Understanding Avoidant Personality Disorder

Advice on dealing with avoidant personality disorder, whether it’s for yourself or a friend.

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The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes 10 different personality disorders—a group of mental health conditions that are characterized by patterns of thoughts, feelings, and behaviors that differ from what society expects. Personality disorders usually begin by late adolescence or early adulthood and can cause long-term distress without treatment.

Here, we’ll take a closer look at a personality disorder called avoidant personality disorder (AVPD), which is a Cluster C personality disorder. Teens and young adults dealing with avoidant personality disorder are likely to be extremely shy, sensitive to criticism, prone to feelings of inadequacy. Continue reading to learn more about avoidant personality disorder symptoms, how it compares to social anxiety, and treatment options to help cope with distress and start living a more fulfilling life.

What is avoidant personality disorder?

It’s perfectly normal to feel a little anxious or self-conscious at times, especially during high school, but avoidant personality disorder moves beyond age-appropriate stress. People with AVPD have an intense fear of being judged or embarrassed and the belief that other people view them judgmentally. In fact, according to the American Psychiatric Association, one of the core beliefs that underpins an avoidant personality disorder is, “I’m not good enough.” 

What are the main avoidant personality disorder symptoms? 

• Low confidence and poor self-image
• Extreme shyness
• Overly sensitive to criticism and disapproval 
• Anxiety in relationships at school, work, or any other social situation
• Rarely taking chances or trying something new
• Feelings of shame and self-loathing

Approximately 2.4 percent of the U.S. population are living with avoidant personality disorder, affecting both men and women equally. The condition is known to co-occur with other types of mental illness, including:

• Social anxiety disorder
• Obsessive compulsive disorder
• Depression
• Borderline personality disorder 
• Dependent personality disorder
• Substance use disorder

Avoidant personality disorder versus social anxiety disorder

For years, the assumption was that avoidant personality disorder was a more severe variant of social anxiety disorder but further research suggests that they are actually two different diagnoses. While there are many similarities between the two, there are also notable differences. To start, AVPD is a personality disorder, while social anxiety disorder, or social phobia, is an anxiety disorder. 

Both conditions involve an intense fear of being judged or embarrassed in social situations or in any given social interaction, but the driving factors behind these fears are different. For someone with avoidant personality disorder, their anxiety stems from an overwhelming feeling of worthlessness. They believe that they’re inadequate and they think that others view them the same way.

For someone with social anxiety disorder, also known as social phobia, they often know that their fears are unreasonable or disproportionate to a situation—even if that doesn’t enable them to change how they feel. 

Another key difference between the two conditions relates to socializing. Someone with avoidant personality disorder will be reluctant to make friends or engage in social activities, while a person with social anxiety usually only avoids certain situations. The latter may be comfortable with their select group of friends or while playing a sport, but the idea of going to a party or using a public gym could trigger social anxiety due to fear of rejection or extreme shyness.

What causes avoidant personality disorder?

There’s limited research on risk factors for avoidant personality disorder, but multiple studies suggest that early childhood experiences play a role. More specifically, experiencing emotional abuse or lack of support from early caregivers may contribute to the development of the condition.  

Similar to social anxiety disorder, childhood neglect (defined as a lack of protection, care, or positive attention from a parent) is a risk factor for AVPD. Another study found that people with AVPD perceived their parents as offering less affection and encouragement, and more rejection and guilt, than people without the condition.

Similar to other personality disorders and mental illnesses, genetics may also play a role so having a family member with AVPD may increase your chances of having it yourself.

Diagnosing avoidant personality disorder

Avoidant personality disorder should only be diagnosed by a trained mental health professional. According to the criteria outlined in the DSM-5, a person is required to experience four or more of the following symptoms in order to be diagnosed with AVPD.

1. Avoids activities that involve significant interpersonal contact due to fear of disapproval, criticism, or rejection.
2. Not wanting to get involved with other people unless they’re sure they’ll be liked.
3. Shows restraint in intimate relationships due to the fear of being shamed or ridiculed.
4. Preoccupied with being rejected or criticized in everyday social situations.
5. Displays inhibition in new interpersonal situations due to feelings of inadequacy.
6. Considers themself to be socially inept, unappealing, and inferior to others.
7. Reluctant to take personal risks or try new activities that might be embarrassing.

Treating avoidant personality disorder 

When left untreated, avoidant personality disorder can have a devastating impact on a person’s life—leading to self-isolation, difficulty managing school or work, and an increased risk for alcohol and substance use disorders. 

Talk therapy is currently considered to be the most effective mental health treatment for avoidant personality disorder, which is challenging due to the nature of the condition. For people living with avoidant personality disorder, it can be uncomfortable to trust and open up with someone new. That said, it’s important to remember that the role and responsibility of a mental health professional is to create a safe space—free of judgment—to help people reflect, cope, and heal.

One type of psychotherapy that’s considered effective for avoidant personality disorder is cognitive behavioral therapy (CBT). The goal of CBT is to help people become more aware of their thoughts and feelings so that they can understand how they contribute to their struggles. Ultimately, CBT can help people reframe their thoughts and behaviors to align with their mental health goals. 

Schema therapy is another type of talk therapy that's used to help treat AVPD and other personality disorders. This integrative approach to care builds on various therapeutic techniques, including CBT, to help people understand how their adverse childhood experiences may have a direct impact on their thoughts, behaviors, and mental health struggles.

Virtual IOP at Charlie Health

Charlie Health offers virtual intensive outpatient treatment for teens, young adults, and their families. Unlike traditional online mental health programs, our program focuses on individual talk therapy and group therapy to provide comprehensive support for mental health disorders. Our compassionate providers are here to listen to your needs, help you explore your treatment options, and help you live a more fulfilling life.