Avoidant Personality Disorder: Symptoms And Diagnostic Criteria

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) defines avoidant personality disorder as “a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts.” Avoidant personality disorder is one of the cluster C personality disorders. 

The DSM-V divides its 10 named personality disorders into three distinct clusters:

1. Cluster A disorders: Cluster A disorders include paranoid, schizoid, and schizotypal personality disorders, conditions that can lead other people to label someone as “odd” or “eccentric.”
2. Cluster B disorders: Cluster B disorders include borderline, antisocial, histrionic, and narcissistic personality disorders. These disorders are typically characterized by high levels of dramatic emotionality and unstable interpersonal relationships.
3. Cluster C disorders: Cluster C disorders include avoidant, dependent, and obsessive-compulsive personality disorders. They are predominantly dictated by experiences of fear and anxiety.

Avoidant personality disorder usually differs from the other personality disorders in its cluster in that the fear and anxiety associated with the condition are linked primarily to social situations. Therapy may help individuals with this disorder overcome anxiety and develop improved social skills.

How is avoidant personality disorder diagnosed?

At first glance, avoidant personality disorder may appear to have a lot in common with other mental health disorders involving social difficulties, such as social anxiety disorder, autism spectrum disorder, or attention-deficit/hyperactivity disorder (ADHD). However, avoidant personality disorder is a distinct and separate mental health condition. 

To be diagnosed with avoidant personality disorder, a person usually needs to display at least four of the following symptoms:

• Avoids jobs that involve a high level of interaction with other people because of fears of disapproval, criticism, or rejection
• Is unwilling to pursue relationships (romantic or otherwise) with other people unless one is certain of being liked and not being criticized
• Does not participate in intimacy, even in romantic or close relationships, because of a fear of being ridiculed or shamed
• Is preoccupied with being rejected in social situations
• Will not engage in new or different social situations because of a sense of inadequacy
• Believes that they are socially inept, personally unappealing, or otherwise inferior to other people
• Does not take any personal risks
• Is reluctant to engage in any sort of new activity because of the risk of embarrassment

How does avoidant personality disorder show up in a person’s day-to-day life?

Avoidant personality disorder can have several detrimental impacts on a person’s daily functioning, particularly their interpersonal relationships. Someone with antisocial personality disorder may encounter the following difficulties:

• They may decline job promotion opportunities because they are terrified that their new responsibilities may bring with them the possibility of being criticized by their coworkers.
• Their friendships cannot involve any level of criticism, or they may stop engaging with that friend entirely.
• They may assume that other people are automatically critical and disapproving of them for some reason, even strangers whom they are meeting for the first time.
• They may not join in group activities unless other members of the group offer unconditional support – typically, multiple such offers are necessary to convince someone with avoidant personality disorder to participate.
• They may always incorporate a sense of restraint into their actions.
• They typically have difficulty talking about themselves, especially sharing personal or intimate details, or showing any level of vulnerability.
• Others may describe them as “shy,” “quiet,” “inhibited,” “timid,” “lonely,” “isolated,” or even “invisible.”
• They may assume that all attention is degrading or rejecting, so they might avoid seeking any sort of attention at all.
• They can expect that no matter what they say, other people will view it as problematic or wrong, which can result in them avoiding all conversation.
• They often misinterpret social cues and react strongly to their misinterpretations.
• They may misunderstand subtlety or sarcasm and automatically assume the person intended to mock or deride them.
• They typically have a strong longing for a robust social life, but they are usually unable to fully engage in relationships with others and pursue the social life they desire.
• They may be particularly frightened of interactions with strangers, which can heighten their doubts about their social competence and personal appeal.
• They nearly always have low levels of self-esteem.
• They may exaggerate the potential dangers of ordinary situations (“I can’t meet up for drinks after work because I might get into a car accident on the way to the bar”).
• They may emphasize the need for certainty and security over everything else.
• They might live a highly restricted and narrow lifestyle as a result of nervousness and fear.
• They may seize on any excuse possible to avoid new activities or social situations, including slight physical symptoms (“I stubbed my toe earlier today”).
• They may vigilantly monitor the movements and expressions of everyone they talk to for warning signs of rejection or humiliation.
• They may be specifically scared of criticism in public because of a fear of having a physical reaction, such as crying or blushing.
• Their social inhibition can result in them lacking a social support system, which may make it more difficult for them to work their way through crisis situations or tough periods in their life.
• They might fantasize about idealized relationships with other people whom they are too nervous to pursue.
• They may not be able to meet the basic demands of their job, as many jobs require some level of social interaction.

People with avoidant personality disorder may also have a heightened risk of additional mental health conditions, including depression, bipolar disorder, anxiety disorders, dependent personality disorder, and borderline personality disorder. 

Concerned you may have symptoms of avoidant personality disorder?

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Finding support for living with avoidant personality disorder

Although the symptoms and drawbacks associated with avoidant personality disorder may seem disheartening, there is hope for people with the condition. Talk therapy with a mental health professional may reduce avoidant personality disorder symptoms. 

In-person therapy appointments may be overwhelming for a person with avoidant personality disorder, particularly if they have never met their therapist before. Online therapy may be an alternative therapeutic option that could remove some of the social pressure. With online therapy, a person can attend therapy from the safety and comfort of their own home, and they can choose how they communicate with their therapist, with online chat and phone call options available if video conferences are too stressful. 

Research has shown that there may be no difference in outcomes between online therapy and traditional in-person therapy in treating a variety of mental health conditions, including personality disorders. One study conducted a meta-review of several online therapeutic treatments for a range of personality disorders and found that online therapy showed promise in reducing personality disorder symptoms.