Avoidant Personality Disorder: Symptoms and Treatment

Avoidant personality disorder (AVPD) is an enduring pattern of behavior related to social inhibition, feelings of inadequacy, and sensitivity to rejection that causes problems in work situations and relationships.

The disorder is characterized by extreme shyness and sensitivity to criticism from others and is known as a Cluster C personality disorder or one that involves anxious and fearful personality disorders.

AVPD is often associated with other mental health conditions like anxiety disorders, in particular, social anxiety disorder. People with the disorder show a pattern of avoidance due to fear of rejection or disapproval, which they experience as extremely painful. The disorder affects about 2.5% of the population, with roughly equal numbers of men and women being afflicted.

Symptoms of Avoidant Personality Disorder

The following is a list of common symptoms associated with avoidant personality disorder:

• A need to be well-liked
• Anhedonia (lack of pleasure in activities)
• Anxiety about saying or doing the wrong thing
• Anxiety in social situations
• Avoiding conflict (being a "people-pleaser")
• Avoiding interaction in work settings or turning down promotions
• Avoiding intimate relationships or sharing intimate feelings
• Avoiding making decisions
• Avoiding situations due to fear of rejection
• Avoiding social situations or events
• Easily hurt by criticism or disapproval
• Extreme self-consciousness
• Failure to initiate social contact
• Fearful and tense demeanor
• Feelings of inadequacy
• Hypersensitivity to negative evaluation
• Lack of assertiveness
• Lack of trust in others
• Low self-esteem
• Misinterpreting neutral situations as negative
• No close friends/lacking a social network
• Self-isolation
• Social inhibition
• Unwilling to take risks or try new things
• Viewing oneself as socially inept or inferior
• Vigilant for signs of disapproval or rejection

Diagnosis of Avoidant Personality Disorder

Avoidant personality disorder can only be diagnosed by a trained mental health professional based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). While a family physician can be the first point of contact for a diagnosis, your doctor should make a referral to a psychologist, psychiatrist, or other mental health professional for diagnosis.

According to the DSM-5, a person must have a consistent pattern of avoiding social contact, being overly sensitive to rejection and criticism, and feeling inadequate, as displayed by at least four of the following criteria:

• Avoidance of occupational activities involving significant social contact out of fear of criticism, disapproval, or rejection
• Unwillingness to become involved with others unless you are certain that they will like you
• Holding back in intimate relationships out of fear of being ridiculed or humiliated
• Preoccupation with criticism or rejection in social situations
• Inhibition in new social situations due to feeling inadequate
• Feelings of being socially inept, unappealing, or inferior to others
• Hesitation to take risks or do new things out of fear of embarrassment

Avoidant Personality Disorder vs. Social Anxiety Disorder

Avoidant personality disorder can seem very similar to social anxiety disorder, with some overlap in symptoms. However, they are distinct conditions that have different causes. 

Like AVPD, social anxiety is a type of anxiety disorder that causes people to feel that they will be judged or rejected by others. However, social anxiety is driven by high levels of anxiety, while significant feelings of worthlessness cause AVPD. While they are distinct, a person can be diagnosed with both conditions.

What Triggers Avoidant Personality Disorder?

The causes of avoidant personality disorder are thought to involve genetic, environmental, social, and psychological factors. Some factors that can play a part in the development of the condition include:

• Emotional abuse
• Criticism
• Ridicule
• Lack of affection or nurturing by a parent or caregiver in childhood
• Rejection by peers

Often, individuals with the disorder are very shy as children and do not outgrow this shyness as they age. Children who are high in behavioral inhibition may be more likely to have negative social experiences, which play a part in the development of thought patterns that increase their risk for developing AVPD.

Related Conditions

Avoidant personality disorder may co-occur and overlap with a variety of other conditions, including:

• Social anxiety disorder
• Dependent personality disorder
• Borderline personality disorder (BPD)
• Substance use disorder
• Depression
• Agoraphobia

How Serious Is Avoidant Personality Disorder?

Unfortunately, the outlook for people with avoidant personality disorder who do not seek treatment is rather bleak. Typically, they become self-isolated and use avoidance as their only coping strategy.

People with the condition may have few relationships and often become very isolated. This often leads to other long-term difficulties, including problems with work and school.

It is not uncommon for people with this condition to avoid school or occupations that involve a lot of social contact. People with the condition may be more likely to experience alcohol and substance use disorders.

Treatment of Avoidant Personality Disorder

Most people with avoidant personality disorder do not seek treatment. When they do, it is often for a specific life problem they are experiencing or other types of symptoms such as depression and anxiety, and they will usually discontinue treatment if that problem is resolved.

Like other personality disorders, avoidant personality disorder can be difficult to treat because it is an enduring pattern of behavior. It can be difficult for the person living with the disorder to recognize that psychotherapeutic help is needed and can be beneficial.

Talk Therapy

Talk therapy for avoidant personality disorder may include cognitive behavioral therapy (CBT), psychodynamic therapy, and schema therapy. Group therapy and social skills training may also be helpful.

CBT helps people learn how to change unhelpful thinking patterns. while psychodynamic therapy is aimed at being aware of how past experiences, pain, and conflict may be contributing to current symptoms.

Schema therapy for avoidant personality disorder is an integrative approach that builds on CBT as well as many other therapeutic techniques. It has a focus on the therapeutic relationship between therapist and client, and a goal of improving daily functioning and gaining insight for change based on understanding and re-engineering of early life experiences.

A key feature of schema therapy is "limited reparenting," in which the client expresses childhood needs and learns to develop and internalize a healthy parent voice.

Medication

While there are currently no medications specifically approved for treating avoidant personality disorder, if a person has other related disorders such as depression or anxiety, medication may be prescribed to help with those symptoms.

For example, antidepressant medication can be helpful for improving mood and anhedonia, decreasing anxiety symptoms, and may also reduce sensitivity to rejection.

Coping With Avoidant Personality Disorder

One of the first steps in improving quality of life with avoidant personality disorder is to recognize the signs. By understanding your specific symptoms, you’ll be able to better work with your therapist to find ways to work around them.

Consider involving friends and family in your therapy, too, so they have a better understanding of what you’re going through and how to help.

Self-care is also essential, including finding healthy coping skills that prevent you turn to drugs or alcohol, smoking, overeating, or self-harm when you’re having a hard time.

If you think someone you know or love may be living with avoidant personality disorder symptoms, it is important to encourage that person to seek help. Without professional treatment such as talk therapy, it is unlikely that the symptoms and their related impacts on relationships will improve.