What's The Relationship Between Avoidant Personality Disorder And Stress?
Avoidant personality disorder (AVPD) symptoms can cause significant stress and affect a person’s social and professional relationships in numerous ways. Exploring the relationship between avoidant personality disorder and stress may help individuals explore ways to seek support, whether they are loved ones of someone with the disorder or someone with AVPD.
Criteria for a diagnosis of avoidant personality disorder
Avoidant personality disorder is categorized as a cluster C personality disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). The American Psychological Association defines avoidant personality disorder as a “personality disorder characterized by (a) hypersensitivity to rejection and criticism, (b) a desire for uncritical acceptance, (c) social withdrawal despite a desire for affection and acceptance, and (d) low self-esteem.”
Cluster C disorders may cause anxiety and fear. The other personality disorders in this cluster are dependent personality disorder (DPD) and obsessive-compulsive personality disorder (OCPD). These conditions are different from cluster A personality disorders, including paranoid personality disorder, which typically has eccentric characteristics, and cluster B personality disorders, like borderline personality disorder (BPD) and narcissistic personality disorder (NPD), which tend to cause profound emotional challenges and relationship difficulties.
According to the DSM-5-TR, an individual may be diagnosed with avoidant personality disorder if they meet at least four of the following criteria:
- Avoiding occupational activities that involve significant interpersonal contact because of the fear of criticism, disapproval, or rejection
- Unwillingness to get involved with people unless certain they are liked or accepted
- Restraint in intimate relationships due to a fear of being shamed or ridiculed
- Preoccupation with being criticized or rejected in social situations
- Inhibition in new interpersonal situations due to a belief they are inadequate
- Views of the self as socially inept, personally unappealing, or inferior to others
- An uncharacteristic reluctance to take personal risks
Causes of avoidant personality disorder
Avoidant tendencies may first appear in infancy or childhood and manifest as shyness or isolation. Research suggests that marginalization and rejection during childhood can contribute to AVPD, as can social anxiety traits. Although many children can experience shyness, this trait tends to dissipate as they age. However, in a person living with AVPD, it tends to increase in adolescence and adulthood.
Differential diagnosis
When assessing a client, mental health professionals may first distinguish between AVPD and social anxiety. Social anxiety disorder, sometimes called social phobia, tends to be related to specific situations, such as public speaking. Contrarily, AVPD tends to be characterized by more pervasive anxiety and avoidant behaviors. Despite the differences between these conditions, AVPD and social phobia are common comorbid mental health disorders.
Clinicians may also consider the similarity between AVPD and schizoid personality disorder, which also tends to involve social isolation. With schizoid personality disorder, a person may isolate due to a disinterest in others. In contrast, those with AVPD typically isolate out of a fear of possible rejection.
How avoidant personality disorder symptoms can cause stress
Avoidant personality disorder can lead to stress in various contexts, including the following.
Fear of social interactions
A person living with AVPD may desire social connection but experience fear and stress at the thought of interacting with others. They may avoid people unless they are certain they will be accepted, which can lead to a lack of a support system.
Fear of others’ reactions
A person with AVPD may also be hyper-vigilant of others’ reactions. They may misinterpret a neutral gesture or reaction as judgmental. This symptom can cause significant stress, not only when they are in a social situation but afterward.
Intimate relationship challenges
Fear of judgment and rejection can also affect a person’s intimate relationships. Individuals may decide not to pursue a relationship due to a fear of rejection, even if the relationship is going well. This symptom could lead to a pattern that leads to isolation, which may increase stress and further reinforce inaccurate ideas they have about themselves.
Strained work relationships
Work relationships can also be affected by AVPD. Those with AVPD may believe that they lack social skills and that their work colleagues perceive them as inferior, which can lead to significant stress throughout the workday. They may avoid work situations that require interaction, which could lead to missed promotions and numerous job changes.
Treatment
Treatment of avoidant personality disorder often involves talk therapy. However, given the nature of AVPD, individuals with the disorder may avoid treatment. When they attend therapy, therapists may use cognitive-behavioral therapy emphasizing social skills. This modality may be helpful for individuals living with AVPD and social phobia, and it may be conducted in groups. Those with both conditions may also benefit from exposure therapy, a type of CBT that typically exposes a person to their fear gradually and in a safe environment.
Individuals living with AVPD may also benefit from supportive psychotherapy, psychodynamic therapy, and interpersonal therapy, which may reduce interpersonal stress. In some cases, a person living with AVPD may be prescribed medication if they experience symptoms of other mental health disorders. For example, they may be prescribed antidepressants or anti-anxiety medication if they have comorbid depression or anxiety.
The BetterHelp platform is not intended to provide any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. You should not take any action without consulting a qualified medical professional.
How avoidant personality disorder can affect loved ones
Friends and family members of people living with avoidant personality disorder may experience frustration if their attempts to help don’t work. They may suggest new activities or social events for their loved one, who may continually decline their invitations. Loved ones may find it challenging to truly understand what the person is experiencing. While everyone can experience nervousness at times, AVPD tends to cause pervasive anxiety and stress across multiple social contexts.
Another point of frustration may come from a heightened sensitivity to criticism. A person living with AVPD may react strongly to minor criticism or even perceived slight. Friends and family members may experience fear of causing their loved one additional stress.
Support options
Friends and family members may find it helpful to speak with a licensed counselor, who can offer personalized advice on communicating with their loved one. Doing so may reduce stress not only for the person with AVPD but also for their loved ones, who may be deeply concerned. People with AVPD may also find therapy helpful, as they can learn new skills for coping with fear and avoidance.
Individuals who cannot find a local therapist experienced with AVPD might consider online therapy through a platform like BetterHelp. Online therapy platforms typically have a large pool of therapists with diverse experience. For example, BetterHelp has a network of more than 30,000 licensed therapists, and individuals can be matched with a therapist who has experience with AVPD.
Family and friends of a person living with AVPD or individuals with this condition can discuss their concerns with an online mental health professional via audio, video, or live chat. They can also contact their therapist anytime through in-app messaging, who will respond once they are available. This feature may be helpful if family members have concerns about a person with AVPD in between therapy sessions or if individuals with AVPD are looking for advice during a challenging moment.
Numerous studies have demonstrated the effectiveness of online therapy. Online therapy has been found to be effective for conditions such as depression and anxiety, which may be common among friends and family members of individuals living with AVPD and those with the condition. If one’s loved one with AVPD is hesitant to attend in-person therapy, loved ones may be able to convince them to try online therapy, which tends to have higher retention than in-person therapy.
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