What is Avoidant Personality Disorder (AvPD)?

Avoidant personality disorder (AvPD) is a psychiatric disorder that can have severe consequences for an individual’s well-being. Its characteristics, such as constant feelings of inadequacy, elevated sensitivity to rejection and criticism, and severe difficulties socializing, can result in withdrawal from productive work and meaningful social relationships.

AvPD is one of the most common personality disorders. It’s estimated that around 3.7% of persons in the United States have the disorder.

General shyness is a common human experience. Speaking in public or meeting a partner’s parents can be uncomfortable. However, for a person with AvPD, these unpleasant sensations are constant, often contributing to a profound distrust for others and self-esteem issues. They believe that avoiding social interactions is the only way to alleviate the distress that such interactions cause them.

AvPD shares some commonalities with social anxiety disorder (SAD), a separate psychiatric condition. Some researchers suggest that they both represent different spectrums of the same disorder.

However, 66% of individuals diagnosed with AvPD do not meet SAD criteria. Social anxiety disorder versus avoidant personality disorder isn’t always always a clear distinction, but there are some important differences.

People with SAD fear embarrassing themselves in social settings, while individuals with AvPD may avoid relationships, even with family, entirely, and are reluctant to take personal risks beyond just social scenarios. SAD centers on what might happen in social situations, while AvPD encompasses a more fundamental, enduring belief in one’s inherent unworthiness in relation to others.

AvPD Effects on Daily Life, Relationships, and Self-esteem

AvPD can be so damaging that some studies have found that individuals battling AvPD experience significant societal costs (like not being able to work) comparable to people with schizophrenia and much higher than anxiety disorders. One study found that during its 6-month duration, 80% of the AvPD patient group didn’t have a job due to their diagnosis.

Fear of embarrassment and criticism can be so overwhelming that it may paralyze a person, preventing them from making friends, finding a partner, or holding a job.

Extreme sensitivity to perceived rejection can have repercussions in every aspect of life. Loneliness is common. Some individuals rely on substances like alcohol and drugs to numb their alienation feelings.

Their sense of inferiority, damaging their self-esteem, gravitates toward a perceived incapacity to perform optimally based on who they are, how they look, where they come from, or some other indelible trait.

Avoidant Personality Disorder Symptoms & Diagnosis

Symptoms of AvPD include extreme social inhibition, fear of rejection, and avoidance of social interactions.

As a condition listed in the DSM-5, AvPD has established diagnostic criteria. A qualified professional will evaluate the following clinical features for diagnosis:

1. The avoidance of occupational, social, and interpersonal activities due to fear of rejection, criticism, or disapproval.
2. Unwillingness to form new relationships without the certainty of being liked.
3. Feeling inhibited in intimate relationships because of the fear of embarrassment or ridicule.
4. Persistent preoccupation with rejection and social criticism.
5. Severe inhibition and avoidance of interpersonal relationships and situations due to feelings of unworthiness.
6. Seeing themselves as inferior, unattractive, or socially incapable compared to others.
7. Participating in novel activities or taking chances seems too risky as they may open the door to criticism, so they are avoided.

People with an AvPD diagnosis are not all the same. The intensity of their symptoms and impairment severity are on a spectrum.

Individuals who struggle with understanding what others might be thinking (an AvPD feature), can experience the most debilitating cases of AvPD, often not working or having any close relationships.

Other individuals who meet the criteria for AvPD may present less incapacitating features or hide symptoms and still struggle internally.

In some online circles, the term high functioning personality disorder is used to describe individuals who may present symptoms of AvPD, like social withdrawal, a preference for solo projects, and other qualities associated with it but still function in society.

It is critical to understand that AvPD is a medically accepted psychiatric condition with defined criteria for its diagnosis, while high functioning personality disorder is not. So, irrespective that some individuals with AvPD get married and hold jobs, being themselves high functioning, this is not a separate disorder.

Also, people who manifest symptoms associated with AvPD should not be labeled with a personality disorder without appropriate clinical evaluation.

FAQs

How is Avoidant Personality Disorder Diagnosed?

