Avoidant Personality Disorder

There are a few causes of difficulties in social situations. However, for some people, severe fears of ridicule and rejection can escalate to a mental health condition called avoidant personality disorder (AVPD). If you think you or someone you love is living with AVPD, it can be valuable to understand its symptoms and how therapy can be a valuable part of a comprehensive treatment plan.

What are personality disorders?

According to the American Psychiatric Association, personality disorders are mental disorders affecting how you think, act, and feel. For a person to be diagnosed with one of these disorders, symptoms must deviate from the expected cultural norm, cause distress, impair functioning, and persist over time with little or no relief without treatment. Below are the three categories of personality disorders listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 

Cluster A

Cluster A personality disorders are often characterized by eccentric thought patterns and behaviors. This category includes schizoid personality disorder and schizotypal personality disorder. 

Cluster B

Cluster B personality disorders are characterized by unpredictable, emotional, and antisocial behaviors and thought patterns. This category includes antisocial personality disorder (ASPD), borderline personality disorder (BPD), histrionic personality disorder (HPD), and narcissistic personality disorder (NPD). 

Cluster C

Cluster C personality disorders are characterized by anxious, fearful thinking and behaviors. This category includes avoidant personality disorder (AVPD), dependent personality disorder (DPD), and obsessive-compulsive personality disorder (OCPD). 

What is avoidant personality disorder?

The American Psychological Association Dictionary of Psychology defines avoidant personality disorder as a mental health condition characterized by a hypersensitivity to rejection and ridicule, a strong desire for uncritical acceptance by peers, social withdrawal despite a desire for acceptance and affection, and low self-esteem. 

First defined by Theodore Millon in 1969, avoidant personality disorder causes long-standing patterns with results severe enough to impair a person’s ability to work and maintain personal and intimate relationships. Symptoms of this condition can include the following:

• Extreme sensitivity to rejection and criticism 

• Intense fear of disapproval, ridicule, or embarrassment, especially in public 

• Profound feelings of inadequacy and inferiority 

• Avoidance of work, school, or social activities that require interpersonal contact 

• Feeling unattractive to potential romantic partners 

• Low self-esteem 

• Exaggeration of social challenges 

• Timid behavior and inhibition in social situations, preferring social isolation over the risk of meeting new people

• Extreme shyness

• Difficulty communicating effectively in personal relationships and social situations 

• Maintaining few or no close friends 

• Reassurance seeking behavior 

Diagnosing avoidant personality disorder

Like the methods used to identify many mental health conditions, the diagnosis process for avoidant personality disorder often begins with a psychologist or doctor taking a complete medical history. This part of the process may rule out other possible causes of symptoms, such as underlying physical health problems. 

If no physical issues are found, you may be referred to a mental health professional to complete various diagnostic personality assessment tools and interviews to evaluate whether your symptoms meet the criteria for AVPD or another mental illness.

How common is AVPD, and what causes it?

According to researchers at the Cleveland Clinic, approximately 2.4% of the United States population has an avoidant personality disorder, occurring across all genders equally. Symptoms often appear during childhood and may escalate by the time an individual reaches adolescence or young adulthood. However, personality disorders often aren't diagnosed until an individual reaches age 18 because teens and children can struggle with many behavioral concerns due to adolescence, hormonal changes, and puberty. 

Like many mental illnesses, the exact cause of AVPD isn't known. However, avoidant personality disorder may be believed to develop due to a combination of biological factors like genetics and various environmental risk factors during childhood. Many people with AVPD report memories of parental or peer rejection that significantly impacted their personality and willingness to make themselves socially vulnerable. 

Avoidant personality disorder treatments

Treating AVPD can be challenging, as personality disorders often involve deeply ingrained behaviors and beliefs. However, those with this condition often want to make changes, as their difficulty with social situations may cause significant distress. Many avoidant personality disorder patients find that the desire to develop relationships is a significant motivator to endure the short-term discomfort of treatment for long-term benefits. Therapy is often most effective when patients have support from friends and family members. 

As with many mental health conditions, psychotherapy or talk therapy may be the primary treatment for this condition. Clients might supplement therapy with medications. However, consult a doctor before starting, changing, or stopping medication for any reason. Below are a few of the most common types of treatments for AVPD. 

Cognitive-behavioral therapy (CBT)

Cognitive behavioral therapy is a therapeutic approach focused on identifying and understanding maladaptive behaviors and thought patterns. Once you can identify why you are thinking and feeling as you are, you can work to reshape your outlook and shift toward healthier habits with the support and guidance of a mental health professional. CBT can help you examine how past experiences may influence your present behavior. 

Schema therapy 

Schema therapy combines elements from various therapeutic approaches and is frequently used for clients with personality disorders who don't respond well to other treatments. This method requires a trusting relationship between the client and therapist. Much of the work involves examining childhood experiences and how they influence your schema, which is a label for unwanted thoughts and behavioral patterns. 

Additional therapy options

Many people with personality disorders may also benefit from the following types of therapy: 

• Exposure and response prevention therapy (ERP)

• Dialectical behavior therapy (DBT) 

• Psychodynamic therapy

• Supportive therapy

• Acceptance and commitment therapy (ACT) 

• Emotion-focused therapy

• Metacognitive interpersonal therapy

• Animal-assisted therapy

AVPD vs. social anxiety disorder: How to tell the difference

Avoidant personality disorder and social anxiety disorder have many similarities, so people may confuse the two. Some mental health professionals may describe AVPD as a severe form of social anxiety, though they are two separate diagnosable mental health disorders. A notable difference is that people with AVPD find their symptoms are not limited to social interactions (as tends to be the case with social anxiety disorder), and their fear of failure or judgment may impact their productivity or long-term success. 

Is AVPD treatable? 

If untreated, AVPD can worsen. The effects of social isolation may grow stronger with time, and the longer you maintain habits influenced by avoidant personality disorder symptoms, the more ingrained those patterns might become. People who don't seek treatment could risk developing depression or other mood disorders, agoraphobia, and substance use disorders. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

While treatment might not change your personality, it can help you find ways to cope with your symptoms and manage their effects to communicate and relate to others more healthfully. There are limited studies on the impact of treatment for AVPD. However, emerging studies show that psychotherapy may be the most effective treatment for those with a primary AVPD diagnosis without co-morbid traits. 

Tips for coping with avoidant personality disorder

Below are a few tips for coping with AVPD if you're living with this condition: 

• Practice self-care with positive affirmations 

• Eat a balanced diet

• Exercise regularly 

• Practice healthy sleep hygiene

• Develop your social skills with a socializing class 

• Attend a support group for those with social anxiety 

• Don't push yourself too much initially 

• Try not to isolate yourself from friends and family members

• Read books about your condition and how to cope 

• Talk to a therapist 

Consider working with a licensed therapist if you are living with avoidant personality disorder. If socializing is a factor holding you back from reaching out for support, you can try online therapy through an online therapy platform like BetterHelp. Therapy can help you identify and replace harmful behaviors, establish healthy coping skills, and build communication skills, potentially increasing your confidence.  

Online cognitive-behavioral therapy and other therapeutic approaches can provide results that are similar to those of in-person therapy, according to a recent study by the American Psychological Association. With an online therapy platform, individuals can be matched with a therapist who understands the differences between various disorders, such as avoidant personality disorder (AVPD), borderline personality disorder, and bipolar disorder. Many clients, including those with AVPD, may find teletherapy's extra physical distance a significant benefit, as it may make it easier to give personal details to their therapist. In addition, you can choose between phone, video, or chat sessions with your therapist, which might reduce social fears surrounding sessions.