Avoidant Personality Disorder: Signs, Symptoms, & Treatments

What Is Avoidant Personality Disorder?

Avoidant Personality Disorder (AVPD) involves the constant fear of rejections due to thinking oneself inferior to others. At the same time, people with AVPD have an intense longing to be liked. Unfortunately, a negative concept of self and deep-seated fear commonly results in social avoidance, making it nearly impossible for them to form personal relationships.

Furthermore, some people with AVPD may attempt to limit emotional expression to protect themselves from painful rejection, which can be interpreted as coldness by others and only exacerbate relationship issues.⁶ They may also lack mentalization (the ability to estimate the intentions and needs of others) which can lead to lower self-esteem and poor social function.⁶

How Common Is Avoidant Personality Disorder?

It is estimated that the frequency of avoidant personality disorder ranges from 1.5%–2.5%. Studies note that based on existing research, women appear to be at a higher risk for developing AVPD, with little data concerning the age of onset.⁶ In related studies, it was found that people with AVPD are less likely to be married or live with a partner. Additionally, they often attain less education and are more likely to collect disability.⁶

Avoidant Personality Disorder Vs. Social Anxiety

It is difficult to distinguish AVPD from Social Anxiety Disorder (SAD) due to overlapping characteristics. In earlier research, avoidant personality disorder was thought to be a more severe form of social anxiety disorder, with both being placed on a social anxiety continuum. Recent research argues that they are different disorders due to genetics, differences in self-concept, negative thinking, and treatability.⁵

Signs of Avoidant Personality Disorder

There are some signs of avoidant personality disorder that are commonly prominent, consistent, and extreme. Often, people with avoidant personality disorder are overly aware of others’ emotional states when they are expecting to be rejected or criticized. This may look like a negative self-concept, an inability to express anger, depression, and a seemingly cold demeanor.⁶

Common signs of avoidant personality disorder include:^5,6

• Quick to make negative self-judgments
• Feeling sad and lonely
• Hypersensitivity to others’ emotions
• Emotional avoidance
• Poor eye contact, blushing, or crying easily
• Skittishness or timidity
• Hypervigilance to threats
• Reluctance to talk about self
• Perfectionism
• Having few or no close friends or romantic relationships
• Commonly exaggerating possible problems
• People-pleasing tendencies
• Difficulties trusting others

Symptoms of Avoidant Personality Disorder

AVPD symptoms can overlap with a lot of other mental health issues such as depression, anxiety, PTSD, and other personality disorders.

Common symptoms of AVPD include:

• Low self-esteem
• Extreme anxiety in social settings
• Shyness or awkwardness
• Intense fears of criticism
• An unwillingness to be social
• Avoidance of relationships
• Preoccupation with being criticized in social situations
• Feelings of inadequacy
• Fear of rejection
• Feelings of inferiority
• Anhedonia or lack of pleasure in activities
• Lack of assertiveness
• Reluctance to take personal risks or seek new opportunities1

What Causes Avoidant Personality Disorder?

The causes of avoidant personality disorder are unresolved. Like other personality disorders, there has been very little empirical research on AVPD. Most of the literature on AVPD states that the interaction of genetically inherited traits and environmental influences is the likely cause.

Possible causes of avoidant personality disorder include:

• Genetic factors: Having a parent with AVPD can increase your risk of developing AVPD as well.
• Childhood trauma: Experiencing childhood abuse or neglect can lead one to not have a secure attachment with their parent(s) and can lead them to develop AVPD as they grow up.
• Parental or peer rejection: Neglect of any kind from anyone can be very damaging for a child and can lead to poor self worth and avoidance tendencies.
• Emotional abuse: Being subject to emotional abuse can lead to AVPD due to the harsh and hurtful nature of what emotional abuse can do to someone’s psyche and thought patterns.

How Is Avoidant Personality Disorder Diagnosed?

AVPD is diagnosed by a psychiatrist. They work with other specialists and therapists to help determine the scope of the issue over a long period of time, as well as based on their own assessment. They are equipped to understand the complex ways in which our minds and mental health are impacted to come to a diagnosis of AVPD.

