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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA,
ANNEXURE-II
APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.
NAME OF THE
CANDIDATE & ADDRESS
DR RITESH KUMAR PATEL
FATHER MULLER HOMOEOPATHIC
MEDICAL COLLEGE AND HOSPITAL,
UNIVERSITY ROAD, DERALAKATTE,
MANGALORE -575018, KARNATAKA.
PERMANENT ADDRESS
S/O SRI L.P.PATEL.
ERB-29, PALI PROJECT COLONY
PO.BIRSINGHPUR PALI
DIST – UMARIA( MADHYA PRADESH)
PIN- 484551
2.
NAME OF THE
FATHER MULLER HOMOEOPATHIC
INSTITUTION
MEDICAL COLLEGE AND HOSPITAL,
DERALAKATTE, MANGALORE-575018
3.
4.
COURSE OF THE STUDY &
MD (HOM)
SUBJECT
HOMOEOPATHIC PSYCHIATRY
DATE OF ADMISSION TO
THE COURSE
5.
16-07-2012
TITLE OF THE TOPIC:
“A BRIEF STUDY ON ANXIOUS (AVOIDANT) PERSONALITY DISORDER
& ROLE OF HOMOEOPATHY IN DEALING WITH THIS PERSONALITY
DISORDER.”
1
6.
BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR STUDY:

Anxious (Avoidant) personality disorder is a cluster c personality disorder
recognized in the Diagnostic & Statistical Manual of Mental Disorders,
handbook as afflicting a person, when they display a pervasive pattern of
social inhibition, feeling of inadequacy, extreme sensitivity to negative
evaluation & avoidance of social inter-action9

Avoidant Personality Disorder is a mental health condition in which a person
has a life-long pattern of feeling very sad, inadequacy & sensitivity to
rejection.11

Personality disorders are life-long pattern of behavior that causes problem
with work & relationship.11

People with Avoidant Personality Disorder often considered themselves to be
socially inept or personally unappealing, & avoid social inter-action from fear
of being ridiculed, humiliated, rejected or disliked.9

Avoidant Personality Disorder is usually 1st noticed in early adulthood,
childhood emotional neglects & peer group rejection ( eg-bullying) or both
associated with is an increased risk of the development of Avoidant
Personality Disorder.9

Avoidant Personality Disorder is common, the prevalence of the disorder is
1% in general population and almost 10% in clinical population.4

No information is available on sex ratio of familiar pattern.4

That’s why it is recognized that Avoidant Personality Disorder is an important
problem of adolescence & adulthood in India. So there is need for more
Research in this field.

According to U.K Hospital statistics in 2006-2007, shows that 43% of those
admitted with diagnosis of Avoidant Personality Disorder where male & 57%
are female in a year & this prevalence is increasing day by day.11

Because infants classified as having timid temperament may be more
susceptible to the disorder than others.6
2

It is found that people with this disorder may develop some ability to relate to
others & this can be improved by treatment.11

So there is special need for the study in this field to understand the various
aspect of Anxious (Avoidant) Personality Disorder & importance of
Homoeopathy in the treatment of Avoidant Personality Disorder based on the
Homoeopathic Principles. It is an attempt to study the effectiveness of
Homoeopathic Medicines in management of this disorder.
6.2 REVIEW OF THE LITERATURE:HISTORY: The Avoidant Personality Disorder has been described in several sources as far
as early 1900’s although it was not so named for sometimes. Swiss Psychiatrist
‘EUGENE BLEUR”, described patients who exhibits Signs of Avoidant Personality
Disorder in his work in 1911 on DEMENTIA PRAECOX, or group of SCHIZOID
PERSONALITIES were frequently confused synonymously. After that KRETCHMER
in 1921 provided the 1st relatively complete description, & developed a distinction.9
Avoidant Personality Disorder was 1st introduced into Psychiatric classification in
DSM –III, before this such patients where included among the Schizoid or Dependent
Personality Disorders.4
The characteristics behavior of this personality disorder is active isolation from
the social environment, extreme sensitivity to rejection, disapproval, criticism, feeling
of inferiority, & low self-esteem.4
This disorder is termed as ANXIOUS PERSONALITY DISORDER in ICD-10,
since Anxiety is basic effective feature of this disorder.4
EPIDEMIOLOGY:According
to
DSM-IV-TR
Avoidant
Personality
Disorder
occurs
in
approximately 0.5% to 1% of the general population.9
However, data from 2001-2002 National Epidemiological Survey on Alcohol &
related condition indicates a prevalence rate of the disorder is 2.36% in American
General Populations.9
3
It is seen in about 10% of Psychiatric out patients.9
Avoidant Personality Disorder is reported in approximately 1/3rd of sufferers of
Anorexia Nervosa. There is no difference between sex are found.4,9
CLASSIFICATION: - INTERNATIONAL CLASSIFICATION OF MENTAL &
BEHAVIORAL DISORDER ICD-10:In ICD-10, F60 – F69 disorders of adult personality and behavioural disorder are
discussed under F60 specific personality disorders:F60 Specific personality disorders:

