What Is Avoidant Personality Disorder?

The avoidant personality disorder (AVPD) is characterized by feelings of extreme social inhibition, inadequacy, and sensitivity to negative criticism and rejection. Yet the symptoms involve more than simply being shy or socially aawkward.

We all feed the desire to be alone sometimes, but when it consumes our daily life, it might be caused by something more serious like avoidant personality disorder. To understand if it might be a problem, learn to recognize some common AVPD symptoms.

People don’t understand how afraid you are of social interactions, how much energy it costs to interact because you are constantly over-thinking your own words, actions and people’s words and reactions and that the stress it causes is chronic.

It causes significant problems that affect the ability to interact with others and maintain relationships in your day-to-day life. A 2018 study published in psychology research and behavior management found that AVPD, though “under-recognized and poorly studied”, is a fairly common disorder, affecting as many as 2,5% of the population.

Most people can admit that they experience some social anxiety from time to time or, like most people, they fear rejection, or worry about what others will think of them. Having these thoughts and feelings is a completely normal part of being human. We all want approval and acceptance.

However, when feelings of inadequacy, social inhibitions, and intense worry of rejection hinder a person’s personal and professional life, they might be suffering from a deeper problem.

People struggling with avoidant personality disorder tend to be extremely uncomfortable in social situations, avoid eye contact with others, and may appear to be tremendously shy. In truth, they are likely trying to cope with very low self-esteem, a fear of being negatively judged, or even rejected by others.

Avoidants who have few close relationships are worthy of love and support. It’s incredibly hard for someone with AVPD to maintain friendships once they’ve created them, and they don’t want to harm anyone through their behavior. Avoidants who disappear for weeks or months and have no contact with their loved ones still deserve happiness. It’s incredibly exhausting for them to perform even simple social interactions, and it can be easy for them to become isolated. They don’t hate their loved ones just because they don’t consistently talk to them as often as possible.

Avoidant personality disorder symptoms include a variety of behaviors, such as:

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning in early adulthood and present in a variety of contexts..

• Avoiding work, social, or school activities for fear of criticism or rejection. It may feel as if you are frequently unwelcome in social situations, even when that is not the case. This is because people with avoidant personality disorder have a low threshold for criticism.
• Afraid to speak up for fear of saying the wrong thing, blushing, stammering, or otherwise getting embarrassed.
• Aware of being uncomfortable in social situations and often feels socially inept, comments by others about your shyness or nervousness in social settings may feel like criticism or rejection.
• Criticism or rejection preoccupies thoughts in social situations.
• Restraint in relationships due to fear of shame.
• Inhibited in new relationships.
• Needs to be sure of being liked before engaging socially.
• Gets around occupational activities with need for interpersonal contact.
• Embarrassment prevents new activity or taking risks.
• Self viewed as unappealing or inferior.
• Hesistant to break routine, try new things, or take risks of any kind
• Tendency to self-isolate
• Lack of any close friends or a social network

Living with these thoughts and feelings can be incredibly debilitating and difficult. People emotionally wrestling with AVPD will often misinterpret completely neutral situations as something negative or personally aimed at them. Left untreated, this condition can worsen and create a host of other issues, such as depression, anxiety disorder, social isolation and substance abuse as a way to self-medicate.

Pathogenesis And Clinical Findings

Avoidant personality disorder is categorized by the DSM-5 under the Cluster C of personality disorders. These are mental health issues like obsessive-compulsive disorder (ocd), that are “characterized by anxious, fearful thinking and behavior”.

Definition of Avoidance

A personality trait characterized by excessive worrying, pessimism, shyness, and being fearful, doubtful, and easily fatigued

Biological

• First degree relative with social anxiety disorder are 3-4 times more likely to have AVPD
• May involve a genetic predisposition to chronic anxiety

Psychosocial

• Harm avoidance
• Negative childhood experiences
• Childhood/ adolescent anxiety disorders

Clinical Features

• Shyness, timidity, and social withdrawal
• Behavior or appearance that’s meant to drive others away (which gives a sense of control)
• Overtalkativeness
• Constant mistrust or wariness of others
• Testing of others’ sincerity
• Difficulty starting and maintaining relationships
• Perfectionism
• Rejection of people who don’t live up to ones impossibly high standards
• Limited emotional expression
• Tenseness and anxiety
• Severe low self-esteem
• Self-loathing
• Emotional distancing
• Feelings of being unworthy of successful relationships
• Self-consciousness
• Loneliness
• Reluctance to take personal risks or engage in new activities
• Frequent escapes into fantasy, such as by excessive reading, watching tv, or daydreaming

What Causes Avoidant Personality Disorder?

Like many mental health issues, there are a variety of reasons a person may develop this condition in adulthood. The main causes of avoidant personality disorder include genetics, and conditions such as a history of emotional abuse, a lack of affection received as a child, or other associated psychological trauma.

Children are not generally diagnosed with the disorder because they are still maturing. Luckily, many of them may yet outgrow behaviors such as shyness or avoidance.

In order for a AVPD diagnosis, the diagnostic and statistical manual of mental disorders (DSM-5), often referred to as the “bible of psychiatry”, requires that a person display a consistent pattern of behavior that qualifies the diagnosis as being AVPD.

It is also related to borderline personality disorder and shares many of the same signs as social anxiety disorder, although AVPD symptoms are usually more severe than the latter.

Treatment

Unfortunately, many people with an avoidant personality disorder never seek treatment because they assume their symptoms are just who they are, rather than the consequences of an untreated mental illness. However, there are treatment approaches to AVPD that can greatly improve a person’s quality of life.

Effective AVPD Treatment Often Includes:

• Healthy lifestyle changes – Though it might not be obvious, one of the first steps is to maintain a healthy lifestyle. Many mental health conditions can be minimized with a nutritious diet, combined with 8 hours of restful nightly sleep and regular exercise. All three of these have shown to be positive steps for keeping the body and mind’s natural chemistry in balance.
• Anti-depressant medications – Specifically prescribed directly for AVPD, but some anti-depressant medications may help with mood and related issues of depression or anxiety. Medication is a typical treatment for many mood disorders and it can be useful when used in connection with a talk therapy routine.
• Behavioral counseling and talk therapy – Other approaches like counseling or cognitive behavioral therapy (CBT), a skill-oriented therapy that helps people engage in more adaptive thinking, is an incredibly effective treatment for avoidant personality disorder. Group therapy can be helpful as well, especially if it involves social skills techniques. Whenever possible, it’s useful to involve family and friends in therapy sessions so they have a better understanding of how the dissorder affects people and why they exhibit specific personality traits.
• Addiction treatment – Unfortunately, many people use drugs or alcohol as coping mechanisms for dealing with mental health conditions, and this practice sometimes leads to addiction. Addiction treatment, if there are substance abuse issues, can help patients with AVPD, but the two conditions together create a co-occurring disorder, which usually requires dual diagnosis treatment for successful recovery.