People with avoidant personality disorder avoid social situations due to fear of rejection and being judged by others. However, because most people with this condition want to develop relations, they may be more likely to respond to the work of psychotherapy.
Avoidant personality disorder is one of a group of conditions known as personality disorders. These disorders, in general, are enduring patterns of behavior out of keeping with cultural norms that cause suffering for an individual or those around them. Avoidant personality disorder is grouped with other personality disorders marked by feelings of nervousness and fear. People with avoidant personality disorder have chronic feelings of inadequacy and are highly sensitive to being negatively judged by others. Though they would like to interact with others, they tend to avoid social interaction due to the intense fear of being rejected by others.
How common is avoidant personality disorder?
It is estimated that about 2.4% of the U.S. population has avoidant personality disorder. It appears to affect men and women equally. Like other personality disorders, avoidant personality disorder symptoms may be noticed in childhood and often begin to create discomfort in adolescence or early adulthood. Avoidant personality disorder is usually not diagnosed in people younger than 18 years of age like many other personality disorders as there should be evidence that these patterns of behavior are enduring and inflexible that do not readily fade with time.
The exact cause of avoidant personality disorder is not known. However, it is believed that both genetics and environment play a role. It is believed that avoidant personality disorder may be passed down in families through genes but this has not yet been proven. Environmental factors, particularly in childhood, do play an important role. Shyness, often normal in young children, lasts into adolescents and adulthood in those with avoidant personality disorder. Those with the disorder often report past experiences of parental or peer rejection, which can impact a person’s self-esteem and sense of worth.
What are the symptoms of avoidant personality disorder?
For people with this disorder, the fear of rejection is so strong that they choose isolation rather than risk being rejected in a relationship. The pattern of behavior in people with this disorder can vary from mild to extreme. In addition to their fear of humiliation and rejection, other common traits of people with this disorder include the following:
- They are oversensitive and easily hurt by criticism or disapproval.
- They have few, if any, close friends and are reluctant to become involved with others unless certain of being liked.
- They experience extreme anxiety (nervousness) and fear in social settings and in relationships, leading them to avoid activities or jobs that involve being with others.
- They tend to be shy, awkward, and self-conscious in social situations due to a fear of doing something wrong or being embarrassed.
- They tend to exaggerate potential problems.
- They seldom try anything new or take chances.
- They have a poor self-image, seeing themselves as inadequate and inferior.
If symptoms are present, a healthcare provider will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests to rule out physical illness as the cause of the symptoms.
If the provider finds no physical reason for the symptoms, they might refer the person to a psychiatrist or psychologist, healthcare professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder like avoidant personality disorder.
Treating personality disorders is difficult, because people with these disorders have deep-rooted patterns of thinking and behavior that have existed for many years. However, people with avoidant personality disorder tend to be good candidates for treatment because their disorder causes them significant distress, and most want to develop relationships. This desire can be a motivating factor for people with avoidant personality disorder to follow their treatment plans.
As with other personality disorders, psychotherapy is the main treatment for avoidant personality disorder. Psychotherapy is a type of individual counseling that focuses on changing a person’s thinking (cognitive therapy) and behavior (behavioral therapy). Therapy is likely to focus on overcoming fears, changing thought processes and behaviors, and helping the person better cope with social situations. Medication—such as an antidepressant or anti-anxiety drug—might be used to help manage the anxiety felt by people with this disorder. For the best results, however, medication therapy should be done in combination with psychotherapy. Treatment for people with this disorder is most effective when family members are involved and supportive.
What are the complications of avoidant personality disorder?
Without treatment, a person with this disorder can become isolated from society, causing long-term difficulties with work and social functioning. They are also at greater risk for depression and substance abuse.
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Although it might not be possible to prevent this disorder, it might be helpful to begin treatment in people as soon as they begin to have symptoms.
As with other personality disorders, treatment for avoidant personality disorder is a long process. The willingness of the individual to seek and stay with treatment can have a significant effect on treatment success and, therefore, the outlook. With treatment, some people with avoidant personality disorder can learn to relate to others more appropriately.
Last reviewed by a Cleveland Clinic medical professional on 10/06/2020.
References
- Skodol AE, Bender DS, Gunderson JG, Oldham JM. The American Psychiatric Publishing Textbook of Psychiatry, Sixth Edition. Chapter 25. Personality Disorders. March 2014.
- American Psychiatric Association. What are Personality Disorders? (//www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders) Accessed 10/7/2020.
- Lampe L, Malhi GS. Avoidant personality disorder: current insights. Psychol Res Behav Manag. 2018 Mar 8;11:55-66. doi: 10.2147/PRBM.S121073. PMID: 29563846; PMCID: PMC5848673.
- Merck Manual Professional Version. Avoidant Personality Disorder (AVPD). (//www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/avoidant-personality-disorder-avpd?query=avoidant%20personality%20disorder) Accessed 10/7/2020.
- Sadock, BJ., et al. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Science/Clinical Psychiatry. Wolters Kluwer, 2015.
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3) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
4) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.