Avoidant Personality Disorder
Avoidant personality disorder is marked by poor self-esteem and an intense fear of rejection. People with the condition often avoid social situations to avoid these feelings. Avoidant personality disorder is treatable with psychotherapy (talk therapy). Medication may help as well.
What is avoidant personality disorder?
Avoidant personality disorder (AVPD) is a mental health condition that involves chronic feelings of inadequacy and extreme sensitivity to criticism. People with AVPD would like to interact with others, but they tend to avoid social interactions due to their intense fear of rejection.
AVPD is one of a group of conditions called “Cluster C” personality disorders. They involve anxiety and fear. Personality disorders are lasting patterns of behavior that are out of touch with cultural norms (how we’re expected to act) and develop in childhood or adolescence. They cause distress for the person with the condition and/or those around them.
Avoidant personality disorder and social anxiety disorder (SAD) share similar features and behaviors. But they’re distinct conditions.
Social anxiety disorder (social phobia) happens when you have an intense and ongoing fear of being judged and watched by others. This leads people with SAD to avoid social situations.
People with AVPD also avoid social situations and relationships. But it has more to do with their low self-esteem than with anxiety. Anxiety is the core feature behind SAD, but it doesn’t have to be present with AVPD
Researchers once thought that AVPD was a severe form of SAD. But studies show that roughly two-thirds of people with AVPD don’t meet the standard diagnostic criteria for SAD according to the DSM-5.
But a person can have both AVPD and SAD. People with both conditions have more severe symptoms than those with just one.
Who does avoidant personality disorder affect?
Avoidant personality disorder usually begins in your late teens or early 20s. AVPD is also more likely to affect people with any of the following mental health conditions:
- Clinical depression (major depressive disorder).
- Persistent depressive disorder.
- Social anxiety disorder.
- Obsessive-compulsive disorder.
- Panic disorder.
- Anorexia nervosa.
- Binge eating disorder.
Personality disorders, including AVPD, are among the least understood mental health conditions.
Researchers are still trying to figure out the cause exact of them, but they think AVPD develops due to several factors, including:
- Genetics: One study on AVPD estimated that genetics account for about 64% of the likelihood of developing AVPD.
- Temperament during infancy: Researchers have found connections between certain temperament traits during infancy and AVPD. They include rigidity, hypersensitivity, not pursuing new experiences, avoiding possible harm more than usual, and excessive fear and distress.
- Attachment style: People with a fearful attachment style may be more likely to develop AVPD. A fearful attachment style means you have a desire for closeness with others but have distrust in them and a fear of rejection. This attachment style can develop, for example, if a minimally expressive infant shows distress and their caregiver is dismissive.
- Early childhood environment: Experiencing rejection and being treated differently from others during childhood may contribute to the development of AVPD.
The main sign of avoidant personality disorder is having such a strong fear of rejection that you choose isolation over being around people. This pattern of behavior can vary from mild to extreme.
Other signs and behaviors of avoidant personality disorder include:
- Having a poor self-image, seeing themselves as inadequate and inferior.
- Being overly concerned about criticism or disapproval.
- May be reluctant to become involved with others unless they know for sure that others will like them.
- Experiencing extreme anxiety (nervousness) and fear in social settings and relationships. This may lead them to avoid activities or jobs that involve being with others.
- Being shy and self-conscious in social situations due to a fear of doing something wrong or feeling embarrassed.
- Tending to exaggerate potential problems or misinterpret feedback as negative.
- Seldom trying anything new or taking chances.
Personality continues to evolve throughout child and adolescent development. Because of this, healthcare providers don’t typically diagnose someone with avoidant personality disorder until after the age of 18. Providers need evidence that these patterns of behavior are enduring and inflexible and don’t fade with time.
Personality disorders, including avoidant personality disorder, can be difficult to diagnose. This is because most people with one don’t think there’s a problem with their behavior or way of thinking.
When they do seek help, it’s often due to conditions such as anxiety or depression from the problems created by their personality disorder, like isolation or a lack of friends.
