Running head: PERSONALITY TRAITS OF ADRIAN MONK

Personality Traits of Adrian Monk

Jenifer Gans
IL School of Professional Psychology

PERSONALITY TRAITS OF ADRIAN MONK

Adrian Monk was a fictional character on the popular TV series Monk. He is portrayed as a
highly intelligent and skilled former police detective turned private investigator with severe obsessivecompulsive tendencies. Monk, as he is informally called, needs a nurse or assistant to manage his day to
day tasks, such as shopping, taking care of him, and even reminding him to pay bills. He displays
dependency issues if his caretaker, Natalie, is gone for some reason. He has always displayed some
obsessive-compulsive tendencies, however, it was not until his wife Trudy was murdered, that his illness
really came out. He was in a catatonic state for three years after his wife was murdered. He did not leave
his house and he received a psychological discharge from the police force. His personality also shifted
after this event to display more dependency characteristics, however, these dependency traits can be seen
as a coping mechanism for Monks OCD management.
Monk is a Caucasian male at the age of 50, with a Welsh ancestry. He lives in a middle to upper
socioeconomic class, aside from his frugal tendencies regarding money. He graduated from the University
of Berkley in 1981 and now lives in a quiet and pleasant neighborhood in San Francisco. Adrians father
left his family when Adrian was only 8 years old and his mother raised him and his brother Ambrose, who
suffers from severe agoraphobia. He grew up in a very rigid, strict household due to his mothers unstable
psychological characteristics. She was very overprotective and very rarely displayed any emotion or
affection towards her sons. She displays some OCD tendencies and eventually, in 1994, passed away from
cancer.
Adrian has over 312 different phobias, with new phobias arising all the time. His phobias and
anxiety disorders make him depend on personal assistants, who drive him around, do his shopping, and
always carry a supply of disinfectant wipes for his use. Monk is fixated with symmetry, going so far as to
always cut his pancakes into equal squares. He strongly prefers familiarity to rigorous structuring in his
activities. Monk has great difficulty in standard social settings, so much that he goes so far as to write
down common small talk phrases on notecards in an attempt to successfully socialize. Monk has always

PERSONALITY TRAITS OF ADRIAN MONK

been seen as a social outcast and tends to isolate himself from others, aside from his very close friends,
and tends to worry about things such as being disliked by others or in how they would perceive him.
Adrian is a bit of a recluse and when he does make a connection with another person, he tends to
become very dependent on them and would go to great lengths to ensure their happiness. For people who
know him well, he is well-liked. However, to outsiders, his obsessions and compulsions tend to annoy
them, making social connections somewhat disadvantaged from the start. His honest and forthcoming
character upset some people. He is often awkward in social settings and at times goes to great lengths to
attempt to feel normal to himself or as perceived by others.
Monks entire life revolves around his need for perfection, as seen through his obsessions and
compulsions. Monk was not the most popular kid in school growing up. In both the present and past,
Monk is an introvert, both shy and timid. He also wants no one to know his inner most thoughts. In his
past, he would often try to take on others and try to investigate when other kids in his school tried to get
him into trouble by blaming their own wrongdoings onto Monk. In his present and earlier life, he has
difficulty with tasks such as picking out his own clothing on a daily basis. At a younger age, his mother
would do this for him while also packing him a very neatly organized and symmetrical lunch on a daily
basis.
Monk is always cautious in everything he does, for example, owning two levelers at the risk that
one may be off balance, and having them checked each year to make sure they are in working condition.
Monk, with his phobias, suffers from anxiety in most situations making him somewhat of a loner who
tends to isolate himself and is awkward, to the outside world. His is imaginative and awefully insightful
yet he is simple and limited in his interests, He needs to constantly be taken care of, yet does not trust
anyone other them himself, aside from his assistant, Natalie. Monk suffers from social anxiety and has
low self-esteem as is commonly displayed when someone makes a joke on his behalf that may be rather
funny or silly, however, to Monk, he considers it criticism to which he is quite sensitive (Paunonen &
Jackson, 2000).