According to the DSM-5 criteria for AVPD, someone must display at least four of the following symptoms:¹

• Avoids occupational activities that involve substantial 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 normal 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 risks or engage in any new activities because these steps may prove embarrassing.

Complications of Living With AVPD

There are many complications of living with AVPD that can impact your relationships, self esteem, and quality of life.

Complications of living with avoidant personality disorder may include:

• Prolonged isolation: Avoidance for a long period of time can lead to social isolation.
• Substance misuse: One may rely on substances to feel less anxious in social situations and to self soothe.
• Depression: Increased isolation can lead to depression and worsen self worth.
• Occupational and educational challenges: AVPD can impact and hinder your education and work.
• Missed opportunities: Ongoing avoidance tendencies can lead you to miss out on opportunities you may not get again.
• Lack of relationships: AVPD can lead to extreme social isolation and leave you without many friends or support systems.
• Physical ailments: The stress of living with AVPD can lead to physical symptoms such as aches, pains, and autoimmune diseases.

Can AVPD Be Prevented?

While AVPD cannot be prevented, it can be managed and treated. AVPD is a personality disorder which happens due to an event or circumstance that disrupts healthy development.

Treatment of Avoidant Personality Disorder

Treatment for AVPD is possible. AVPD has many therapy options that can treat the various symptoms that come along with the diagnosis.

Therapy

There are a handful of therapy approaches that can help someone to learn how to manage and cope with AVPD, as well as challenge and heal the parts of yourself that are hurt that led to this diagnosis.

Therapies for avoidant personality disorder may include:

• Cognitive behavioral therapy (CBT): Challenges our thoughts so we can reframe them so they lead to different behaviors.
• Family therapy: Gives the family a chance to share their feelings and feel validated while also finding ways to support the loved one with AVPD.
• Schema therapy: This challenges the ways in which you think; helps you play out different scenarios and challenges your original thought patterns.
• Psychodynamic therapy: This takes a deep dive into why the behavior is happening and where it comes from to learn about how to challenge it.
• Acceptance and commitment therapy (ACT): This helps you radically accept yourself and your feelings so you can feel them and relate to them.
• Metacognitive interpersonal therapy: This approach focuses on challenging cognitive beliefs and changing cognitive distortions.
• Group therapy: This approach helps someone feel seen and heard in a supportive way while also learning ways to relate to others in a safe space.

Medication

There are currently no FDA-approved medications for avoidant personality disorder. When medication is prescribed, the main focus is typically placed on medicating symptoms of co-occurring disorders, such as major depressive disorder.^4,6  Depression and anxiety are the two most common features of AVPD treated with medication.

Coping With Avoidant Personality Disorder

Coping with AVPD can be challenging due to the nature of the disorder, but it is not impossible. AVPD can make it hard to be around people who you trust and feel safe with, but learning ways to self soothe and take the risk will help you grow your confidence and learn new skills.

Below are some tips for coping with avoidant personality disorder:

• Build a social network: Connecting with one person or an organization that is warm, open, and non-judgmental could be a first step. This could be a church, a knitting circle, a meditation group, or a gaming club.
• Appreciate small wins: Stop and reflect on the positive aspects of your experience and small accomplishments.
• Maintain a journal: Keep a journal noting what went right and what needs to be changed.
• Maintain a healthy self-care routine: Taking good care of yourself with your sleep, proper nutrition, and grounding yourself is important for balance.
• Develop coping skills: Finding ways to self soothe when you are feeling symptoms is important, as it will help you learn that you are capable of change.
• Avoid using substances to cope: Avoiding substances is important as they function as more of a bandaid to the problem instead of dealing with the root of the matter.
• Practice gratitude: Make a gratitude list of each improvement no matter how small.
• Seek treatment: Treatment can help. One is not doomed to live in the endless loop of disconnected unhappiness. Taking the first risk of connecting to a therapist who can help starts the road to positive change. With time and problem-focused therapy, behaviors can change and one can develop a satisfying life.

Final Thoughts

If you or someone you love is dealing with AVPD, there is hope that things will improve. Working with a therapist and having a good support system of even a few trusted friends or family members can make a big difference in how you feel. Remember, you are in charge of your life and your future.