Avoidant personality disorder is characterized by a widespread avoidance of social interaction. People with avoidant personality disorder struggle with deep-seated feelings of inadequacy and fears of rejection. These feelings and fears drive their social avoidance and contribute to a wide range of impairments in their daily lives, work, and relationships. [1][2]
- Avoidant personality disorder (AVPD) involves a pattern of avoiding contact with others in social, interpersonal, and vocational settings.Â
- People with AVPD want to develop close relationships, but isolate themselves because of personal insecurities and an expectation and fear of being rejected.
- Therapies like CBT can help people with AVPD develop healthier thinking patterns and social habits that can build confidence, improve social skills, and teach healthier methods of coping.
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Understanding avoidant personality disorder (AVPD)
Avoidant personality disorder (AVPD) is one of the ten personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Like all personality disorders, AVPD interferes with a person’s mental and emotional well-being and causes disruptions in their work, life, and personal relationships. AVPD causes people to avoid interacting with others because of insecurities and fears that others won’t like or accept them. [2]
People with AVPD want connection but avoid going out, socializing, and forming relationships because they assume they’ll be judged, criticized, and ultimately rejected. When they are around others, they may have a tendency to be reserved, quiet, and overly self-conscious or nervous. Most people with AVPD also struggle with self-esteem and have negative thoughts about themselves that feed into their insecurities and avoidance patterns. [1]
AVPD is considered one of the more severe and debilitating personality disorders, as it is linked to a higher risk for social isolation, depression, substance use, unemployment, and poor physical and mental health. It is a relatively uncommon condition, affecting only 1.5 to 2.5% of the population. [3] Due to its rarity and the frequency those with AVPD seek treatment, this condition has been understudied, and more research is needed to fully understand the condition and how to effectively treat it.
AVPD and social anxiety disorder
There are several similarities between avoidant personality disorder and social anxiety disorder, and between a third to a half of people with AVPD also have social anxiety disorder. [3] Some experts believe that AVPD is a more severe form of social anxiety, rather than a distinct condition. [4] While there are significant overlaps between the two, they are still considered different disorders. One key difference is that people with APVD may experience more shame and insecurity in social situations, rather than the anxiety and panic more common in social anxiety disorder. [5]
Symptoms and characteristics
All mental health conditions are diagnosed using a standardized set of symptoms from the DSM-5, which is a diagnostic guide used by health and mental health professionals. Avoidant personality disorder symptoms may be present in adolescence, but the condition is normally diagnosed in young adulthood. Avoiding social, interpersonal, and vocational activities that involve interacting with others is a key feature of AVPD, which is driven by insecurities and fears of rejection. [1][2]
The symptoms and characteristics of avoidant personality disorder include: [2]
- A widespread pattern of avoiding social interactions and relationships.
- Feelings of personal inadequacy & negative thoughts about oneself.
- Excessive concern and fear of criticism, disapproval, or rejection.
- An unwillingness to form new relationships without certainty of being liked & accepted.
- Being overly reserved or inhibited around others because of the fear of criticism.
- Preoccupation about whether others like, accept, and approve of them.
- Low self-esteem and a lack of confidence in oneself.
- Reluctance to risk failure or embarrassment.
- Becoming easily overstimulated in social situations.
- Longing for close personal relationships but not feeling able to form them.
- Being hypersensitive to criticism and anticipating being disliked.
Causes and risk factors
There is not one specific known cause of avoidant personality disorder, and a number of internal and external factors likely contribute to the condition. These are sometimes called risk factors because they can increase the risk of developing a disorder. Risk factors include internal factors like genetic predispositions and personality differences, as well as external factors like traumatic experiences or the environment someone was raised in.Â
Here are some of the risk factors that may make a person more likely to develop avoidant personality disorder: [1][3][6]
- Emotional neglect, abuse, or excessive criticism in childhood.
- Having an insecure attachment style (i.e., avoidant attachment style).
- A tendency to avoid social risks and criticisms.
- Overuse of avoidance and withdrawal to cope.
- Low self-esteem and a tendency to be overly self-critical.
