How Are Avoidant Personality Disorder And Loneliness Connected?

Avoidant personality disorder (AVPD) is a personality disorder usually involving immense amounts of social anxiety. This social anxiety often prompts a person to avoid social interaction, which can result in social isolation and loneliness. Meanwhile, loneliness is an emotion that almost everyone experiences at some point. Excessive loneliness can negatively impact a person’s physical and mental health. While not everyone who experiences loneliness has avoidant personality disorder, individuals living with either concern often benefit from therapy.

Overlap between avoidant personality disorder and loneliness

The primary connection between avoidant personality disorder and loneliness may be that people with AVPD tend to feel immensely lonely at times. A deep fear of being rejected, judged, or criticized can keep people with the disorder from developing relationships or from opening up and being authentic in the relationships they do have.

As a result, people with avoidant personality disorder might believe that no one knows the "real" them. They may also spend large quantities of time alone, despite having a deep longing for interaction with others. People with more severe forms of AVPD often build lives that involve living and working alone and having few to no friends. This lifestyle doesn't usually reflect their deepest desires, however. Many people with AVPD crave connection and intimacy, but their fear of rejection tends to outweigh those desires, resulting in a deep sense of loneliness.

What is avoidant personality disorder?

Avoidant personality disorder is one of the 10 personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). In order to qualify as having the disorder, a person must have a long-term pattern of being socially inhibited, experiencing a sense of inadequacy, and being hypersensitive to judgment, and this pattern must cause them distress or impair their functioning in some capacity. Usually, symptoms begin in early adulthood. 

A person must fit four of the following seven diagnostic criteria to have AVPD:

• Avoids activities involving frequent interactions with others out of a fear of rejection, criticism, or judgment
• Is unwilling to enter new relationships without the certainty that they will be liked
• Holds back in relationships due to a fear of being shamed or mocked
• Is preoccupied with rejection and criticism
• Acts inhibited in new social situations due to a sense of inadequacy
• Has low self-confidence and believes others dislike them or find them inferior
• Hesitates to take risks or try activities that may end in embarrassment or failure

While AVPD can seem similar to social anxiety disorder, the two disorders have differences. AVPD tends to be long-lasting and usually involves personality traits that remain consistent for decades of a person’s life, while social anxiety disorder symptoms may occur temporarily or ebb and flow over time.

AVPD symptoms are nearly the opposite of those found in dependent personality disorder (DPD) and borderline personality disorder (BPD), despite all three conditions being classified as personality disorders. People with DPD and BPD tend to have a deep fear of being abandoned, so they cling tightly to their interpersonal relationships as a result. People with avoidant personality disorder typically have different personality traits, so they may avoid relationships despite deeply desiring them. As a result, they may also lack effective social skills, although this may not always be the case.

What is loneliness?

Loneliness can be seen as a common emotion to which nearly everyone can relate. According to Britannica, people can be described as lonely when they believe they don't have the quantity or quality of relationships they would like. People tend to have a loneliness "set-point," meaning that their level of loneliness can fluctuate over time, but tends to hover fairly consistently around the same level before increasing during older age. 

Long-term loneliness can be linked to mental illnesses like depression and the personality trait of introversion. Severe loneliness is often distressing and can increase a person's risk of illness and death.

Unlike avoidant personality disorder, loneliness is not considered a mental illness. Instead, it can be seen as a normal human emotion, though it may be associated with mental and physical illnesses. Simply being alone is not the same as experiencing loneliness. Some people enjoy solitude, but loneliness can arise when being alone is isolating, sad, or generally unpleasant, or when it is not what a person wants for themselves.

Although loneliness isn't a diagnosable illness, some researchers have created a scale to identify how lonely a person is. The Revised UCLA Loneliness Scale involves assigning a number between one and four to each of 20 items, where one means "never," two means "rarely," three means "sometimes," and four means "often." Here are summarized items from the loneliness scale:

1. I feel connected to those near me
2. I'm lacking in companionship
3. I don't have anyone to turn to
4. I don't feel alone
5. I am part of a friend group
6. I have many things in common with those around me
7. I'm not close to anyone anymore
8. People around me don't share my interests or ideas
9. I'm outgoing
10. I feel close to people
11. I feel left out
12. My relationships are superficial
13. No one really knows me well
14. I'm isolated from people
15. I find companionship when I desire
16. Some people really understand me
17. I feel unhappy being withdrawn
18. The people around me aren't truly “with” me
19. I can talk to people
20. I can turn to people

To identify a person's score, they must add up the sum of all items, except for 4, 5, 6, 9, 10, 15, 16, 19, and 20. These items should also be added to the total, but first scored in reverse. For example, if a person chose two, they would add three to the score. If they chose four, they would add one to the score. The higher a person's total score, the lonelier they are said to be.

Remote therapy for loneliness

Researchers haven't extensively studied avoidant personality disorder treatments. Instead of trying to change the personality of a person with AVPD, experts recommend treating the symptoms that distress a person with avoidant personality disorder. Often, loneliness is the emotion that's most bothersome for people with AVPD.

Remote therapy is one treatment option available for loneliness, whether experienced on its own or associated with avoidant personality disorder. People who are experiencing loneliness but also avoiding social situations due to anxiety may appreciate the online nature of remote therapy. Because remote therapy sessions can be attended from anywhere with an internet connection, they generally allow people to avoid going out in public or putting themselves in new social situations, such as waiting in a public waiting room or meeting a therapist in person. BetterHelp is a remote therapy platform that can connect you with a suitable therapist for your needs.

Feeling lonely, yet still avoiding people?

Therapy can help you build relationships

A 2020 randomized controlled research study with 73 participants analyzed the effect of internet-based therapy on loneliness. After eight weeks of online treatment involving cognitive behavioral therapy (CBT), people who were in the treatment group generally had a greater decrease in loneliness compared to those in the control group, suggesting that remote therapy could be a valid treatment for reducing loneliness.