Avoidant Personality Disorder
Avoidant personality disorder (AVPD) is a condition that causes people to experience extreme fear, anxiety, and discomfort in social situations. The person with AVPD will go to great lengths to avoid interpersonal interactions outside of a small circle of trusted family members and friends, to prevent themselves from being criticized, rejected, or exposed as weak or inferior. People with AVPD have a distorted image of themselves and of other people, but with intensive treatment they can learn to control their most debilitating symptoms and gain a more accurate perception of reality.
What Is Avoidant Personality Disorder?
People with avoidant personality disorder (AVPD) find social interactions highly stressful and intimidating. They view themselves as socially inept, and they have an irrational fear of being scorned, ridiculed, or laughed at, based on their low self-esteem and lack of self-confidence.
Powerful anxiety symptoms often accompany their attempts to initiate or join conversations, or to express themselves in public settings, making these occurrences even more unpleasant.
Because of their chronic discomfort, individuals with AVPD exert great effort in avoiding most types of social situations, and over time their distaste for socializing will only grow in intensity.
Unfortunately, the fears of embarrassment and rejection that motivate the behavior of men and women with AVPD often become a self-fulfilling prophecy. Because they habitually avoid people, their social skills never develop and they never learn how to manage their anxiety. Consequently, the social interactions they do have often end in disappointment, which only reinforces their feelings of inadequacy and powerlessness.
Avoidant personality disorder is in many ways similar to social anxiety disorder or social phobia. But people with social phobia usually understand that their anxieties are exaggerated, while those with AVDP are utterly convinced that their fears are legitimate and that their poor self-image is grounded entirely in reality—and as a result, their reclusive personality becomes a permanent fixture.
But avoidant personality disorder can be treated. Despite the tenacity of their self-sabotaging beliefs, with professional assistance people with AVPD can experience improvement in their symptoms, which can eventually precipitate changes in lifestyle and behavior that bring fresh and exciting opportunities for personal growth and achievement.
Facts and Statistics
It is estimated that somewhere between two and three percent of American adults have avoidant personality disorder, and men and women are about equally likely to develop it. While avoidant personality disorder won’t be diagnosed until adulthood, the signs of the disorder will usually be evident during adolescence, manifesting as extreme shyness and low self-esteem.
AVPD is classified as a Cluster C personality disorder, along with dependent and obsessive-compulsive personality disorders. Cluster C conditions are associated with high levels of anxiety and fear, and they can inflict an enormous amount of emotional suffering if treatment services are not forthcoming.
Symptoms and Diagnosis of Avoidant Personality Disorder
Some of the defining characteristics of avoidant personality disorder include:
- Hypersensitivity to criticism or rejection (real or perceived)
- Excessive fear of failure, especially in social situations
- Extreme self-consciousness about appearance, behavior, and the impressions being made (real or imagined) on others
- A tendency to obsess over mistakes, regardless of how small they might be
- An inability to express true feelings or opinions, even around friends, family, or romantic partners
- Approval-seeking behavior, which is designed to avoid the stinging judgments of others
- Secretiveness, guardedness, discomfort over being asked personal questions
- Feelings of shame and guilt about a lack of life accomplishments (which may or may not be based on reality)
- Persistent feelings of anxiety and nervousness
- Harsh self-evaluations (people with AVPD are often believe they are unattractive and unintelligent, and they criticize themselves severely for their poor performances in social settings)
- A strong preference for staying at home, or in other safe and protected environments
- Panic attacks in social situations or when asked to speak in front of others
When someone has AVPD, they develop a reclusive personality and will take extraordinary measures to avoid social contact. They often seek out jobs that involve little human contact, or go on disability if their fear gets in the way of finding a job.
They may desire friendships or romantic relationships, but they will be too afraid of rejection to pursue opportunities when they arise. Their family relationships may be unstable and unsupportive, as loved ones struggle to understand and cope with an enigmatic and unusual personality disorder.
Diagnosing Avoidant Personality Disorder
For avoidant personality disorder to be officially diagnosed, a person must manifest the following symptoms:
- Notable impairments in personality functioning
Impairments in self-functioning must be observed in at least one of two areas:
- Identity. Impairments include low self-esteem, a conception of self as socially inept, and/or feelings of inferiority and inadequacy in comparison to others.
- Self-direction. Impairments usually include a reluctance to pursue goals or ambitions because of the fear of failure and embarrassment.
Impairments in interpersonal functioning must be observed in at least one of two areas:
- Empathy. Impairment is rooted in an extreme fear of being criticized or rejected, based on false beliefs that others will be hostile or judgmental, which often leads to an avoidance of social interactions.
- Intimacy. Impairments may include an inability to initiate social contact that might lead to intimacy, based on fears of rejection and embarrassment, or an unwillingness to be emotionally open in relationships that are already established.