Only a qualified professional can diagnose AvPD. They will use the DSM-5 as their clinical guideline to evaluate symptoms. They will also ask questions about your personal, professional, and intimate life to understand the impact of your patterns of avoidance on them.

A diagnosis of AvPD is typically predicated on a severe and persistent pattern of behavior in which the avoidance of social interactions impacts one’s ability to function, including the ability to work, attend school, or build healthy relationships with friends, family members, or romantic partners.

Can Avoidant Personality Disorder Be Cured?

The word “cured’’ in medicine is hardly used due to the possibility that diseases may come back and if so, generate false expectations.

AvPD can be treated. Several behavioral therapies, like cognitive behavioral therapy (CBT), have proved effective in reducing distressing symptoms and helping individuals function in society.

What is the Difference Between Social Anxiety Disorder and AvPD?

SAD and AVPD are characterized by fear of negative evaluation in social situations, but they differ significantly in scope and self-perception.

SAD is an anxiety disorder characterized by intense fear in specific social or performance situations where scrutiny might occur, with symptoms that must persist for at least six months.

AVPD is a more pervasive personality pattern affecting a person’s entire identity and relationship approach. It features a deeply ingrained personal belief in being fundamentally inadequate or inferior. This belief may extend beyond social contexts to include avoidance of novel situations, risks, or emotionally intense experiences.

How Can Therapy Help with AvPD?

Therapy can help you reduce AvPD symptoms that cause distress (like low self-esteem) while providing skills to participate in social activities that can enrich your life (such as meeting new people).

Trained professionals can help you address negative beliefs about yourself. Therapy can also help as AvPD is associated withco-occurring mental health conditions such as alcohol and drug abuse, anxiety disorders, eating disorders, and depression.

How Do I Find a Specialist for AvPD?

Online directories like Rehab.com offer numerous resources for accessing mental health support. This includes a comprehensive guide that will help you find a therapist that is compatible with your values, challenges, and insurance.

What Causes Avoidant Personality Disorder?

Mental health conditions, especially personality disorders, are not caused by a single factor. 

Personality is the pattern of how a person uniquely behaves, thinks, and feels in response to internal and external influences. Each person’s biological, social, and psychological characteristics will result in a distinct personality. This personality changes to some extent over time based on experiences but it also has inherited components, known as personality traits.

Some individuals may be more extroverted, while others may be more conscientious (organized). These traits are heritable and have an innate psychobiological characteristic that may affect AvPD. A person with AvPD may have a higher desire to avoid rejection (elevated harm avoidance trait) than to enjoy new experiences (low novelty-seeking trait).

For example, it’s estimated that 25% to 65% of AvPD cases could be traced to hereditary factors, suggesting a genetic predisposition.

Early childhood experiences, like shyness and fear of strangers, can lead to a propensity to worry or withdraw. These avoidant behaviors are found in many children and can be part of normal development. However, when they become recurrent and not a temporary aspect of growing up, they can lead to AvPD in some children and adolescents.

Environmental factors like parenting styles (sheltered or neglected children), adverse childhood experiences, negative relationships with adults, bullying, and rejection have all been associated with a higher risk of AvPD because they can create trust issues and fear of intimate relationships.

Psychological research on individuals with AvPD shows that they may struggle with correctly identifying negative facial expressions. This suggests a potential explanation for the heightened sensitivity to criticism.

People diagnosed with AvPD, compared with people with social phobia, can have greater difficulties interpreting other people’s internal states (what they think or feel), with researchers hypothesizing that these limitations may account for their difficulties navigating relationships.

Studies comparing SAD with AvPD have found that people with the latter diagnosis experienced more anxiousness and discomfort with both negative and positive emotions, offering a potential clue to the frequent drive to isolate themselves due to their elevated response to stress.

Studies of the brains of individuals with AvPD suggest they may be more alert (due to heightened amygdala activation) to situations that require emotional control, but more research is needed to find neural correlates for this condition.

Medical conditions (like head trauma) that damage neurons are also associated with personality disorders.