F60.0- paranoid personality disorder.

F60.1- schizoid personality disorder.

F60.2- Dissocial personality disorder.

F60.3- Emotionally unstable personality disorder.
-
.30 Impulsive type.
-
.31 Borderline type.

F60.4- Histrionic personality disorder.

F60.5- Anankastic personality disorder.

F60.6- Anxious (avoidant) personality disorder.

F60.7- Dependent personality disorder.

F60.8- other specific personality disorders.

F60.9- personality disorder unspecified.1
4
DIAGONSIC & STATISTICAL MANUAL OF MENTAL DISORDER (DSM)
CLASSIFICATION.
IN DSM- IV- TR, it has been included under Axis II Personality disorder:301.0- Paranoid personality disorder.
301.20- Schizoid personality disorder
301.22- Schizotypal personality disorder.
301.7- Antisocial personality disorder.
301.83- Borderline personality disorder.
301.50- Histrionic personality disorder.
301.81- Narcissistic personality disorder.
301.82- Avoidant personality disorder.
301.6- Dependent personality disorder.
301.4- Obsessive compulsive personality disorder.
301.9- Personality disorder NOS. 2
ETIOLOGY:Some familial transmission is possible, perhaps involving learning and
identification, but genetic transmission may also be involved. The biological
mechanism involved in anxiety disorder and social phobia may have a role in
development of this personality disorder. It has been suggested that hyper-sensitivity
of brain areas involved in the separation anxiety-response and over activity of
serotonin limbic neuronal circuits may underline the Avoidant temperament trait.4
CLINICAL FEATURE:
Avoidance of occupational activities.

Unwilling to be involved with the others.

Preoccupation of being criticized or rejected.

Inhibition in new social situation because of feeling of inadequacy.

Fearful and tense demeanor.

Fear of blushing and crying in front of others.

View of a socially inept, personally unappealing or inferior to others.5
5
DIAGNOSTIC CRITERIA:According to the World Health Organization ICD-10, Avoidant Personality
Disorder as –(F.60.6), ANXIOUS (avoidant) PERSONALITY DISORDER, should be
characterized by at least four of the following:a) Persistent and pervasive feeling of tension and apprehension.
b) Belief that one is socially inept, personally unappealing, or inferior to others.
c) Excessive preoccupation with being criticized or rejected in social situation. .
d) Un-appealing to become involved with people, unless certain of being liked.
e) Restriction in life- style because of need to have physical security.
f) Avoidance of social or occupational activities that involve significant
interpersonal contact because of fear of criticism, disapproval or rejection.1,9
According to American Psychiatric Association, DSM-IV-TR:Four out of seven criteria should met for diagnosis of avoidant personality disorder,
which are :
Avoidant occupational activities that involve interpersonal contact, because of
fear of criticism, disapproval or rejection.

Is unwilling to get involved with people unless certain of being liked.

Shows restraint within intimate relationship because of the fear of being
shamed of ridiculed.

Is preoccupied with being criticized or rejected in social situation.

Is unusual reluctant to take personal risk or to engage in any new activities
because they may prove embarrassing.

