your psychology your mind and your physiology develop so when we're young

20:43 right the the concrete is still wet and if we draw in it it'll kind of solidify in that way so based on your upbringing kind of the way that you're shaped is the way that I think about a personality disorder and perception is absolutely a huge part of that and I think it's a beautiful way to Just Launch into everything MH um and so what we're talking about an avoidant personality disorder is not so much Frank abuse but more neglect right typically and this is also why I think it's hard for people to recognize that right because it feels normal to them and and and we hear stories of things like physical abuse or sexual abuse and some people will be thinking about their childhood they were like none of that happened so they think that they don't even realize that there is a

21:29 developmental trauma or neglect or something that could have shaped you in a certain way it just feels really normal to them because the red flags that they have heard about don't apply to them exactly and then I I thought it was super cool how you described this like made to feel afraid of social situations because then the question in my mind was what does that look like but I I loved your kind of onew punch forced into dayare mhm and then when they but daycare is bad you get bullied whatever and then when they pick you up that forc into a social situation plus the neglect or absent parent is really what I like clicked for me yeah right so when you come home and you tell your parents hey I don't like daycare mhm and then they're like not

22:15 paying attention and it's really interesting because I can think about the patients that I've worked with and it's the ones that are okay or the ones that only have one of two those two things so if you get forced into daycare but you have support of parents when you come home you'll be okay and presumably and then if you go to daycare and it's not traumatic then you'll be okay MH but when you have those two things it that's really what what is the birth of of avoidant Personality Disorder yeah yeah right and you rinse and repeat that because you're anxious and then you're awkward and then you get shunned and then it gets worse and worse and worse right and then you develop this idea that you're uh inherently ridiculous for some reason and there's no point in even trying because everyone knows that

23:01 you're ridiculous there's something deep down uh in your soul that makes you inherently rejectable in social situations that everyone can see that's the perceptual Distortion is that everyone knows how ridiculous that I am you know there's no hiding it so there's no point in even trying to hide it there and may be no point in leaving my house so how does that cycle can you tell us a little bit about how someone goes from not having fun at daycare and then you kind of alluded to the cycle that results in such a concrete belief about inherent reject ability that is impossible to hide which I think also is just a brilliant way of describing it yeah well it's chronic and even in the

23:49 you know well-meaning parents that might even bring their kids to therapy but if there isn't enough so the uh cure if you will the treatment involves the correct so there I summarize in my mind all therapy into two prongs which is awareness so you have cognitive therapy and other kinds of uh uh you know discoveries about the self so you can discover your triggers you can manage things better in the moment but the other prong is corrective experiences and for people with avoidant personal disorder awareness is important and can definitely help but it won't take away the intense fear and the propensity to distort reality to fit the

24:37 way things feel so the corrective experience is to have social situations that go relatively well and the individual habituates to that while they are being loved and it and attuned to so that you know commonly in my world can look like someone who has a spouse and a therapist with me who cares about them and is loyal to them and understands them and attunes to them and doesn't reject them and doesn't uh buy into their or doesn't uh uh slot into their their perceptual Distortion Distortion that they're going to be rejected and that they're ridiculous and they uh you know Venture

25:22 off into what they believe to be risky social situations and you know do their deep breathing and reassure themselves and it's a graduated exposure and then they come back to me they come back to their spouse and they're welcomed back you know sort of like the opposite of what happened when they came back from dayare that kind of thing and you rinse and repeat that enough times and you know the neurology eventually habituates and a new story and a new reality and a new perception a new feeling is generated okay so that's cool I I'm wondering about so there are a couple of assumptions that really worry me about that so the the first is that there's a spouse yeah the second is that there's a

26:08 therapist yeah because I imagine a lot of people with um avoidant personality disorder have trouble engaging in romantic relationships yeah where yes they have trouble with the beginning because it's risky but once they actually feel they can trust someone which is a big leap I mean there's a lot of things you have to do to get there then they're actually U you know they Revel in that right then they're just uh because it's it's not close I mean not all but frequently people avoid a personality disorder if they have a family member or they manage to get in you know through awkwardness maybe they find someone who's also kind of awkward and and they go down the road and Bumble together then there's not as