PERSONALITY TRAITS OF ADRIAN MONK

Following from the different models of personality, and although it may seem as if Monk meets
the criteria for dependent personality disorder, this is just a smokescreen in that it is a protective measure
for Monk to deal with his OCD tendencies. Monk meets the criteria for Avoidant Personality disorder
according to the DSM-5. The diagnostic criteria for APD 301.82 (F60.6) are a pervasive pattern of social
inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early
adulthood and present in a variety of contexts (APA, 2013, p. 672). There are four criteria that must be
met.
Monk is often preoccupied with being criticized or rejected in social situations that are shown in
just about every episode of the series. In many instances, Monk is afraid to voice his opinion for fear of
ridicule and torment. He constantly avoids social situations for fear of what they will do to him and the
possibility of being embarrassed or criticized by others. Avoiding occupational activities that involve
significant interpersonal contact, because of fears of criticism, disapproval, or rejection, is another
characteristic that Monk identifies with. Although Monk takes on cases as a private consultant, he is often
reluctant to get involved in any detective work with the police for fear of rejection or disapproval. He
avoids occupational contact which may force him to become involved with others and with any of his
fears or phobias. Further, a third criteria can be portrayed in Monk where one views themselves as
socially inept, personally unappealing, or inferior to others. Monk often suggests feelings of inadequacy
and self-doubt, feeling unappealing to others or inferior because of his disability. He is constantly
hopeless, or inept, socially, as he cannot make friends nor does he attempt to.
Finally, Monk is unusually reluctant to take personal risks or to engage in any new activities
because they may prove embarrassing. Not only does Monk not take risks for fear of embarrassment, he is
generally scared of any risk taking activities or forcing himself to subject himself to a possible phobia. He
constantly avoids all situations and his low self-esteem and hypersensitivity to rejection are associated
with restricted interpersonal contacts. These individuals may become relatively isolated and usually do
not have a large social support network that can help them weather crises. They desire affection and

PERSONALITY TRAITS OF ADRIAN MONK

acceptance and may fantasize about idealized relationships with others. The avoidant behaviors can also
adversely affect occupational functioning because these individuals try to avoid the types of social
situations that may be important for meeting the basic demands of the job or for advancement. Monk
dreams about rejoining the police force again, but on numerous attempts or trials, fails to either meet any
criteria or even stay a full day because of his anxieties and fears.
According to the second model on personality disorders in the DSM-5, Monk fits in with
avoidant personality disorder. The proposed diagnostic criteria for this model describes two criterion. The
first is a moderate or greater impairment in personality functioning, manifest by characteristic difficulties
in 2 or more of the following areas: 1. Identity; Monk displays low self-esteem associated with selfappraisal as socially inept; and 2. Empathy; preoccupation with, and sensitivity to, criticism or rejection,
associated with distorted inference of others perspectives as negative. Monk is overly sensitive regarding
others opinions of himself and displays this with his lack of social support and friendships and reluctance
to leave the house without his assistant.
The second criteria are three or more of the documented four pathological personality traits, one
of which must be anxiousness: 1. Anxiousness; Monk displays intense feelings of nervousness, tenseness,
or panic, in reaction to social situations among other conditions. A second factor is withdrawal; reticence
in social situations. Monk is always full of restraint when it comes to social situations displaying reticence
in this category. Finally, a third criteria to meet in order to fulfill this diagnosis is intimacy avoidance;
Monk never seeks out love interests and he feels he would never be able to connect on a physical or
emotional level ever again. The one date he attempted turned in to a disaster where he could not connect
on any level, including a social one.
The DSM proposed dimensional model, personality disorder trait specific (PD-TS) approach has
two criterion that must be met. Criterion A is the level of personality functioning and criterion B is
pathological personality traits. The impairments are described in terms of impairments with respect to
self, and impairment with respect to others. The second key feature is inflexibility. In other words, the

PERSONALITY TRAITS OF ADRIAN MONK

impairments and personality traits are stable across a broad range of situations and across time. Criterion
A, the level of personality functioning, is divided into four aspects of personality functioning; identity,
self-direction, empathy, and intimacy (Hopwood, et al., 2012).
Identity refers to a persons knowledge and awareness of self. A person with little to no
impairment readily recognizes their own unique characteristics and accurately appraises these
characteristics. They have a clear sense of their own boundaries and can experience, tolerate, and regulate
a full range of emotions. Monk has some impairment on this level of functioning and in identity.
According to the DSM-5 model, Monk would fall under the moderate level of impairment in this area
because he depends excessively on others for identity definition, with compromised boundary delineation
(APA, 2013).
Self-direction refers to people's internal ability to establish and achieve reasonable expectations
of themselves, personal goals, and standards of personal conduct. A person with little to no impairment
sets realistic goals based on an accurate appraisal of strengths and limitations. Because of their ability to
be self-directed, they can reflect on their own internal experiences and they generally attain fulfillment
and satisfaction in life (Hopwood, 2012, p. 427). It is exemplified in a person who sets and aspires to
reasonable goals based on realistic assessment of personal capacities; utilizes appropriate standards of
behavior, attaining fulfillment in multiple realms, and can reflect on, and make constructive meaning of,
interpersonal experience (Bell, 2013, p. 857). Monk rates a moderate to severe impairment(s) on this
level of functioning, as he has difficulty establishing and/or achieving personal goals and they are more
often a means of gaining external approval (APA, 2013).
In the DSM-5 model of personality dysfunction, the level of interpersonal functioning refers to
empathy for others and intimacy with others. A person has healthy empathy for others if he or she is:
capable of accurately understanding others experiences and motivations in most situations;
comprehends and appreciates others perspectives, even if disagreeing, and is aware of the effect of [his or
her]...actions on others (APA, 2013, p.775). Monk has some impairment at this level of functioning and