Is inhibited in new inter personal situation because of feeling of in adequacy.

Views self as a socially inept, personally unappealing, or inferior to others.1,9
COMPLICATION:- Complication include social phobia.5
CO-MORBIDITY:The patients are at increased risk for mood and Anxiety Disorder(especially
Social Phobia),generalized type.5
The most common co-occurring disorder are – Schizotypal, Schizoid, Paranoid,
Dependent, and Borderline type.5
6
IMPAIRMENT:Impairment can be severe and typically includes occupational and social
difficulties.5
SEX RATIO:According to DSM-IV-TR, this disorder is equally frequent in men and women.5
COURSE:Frequently begins in childhood with shyness, and fear, of strangers and new
situation. Disfiguring illness and shyness in childhood predispose children for this
personality disorder.5
DIFFERENTIAL DIAGNOSIS:a) Schizotypal and Schizoid (social isolation), of Avoidant Personality Disorder
is accompanied by the desire for social relation, which is not observed in
Schizoid and Schizotypal disorder.
b) Paranoid (which includes guarder attitude, pre-occupation with hidden
meaning, and conspirational explanation of events).5
HOMOEOPATHIC APPROACH:Homoeopathy is a system of medicine based on Principle; “Similia Similibus
curantur,” like cure like.7
Mental diseases are a type of one-sided disease, which affects the whole Psyhosomatic entity, but the symptoms of mind and disposition increases with decline of
corporeal symptoms and they are of psoric in origin7.
Homoeopathy is based on the totality of the symptoms and not the name of
condition/ disease. Dr Hahnemann classifies the Mental Disease and gives brief
guidelines on their treatment in 6th edition of Organon Of Medicine (Aphorism-210230)7.
1. Somatic Psychic Disease ( Aphorism-216):Treatment consists of selection of similimum on the basis of Corporeal and Mental
symptoms in a person followed by an antipsoric remedy.7
2. Acute flurring of symptom’s by some exciting cause (Aphorism 221):Acute remedy is selected on the basis of Corporeal and Mental symptoms followed
by an antipsoric remedy, is the suggested way of treatment.
7
3. Mental Diseases of doubtful origins ( Aphorisms 224):In this type of diseases, display of confidence, friendly exhortations and sensible
advice is to be given to bring down the emotional upset, and if it does not help, a deep
Anti-Psoric remedy has been suggested as the proposed mode of treatment.7
4. Psycho-Somatic Disease (Aphorism 225):Treatment consists of display of confidence, friendly exhortations, sensible advice
to bring down the emotional upsets, and if does not help, a deep Anti-Psoric remedy is
prescribed.7
Many authors has given their views on treatment of psycho-somatic disorders
which are as follows:According to H.A Robert:He mentioned that behind every mental disease psora is predominant. Because our
treatment is based upon symptom similarity ,and where psora is present, it will be the
most outstanding in the symptom totality in earlier manifestation, so this must be
treated first than others, and continued in this way until cure is attained.8
According to Dr Farokh J. Master:In order to cure mental disease the prescription being aimed towards inner most
mental and emotional state rather than outward physical expression.
Whenever the remedy prescribed must be similar with mental/ emotional state, in
the absence of clear mental and emotional symptoms, the physical generals has given
much importance, And the prescription should be given the form of single remedy in a
single dose, in higher potency, and then wait for the response to the prescription has
clearly ceased before repeating or represcribing.15
According to Dr Rajan Sankaran:He mentioned that mostly the cases of mental disorders and psychosomatic
disorders are psoric in origin. And the dominant miasm behind it is latent psora,
which can cause many deformities like anxiety, restlessness, worry, and this can be
usually expressive during case taking. So this can be treated by well indicated
antipsoric remedy according to the totality of the symptom.
According to Homoeopathic Philosophy, Individualization helps in selecting the
perfect similimum. So here are some of the common indicated remedies in the
8
Homoeopathic Materia Medica, which helps in management of ‘Avoidant
Personality Disorder’ patients.17
Argentum nitricum:-12,13,14

Fearful and nervous.

