Avoidant Personality Disorder

People with avoidant personality disorder experience a long-standing feeling of inadequacy and are extremely sensitive to what others think about them. This leads to the person to be socially inhibited and feels socially inept. Because of these feelings of inadequacy and inhibition, the person with the avoidant personality disorder will seek to avoid work, school and any activities that involve socializing or interacting with others.

Individuals with Avoidant Personality Disorder often vigilantly appraise the movements and expressions of those with whom they come into contact. Their fearful and tense demeanor may elicit ridicule from others, which in turn confirms their self-doubts. They are very anxious about the possibility that they will react to criticism with blushing or crying. They are described by others as being “shy,” “timid,” “lonely,” and “isolated.”

Individuals with Avoidant Personality Disorder are chronically prone to anxiety, are socially anxious and avoidant, and attempt to manage anxiety in ways that limit and constrict their lives.

The major problems associated with this disorder occur in social and occupational functioning. The low self-esteem and hypersensitivity to rejection are associated with restricted interpersonal contacts. These individuals may become relatively isolated and usually do not have a large social support network that can help them weather crises. They desire affection and acceptance and may fantasize about idealized relationships with others. The avoidant behaviors can also adversely affect occupational functioning because these individuals try to avoid the types of social situations that may be important for meeting the basic demands of the job or for advancement.

Avoidant Personality Disorder (AvPD)
Avoidant Personality Disorder (AvPD)

Symptoms of Avoidant Personality Disorder

The avoidant personality disorder is characterized by a long-standing pattern of feelings of inadequacy, extreme sensitivity to what other people think about them, and social inhibition. It typically manifests itself by early adulthood and includes a majority of the following symptoms:

  • Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
  • Is unwilling to get involved with people unless certain of being liked
  • Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
  • Is preoccupied with being criticized or rejected in social situations
  • Is inhibited in new interpersonal situations because of feelings of inadequacy
  • Views themselves as socially inept, personally unappealing, or inferior to others
  • Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
  • Hypersensitivity to rejection and criticism
  • Self-imposed social isolation
  • Extreme shyness or anxiety in social situations, though the person feels a strong desire for close relationships
  • Avoids physical contact because it has been associated with an unpleasant or painful stimulus
  • Feelings of inadequacy
  • Drastically reduced or absent self-esteem
  • Self-loathing, autophobia or self-harm
  • Mistrust of others or oneself; exhibits heightened self-doubt
  • Emotional distancing related to intimacy
  • Highly self-conscious
  • Self-critical about their problems relating to others
  • Heightened attachment-related anxiety, which may include a fear of abandonment
  • Problems in occupational functioning
  • Lonely self-perception, although others may find the relationship between them meaningful
  • Feeling inferior to others
  • Substance abuse and/or dependence
  • In some extreme cases, agoraphobia
  • Uses fantasy as a form of escapism to interrupt painful thoughts

As with all personality disorders, the person must be at least 18 years old before they can be diagnosed with it.

Avoidant Personality Disorder (AvPD)
Avoidant Personality Disorder (AvPD)

Avoidant personality disorder appears to occur between 0.5 and 1.0 percent in the general population.

Like most personality disorders, avoidant personality disorder typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s.

How is Avoidant Personality Disorder Diagnosed

Personality disorders such as avoidant personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood or genetic tests that are used to diagnose an avoidant personality disorder.

Since childhood or adolescence was socially withdrawn due to lack of confidence, pessimism, fear of rejection, and feelings of inferiority.

Many people with the avoidant personality disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.

Avoidant Personality Disorder (AvPD)
Avoidant Personality Disorder (AvPD)

A diagnosis of avoidant personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.

The World Health Organization’s ICD-10 lists avoidant personality disorder as anxious (avoidant) personality disorder

It is characterized by at least four of the following:

  • persistent and pervasive feelings of tension and apprehension;
  • the belief that one is socially inept, personally unappealing, or inferior to others;
  • excessive preoccupation with being criticized or rejected in social situations;
  • unwillingness to become involved with people unless certain of being liked;
  • restrictions on lifestyle because of the need to have physical security;
  • avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection.