PERSONALITY TRAITS OF ADRIAN MONK

some limited ability to understand others' experiences but they may discount it as valid or important.
Conversely, they may overly-attuned to others but only in a self-referential manner. They can be highly
threatened by differences of opinion and they frequently misattribute their own destructive motivations to
others. They have little to no ability to understand how their actions affect other people and may be
bewildered or hostile when someone attempts to explain how their actions harmed another person
(Hopwood, et al., 2012).
The last level of interpersonal functioning related to interpersonal relationships is intimacy and
states that intimate aspects of a personality are normal if the person is capable of: maintaining multiple
satisfying and enduring relationships in personal and community life; desiring and engaging in a number
of caring, close, and reciprocal relationships; and striving for cooperation and mutual benefit and flexibly
responds to a range of others ideas, emotions, and behaviors (APA, 2013, p.775). In this level of
functioning, Monk rates severe impairment as his social functioning is his strongest disposition attribute
and predictor.
To summarize: Monk has moderate impairment on identity; moderate levels of impairment on
self-direction; mild to moderate impairment on empathy; and severe impairment on intimacy. Monk meets
the first criteria for a personality disorder based on the PD-TS. The second criteria is one more
pathological personality trait domains or specific trait facets within domains considering all the following
domains:
Monk displays traits of negative affectivity with facets including: anxiousness, separation anxiety,
and submissiveness. He displays detachment with facets including: withdrawal, intimacy avoidance,
anhedonia, restricted affect, and suspiciousness. Monk can be seen as the polar opposite of antagonism
which is agreeableness and does not include the facets involved. For disinhibition, Monk displays rigid
perfectionism as a facet for the trait. Finally, on the Psychotism trait, Monk displays facets on unusual
beliefs and experiences and cognitive and perceptual dysregulation. Monk meets the criteria according to
the DSM-5 for a personality disorder under the first model and the third model or PD-TS.

PERSONALITY TRAITS OF ADRIAN MONK

A personality disorder is not Monks only mental health concern. He has Obsessive-compulsive
disorder as described in the DSM-5. Further, he suffers from specific phobia, all types. OCD requires the
presence of obsessions and compulsions. Obsessions are recurrent and persistent thoughts, urges, images
that are experienced as intrusive and unwanted, whereas compulsions are repetitive behaviors or mental
acts that an individual feels driven to perform in response to an obsession(APA, 2013, p. 235).
According to the APAs criteria in the DSM for a diagnosis of OCD, aside from having obsessions and/or
compulsions, they must be time consuming or cause clinically significant impairment in some important
area of functioning in the individuals life.
Monk is a clear example of an individual with OCD. He displays rituals in the form of
compulsions as a result of his obsessions. He has 312 different phobias and faces many stressors every
day due to these phobias. He tends to be perpetually worried about worrying itself, and the possibility of
confronting any of his phobias. Adrian suffered from a catatonic state for three years and he does not like
different types of food to touch on his plate. He does not like to shake the hands of other people, riding in
an elevator and airplanes. Furthermore, he needs to be certain that all the hangers in the closet face the
same way. On a positive note, his need to put things in order compulsively, is part of what makes him
such a great and unique detective.
However, his disorder effects his work because he would be reluctant to get involved in a case
that would force him to confront his phobias. He is frightened of life and most of the time decisions
paralyze him. He believes in logic and reason which obviously are needed in his profession. The client
has mannerisms that are recurring. He has a compulsion to touch things lightly with his index finger like
heat lamps, parking meters and hat racks. Monk displays observations by tilting his head and viewing
objects between his fingers, and finally he has this excessive devotion to work such that when he has a
crime to solve, it occupies all of his attention.
Monks phobias are in the three hundred range and consist of too many phobias to list. However,
some of his greatest phobias consist of dentists, germs, needles, milk, death, snakes, mushrooms, heights,