26:55 much complications as there are with other like with borderline it's sort of the opposite the closer you get to someone with borderline like a spouse or relationship the more you're going to be distorted and transferred to um but uh but yeah it I hate to um say that treatment and change and alleviation of symptoms involves things that for some they don't have access to or will have a great difficulty overcoming the anxiety to get there but that's the way that I see it and that's how I've experienced things you know it's a select U You Know sample size because I happen to have clients who are in that category right I

27:40 I don't treat people that I don't treat so uh but it's the way that I see how we operate as human beings we're we're you know perhaps the most social creature that's ever lived in the universe and if we're going to develop the things socially then we're going to get out of them socially okay so when you're working with someone who has avoidant personality disorder you said it the beginning is hard but then later on it becomes a little bit easier once you establish that trust and safety can you tell us a little bit about what that process looks like well you know everyone's so different and I as I'm talking I'm referencing like a dozen people and every one of them is is

28:28 different and when I think about this this course you know the course of them uh either in the past before I met them or during or after how they manag to cultivate you know for some people they just kind they don't really associate uh spousal or romantic or sexual relationships with the risky social interesting yeah they don't um it's it's like they might be okay with Tinder but they're terrified of small talk with the grocery store clerk or introducing themselves at work when you know over zoom and there's like okay everyone go around the room and introduce uh but to even just walk up to

29:13 someone on the street and introduce them you know everyone's different is a thing so um it it can kind of depend plus with romantic relationships if someone pursues you then you can kind of get over it plus you have this urge you know you know from several angles in your body that might say I don't care if this freaks me out I'm going to do it anyway um so there's that but you know then I also will know people with void personality sorder who have never had any romantic relationships and have given up on that ever happening and are absolutely terrified of things like Tinder it was it that would be worse than talking so you know everyone has their own journey and associations and it to me has to do

30:00 with where their traumas came from you know if you're if your social traumas came from acquaintances or you know sometimes it's a waitress like you're forced to order for yourself um and it's a a spike and distress and you know so uh for some people it's it's those kinds of interactions others it would be like on the playground when you're flirting or or some other people come over on the playground and start wanting to talk with you and that's more emulative of what a peer-to-peer romantic relationship so you know everyone everyone has a different and usually what I find is that people there's some there's some in you know like there's some Oasis of comfort in so and and

30:48 finding that is important you know to capitalize on it kind of pour all there and you know for some people it's young younger people they they they like to be a a daycare worker and they they they don't have any nervousness around kids that that kind of thing yeah so I it's interesting because it sounds like what what I'm hearing you kind of say is that so we have this experience early in childhood where or not experience several experiences right it's chronic for it to be a personality disorder so there there's this pattern of forced social interaction followed by a lack of support yeah and then well it'll feel forced to them it it it it can be forced obviously but they will feel pushed into it like no no no and then it'll go horrible for them yeah okay right so so

31:35 and then they develop a perception a perceptual Distortion yeah but that perceptual Distortion circuitry doesn't necessarily translate to things like romantic relationships right there are some situations or age differences so like our our our brain is uh basically figured out what triggers this kind of cycle yeah yeah exactly yeah for for some those traumas will be triggered those circuits will be triggered with uh the beginning of a romantic relationship but for others it won't be okay and and it's and and they won't be triggered necess if they have

32:21 an established relationship with like a like a sibling or even a parent um those relationships won't trigger them at all and those people will say if only the rest of the world knew you the way that I knew you because I see you around other people and you're a completely different person and when I'm with you you're this you know easygoing funny spontaneous um individual uh which isn't a common wh which is common for people with aoid a personality story they they often will have one person now sometimes they keep that person at arms length but um I am Optimist more optimistic when I have a client who says oh yeah I I feel

33:09 comfortable around my dad and we're really close and we see each other every other day and he's he's my guy you know what I mean and so that's that we can capitalize on that you know yeah so uh I'm curious can you give us like so a couple of these examples are awesome so like this sort of getting feedback of oh you're a completely different person around me I see this version of you what are some other things that you've seen or kind of common experiences almost from a qualitative researcher subjective experience um you know if someone has avoidant personality disorder what is their experience of Life what does it look like or feel like well um it can look a lot so one angle that

