What Is 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.

 

 

Causes

Symptoms

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 

  • A need to be well-liked
  • 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 decisions
  • Avoiding situations due to fear of rejection
  • Avoiding social situations or events
  • 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-esteem
  • 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 inferior
  • 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 rejection
  • 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 situations
  • Inhibition in new social situations due to feeling inadequate
  • Feelings of being socially inept, unappealing, or inferior to others
  • Hesitation to take risks or do new things out of fear of embarrassment

Treatment

Cognitive behavioural therapy

Schema therapy

Medication

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

Main Concepts of Schema Therapy

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

  1. 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.
  2. What coping styles were learned as a child (e.g., escape, fighting back).13
  3. What schema modes are being used to cope and how they are unhelpful (e.g., avoidance, detachment, compliance, punishment).
  4. How to develop healthy adult modes of coping and get core emotional needs met.

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.

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