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The key path
- Avoidant personality disorder is a condition where people fear rejection, feel inadequate and avoid social situations.
- Treatment options include talk therapy such as cognitive behavioral therapy to change unhelpful thinking patterns.
- There are no specific medications for avoidant personality disorder, but medications can help with symptoms such as anxiety and depression.
Avoidant personality disorder (AVPD) is an enduring pattern of behavior related to social inhibition, feelings of inadequacy, and sensitivity to rejection that cause problems in work situations and relationships.
This disorder is characterized by extreme shyness and sensitivity to criticism from others and is known as cluster C personality disorder or a personality disorder characterized by anxious and fearful personality disorder.
AVPD is often associated with other mental health conditions such as anxiety disorders, in particular, social anxiety disorder. Individuals with the disorder display a pattern of avoidance due to fear of rejection or disapproval, which they experience as extremely distressing. This disorder affects approximately 2.5% of the population, with approximately equal numbers of men and women affected.
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Symptoms of avoidant personality disorder
The following is a list of common symptoms associated with narcissistic personality disorder:
- Needs 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 interactions or rejecting advances in work settings
- Avoiding intimate relationships or sharing intimate feelings
- Avoid making decisions
- Avoiding situations due to fear of rejection
- Avoiding social situations or events
- Easily hurt by criticism or disapproval
- Extremely self-conscious
- Inability to initiate social interaction
- Frightened and stressed behavior
- Feelings of inadequacy
- Hypersensitivity to negative evaluation
- Lack of claim
- Lack of trust in others
- Low self-esteem
- Misinterpreting neutral situations as negative
- No close friends/lack of social network
- Isolating myself
- Social prevention
- Unwilling to take risks or try new things
- Viewing oneself as socially incompetent or inferior
- Be alert for signs of disapproval or rejection
recovery
The three primary symptoms of avoidant personality disorder are feelings of inadequacy, social inhibition, and excessive sensitivity to rejection or criticism.
A diagnosis of avoidant personality disorder
Avoidant personality disorder can only be diagnosed by a trained mental health professional based on criteria outlined in Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Although a family physician may be the first point of contact for diagnosis, your doctor should refer you to a psychiatrist, psychologist, or other mental health professional for diagnosis.
Avoidant personality disorder is usually diagnosed in adults, because children’s personalities are still developing and behaviors such as shyness can be common experiences in childhood that are carried over into later life.
According to the DSM-5, a person must have a persistent pattern of avoiding social contact, being overly sensitive to rejection and criticism, and feeling inadequate, as demonstrated by at least four of the following criteria:
- Avoidance of professional activities involving significant social contact for fear of criticism, disapproval, or rejection
- Not willing to get involved with others unless you are sure they will like you
- Holding back on intimate relationships for fear of being ridiculed or humiliated
- Interest in criticism or rejection in social situations
- Inhibition in new social situations due to feeling inadequate
- Feelings of being socially incompetent, disliked, or inferior to others
- Reluctance to take risks or try new things for fear of embarrassment
Avoidant personality disorder versus social anxiety disorder
Antisocial personality disorder can seem very similar to social anxiety disorder, with some overlap in symptoms. However, they are separate conditions with different causes.
Like AVPD, social anxiety disorder is a type of anxiety disorder that causes people to feel that they will be judged or rejected by others. However, social anxiety is driven by high levels of anxiety, while significant feelings of worthlessness cause AVPD. Although they are distinct, a person can be diagnosed with both conditions.
Social anxiety disorder and avoidant personality disorder share similar symptoms and genetics, and AVPD is sometimes presented as a more severe form of social anxiety disorder.
Which dynamic personality disorder to avoid?