33:55 I've alluded to or described briefly is that they're convinced that everyone knows that they're ridiculous it's a very common whether they they wouldn't necessarily frame it that way but they you know they might have a very common social anxiety that is you know even that is extremely excessive like they have to plan for several hours before there's a meeting at work in which they might be asked to introduce themselves you know and they like are worrying about it and thinking about it and uh and at best honestly they're practicing in the mirror this is what I'm going to say you know but often people get so bogged down in the anxiety that they can't even do

34:40 that because imagining it and planning for it actually exposes them to the anxiety which is overwhelming to them um so there's that they will often choose jobs that don't require those kinds of random social interacting but other people you know I had a client once that was convinced that everyone knew that they dressed and walked weird that as soon as they walked out of the house that everyone would notice that they're they were incredibly unfashionable like ridiculously laughably goofy when they dressed and also that the way they walked um just their gate you know the what the way their arms would swing they just would

35:27 like um so I have so they would do everything they could to you know try to make sure that they were as un ridiculous as possible even though they knew that they were but that would make them look a little weird because when they're trying when they're thinking about every muscle movement as they're walking you know it just kind of looks a little OD yeah awkward people probably don't care you know what I mean they if they do notice they're just like oh that guy you know has a limp or whatever but they're convinced and then they see people kind of react act occasionally because they are acting a little strange they like see you know everyone everyone knows and I should just go home and and and you know the foundation of this which might differentiate it from social anxiety itself is that the individual believes

36:13 deep down that there's something inherently ridiculous and rejectable about them there's a defect deep down that they uh that they only have honestly you know if they hear other people that will say some more things are like well yeah but you know I really have that def you know and and I'm it they just because of the way they were treated right they were shunned and they went through these social anxieties they developed an almost magical thought that there's something inherently def defective about them and then they find something in society to latch on to like fashion like the way their faces or like the way they swing their arms or like the way that they talk or or whatever or

37:00 how good-look they are and that helps them to feel like well at least there's some concrete reason why I feel the way I do but if we strip away and we combat that you know in therapy cognitive therapy and narrative therapy and stuff and we strip away that and we're like no you know empirically all these people are saying that's not how they see you they're still left with the the knowledge they know that they're defective and rejectable there's something wrong with them um maybe it's not what I originally thought it was like my fashion but I still know and so that's where the corrective experiences come in where they can actually go through enough experiences to create new

37:45 new neurology new circuits that show them otherwise yeah so that that's so interesting it almost reminds me of um when I was learning about schizophrenia and and uh understanding that the basic problem there is a hyperactive pattern recognition in the brain so what happens is people will have this feeling that they are being watched and then what happens is once they have the feeling that they're being watched then they start to interpret the world around them and this is why people who are like paranoid or delusional will believe that the FBI or Mafia is following them it's really interesting it's not that they have direct data it's that they first of all I feel like I'm

38:31 being watched and then they notice this person is sitting in a car across the street they notice that when they go into a gas station there's someone who has a blue hat on and then the next time they go to a gas station there's someone else with a blue hat is this some kind of uniform so this the part of our brain that generates patterns is hyperactive and then what happens is their intelligence their analytical capability kicks in and asks themselves the question who is it that has the resources to deploy all of these people and follow me around it must be the FBI it must be the mafia it has to be some sort of you know worldwide organization Illuminati kind of thing because who else could pull this off right yeah and we all do this right our feelings are

39:19 first and then we fit reality to our feelings none of us are not like that if that's a sentence absolutely C can you tell us a little bit more about that because I don't think many people understand that you know a common experience is if you are dealing with the other side of the aisle politically and you're thinking how did you come to that conclusion that's divorced from the facts and they're looking at you in a similar way uh you know depending and that's I know I think a lot of people will conclude well it's motivated reasoning it's confirmation bias and that's all just manifestations of this is the way it feels and so I'm

40:04 conforming reality or I'm cherry-picking reality to justify the way that it feels this feels scary or I've been convinced of that and research shows that you know that if you've been through trauma then you're more likely to believe in a conspiracy theory right you're more likely going to believe that uh there's a powerful force that is conspiring against you because that was actually true when you were three there was a powerful force conspiring against you and uh we all you know and I I do this all day long and and it's probably helpful in a lot of ways right like if I believe that my two dogs love me but I can't confirm that I'm going to