PERSONALITY TRAITS OF ADRIAN MONK

crowds, and elevators. These phobias are actively avoided as it causes severe fear and anxiety. The fear of
phobias is out of proportion to the threat in real life and the anxiety surrounding is persistent and causes
clinically significant impairment in all important functional areas of his life (Grohol, 2013).
But people with specific phobias, or strong irrational fear reactions, work hard to avoid common
places, situations, or objects even though they know there's no threat or danger. The fear may not make
any sense, but they feel powerless to stop it. People who experience these seemingly excessive and
unreasonable fears in the presence of or in anticipation of a specific object, place, or situation have a
specific phobia. Having phobias can disrupt daily routines, limit work efficiency, reduce self-esteem, and
place a strain on relationships because people will do whatever they can to avoid the uncomfortable and
often-terrifying feelings of phobic anxiety.
The three mental disorders; OCD, APD, and specific phobia; all are complex illnesses that often
overlap or are comorbid. Each diagnosis must go through the process of differential diagnosis to ensure
the accuracy of the label. First, Avoidant personality disorder (APD) was chosen over other personality
disorders through this process of differential diagnosis. The main theoretical distinction between both
schizoid personality disorder and an autism spectrum disorder is the notion that a person with APD really
wants social contact, however, they are afraid to seek it out. Those with APD and Autism Spectrum
Disorder are less intrinsically interested in social contact. One of point of contention, however, is in
people with Autism Spectrum Disorder. In many cases they actually do seek out human contact yet
struggle with how to achieve it. Therefore, it is important to obtain a great developmental history if both
of these disorders are being considered with APD (Casper & Ecker, 2008). A second point of distinction
between APD and Autism Spectrum Disorder relates to social cues. Children with Autism Spectrum
Disorder tend to ignore these cues, while APD individuals are hypersensitive to them (APA, 2013).
It is important to distinguish from other personality disorders based on differences in their
characteristic features. Both APD and DPD are characterized by feelings of inadequacy, hypersensitivity
to criticism, and a need for reassurance. Although the primary focus of concern in those with APD is

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avoidance of humiliation and rejection, in DPD the focus is on being taken care of. Further, like APD,
schizotypal personality disorder is characterized by social isolation. However, individuals with APD want
to have relationships with others and feel their loneliness deepen, where with schizoid or schizotypal,
these individuals may be content with and even enjoy or prefer that social isolation.
Perhaps the greatest diagnostic dilemma pertains to boundaries between APD and the general
subtype of social anxiety disorder (GAD). The diagnostic criteria overlap considerably. Researchers have
been interested in the vertical boundaries between APD and established personality or temperamental
traits, such as shyness. There certainly appears to be significant and overlap between certain disorders,
such as APD and specific personality dimensions. Nevertheless, the increasing popular hypothesis that
APD simply represents the extreme end of a normally distributed trait, such as shyness appears to be
overly simplistic. Studies of the relationship between shyness and GAD show that many people with very
high levels of shyness do not meet the criteria for GAD. This lack of continuity has stimulated researchers
to begin looking for other features that could moderate the relationships between shyness and psychiatric
disorders. These include other personality or temperamental traits (such as emotion regulation) or specific
cognitive factors that may exacerbate shyness into full-fledged APD (Huppert, 2008).
The differential diagnosis of OCD includes disorders of depression, Generalized Anxiety
disorder, PTSD, Hypochondriasis, body dysmorphic disorder, Tic disorder, and OCPD. Obsessions and
compulsions must be differentiated from similar symptoms that occur in other disorders. In contrast with
obsessions, depressive ruminations usually drag the patient into the past, where self-criticism, guilt, and
regret dominate the mental landscape; when the focus is the future, it is a place of futility, where attempts
to improve life will certainly fail (Turk & Mennin, 2011, p. 77). For example, the speculative thoughts of
depressed patients may be differentiated from obsessive preoccupations in that depressed patients usually
do not consider their thoughts absurd or alien and make no attempt to block or avoid them. The patient
with depression who is preoccupied with the thought I am worthless experiences this thought as
reasonable and accepts it as part of himself or herself. On the other hand, the patient with obsessive-