- Pathological personality traits of detachment and negative affectivity
Detachment is revealed by:
- Habitual social withdrawal
- Avoidance of intimate relationships
- Anhedonia (an inability to have pleasurable experiences)
Negative affectivity is revealed by:
- Chronic anxiety, as a reaction to anticipated social situations, or to life responsibilities that require interactions with other human beings (as most life responsibilities do)
Impairments in self-functioning and interpersonal functioning, and pathological personality traits of detachment and negative affectivity, must be stable over an extended period of time and be evident in a variety of contexts. For AVPD to be diagnosed, none of these personality characteristics should be traceable to cultural norms, developmental stages, substance use disorders, or general medical conditions.
Avoidant Personality Disorder Causes and Risk Factors
Research has established a strong genetic component to all personality disorders, creating the majority of the risk for such conditions.
However, personality disorders inevitably emerge from an interplay of genetic causes and environmental factors. Some of the known environmental risk factors for avoidant personality disorder include:
- Traumatic events. About three-fourths of people with avoidant personality disorder have experienced some type of significant life trauma, involving violence, the threat of violence, and/or serious injury.
- Exposure to childhood abuse and neglect. Physical, emotional or sexual abuse, or serious parental neglect, are highly traumatic and life-altering, and are often implicated in the onset of AVPD.
- Rejection or bullying at early ages. Young people who are mistreated or abused by peers may be deeply affected by these experiences, which can leave emotional scars that continue to influence thinking and behavior into adulthood.
- Personality and temperament. Children who are shy or inhibited usually grow out of it as they age, but those who have experiences that reinforce those tendencies may develop avoidant personality disorder.
The interaction between life experiences and genetic predisposition is what causes avoidant personality disorder to develop. Trauma is a significant underlying factor in the onset of this condition, and therapy for AVPD must focus on past traumatic experiences if it is to achieve satisfactory results.
While the process of diagnosing them together can be somewhat complicated, some people do develop both social anxiety disorder and avoidant personality disorder. Treatment will address all symptoms as if they were a part of the same disorder, but when the two conditions appear simultaneously the level of impairment is more significant than with either social phobia or AVPD alone.
In general, people with personality disorders have an elevated risk for anxiety disorders. One comprehensive analysis of data collected over a 30-year period found that AVPD was diagnosed more frequently among people with anxiety disorders than any other personality disorder. This is hardly surprising, since feelings of chronic anxiousness are regularly reported by patients in treatment for AVPD.
Depressive conditions are known to frequently co-occur with social anxiety disorder, and the same relationship holds true with AVPD. In one clinical study, more than 28 percent of patients with major depressive disorder also met the criteria for avoidant personality disorder, which was actually greater than the percentage that had comorbid social anxiety disorder.
While there is a tendency to think of different personality disorders as distinct, some people will receive a diagnosis for more than one such condition. Two personality disorders known to co-occur quite frequently with AVPD are dependent personality disorder and borderline personality disorder, both of which are associated with a poor self-image, unsteady emotions, and the tendency to feel overwhelmed by challenging encounters, events, or circumstances.
Unfortunately, many people with personality disorders attempt to cope with their troubling symptoms and life frustrations by abusing drugs or alcohol. In fact, some studies indicate that a majority of patients who enter treatment for substance use disorders meet the criteria for one or more personality disorders.
A dual diagnosis for substance abuse and AVPD will require specialized treatment, since lasting sobriety can only be achieved if the underlying causes of the substance use disorder are acknowledged and addressed.
Treatment and Prognosis for Avoidant Personality Disorder
Treating avoidant personality disorder is complex and challenging, but mental health treatment centers offer customized inpatient and outpatient avoidant personality disorder treatment programs that are specifically designed to help patients overcome their debilitating habits of thinking and acting. Programs last 30-90 days and feature an intensive, focused therapeutic environment where sources of stress and discord are removed, making it easier for people with AVPD to adjust as they strive to build constructive relationships with the members of their treatment team.
Treatment plans for avoidant personality disorder usually involve a mixture of individual, group, and family therapy, although patients with AVPD may not be comfortable with group therapy sessions until they’ve been in recovery for a few days or weeks. Nevertheless, people with AVPD will be encouraged to participate in group therapy, where honest and open expression is welcomed and encouraged.
Medications are not used to treat personality disorders. However, they may be provided to those who have co-occurring anxiety or mood disorders (as a significant number of men and women with AVPD will).
Treatment plans for avoidant personality disorder will likely be supplemented by social skills training, which is vital for those who must sharpen their communication techniques and learn to manage their anxiety in social settings. Holistic healing practices like yoga, meditation, biofeedback, and massage therapy are often included in the healing regimens of AVPD patients, who can benefit from instruction in anxiety- and stress-management techniques.
Personality disorders are not curable, and those who have avoidant personality disorder will have symptoms to deal with for the rest of their lives. But in therapy they can gain greater self-understanding and perspective, while learning practical strategies for overcoming their self-consciousness and anxiety. As their self-image develops and their confidence in their ability to perform in social situations improves, they may finally feel free to pursue at least some of their hopes and dreams.