When a mental health professional, such as a psychologist or psychiatrist, suspects someone might have avoidant personality disorder, they often ask broad, general questions that won’t create an environment that the person might think of as critical or embarrassing. They ask questions that will shed light on:
- Past history.
- Relationships.
- Previous work history.
- Reality testing.
A person suspected of having avoidant personality disorder may lack insight into their behaviors and thought patterns. So, mental health professionals often work with the person’s family and friends to collect more information about their behaviors and history.
Mental health providers base a diagnosis of avoidant personality disorder on the criteria for the condition in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Diagnostic criteria for avoidant personality disorder involve a persistent pattern of at least four of the following behaviors:
- Avoiding job-related activities that involve working with others because they fear others will criticize or reject them.
- Being unwilling to get involved with others unless they’re sure others will like them.
- Being passive or reserved in close relationships because they fear ridicule or humiliation.
- Extreme worry about others criticizing or rejecting them in regular social situations.
- Feeling self-conscious in new social situations because they feel inadequate.
- Assessing themselves as socially unskilled, unappealing or inferior to others.
- Being reluctant to take personal risks or try new activities because they may feel embarrassed.
Treating personality disorders is difficult because people with these conditions have deep-rooted patterns of thinking and behavior that have existed for many years.
However, people with avoidant personality disorder tend to be good candidates for treatment because the condition causes them significant distress. And most people with AVPD want to develop relationships. This desire can be a motivating factor for people with AVPD to follow their treatment plans, which will likely include psychotherapy and, potentially, medication.
Treatment for people with this condition is most effective when family members are involved and supportive.
Psychotherapy for AVPD
Psychotherapy (talk therapy) is the treatment of choice for personality disorders. The goal of treatment is to help you uncover the motivations and fears associated with your thoughts and behavior. In addition, you can learn to relate to others more positively.
Two specific types of psychotherapy that can help people with AVPD include:
- Psychodynamic therapy: This type of therapy focuses on the psychological roots of emotional suffering. Through self-reflection, you look into problematic relationships and behavior patterns in your life. This helps you better understand yourself. It can help you change how you relate to other people and your environment.
- Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. A therapist or psychologist helps you take a close look at your thoughts and emotions. You’ll come to understand how your thoughts affect your actions. Through CBT, you can unlearn negative thoughts and behaviors. You’ll learn to adopt healthier thinking patterns and habits. It may especially focus on developing social skills.
Medication for AVPD
There’s currently no medication that can treat personality disorders. But there’s medication for depression and anxiety, which people with avoidant personality disorder may also have. Treating these conditions can make it easier to treat AVPD.
For the best results, however, you should take medication in combination with psychotherapy.
The prognosis (outlook) for AVPD depends on if it’s treated or not.
Left untreated, AVPD may result in:
- Additional mental health conditions, like depression, substance use disorder and eating disorders.
- Increased risk of postpartum depression.
- Dissatisfaction with life.
- Work difficulties.
- Impaired social functioning.
People with AVPD also experience higher rates of suicidal ideation and suicide attempts. If you or a loved one are thinking about suicide, dial 988 on your phone to reach the Suicide and Crisis Lifeline. Someone is available to help you 24/7.
Treatment for avoidant personality disorder is a long process. Your willingness to seek and stay with treatment can have a significant effect on your outlook. With treatment, some people with AVPD can learn to relate to others more healthily.
You can’t prevent avoidant personality disorder. But treatment can help lessen the issues it causes. Seeking help as soon as symptoms appear can help decrease the disruption to the person’s life, family and friendships.
References
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- Anxiety disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml. Accessed Jan. 27, 2023.
- Brown A. Allscripts EPSi. Mayo Clinic, Rochester, Minn. March 5, 2018.
- Anxiety disorders. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Mental-Health-Conditions/Anxiety-Disorders/Overview. Accessed Jan. 27, 2023.
- What are anxiety disorders? American Psychiatric Association. https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders. Accessed Jan. 27, 2023.
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