Avoidant Personality Disorder (AVPD)
(See also Overview of Personality Disorders.)
Avoidant personality disorder is characterized by avoiding social situations or interactions that involve risk of rejection, criticism, or humiliation.
People with avoidant personality disorder are afraid of being rejected, criticized, or embarrassed and thus avoid situations where they may experience such reactions.
Doctors diagnose avoidant personality disorder based on specific symptoms, such as avoiding situations that involve interpersonal contact because of fear of rejection and disapproval or feelings of being socially incompetent, unappealing, or inferior to others.
People with this disorder may benefit from cognitive-behavioral therapy, other psychotherapies, and antianxiety drugs and antidepressants.
Personality disorders are long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or impair the person's ability to function.
People with avoidant personality disorder feel inadequate. They manage these feelings by avoiding any situations in which they may be evaluated negatively.
Avoidant personality disorder occurs in 1 to 5.2% of the general population. It is more common among women.
Other disorders are also often present. They include one or more of the following:
People who have social phobia and avoidant personality disorder have more severe symptoms and are more disabled than those who have only one of the disorders.
Genes and environmental factors may contribute to the development of avoidant personality disorder. For example, people may have an inborn anxiety in social situation, and/or they may experience rejection and marginalization during childhood. Avoidance in social situations has been observed in children as young as about 2 years old.
People with avoidant personality disorder avoid social interaction, even at work, because they fear that they will be criticized or rejected or that people will disapprove of them. For example, they may do the following:
People with this disorder assume others will be critical and disapproving until there is clear-cut, indisputable proof to the contrary. Thus, before joining a group and forming a close relationship, people with this disorder require repeated assurances of support and uncritical acceptance.
People with avoidant personality disorder are very sensitive to anything critical, disapproving, or mocking because they constantly think about being criticized or rejected by others. They are vigilant for any sign of a negative response to them. Their tense, anxious appearance may elicit mockery or teasing, thus seeming to confirm their self-doubts.
People with avoidant personality disorder long for social interaction but fear placing their well-being in the hands of others. Because these people limit their interactions with others, they tend to be relatively isolated and to lack a social network that could help them when they need it.
Low self-esteem and a sense of inadequacy inhibit these people in social situations, especially new ones. They hold back in interactions with new people because they think of themselves as socially inept, unappealing, and inferior to others. They tend to be quiet and timid because they tend to think that if they say anything, others will say it is wrong.
People with avoidant personality disorder are reluctant to talk about themselves lest they be mocked or humiliated.
People with this disorder are very reluctant to take risks or participate in new activities for similar reasons. In such cases, they tend to exaggerate the dangers and use minimal symptoms or other problems to explain why they are not participating. They may prefer a limited lifestyle because of their need for security and certainty.
Doctors usually diagnose personality disorders based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5—see Classification and Diagnosis of Mental Illness), published by the American Psychiatric Association.
For doctors to diagnose avoidant personality disorder, people must persistently avoid social contact, feel inadequate, and be hypersensitive to criticism and rejection, as shown by at least four of the following:
They avoid job-related activities that involve interpersonal contact because they fear that they will be criticized or rejected or that people will disapprove of them.
They are unwilling to get involved with people unless they are sure of being liked.
They are reserved in close relationships because they are afraid of being ridiculed or humiliated.
They are preoccupied with being criticized or rejected in social situations.
They are inhibited in new social situations because they feel inadequate.
They view themselves as socially incompetent, unappealing, or inferior to others.
They are reluctant to take risks or participate in any new activity because they may be embarrassed.
Also, symptoms must have begun by early adulthood.
General treatment of avoidant personality disorder is similar to that for all personality disorders.
People with avoidant personality disorder may avoid treatment.
If people have social phobia and avoidant personality disorder, the following treatments can be effective:
Cognitive-behavioral therapy that focuses on acquiring social skills, done in groups
Other group therapies if the group consists of other people with the same difficulties
People with avoidant personality disorder benefit from
Psychodynamic psychotherapy may be helpful. This type of psychotherapy focuses on underlying conflicts.