The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) of the APA also has an Avoidant Personality Disorder diagnosis Four of seven specific symptoms should be present, which are the following:

Avoidant Personality Disorder (AvPD)
Avoidant Personality Disorder (AvPD)
  • Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
  • Is unwilling to get involved with people unless certain of being liked
  • Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
  • Is preoccupied with being criticized or rejected in social situations
  • Is inhibited in new interpersonal situations because of feelings of inadequacy
  • Views self as socially inept, personally unappealing, or inferior to others
  • Is unusually reluctant to take personal risk or to engage in any new activities because they may prove embarrassing

Causes of Avoidant Personality Disorder

Researchers today don’t know what causes avoidant personality disorder. There are many theories, however, about the possible causes of avoidant personality disorder. Most professionals subscribe to a biopsychosocial model of causation – that is, the causes of are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children.

Avoidant Personality Disorder (AvPD)
Avoidant Personality Disorder (AvPD)

Social anxiety disorder (social phobia) and Avoidant Personality Disorder have similar symptoms, genetics, and treatment response.

Subtypes of Avoidant Personality Disorder

Phobic avoidant (including dependent features)

  • General apprehensiveness displaced with avoidable tangible precipitant;
  • qualms and disquietude symbolized by repugnant and specific dreadful object or circumstances.

Conflicted avoidant (including negativistic features)

  • Internal discord and dissension;
  • fears dependence; unsettled; unreconciled within self;
  • hesitating, confused, tormented, paroxysmal, embittered; unresolvable angst.

Hypersensitive avoidant (including paranoid features)

  • Intensely wary and suspicious;
  • alternately panicky, terrified, edgy, and timorous, then thin-skinned, high-strung, petulant, and prickly.

Self-deserting avoidant (including depressive features)

  • Blocks or fragments self-awareness;
  • discards painful images and memories;
  • casts away untenable thoughts and impulses; ultimately jettisons self (suicidal).

Alden and Capreol found two other subtypes of avoidant personality disorder:

Cold-avoidant

Characterised by an inability to experience and express positive emotion towards others.

Exploitable-avoidant

Characterised by an inability to express anger towards others or to resist coercion from others. Maybe at risk for abuse by others.

Avoidant Personality Disorder (AvPD)
Avoidant Personality Disorder (AvPD)

Differential diagnosis

According to the DSM-5 avoidant personality disorder must be differentiated from similar personality disorders such as dependentparanoidschizoid, and schizotypal. But these can also occur together; this is particularly likely for AvPD and dependent personality disorder. Thus, if criteria for multiple personality disorders are met, all can be diagnosed.

There is also an overlap between avoidant and schizoid personality traits (see schizoid avoidant behavior) and AvPD may have a relationship to the schizophrenia spectrum.

Treatment of Avoidant Personality Disorder

Treatment of avoidant personality disorder can employ various techniques, such as social skills training, cognitive therapy, and exposure treatment to gradually increase social contacts, group therapy for practicing social skills, and sometimes drug therapy.

A key issue in treatment is gaining and keeping the patient’s trust since people with the avoidant personality disorder will often start to avoid treatment sessions if they distrust the therapist or fear rejection. The primary purpose of both individual therapy and social skills group training is for individuals with the avoidant personality disorder to begin challenging their exaggerated negative beliefs about themselves.

Significant improvement in the symptoms of personality disorders is possible, with the help of treatment and individual effort.

Psychotherapy for Avoidant Personality Disorder

Avoidant Personality Disorder is a very common disorder, yet there is surprisingly little research on the effectiveness of its treatment. There are few randomized controlled clinical trials on psychotherapy for this disorder. One study found that cognitive behavioral therapy (graduated exposure) was partially effective. The same study showed that brief dynamic therapy was ineffective. Older studies showed that social skills training was an effective treatment, but no new studies on social skills training have been published since 1994.

Avoidant Personality Disorder (AvPD)
Avoidant Personality Disorder (AvPD)

Pharmacotherapy for Avoidant Personality Disorder

There are currently no medications approved by the FDA to treat this disorder. Vitamins and dietary supplements are ineffective for all Personality Disorders.

Complications of Avoidant Personality Disorder

Individuals with Avoidant Personality Disorder have few close friends but are very dependent on them. They are described by others as being “shy”, “timid,” “lonely,” and “isolated”. Their occupational functioning may also suffer because they avoid social situations that are important for job advancement.

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