40:49 look for oh you know the dog comes to me when she's scared of fireworks that means she loves me you know it helps me to sleep better at night yeah so so it's it's I I think it's interesting because you're mentioning a couple of things that I kind of want to highlight so the first is when we're talking about avoidant PD one thing that I thought was really cool was your people seem to do a lot of mind reading right so people are so if you are convinced that you know what is in someone else's mind when they look at you I'm sure that this person thinks that I look like an idiot that's one really like power ful feature of it right when you like CU you don't know what's in someone else's mind but something is telling like you believe that you know what's in other people's

41:34 heads the other thing is the uniqueness of it that one person potentially with avoidant personality disorder can look at someone else and say you are ridiculous for believing that but I am I'm sure that I'm fundamentally flawed MH and and so the the third thing that I thought was really interesting is that the way that you almost described how they latch on to a particular defect but the defect is deep rooted and then they try to find some reasoning for it because honestly and that's almost seems a little bit protective to me because at least if I have an explanation oh like I feel if I feel horribly broken and I can blame my awkward fashion sense for it that almost is protective because then I

42:21 know why I'm broken and it's not this raw feeling of unbroken it gives you some sense that okay if I could fix this one day and I I know they don't try to because they feel like nothing ever works or maybe they try and they just feel like it never works because that's not actually the problem um but I I think it's really interesting how so when you're working with people do you kind of as you strip away those distortions what happens to that raw feeling underneath yeah um and by the way it's brilliant of you to make that connection I actually had never thought about that for that it would be almost like a def it's almost better to think it is fashion than it is something deep to my core so at least in the conscious mind it's a temporary reprieve from what they

43:07 believe to be true because of the mistreatment they went through growing up um uh but uh yeah when people have those defenses or uh you know surface level conclusions Stripped Away it can actually be worse for them uh it can feel raw and hopeless like as you're saying at least with fashion there's a chance right but if it's just you then there is no chance right and that's where you know depth therapy actually helps you know a deep relationship with the therapist so that the because it'd

43:53 be tempting if you're a friend or a family member to just say uh don't do that to yourself you're a good person and to try to reassure the person right but and maybe that would temporarily help but that's not going to take it away you know a a trained specialist would understand okay we've arrived at something that will take potentially a few years of corrective experiences and hard work to actually chip away at and here we are and it's okay and the you know I'm thinking of a few moments in my mind and it can be scary for me too you know I'm a human being and I don't want someone to feel that way about themselves and it it'll break my heart and I'll absorb their anxiety about having to look into the abyss but when I'm at my best I'm like it feels like an

44:40 abyss but it's not an abyss and it feels like an emergency but it's not an emergency in fact the fact that it feels like an emergency means we've worked hard to get to this place which is a very necessary place and it's this is the same with all personal disorders there's a moment of looking into the abyss and and having that fear it can happen in the first session but it can also happen in like the 100th but the the trick is is that you at the very least as a therapist have to believe that it's not an abyss that there are things down there there is a self there there is safety in the unknown and uh we just have to you know search around in the dark or start turning up the dimmer switch but you

45:26 know to see it I don't know if I'm making any sense but when it comes to avoided personality shorter that looking into the defect the inherent defective self and for me to say I'm glad that we're here I'm sorry that you feel this way but the fact that we're here means that we have gotten to a certain phase and it sucks and it hurts and it's scary and it's the worst and you know I'm in it with you and we'll you know we'll go through this together but know that I know that you're not defective know that I know that there's nothing wrong with you and know that I know that you were told that and treated in a way that was like that to convince your 2-year-old

46:12 self that that was true but know that I know that that was not true that's so interesting I and I think you made a lot of sense for people who have been there I I love this um concept of looking into the abyss CU cuz when I work with um it's so interesting because you said you know antisocial personality disorder is a little bit different um in my so I I work primarily with cluster B personality disorders yeah and um I just think they're more fun uh well they're more likely to come into therapy that's for sure uh and and so the interesting thing is when I work with people who are sociopaths we look into the abyss and I I love the way you describe it because I I think every patient that I've worked with has this experience of looking into the Abyss there's one moment where we