Avoidant Personality Disorder & Relationships

Hegel, a renowned philosopher, once said “To be is to be perceived.” This existential truth is a harsh reminder of AvPD’s debilitating nature. Avoiding social interactions comes at a steep price.

Growth in every facet of life involves taking risks, embarking on new experiences, and pushing personal boundaries.

In severe AvPD cases, people may go to great lengths to remain unnoticed by others, living isolated and secretive lives, actively avoiding social contact, withdrawing from romantic relationships, and in some instances, severing their connection to friends and family.

Some individuals with AvPD may long for love and intimacy but struggle with feelings of shame and inferiority, making it difficult for them to put themselves out there and form connections.

Some people with AvPD get married or have intimate relationships. However, these things tend to occur when the person feels almost a guarantee of being with someone who never criticizes them.

This belief that others should accept them without any negative evaluation can affect the capacity of a person with AvPD to maintain relationships with friends and family members that they may perceive as critical.

Individuals with AvPD who hold a job may reject the chance of getting a promotion which may put them on the spot for more open criticism, settling for roles where failure and public shame appear less likely.

Strategies for Individuals With AvPD to Develop Healthier Relationships

If your avoidance tendencies are causing difficulties in your professional and personal lives, it’s best to seek professional help. However, some self-help tips can be valuable to have a more social approach to life.

Learning conversational skills can help you feel more comfortable in social situations, especially with new people. Try to make small talk with cashiers and other people you encounter to get used to being a more social version of yourself.

Sports and other activities like mindfulness can help you be more relaxed. This is a state conducive to less anxiety and reduced stress responses.

Make a habit of communicating with friends and family even when you don’t feel like it. Relationships are a healthy component of adult life. People want to hear from you. You are not bothering them.

Therapy can help you develop skills to reframe your thoughts and deep-held beliefs that reinforce your desire to withdraw. It can also help you understand the root of your avoidance patterns, so consider it.

Advice for Loved Ones on Supporting Someone with AvPD

If someone you love battles with AvPD, adopt a compassionate approach to helping them. AvPD is a psychiatric condition, not a conscious choice to withdraw.

Using gentle suggestions, you can help them break their avoidance patterns. They take small steps to help them embark on new experiences, like visiting an unfamiliar shop, getting ice cream together, or updating their LinkedIn profile as a first step to seeking a job.

Help them see their positive attributes. Remember them about their talents and past achievements. People with AvPD are too critical of themselves.

If your partner or family member is in therapy, it is important to discuss with the therapist the tasks you have taken upon yourself that may contribute to reinforcing avoidance patterns, as you may be enabling them to withdraw from society by doing things they should do for themselves.

Encourage your loved one to seek professional help. Do it gently, since a characteristic of AvPD is to misinterpret other people’s comments as derogatory.

Avoidant Personality Disorder Treatment & Therapy Options

A mental health professional will help you find the best approach to treating AvPD based on your personal preferences, circumstances, and the impact of avoidance patterns in your life.

CBT is the first-line treatment for managing AvPD symptoms and consequences. Many thoughts and beliefs that contribute to social withdrawal can be categorized as maladaptive thinking patterns.

CBT has proved efficacious in addressing these automatic low self-esteem thoughts that characterize AvPD by teaching skills that help reframe them. You will learn techniques to analyze social cues, and methods to shift how you think, cultivating a healthier sense of self that does not fear social rejection and considers themselves valuable and worthy of participating in life.

Exposure therapy is a CBT methodology that has also proved efficacious in addressing social withdrawal symptoms. The goal is that a person confront their fears as avoiding them may reinforce them, making them worse. In a controlled environment, a trained professional will use different tools (like virtual reality or imagination techniques) to gradually create therapeutic situations to address fears.

The fear of ridicule, for instance, which is common in AvPD, can be tackled by creating progressively more challenging tasks that finally expose the person to what they fear (talking to strangers, for example) in a comfortable way.

The Transformative Role of an Avoidant Personality Disorder Specialist

Therapists are invaluable for people battling AvPD, as they are trained to create safe environments where a person feels respected, not judged, and listened to, all preconditions to address a condition characterized by extreme sensitivity to negative inputs and severe low self-esteem.