Faintiss and tremulous.

Melancholic: apprehension to serious disease.

Time passes slowly.

Error of perception.

Fear and anxiety and hidden irritational motives action.
Calcarea carb:
Apprehensive; worse in evening.

Fear loss of reason, misfortune, and contagious disease.

Forgetful, confused, low spirited.

Anxiety with palpitation.

Aversion to work and exertion.
Kali phos:
Anxiety, nervous dreads, lethargy.

Indisposition to meet people.

Extreme lassitude and depression.

Brain fag.

Shyness: disinclined to converse.
Lycopodium :
Melancholic: afraid to be alone.

Extreme sensitivity.

Averse to undertake new things.

Loss of self-confidence.

Constant fear of breaking down under stress.

Confused thoughts.
Silicea :
Yielding, faint hearted, anxious.
9

Nervous and excitable.

Sensitive to all impressions.

Abstracted.

Fixed ideas; thinks only of pin, fear them, searches and count them.
Arsenicum album:
Great anguish and restlessness.

Changes place continually.

Fear, of death, of being left alone.

Thinks it’s useless to take medicines.

Suicidal thoughts.

Sensitivity to disorder and confusion.
Ignatia amara: Bad effects of anger, grief or disappointed love.
 Desire to be alone.
 Inconstant, impatient, irresolute, quarrelsome.
 Finally sensitive mood, delicate consciousness.
 Person mentally and physically exhausted by long concentrated grief.
Phosphorus:
Nervous, weak, desire to be magnetized.

Weary of life, full of gloomy, fore-bodings.

Apathetic, unwilling to talk, answers slowly, moves sluggishly
Natrum. Mur:
Bad effect of anger, of grief, fright vexation, mortification or reserved
displeasure.

Irritability, child cross when spoken to, crying from slightest cause.

Awkward, hasty, drops things from nervous weakness.

Marked disposition to weep: sad weeping mood, without cause but consolation
from others aggravate her troubles.