Causes of avoidant personality disorder include genetic, environmental, social, and psychological factors. Some factors that may contribute to the development of the condition include:
- Emotional abuse
- Criticism
- sarcasm
- Lack of love or nurturing by a parent or caregiver in childhood
- Rejected by peers
Often, people with the disorder are very shy as children and do not outgrow this shyness as they age. Children who are high in behavioral inhibition may be more likely to have negative social experiences, which contribute to the development of thinking patterns that increase their risk for developing AVPD.
Related Terms
Antisocial personality disorder can co-occur and overlap with a number of other conditions, including:
How serious is altruistic personality disorder?
Unfortunately, the outlook for people with avoidant personality disorder who do not seek treatment is bleak. Usually, they isolate themselves and use avoidance as their only coping strategy.
People with this condition may have few relationships and often become very isolated. This often leads to other long-term difficulties, including problems at work and school.
It is not uncommon for people with this condition to avoid school or occupations that involve a lot of social contact. People with this condition may be more likely to develop alcohol and substance use disorders.
Do people with AVPD want relationships?
Some people with avoidant personality disorder want to develop relationships with others, but find it very difficult to maintain them. Some research shows that people with this condition are long for contact but fear and dread being close.
Treatment of avoidant personality disorder
Most people with avoidant personality disorder do not seek treatment. When they do, it’s often for a specific life problem they’re experiencing or other types of symptoms like depression and anxiety, and they’ll usually stop treatment if that problem resolves.
Like other personality disorders, avoidant personality disorder can be difficult to treat because it is an enduring pattern of behavior. It can be difficult for a person with the disorder to recognize that psychotherapy help is needed and can be beneficial.
Successful treatment can help reduce symptoms and increase the range of coping strategies a person can use to manage their anxiety. A person with avoidant personality disorder will probably always be somewhat shy, but their avoidance will not dominate their thoughts.
Talk therapy
Talk therapy for narcissistic personality disorder may include cognitive behavioral therapy (CBT), psychodynamic therapy, and schema therapy. Group therapy and social skills training can also be helpful.
CBT helps people learn how to change unhelpful thinking patterns. Although the goal of psychodynamic therapy is to become aware of how past experiences, pain, and conflict are contributing to current symptoms.
Schema therapy for avoidant personality disorder is an integrative approach that draws on CBT as well as many other therapeutic techniques. It focuses on the therapeutic relationship between therapist and client, and aims to improve daily functioning and gain insights for change based on the understanding and reengineering of early life experiences.
A key feature of schema therapy is “limited reprinting,” in which the client expresses childhood needs and learns to develop and internalize a healthy parent’s voice.
Key Concepts of Schema Therapy
In schema therapy, the client learns about four key concepts:
- How there are patterns of maladaptive schemas that repeat throughout life.These patterns are divided into five areas: disengagement and rejection, autonomy and performance, poor boundaries, excessive responsibility and standards, excessive vigilance and inhibition.
- Coping styles that were learned in childhood (eg, escape, withdrawal).
- What schema methods are being used to cope and how they are unhelpful (eg, avoidance, detachment, compliance, punishment).
- How to develop healthy adult ways of coping and meet basic emotional needs.
Treatment
Although there are currently no medications specifically approved to treat narcissistic personality disorder, if a person has other related disorders such as depression or anxiety, medication may be prescribed to help with these symptoms.
For example, antidepressant medications can be helpful for improving mood and anhedonia, reducing anxiety symptoms, and reducing sensitivity to rejection.
Coping with narcissistic personality disorder
A first step to improving quality of life with narcissistic personality disorder is recognizing the symptoms. By understanding your specific symptoms, you’ll be better able to find ways to work with your therapist.
Consider including friends and family in your therapy, so they have a better understanding of what you’re going through and how to help.
Self-care is also important, including finding healthy coping skills that prevent you from turning to drugs or alcohol, smoking, overeating, or harming yourself when you’re having a hard time.
If you think you know or a loved one is living with avoidant personality disorder symptoms, it’s important to encourage that person to seek help. Without professional treatment such as talk therapy, it is unlikely that symptoms and their related impact on relationships will improve.