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11

compulsive disorder who is preoccupied with the thought If I touch a public telephone I will become
contaminated and infect my children will often consider this thought to be absurd and foreign (Koran,
2007, p. 303).
Patients with generalized anxiety disorder may present with excessive worries that resemble
obsessive thinking; however, they usually consider these worries to be realistic and appropriate rather
than absurd. Sometimes the patient with obsessive-compulsive disorder has obsessional concerns that
become so intense and irrational that the patient may appear to be psychotic. However, true obsessions are
almost always accompanied by some form of compulsive ritual, whereas this is not usually the case in
patients with delusional thinking (Koran, 2007).
In posttraumatic stress disorder, the intrusive thoughts and images recreate actual traumatic
events, whereas in OCD the ideation concerns possible future events (Poyurovsky et al., 2003). The
hypochondriac's fear or belief that he or she has a serious disease stems from misinterpreting benign
bodily signs or symptoms, whereas in OCD these fears arise from external stimuli, e.g., exposure to
"contamination." A recent study showed that chest pain, other pain complaints, palpitations, dizziness, and
headache are more common primary fears in hypochondriasis than in OCD (Greeven et al., 2006).
Finally, in determining specific phobia, other disorders had to be distinguished to determine a
diagnosis. The main disorders to distinguish from specific phobia are agoraphobia, social anxiety
disorder, separation anxiety disorder, and OCD. With agoraphobia, there is overlap in its clinical
presentation because of the overlap in feared situations. If an individual fears only one of the agoraphobic
situations, then specific phobia, situational, may be diagnosed. If two or more agoraphobic situations are
feared, a diagnosis of agoraphobia is likely warranted. Monk does not display two or more agoraphobic
fears so a diagnosis is not warranted. With social anxiety disorder, if the situations are feared because of
negative evaluation, social anxiety disorder should be diagnosed instead of specific phobia (APA, 2013).
Separation anxiety disorder is distinguished from specific phobia if the situations are feared because of
separation from a primary caregiver or attachment figure, separation disorder should be diagnose. Monk

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does not have any separation issues with caregiver types of figures so again, this diagnosis is not
warranted. OCD can be distinguished if the individuals primary fear or anxiety is of an object or situation
as a result of obsessions, and if other diagnostic criteria for OCD are met, then OCD should be diagnosed.
Everyone has a personality, yet not everyone has a personality disorder. Many individuals have a
healthy functioning personality. So what diversity factors influence or contribute to some individuals
personality and functioning? Factors that contribute to the functioning and/or diagnosis of the individual
with the personality disorder follow from the biopsychosocial model in understanding the development of
personality disorder. Personality disorder develops as a result of interactions between biological based
vulnerabilities, early experiences with significant others, and the role of social factors in buffering or
intensifying problematic personality traits. Genetics and temperament are the first factors that contribute
to functioning. Biological vulnerability includes the genetic and biological elements to personality
developments (Bell, 2013).
Culture can define which traits and behaviors are considered important, desirable, or undesirable.
Culture has also been connected to gender roles and how they in turn influence personality and identity.
Cultural norms can dictate what traits are considered important to personality. The researcher Gordon
Allport considered culture to be an important influence on traits and defined common traits as those
recognized within a culture. These may vary from culture to culture based on differing values, needs, and
beliefs. Positive and negative traits can be determined by cultural expectations: what is considered a
positive trait in one culture may be considered negative in another, thus resulting in different expressions
of personality.
One well-documented example of how culture can affect personality is the difference between
individualistic societies and collectivist societies. Individualist cultures emphasize personal achievement
regardless of the group goals, resulting in a strong sense of competition. Collectivist cultures emphasize
family and group goals above individual needs or desires. The stereotype of a "good person" in a
collectivist culture is trustworthy, honest, and generous. This culture emphasizes traits that are helpful to

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people working in groups. A "good person" in an individualist culture is more assertive and strong, both
of which are characteristics that are helpful for competing.
Ideas of appropriate behavior for each gender vary among cultures and eras. In much the same
manner that cultural norms can influence personality and behavior, gender norms can also emphasize
different traits between men and women. There are huge differences in attitudes towards appropriate
gender roles based on era and culture. In the United States, aggression and assertiveness are often
emphasized as positive traits in males. Some researchers believe that these traits were originally
emphasized in areas where resources were limited and competition was key. The expectations for men in
a certain time and place may lead to boys learning to manipulate their physical and social environment
through strength or other skills, resulting in greater confidence and an internal locus of control.
Meanwhile, the expectations for women at that same time and place may emphasize submissiveness and
deference as ideal traits in females. The expression of these traits could be reversed based on differing
societal expectations (Borge, et al., 2010).
Society expects different attitudes and behaviors from boys and girls. Gender socialization is the
tendency for boys and girls to be socialized differently. Boys are raised to conform to the male gender
role, and girls are raised to conform to the female gender or role. A gender role is a set of behaviors,
attitudes, and personality characteristics expected and encouraged of a person based on his or her sex.
Experts disagree on whether differences between males and females result from innate, biological
differences or from differences in the ways that boys and girls are socialized. In other words, experts
disagree on whether differences between men and women are due to nature, nurture, or some combination
of both. Every culture has different guidelines about what is appropriate for males and females, and
family members may socialize babies in gendered ways without consciously following that path. For
example, in American society, the color pink is associated with girls and the color blue with boys. Even as
tiny babies, boys and girls are dressed differently, according to what is considered appropriate for their