Dreams: of robbers in house and on waking will not believe to be contrary
until search is made.
10
6.3 OBJECTIVE OF THE STUDY:1. To study the various causative factors leading to the development of Avoidant
Personality Disorder.
2. To study the effectiveness of Homoeopathic remedies in treatment of Avoidant
Personality Disorder.
7.
MATERIALS AND METHODS
7.1 SOURCE OF DATA:A sample of 30 cases will be taken from OPD, IPD, peripheral centers, and village
camps of Father Muller Homoeopathic Medical College, Mangalore as per inclusion
criteria.
7.2 METHOD OF COLLECTION OF DATA:The Materials used for the Study:The data will be collected by purposive sampling method and processed in a
standardized case record.
All the cases will be processed in the SCR format of case recording. Then all the
cases will be followed up for a minimum of 3 months durations.
Every case will be analyzed with reference from Materia Medica, Repertory &
Therapeutics whenever required.
Each case will be evaluated according to Hamilton anxiety scale for the scoring
criteria, which includes the intensity of the symptoms before & after the treatment.
INCLUSION CRITERIA:1. The sample of both the sexes of age groups between 15-50 years.
2. Diagnostic criteria are based mainly on clinical presentation.
EXCLUSION CRITERIA:Cases below 15 yrs. & above 50 yrs.
RESEARCH HYPOTHESIS:Homoeopathic Medicines are effective in treatment of Anxious (Avoidant)
Personality Disorder.
11
NULL HYPOTHESIS:There is no significant difference in the scoring criteria before & after the treatment.
PLAN FOR DATA ANALYSIS:The significance in parameter will be tested by student “t” test for continuous
numerical values.
7.3 Does the study require any investigations to be conducted on patients, or
other humans (or animals)? If so please describe briefly.
No, the study does not require any investigation.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes, enclosed.
12
8.
LIST OF REFERENCES:1. The ICD- 10: Classification of mental and behavioral disorders, clinical
description and diagnostic guidelines, authorized reprint 2007, by A.I.T.B.S.
publishers and distributor’s Pvt Ltd (registered) J-5/6, Krishnanagar, New
Delhi, 11005, India. p. 200-206.
2. DSM-IV-TR, Diagnostic and Statistical Manual of Mental disorder, 4th
edition, text revision, first Indian edition, 2005, Published by Jaypee Brothers
Pvt.LTD, Washington, DC. p. 24, 718-721.
3. AHUJA NIRAJ - A short text book of psychiatry 7th edition, 2011, New Delhi,
Jaypee publishers Pvt. Ltd, p. 113-117.
4. New Oxford Textbook of psychiatry 2nd reprint edition – 2009, volume 1,
Indian edition by oxford university press, p. 847-873.
5. Sadock Benjamin James, Sadock Virginia Alcott: Kaplan and Sadock’s
comprehensive textbook of psychiatry, volume-II, 8th edition, Philadelphia,
Lippincott Williams and Wilkins, 2005, p. 2063-2086.
6. Sadock Benjamin James: Kaplan and Sadock’s synopsis of psychiatry:
behavioural science, clinical psychiatry 9th edition, Benjamin James, Sadock
Virginia Alcott, Philadelphia, Lippincott Williams and Wilkins, 2007, p. 791804.
7. Hahnemann Samuel: Organon of medicine 6th edition, translated by William
boericke, reprint edition 2004, from aphorism 210-230, p. 184-194.
8. Robert Herbert A: The principals and art of cure by homoeopathy low priced
edition August 2002, reprint edition 2000-2007, published by B.Jain publishes
Pvt.LTD, New Delhi, India, p. 203-207.
9. http:// en.wikipedia.org/wiki/avoidant personality disorder, cited on 18/2/2013.
10. http:// out of fog.net/disorder/avpd.html: cited on 16/3/2013.
11. http:// medical.hpathy.com/content.aspx? cited on 16/02/2013.
12. Allen H.C: Allen’s keynote, rearranged and classified with leading remedies
of materia medica and bowel nosodes, 10th edition, B.Jain publishes Pvt.LTD,
New Delhi, India, 2005.
13
13. Boericke William: Pocket manual of homoeopathic materia medica and
repertory, 51st impression 2011, B.Jain publishes Pvt.LTD, New Delhi, India,
110055(India).
14. Vithoulkas George, essence of materia medica, B.Jain publishes Pvt.LTD,
New Delhi, India, (Reprient edition:-2010).
15. The Bedside: Organon of medicine, edited by Farok J. master, M.D (hom),
B.Jain publishes Pvt.Ltd, New Delhi, India, 1st edition 1996, p. 92-94.
16. Dr. Praful G: Vijayakar, Predictive Homoeopahty, part 3: The end of
miasmation of miasms, 2003, published by Mrs. Preeti Vijaykar, Shivaji park
Dadar, Mumbai 400028, p.139-142.
17. Sankaran Rajan: The substance of Homoeopahty, reprinted edition. 2005,
published by Homoeopathic medical publishers, Santa Cruz (W), Mumbai
400054, India, p. 38-45.
14
9.
SIGNATURE OF THE
CANDIDATE
10.
REMARKS OF THE GUIDE
11.
11.1 NAME AND
DESIGNATION OF THE
GUIDE (IN BLOCK LETTERS)
DR GIRISH NAVADA
BHMS, MD (HOM)
PROFESSOR, DEPT. OF PSYCHIATRY,
FATHER MULLER HOMOEOPATHIC
MEDICAL COLLEGE AND HOSPITAL,
DERALAKATTE, MANGALORE.
11.2 SIGNATURE
11.3 CO-GUIDE (IF ANY)
11.4 SIGNATURE
11.5 HEAD OF THE
DEPARTMENT
DR JACINTHA MONTERIO
BHMS, MD (HOM)
ASSISTANT PROFFESSOR, FATHER MULLER
HOMOEOPATHIC MEDICAL COLLEGE AND
HOSPITAL, DERALAKATTE, MANGALORE.
11.6 SIGNATURE
12.
12.1 REMARKS OF THE
CHAIRMAN & PRINCIPAL
12.2 SIGNATURE
15