46:58 look into that interesting is with people who are sociopaths we say we don't I I I say there is an abyss there I see it you see it and it's okay what are we going to do about it right so I think their emotional architecture is also a little bit different to where that's not quite as scary to them MH and and um but it it's it's so I I think you described it well and I think this is the hard part for a lot of people is that the you know the deeper we get into describing what happens in therapy the less words work yeah right so so you just have this moment where everything is kind of laid bare and it is super scary and and I think what you're really describing is that's really healing

47:43 about that is that in that moment they're not alone mhm right so when you look into and see the worst parts of yourself there's someone there who doesn't reject you MH and even if you say hey I think it's just feelings and they're like no it's reality I think the beautiful thing that and this is what little clinical experience I have is that in that moment you know what what they believe or don't believe is not nearly as powerful as you being there with them and then also so what time next week yeah right that yeah yeah and that's you know uh that's the magic right that's the formula is consistency and being with someone and the client

48:31 puts their hope in you cuz you have hope because it's too much to expect a client to have hope about that it's too overwhelmingly convincing to them in this specifics of avoidant Personality that the individual is defective and ridiculous but they are convinced enough that you're convinced and you are an expert so maybe there is hope my therapist has hope I I'm choosing to go along with that I'm taking the leap but yeah and that's hard to do you know because you could just say as a therapist I have hope but you have to uh be you know uh connected on a deep level with the client and the client has to be

49:17 convinced of that you can't just uh do this from the sideline you got to get in yeah to the the scrum of it you know so I I I think when when you you say take the leap I think that's where the neuroplasticity happens right so before you take the leap you know everything your logical mind is fixed you have all of the answers so if you really think about it that that confidence in your beliefs is what that's not neuroplasticity when you take the belie when you when you take a leap into the unknown that creates a question mark from a psychological perspective and what I've kind of seen is that's what really triggers the change is being being able to take that leap and then that's the moment that like you're saying you start to question and when you start to question your beliefs

50:03 that's when the brain starts to change the mind starts to change um I'm kind of curious wasn't was it I mean you would know more than I would but isn't that one of the theories as to why ssris work is that it doesn't make you happy but it makes your brain more plastic it makes your brain more flexible to change in those moments it it is absolutely one of the iies yeah but I I I think that the tricky thing about ssris is that for most psychiatric medication we're not too clear how it works right so so I I think there's absolutely some evidence of neuroplasticity induced through ssris but the mechanism of that is also like questionable so um you know people who

50:49 are very anti- SSRI basically will even acknowledge that the one thing that an SSRI does is emotional numbing so and it doesn't make you happy it just potentially makes you less sad and what I would say is the mechanism that I would kind of lean into there is if you look at emotional numbing then I feel less sad and what are we talking about we're talking about when an emotion is very very strong you are more convinced right so when you're when I'm super super depressed it's not depression it's reality right and so if we quiet the emotion then it opens the door for more cognitive flexibility ah and and that's

51:35 evolutionary right so if we think about why have emotions evolved they've evolved to shortcircuit analysis if I slap you across the face your analytical mind is not going to be like hm I wonder what he's going through today what's the ethics of slapping people across the face I wonder what what uh Plato would say you need to just react you know yeah um maybe if I yeah so uh so I I think it's interesting so I think that's one mechanism of of potentially neuroplasticity the really interesting thing is if we look at um I think there are more robust studies on maybe not more robust but if we look at the mechanism of action of a lot of these like pilot studies on psychedelics neuroplasticity is a huge part of it a lot of the meditation literature is

52:22 about neuroplasticity um and so I I think we absolutely see see that as as a goal the really interesting thing is that even if we look at psychedelics and meditation um we just did a stream about this recently and uh what's interesting is it just induces neuroplasticity what you do with the neuroplasticity is up to you so one of the really scary things that I've seen is when people hear psychedelics are healing they'll be suicidal and depressed and they'll take psychedelics with the hope that it heals them but all it does is induces change in the brain and if you're an negative environment you can actually end up way worse so I've seen a ton of patients who have anxiety disorders PTSD from Bad trips and if you look at psychedelic assisted Psychotherapy or the religious

53:08 Traditions what you tend to find is that when they use these neuroplasticity inducing agents you have a guide like a shaman or a guru or a therapist who helps you then integrate that experience and make sense of it in a much more positive way that's probably what's responsible for the healing and like what what we're describing is um you know when you're in that moment of staring into the abyss and they take the leap of faith you're in the room with them and if they do it on their own it can be way too scary yeah yeah yeah H I feel like I just took psychedelics so my mind is blown uh that's interesting how all those connections yeah I'm going to have