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respective sexes. Even parents who strive to achieve a less gendered parenting style unconsciously
reinforce gender roles.
Gender roles play an important part in personality development and include concepts such as
gender bias, assessment gender bias, and whether how we are socialized determines our gender roles,
thereby affecting our socialization into personality traits and functioning. "Socialization" is a term used
by sociologists, social psychologists, anthropologists, political scientists, and educationalists to refer to
the lifelong process of inheriting and disseminating norms, customs, and ideologies, providing an
individual with the skills and habits necessary for participating within his or her own society.
Socialization is thus "the means by which social and cultural continuity are attained."
Socialization is the means by which human infants begin to acquire the skills necessary to
perform as a functioning member of their society and is the most influential learning process one can
experience. Unlike other living species, whose behavior is biologically set, humans need social
experiences to learn their culture and to survive. Although cultural variability manifests in the actions,
customs, and behaviors of whole social groups, the most fundamental expression of culture is found at the
individual level. This expression can only occur after an individual has been socialized by his or her
parents, family, extended family, and extended social networks.
The looking-glass self is a social psychological concept, created by Charles Horton Cooley in
1902, stating that a person's self grows out of society's interpersonal interactions and the perceptions of
others. The term refers to people shaping themselves based on other people's perception, which leads
people to reinforce other people's perspectives on themselves. People shape themselves based on what
other people perceive and confirm other people's opinion on themselves.
George Herbert Mead developed a theory of social behaviorism to explain how social experience
develops an individual's personality. Mead's central concept is the self: the part of an individual's

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personality composed of self-awareness and self-image. Mead claimed that the self is not there at birth,
rather, it is developed with social experience.
Gender socialization Henslin (1999) contends that "an important part of socialization is the
learning of culturally defined gender roles" (p. 76). Gender socialization refers to the learning of behavior
and attitudes considered appropriate for a given sex. Boys learn to be boys, and girls learn to be girls. This
"learning" happens by way of many different agents of socialization. The family is certainly important in
reinforcing gender roles, but so are one's friends, school, work, and the mass media. Gender roles are
reinforced through "countless subtle and not so subtle ways," said Henslin (1999, p. 76).
Cultural socialization refers to parenting practices that teach children about their racial history or
heritage and, sometimes, is referred to as "pride development. Preparation for bias refers to parenting
practices focused on preparing children to be aware of, and cope with, discrimination. Promotion of
mistrust refers to the parenting practices of socializing children to be wary of people from other races.
Egalitarianism refers to socializing children with the belief that all people are equal and should be treated
with a common humanity.
Monk was raised in a very strict household with rigid rules and an overly-protective mother. His
father abandoned him early on in his life, suggesting abandonment issues from an early start. In his school
years, Monk is often humiliated by his peers for being different and the students make fun of him and
play pranks on him all the time. Monks mother rarely displayed emotional gestures towards her children
and she was controlling in making decisions for her children and in allowing them to participate in certain
activities. All the above etiology factors discussed and their involvement in the functioning and diagnosis
display a pretty accurate picture of Monks developmental life.
There may be variations in the prevalence of diagnosed individuals across cultures as the degree
of appropriate diffidence and avoidance differs between societies. Avoidant behavior may also be

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influenced by problems in acculturation following immigration ("culture shock"). Avoidant Personality

