More than just a social anxiety disorder, avoidant personality disorder (AVPD) is marked by shyness and sensitivity to criticism. It often involves behaviors of social inhibition, feelings of inadequacy, and negative reactions to rejections. ¹

Naturally, such a condition can cause daily problems. Furthermore, since symptoms of AVPD often replicate that of anxiety disorders, mental health professionals may initially have problems with diagnosis.

Symptoms

As a Cluster C personality disorder, people with AVPD often experience anxiety and fear when it comes to social situations. Naturally, this may initially confuse some with a social anxiety disorder. However, the conditions are quite different.

AVPD symptoms include: ¹ ²

• Anhedonia (lack of pleasure in activities you once enjoyed)
• Avoid sharing feelings or developing intimate relationships
• Desire to be well-liked
• Difficulty making decisions
• Fear of saying or doing the wrong thing
• Feelings of inadequacy
• Inability to initiate social contact
• Lack of trust in others
• Low self-esteem
• Misinterpretation of situations or events
• No close friends
• Not assertive
• “People-pleaser” (avoiding conflict)
• Rejection fears
• Self-isolation (or social inhibition)
• Sensitive to criticism or disapproval
• Social anxiety
• Tense demeanor
• Unwilling to try new things
• Very self-conscious
• Viewing yourself as socially inferior (or inept)

Naturally, the combination of these symptoms can lead to depression which brings a host of other symptoms. The most notable of these is suicidal ideation.

If you or someone you love is at risk of suicide, help is available. In crisis situations, contact 911 or go to your nearest emergency room. In all other cases, you can reach out to the 988 Suicide & Crisis Lifeline.

Avoidant Personality Disorder vs. Social Anxiety Disorder

Since symptoms of AVPD and social anxiety disorder (SAD) overlap, there can be some confusion between the two. Most notably, people with AVPD and SAD feel rejection and the judgment of others.

However, the key difference between the two is people with SAD struggle with high levels of anxiety. In turn, they become extremely fearful of social situations. ³

On the other hand, people with AVPD aren’t driven by anxiety. Rather, symptoms come from feelings of worthlessness.

Still, a person may receive a diagnosis for both disorders, depending on their circumstances. However, most mental health professionals consider AVPD a more severe form of social anxiety. ⁴

Causes

While researchers aren’t 100% sure what causes AVPD, they believe the following factors play a major role:

• Emotional abuse (especially during childhood)
• Genetics
• Lack of affection (or nurture) from parents or caregivers
• Previously experienced harsh criticisms or ridicule
• Rejection from peers

It has been observed that people with AVPD experienced shyness during childhood and adolescence. In many regards, they simply never outgrew this shyness. For this reason, shy children are more at risk of growing into adults with AVPD. ⁵

Risk Factors

Since people with AVPD tend to spend more time in isolation, they’re less likely to seek out the necessary treatment. Furthermore, people with this condition often struggle to develop relationships. As a result, this can make it difficult to create a support system to help them through treatment.

However, this isn’t to say people with AVPD don’t want relationships. In fact, many long for a connection with others. ⁶ But due to the nature of this condition, such connections can be difficult to make.

Diagnosis

AVPD has been outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Therefore, psychologists, psychiatrists, and other mental health professionals can make a diagnosis of the condition.

Since AVPD is typically observed in adults, it’s not common for children to receive a diagnosis. In cases of childhood shyness, most psychologists agree this will be overcome later in life.

For an AVPD diagnosis, you must show consistent signs of social avoidance, sensitivity to criticism and rejection, and feelings of inadequacy. These signs must be displayed by four of the following criteria: ⁷

• Avoiding occupational activities (out of fear, disapproval, or rejection).

• Reluctant to become involved with others (unless you’re sure they like you).

• Avoiding intimate relationships (out of fear of ridicule or humiliation)

• Fears and inhibitions in new social situations (due to feelings of inadequacy)

• You feel as though you’re socially unappealing, inferior, or inept.

• You’re hesitant to try new things (namely out of fear of embarrassment).

Treatment

AVPD is one of the most difficult personality disorders to treat due to the nature of the condition. Since people with AVPD avoid social situations, they’re less likely to seek out treatment (or remain on treatment). Furthermore, they may develop other mental health conditions, such as anxiety and depression.