53:54 to chew on that for a while but I like it yeah so maybe a conversation for a different day after you've had a chance to chew um and I was wondering if we can kind of switch gears a little bit for a second so tell us tell me a little bit about the difference between social anxiety and avoidant personality disorder yeah well I'll tell you that uh if it's you know fairly severe social anxiety but not beyond the fuzzy threshold into a personality disorder you present that case and give each clinician a good amount of time to assess you know maybe five sessions you're G to get varying diagnoses some saying it's just highlevel social

54:39 anxiety and some saying it's low-level avoidant personality order but a common differentiating factor with a heavy asterisk is that people with social anxiety tend to know that they have excessive anxiety without treatment they tend to understand and yeah I I have this phobia of meetings or of social situations and you know it it's all in my head I get up in my head and I I'm convinced at everyone and I know that they're not but in the moment I get stressed out so when they're relaxed they uh often but that's the thing is it's a heavy asteris because some people with what we would call social anxiety don't have insight into it or have

55:25 pockets of lack of insight um meaning that they are convinced that people are thinking negative things about them when they're not um or that they're inherently ridiculous when they're not um but that's generally the demarcation line is for me anyway it's the pre-treatment pre-awareness the extent to the semi- delusional perceptual Distortion you know how convinced are they of the fear when they are Cal and how severe is it and sometimes it's very obvious right if someone is absolutely convinced that they are the most disgustingly ugly person on the planet and as one human in the culture I'm looking at them and

56:12 saying I mean maybe you're a a a six out of 10 I don't know but you're definitely and even if you were a one I I can't imagine you know what are we talking about here like uh like you're just this uh HP Lovecraft like unnamed spaghetti monster face or something I don't even know like what do you like that's the image so that would definitely differentiate it from social anxiety right but you know every not everyone has that kind of obvious uh perceptual Distortion that they latch on to so um I in practice don't really differentiate between the two the treatment is essentially the same if someone's in the

56:59 middle Zone you know it doesn't really matter what label we put to it it's similar with border line if someone is you know on the moderate end of the scale and or moderate middle of the scale and another clinici might say that they are sub threshold and just have traits or have severe preoccupied attachment or something it doesn't really matter the treatment's the same okay interesting so so a couple of things that I'm taking away one is that so how do you know you have a void personality disorder if you look into the abyss and there is a cthulu esque monster there that makes you not human fundamentally not human right you are you are a cthulu esque monster wrapped in a human form yeah and and you're everyone sees it and

57:45 everyone's going to see it which is why you have to avoid them and you have to go out to a cabin in Massachusetts which is you know what happened with HP Lovecraft and so so that it's such a great characterization and I I also like this kind of and fair point that these diagnoses are essentially artificial distinctions that we make right and that the underlying pathology is along a Continuum yeah people with social anxiety have a often have a similar background a similar trauma a similar path yeah so so and I I'd say what I kind of heard there which is sort of squeezing it through my understanding of the difference between the two is actually kind of the degree of pervasiveness to it right so if you have

58:33 a psychological architecture that develops at least somewhat in a healthy Manner and then social anxiety happens to you later so I think that you know it diagnosis really starts to spike around puberty for example so you can have a relatively normal childhood but also heavy asterisk there that you probably had some of these experiences which make you somewhat vulnerable and then so so since you have that normal personality architecture developed then social anxiety sets in which is what allows you to see and have some degree of insight when you were calm cuz you know like hold on a second like I wasn't that way when I was eight something's changed like now I recognize that I'm not you know I have friends I I'm able to see that at times and then depending on the

59:20 physiology stress level be depending on what's going on in your amydala and and things like that you can lose that Insight but it's essentially the way that I kind of conceptualize it or the way I teach it is you know personality disorders are about the way that you're shaped and then usually um what we used to call kind of axis one diagnosis back in the day right these are things that happen to you so you developed relatively normal normally and then something happens but i' completely completely make sense that there's a shared experience and there's a fuzzy line in the middle and that from a clinical perspective you know the treatment is the same so right and so yeah right that's all yeah that's just a another way of of saying the way that that I see it absolutely the