Disorder seems to occur equally between males and females (Rettew et al., 2003).
Treatment planning in patients with Avoidant Personality disorder (APD) can often be difficult
because of its high comorbidity rate with anxiety disorders. When working with patients with APD, it is
important to keep in mind a few things throughout the treatment planning and intervention process.
Caspar and Ecker, in their article, Treatment of an avoidant patient with comorbid psychopathology: A
plan analysis perspective, (2008) takes a step by step approach when dealing with these types of clients.
The first thing to consider is their view of themselves. It would be typical for a client with APD to make
remarks suggesting distorted images of oneself. They may see themselves as physically unappealing,
socially inept, and inferior to others. Therefore, the primary treatment goal is to enhance their view of
themselves as a social object.
Since patients with APD are avoidant in nature, they very well will possibly come to see the
therapist and then terminate therapy. Early termination is often a frequently experienced issue in patients
with ADP. Therefore, forming a therapeutic allegiance early on is essential. Forming initial rapport is
likely to be more difficult with someone who has this disorder, since early termination is often an issue.
Once rapport is formed, therapy is usually quite stable, unless issues are brought up which are extremely
difficult for the client to deal with. Care should be used by the clinician in exploring new material,
therefore (Caspar & Ecker, 2008, p. 141). Professionals working with individuals who have AVPD will
be committed to devising a treatment program that involves a detailed evaluation of a client's history and
symptoms. This will ensure treatment is tailored to deal with specific problems that may be underlying
the disorder. Therapists will be particularly sensitive to forming a solid therapeutic relationship with their
client in order to make them feel comfortable and secure in therapy. They will also need to take extra care
when exploring new material and issues as these may be particularly difficult for the client to deal with.
Individuals who suffer from this disorder typically have poor self-esteem and issues surrounding
any type of social interactions. They often see only the negative in life and have difficulty in looking at

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situations and interactions in an objective manner. This can also interfere with their self-report when they
present for an initial evaluation, which can lead to important life history and medical information being
missed (because the patient deems it and himself too unimportant to bother). It is necessary to take a more
detailed evaluation than usual, while doing so in a relatively unobtrusive fashion. The clinician should be
sensitive to nonverbal cues of the client during this session, to evaluate when information is being
withheld.
This is essential to making a differential diagnosis with similar looking but vitally different
disorders. As with other personality disorders, the individual is not likely to present himself to therapy
unless something has gone wrong in their life with which their dysfunction personality style cannot
adequately cope. In order to develop rapport, it is important to show the client a lot of support and
acceptance. Faith (2009), suggests starting the session in a directive and structured manner in order to
maintain a focus. Seligman and Reichenberg (2007) note the overall goal is to promote a clients selfreliance, self-expression, and autonomy in the safety of counseling and to then transfer these
characteristics outside of the sessions (p. 474).
Effective treatment of Avoidant Personality Disorder requires a devoted approach dedicated to
reversing the underlying relationship anxiety via avoidance reduction. It will be applicable to reduction of
avoidance in all its forms.
Avoidance reduction should focus not only on fear of criticism (the official dynamic explanation
of avoidance) but also on the equally important fears of flooding, depletion, and acceptance. Avoidants
are not simply afraid of criticism and humiliationthe only reason for avoidance currently identified in
the official literature. They are also afraid of being flooded by feelings they cannot tolerate, and of being
depleted should they express these feelings. Most importantly, they fear acceptance as much as they fear
rejection because they fear losing their identity and personal freedom. In practice Avoidance reduction
involves a pastiche of familiar psychotherapeutic approaches in use today, including psychodynamic,

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cognitive-behavioral, interpersonal, and supportive approaches, selected elements of which are combined
for a synergistic effect.
One type of therapy suggested in this article for APDs is psychodynamic therapy. These
approaches are usually supportive; the therapist empathizes with the patient's strong sense of shame and
inadequacy in order to create a relationship of trust. Therapy usually moves slowly at first because
persons with avoidant personality disorder are mistrustful of others; treatment that probes into their
emotional state too quickly may result in a more protective withdrawal by the patient. As trust is
established and the patient feels safer discussing details of his or her situations, he or she may be able to
draw important connections between their deeply felt sense of shame and their behavior in social
situations (Emmelkamp et al., 2006).
In regard to this disorder there can often be a mixture between both individual as well as group
therapy; however, the group aspect is often in the latter stages due to the particular type of disorder that is
being discussed. Therapy can make some important breakthroughs for the sufferer, but it is important that
it does not go on for too long to prevent them from becoming too dependent on their therapist.
Psychotherapy is often seen as being able to help with short term goals and is focused on helping
the sufferer meet certain aims and targets that they have set themselves. It is a great way to help rebuild
self-esteem, which is often a problem for someone with this condition, but it should be said that negative
thoughts about themselves is something that does require more long term treatment through other types of
therapy.
The therapist will often undertake a less obtrusive approach than they would for other disorders
due to the very nature of the problem and it has to be said that this particular treatment is one of the most
difficult to get the sufferer to in the first place. However, if they manage to get there, then the
psychotherapist will guide the person through therapy quietly and slowly as an approach that is deemed to
be too aggressive will often result in the person ending the sessions early. This means the relationship

