Avoidant personality disorder

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.1

Symptoms

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

A need to be well-liked1

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 decisions2

Avoiding situations due to fear of rejection

Avoiding social situations or events1

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-esteem1

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 inferior3

Vigilant for signs of disapproval or rejection

Diagnosis

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.

Avoidant personality disorder is typically diagnosed in adults, as children's personalities are still developing and behaviors such as shyness can be normal experiences in childhood that are later outgrown.

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 rejection4

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 situations4

Inhibition in new social situations due to feeling inadequate

Feelings of being socially inept, unappealing, or inferior to others4

Hesitation to take risks or do new things out of fear of embarrassment

Causes

The causes of avoidant personality disorder are thought to involve genetic, environmental, social, and psychological factors. Emotional abuse, criticism, ridicule, or lack of affection or nurturing by a parent or caregiver in childhood may result in the development of this personality disorder if other factors are also present. Rejection by peers may similarly be a risk factor.

Often, individuals with the disorder are very shy as children and do not outgrow this shyness as they age.

Social anxiety disorder and avoidant personality disorder share similar symptoms and genetics, with AVPD being the more severe form of the condition.5 

Related Conditions

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

Social anxiety disorder6

Dependent personality disorder

Borderline personality disorder (BPD)

Substance use disorder7

Depression

Agoraphobia

Treatment

Most people with avoidant personality disorder do not seek treatment.4 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.

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

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.8

On the other hand, when treatment is successfully applied, it can help to reduce symptoms and increase the range of coping strategies that the person can use to manage their anxiety. A person with avoidant personality disorder will probably always be somewhat shy, but avoidance won't dominate their thoughts.

Talk Therapy

Talk therapy for avoidant personality disorder may include cognitive behavioral therapy (CBT), psychodynamic therapy, and schema therapy.9 Group therapy and social skills training may also be helpful.

CBT is helpful for learning 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.10

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.11

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.11

Main Concepts of Schema Therapy

In schema therapy, the client learns about four main concepts:

How maladaptive schemas are patterns that are repeated throughout life.12 These patterns are grouped into five areas: disconnection and rejection, impaired autonomy and performance, impaired limits, excessive responsibility and standards, over-vigilance, and inhibition.

What coping styles were learned as a child (e.g., escape, fighting back).13

What schema modes are being used to cope and how they are unhelpful (e.g., avoidance, detachment, compliance, punishment).

How to develop healthy adult modes of coping and get core emotional needs met.

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.8

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

 The 9 Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain.

Coping

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.