1:00:06 pervasiveness and the structure of Personality that for people uh without a precise order with you know with just social anxiety and and just social anxiety can be crippling by the way it can be really really debilitating um that the individual Baseline has uh you know what some literature will call an intact personality or their uh you know their reality checks are stronger their ego strength is stronger that kind of stuff but but uh but yeah but I I will say that you can have what we would call social anxiety and feel pretty confident as a diagnosis and also have a personality disorder you probably

1:00:51 wouldn't see someone diagnosing someone with social anxiety and avoidant personality disorder but you could have social xiety and say borderline personal disorder or or some other personality disorder um so it gets a little weird but yeah what you're saying in the beginning is you know these are constructs these are uh things that we in Psychology and Psychiatry construct as a way of conceptualizing uh behavioral clumps and experiences so that we can research and guide treatment and you know it tends to pan out these labels have been around for over 100 years or at least the concepts have maybe the the the exact wording of the label has changed over time but the construct of avoidant personal disorder and and other uh

1:01:36 personality disorders have been around for a long time because there's just been a lot of observation of humans that seem to fit into this category yeah so speaking of kind of long time and changes over time so what's been what's your take on the rise in technology and how that affects social anxiety or avoidant personality disorder well on one hand it is been helpful because subreddits will provide these extremely quick SEO found um uh you know forums and communities where people are generally speaking healthy and and speaking openly and um I as a clinician

1:02:22 will sometimes read these subreddits just to remind me of the variance within a particular personality disorder I you know have to filter I can't I am always a little skeptical of people self- diagnosing of course so I'm always um reading a post and thinking okay where's where's the marker so that I can be assured that this person actually does have this disorder and and I would say half the time I'm not uh satisfied in that way and you know it makes sense cu the landscape would be hard for people to discover but but at the very least uh I think the internet has has really helped you and I are in the internet right now talking to people that who might have never even heard of a

1:03:07 personality sorder prior and you know we see the evidence of that you know the problematic tip of the iceberg is that people are labeling everyone a narcissist these days and gaslighting and stuff and we can lament that but that's the result of having worked for decades in our field to raise awareness about abuse and about personality Shores and moving away from just in like you know the idea of inherent spiritual Badness you know so uh uh we see some ill effects which you know uh I I don't I didn't predict but well how was I supposed to know but overall you have a lot more people going to therapy and you have people tuning into this live stream who 30 years ago would have thought well

1:03:53 that's where crazy people why would they want to watch uh to clinicians talk you know so um so there's a lot of good things um the bad thing is that it uh can inadvertently create a platform upon which individuals lack the exposure that typically will occur naturally when you have nothing to do at home you know like when I was a kid in the 70s I uh there wasn't anything to do uh that you know there was three TV channels and none of the programming was geared towards kids so aside from like before school and maybe an hour after school and um I you know you just were

1:04:40 bored out of your mind and toys weren't as prevalent you know there weren't as many cheaply made readily available things to play with certainly so video games and so uh you either had to read draw or climb trees with your friends and that that's what I did and so uh with uh the internet and with media and you have a lot of young people and old people you know adults who uh you know if there's several wise in the road and if there was no internet there was no technology there were no video games they would say like H okay fine I'll go knock on the door of my neighbor and see if they want to play or something like that and then you just

1:05:27 you know you go through the normal exposure and habituation and trials and tribulations and in you know hopefully not always but you uh progress through that experience learning that things are going to work out uh in the end and bad things will happen but you know overall you'll get through it and because the other people depend on you because they don't they don't have video games either you know so if they don't want to shun you because they don't want to be alone they don't want to be without um so you know I I I I'm not saying anything mind-blowing right now but uh you know I I think that uh we see that and and that seems to be the the consensus is that there's a lot of things conspiring for isolation helicopter parenting is another is

1:06:13 another factor I think that people identify yeah so so it I mean it sounds like you're kind of and that's been my experience too that I I think when I was growing up in the 80s and and '90s you when you got bullied when things were socially difficult you kind of didn't have a choice right so you were kind of tossed into the deep end and it's like sink or swim and and so it was it was a really brutal um I had a really rough period of time between probably fifth grade and eighth grade and and it was like you know you just had to learn there's no retreating to anywhere what happened I was bullied very heavily oh really yeah oh ouch yeah made who I am today um so have you found them have you