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with the therapist is key on order to gain some long term benefit from psychotherapy and they must be an
expert at identifying small clues in what the sufferer says or does due to them often hiding the true extent
of the problem to anybody other than themselves..
The psychoanalytic therapies aim for changes in personality and emotional development. The
basic idea is that we all have a less conscious or unconscious part of our minds, and that this has a
powerful effect on ourselves and our lives, even though by definition we are not consciously aware of
it. If we can be more aware of our inner world we can understand ourselves better, and have more control
over some of our feelings and thoughts. We are influenced by how we have reacted to the crucial
experiences of growing up, of our early attachments, of being dependent, and these experiences will have
formed patterns of thoughts and feelings in us, especially about relationships. These internal working
models will be explored in therapy. The therapeutic relationship with the therapist is crucial in enabling
this understanding to be effective and experienced in the here and now (transference), rather than the
less effective understanding that may be reached from self-help books or introspection. Intellectualized
insight is unlikely to be internalized or lead to lasting change in functioning.
The other type of therapy suggested is cognitive behavioral therapy. This approach assumes that
faulty thinking patterns underlie the personality disorder, and therefore focuses on changing distorted
cognitive patterns by examining the validity of the assumptions behind them. If a patient feels he is
inferior to his peers, unlikable, and socially unacceptable, a cognitive therapist would test the reality of
these assumptions by asking the patient to name friends and family who enjoy his company, or to describe
past social encounters that were fulfilling to him. By showing the patient that others value his company
and that social situations can be enjoyable, the irrationality of his social fears and insecurities are
exposed. This process is known as "cognitive restructuring."
You may recall, people with personality disorders have characteristic patterns of thinking that get
them into trouble. This is because their ways of thinking tend to be somewhat extreme, inflexible, and
distorted. CBT is particularly helpful for people with personality disorders because of its emphasis on

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identifying and changing dysfunctional thinking patterns. In particular, core beliefs underlying those
patterns are exposed and challenged. Thus, cognitive-behavioral therapy functions to identify and
challenge automatic and faulty interpretations of the environment that are driven by core beliefs.
A person corrects these faulty interpretations of the environment by replacing them with more
accurate, rational interpretations. With a more accurate interpretation, new, more accurate core beliefs are
formed. This is because there is a circular causality between people and their environment: The
environment has an effect upon me, and I have an effect upon my environment. These new, positive
experiences allow the person to update their core beliefs about the world. This in turn enables them to
have more positive and affirming experiences and so on. As core beliefs become more rational and less
biased, the client's appraisals of the meaning of events becomes more accurate. This results in emotional
and behavioral reactions that are less exaggerated and problematic.
Although cognitive behavioral therapy is sometimes employed to help patients with avoidant
personality, the preferred course of action for most of those living with the stress of this condition is
psychotherapy. This involves therapists helping the patient to reach a more objective understanding of
their social interactions and to find methods to deal with the negative feelings involved. This may be done
on an outpatient basis, but many patients find that residential treatment gives them a faster and more
intensive head start on the path toward recovery. Group and family therapy may also be helpful in treating
some patients with avoidant personality disorder.
For Monk, one must consider his comorbid conditions in thinking about therapy and thus just
involve a mix of therapeutic techniques. Medication is something that can be discussed, although Monk
refuses to take medication as he tried it once and it made him lose his unique abilities as a detective.
Considering this, CBT works well with DPD and is known to work on OCD patients so it is probably the
best bet. A mix of group therapy along with single therapy would be ideal to expose Monk to others and
let him work on his social skills. Psychodynamic therapy should still be utilized as one of main goals of

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therapy in this case is in dealing with Monks dependency issues and that therapy directly focuses on such
things.
Some of the implications to think about regarding therapy and APD are the obstacles the therapist
may have to overcome. Individuals with Avoidant Personality Disorder have few close friends, but are
very dependent on them. They are described by others as being "shy", "timid," "lonely," and "isolated".
Their occupational functioning may also suffer because they avoid social situations that are important for
job advancement. So for one, the client may experience a significant loss such as a job or other set back
that may cause them to regress in therapy. The therapist should be aware of this and be supportive of the
regression and accepting of the interruption it may cost to therapy. Further, the client may seem to not be
making any changes outside of therapy simply because they are afraid to lose that attachment they have
gained from the therapist (Faith, 2009). All of these obstacles must be considered before entering
interventions and therapy with patients to make sure one is capable and competent to go forward.

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