Still, treatment options are available in the form of medication and psychotherapy. If done as a mental health professional directs, many have overcome AVPD symptoms.

Medication

Currently, no medication has been approved for the treatment of AVPD. However, you may receive a prescription if you struggle with another disorder.

For example, depression is common among people with AVPD. Therefore, you may receive a prescription for antidepressants to relieve depression symptoms.

Psychotherapy

More commonly, people with AVPD are recommended various forms of talk therapy. The most common include:

• Cognitive behavioral therapy (CBT)
• Psychodynamic therapy
• Schema therapy

CBT is the most common and effective of these. Through this form of talk therapy, you’ll develop an understanding of negative thought patterns, where they come from, and how to overcome them. ⁸

You may also participate in schema therapy. This helps you develop therapeutic techniques with a focus on relationships. The goal is to help you re-establish previous beliefs about other people, namely through re-engineering childhood experiences. ⁹

Final Word

While avoidant personality disorder comes with its challenges, it’s possible to overcome them. If you or someone you love struggles with the condition, it’s key to seek treatment as soon as possible. Early intervention will not just prevent the condition from further developing, it will also ensure you or your loved ones don’t fall victim to self-isolation.

References

¹ Lampe L, Malhi GS. Avoidant personality disorder: current insights. Psychol Res Behav Manag. 2018 Mar 8;11:55-66. doi: 10.2147/PRBM.S121073. PMID: 29563846; PMCID: PMC5848673.

² Weme AV, Sørensen KD, Binder PE. Agency in avoidant personality disorder: a narrative review. Front Psychol. 2023 Sep 18;14:1248617. doi: 10.3389/fpsyg.2023.1248617. PMID: 37790232; PMCID: PMC10543493.

³ Alomari NA, Bedaiwi SK, Ghasib AM, Kabbarah AJ, Alnefaie SA, Hariri N, Altammar MA, Fadhel AM, Altowairqi FM. Social Anxiety Disorder: Associated Conditions and Therapeutic Approaches. Cureus. 2022 Dec 19;14(12):e32687. doi: 10.7759/cureus.32687. PMID: 36660516; PMCID: PMC9847330.

⁴ Frandsen FW, Simonsen S, Poulsen S, Sørensen P, Lau ME. Social anxiety disorder and avoidant personality disorder from an interpersonal perspective. Psychol Psychother. 2020 Mar;93(1):88-104. doi: 10.1111/papt.12214. Epub 2019 Jan 17. PMID: 30656823.

⁵ Eggum ND, Eisenberg N, Spinrad TL, Valiente C, Edwards A, Kupfer AS, Reiser M. Predictors of withdrawal: possible precursors of avoidant personality disorder. Dev Psychopathol. 2009 Summer;21(3):815-38. doi: 10.1017/S0954579409000443. PMID: 19583885; PMCID: PMC2774890.

⁶ Sørensen KD, Råbu M, Wilberg T, Berthelsen E. Struggling to be a person: Lived experience of avoidant personality disorder. J Clin Psychol. 2019 Apr;75(4):664-680. doi: 10.1002/jclp.22740. Epub 2019 Jan 4. PMID: 30609024.

⁷ Weinbrecht A, Schulze L, Boettcher J, Renneberg B. Avoidant Personality Disorder: a Current Review. Curr Psychiatry Rep. 2016 Mar;18(3):29. doi: 10.1007/s11920-016-0665-6. PMID: 26830887.

⁸ Gabbard GO. Psychotherapy of personality disorders. J Psychother Pract Res. 2000 Winter;9(1):1-6. PMID: 10608903; PMCID: PMC3330582.

⁹ van den Heuvel BB, Dekker JJM, Daniëls M, Van HL, Peen J, Bosmans J, Arntz A, Huibers MJH. G-FORCE: the effectiveness of group psychotherapy for Cluster-C personality disorders: protocol of a pragmatic RCT comparing psychodynamic and two forms of schema group therapy. Trials. 2023 Apr 29;24(1):300. doi: 10.1186/s13063-023-07309-w. PMID: 37120550; PMCID: PMC10149026.