1:07:00 looked him up and given him the finger and said Look At Me Now MF first um not really yeah do you want to I used to want to but I want to I want to find these guys and tell them look at him find the people that bullied me yeah why uh I can see you as a fifth grader I don't know what happened but I can visualize it and to think that people would mistreat anyone but you know mistreat you which I imagine if your demeanor is similar in the fifth grade as it is now

1:07:46 that it's you know curious smart uh active a talker but not harmful and not um uh you know problematic not worthy of being targeted you know and to think that there would be people that would habitually you know Target you and harm you is uh upsetting to me it makes me angry it makes me want to go to those people and say uh I don't know I don't know what I don't know what I would I do but it just uh I guess I want a time machine and go back and and like alert

1:08:31 adults when you were in the fifth grade to tell them to protect you or something I don't know I just have that urge yeah so so I I I appreciate the this is great dude I'm I'm loving this because you know oftentimes what we do on stream is is I I do what you're doing yeah and and it's it's um it's fun this is the first time I've been on the receiving end and it's quite the experience so thank you so much much um and well I apologize if it's like invasive or no I I I maybe I was caught off guard because I wasn't expecting it um but I my first you know the thought that had popped into my head is like well I do this to people all the time so like you know um so and and I I think it's it's it's important to do

1:09:17 right so I think it's important to acknowledge um I think for me personally like I think a lot of that I used to sort of feel that way and I remember I had one experience where I went back to my hometown and I ran into one of my bullies um at a bar actually and um it was sort of At first I felt a little bit triumphant and then I sort of like realized so like I I I have I have a history of kind of spiritual practice and I think a lot of that stuff has to do with ego so like you know wanting Vengeance on people is like a gratification of the ego is it is it sad was that kid hurt sure yes absolutely um

1:10:06 and at the same time part of my post-traumatic growth and part of my narrative and part of the work that I've done is is like to really stop and think about that right so just because it was sad for that kid um that this is part of the experience of life that negative things happen to us uh I happen to believe that that's my karma so did I do anything to deserve it maybe not in this life um but that all things there's an order to things and that also those experiences make me part of who I am today and this is pretty post-traumatic growth kind of you know narrative rebuilding and all that good stuff but like I I really do believe that and so now I I try really hard to not hold ill will towards them because they too were

1:10:52 just kids right like I mean a fifth grader they don't know what they're doing they're you know so it's like what's the point of you know going back and telling them I mean there there can be some gratification there there can be a sense of justice there can be a giving in to anger um but I I generally have the attitude of like what's the point like I'm on this Earth for who knows how many more years like do I want to spend any iota of energy going back and feeling triumphant like there's more there's like more important things to do yeah um so I I well the limus test would be and I you know I will ask this as generally as possible but you and I are

1:11:38 on the internet and will'll experience occasional groups of people that are coming after us you know and the litmus test I guess would be that as you and I go through this are we having understandable and within normal limits reactivity to that it's hard to deal with regardless but if we are unresolved or still you know processing these feelings of uh past bullying then I guess we would see symptoms of overreactivity um or under reactivity yeah yeah right something um but it's interesting I have a very similar experience I uh uh I

1:12:26 wasn't bullied generally speaking I was a big kid um I actually was one of those kids that would walk around trying to act like I was shorter because I felt so awkward because I was so tall you know and so big um but uh and you know it was the 70s and 80s and because I'm Asian everyone assumed I knew karate and I could kill them you know or something because I grew up in a mainly white community and so there was that that worked for me which kind of meant that I never really learned how to fight well because no one would ever fight me but anyway um I was in like uh seventh grade and I'm walking home and it's you know the Pacific Northwest in Seattle and it's kind of

1:13:11 cold in the winter and um as was the fashion of the time you didn't wear socks so my shoe my feet were basically numb and this bully this older guy I had no idea who he was he him and his friend are walking right towards me as I'm walking home from school and he walks up to me and he he just Stomps on my foot as hard as he can and pushes me down and oh my God I'm just like flabber I'm like what is happening did did I do something did he did he mistake and he and he just continued walking you know looking back it's obviously uh you know likely that this guy had something going on in his life some maybe some home life problems who

…