- Higher levels of self-consciousness and self-doubt.
- A history of negative or disappointing experiences in relationships.
- Difficulty expressing emotions or communicating with others.
- Excessive nervousness or shyness around others.
- A frequent need for reassurance from others.
- Difficulty using reasoning skills when emotional.
How is AVPD diagnosed?
Avoidant personality disorder can only be diagnosed by a licensed mental health provider. Typically, this occurs during the first visit, where a clinical assessment or evaluation is performed. During a clinical assessment, the provider will ask questions to gather more information about the specific symptoms a person has and when, where, and how they manifest. At the end of the visit, the provider should provide the person with information about their diagnosis and discuss treatment options.
How do you know if you have AVPD?
The only way to confirm a diagnosis of avoidant personality disorder is to schedule a clinical assessment with a licensed medical, psychiatric, or mental health professional. For many, scheduling an appointment with a licensed therapist is the first step in this process. These visits may be covered by your health insurance, and many plans offer flexible options for being seen in an office or online. Check with your health insurance provider before scheduling an appointment.
Treatment and management of AVPD
Avoidant personality disorder has been insufficiently studied, and more information is needed to determine the most effective treatments for this condition. [1][3] Due to the similarity and overlap between AVPD and social anxiety disorder, certain treatments that work for social anxiety may also help with AVPD. [4] Therapy is considered a first-line treatment for anxiety disorders, and could help people with AVPD improve social skills, self-esteem, and build healthier habits and routines that keep them socially connected.
Cognitive behavioral therapy (CBT) is considered one of the most effective treatments for social anxiety, and focuses on helping people learn to adjust their thinking and behavior in ways that help them build more social confidence. A certain type of CBT called exposure therapy may also help people make a gradual plan to overcome their tendency to avoid social situations, while also building healthy coping skills along the way. Group therapy that focuses on social skills could also help people with AVPD practice social skills and connect with others who struggle with similar issues. Normally, medication is not a recommended treatment for AVPD (and other personality disorders), and there are no FDA-approved medications for AVPD. [1]
Coping strategies and support systems
People with AVPD tend to cope with their social anxiety and insecurities by withdrawing, isolating themselves, and avoiding interactions and relationships. While this strategy can provide temporary relief, it isn’t an effective long-term solution. In fact, avoidance tends to make the symptoms of AVPD worse over time because it feeds into negative beliefs and insecurities about interacting with other people. For these reasons, it’s important for people with AVPD to develop healthy social habits to manage their condition.
If you struggle with AVPD, here are some recommendations about healthy social routines that can improve your symptoms:
- Reconnect and maintain contact with existing friends and family members through regular phone calls, messages, and face-to-face interactions.
- Avoid becoming isolated by making weekly scheduled outings into public places or committing to joining a social group.Â
- Practice social skills and develop more confidence by making small talk with strangers when ordering food, paying for items, or doing things in public.
- Train the mind to think more positively by making daily lists of things to be grateful for or things you like and appreciate about yourself.
- Challenge yourself to take small risks that could lead to more frequent or deeper social connections with others, like starting conversations or asking a coworker to lunch.
- Practice mindfulness by focusing on your surroundings, bodily sensations, or 5 senses to get out of your head during times when you become overly anxious or self-critical.
AVPD and co-occurring disorders
Being diagnosed with more than one mental health condition is sometimes called having a ‘co-occurring disorder. Avoidant personality disorder often co-occurs with other mental health disorders, including substance use disorders, depression, social anxiety disorder, and other personality disorders. [1] Having co-occurring disorders can lead to more severe symptoms and impairments, especially when these disorders go unaddressed and untreated.Â
Outlook and prognosis: Living with AVPD
Living with avoidant personality disorder can be very difficult because of the way this condition impacts a person’s self-esteem and their ability to form healthy and close relationships. Many people with AVPD become socially isolated because of their tendency to avoid interacting with people, which can limit their ability to live healthy, productive, and fulfilling lives. Entering into therapy, developing more active social habits, and learning healthier methods to cope with insecurities and anxiety can greatly improve the outlook and prognosis for people living with AVPD.
