Avoidant Personality Disorder is a psychiatric condition characterized by extreme anxiety and hypersensitivity in social situations.
The DSM-V categorizes it among other nine personality disorders. Patients with personality disorders exhibit rigid and unhealthy ways of thinking and behaving that make it difficult for them to interact with others and their environment. Consequently, patients struggle to maintain relationships and may perform poorly at work or school.
In the United States, about 9% of the population suffers from a personality disorder.
The DMS-V groups personality disorders in three clusters. AVPD belongs in Cluster C, which is characterized by pervasive anxiety.
What Is Avoidant Personality Disorder (AVPD)?
As a Cluster C personality disorder, AVPD causes fear and nervousness primarily in social situations. The intense negative feelings of inadequacy and self-consciousness cause people with this personality disorder to avoid interacting with others. These feelings and behaviors cause limitations in many areas of their lives.
Approximately 2.4% of people in the United States suffer from AVPD, and it appears to affect men and women in equal measure.
While it may seem like average shyness, the difference between a healthy personality trait and a personality disorder is the level of disruption it causes in a person’s life.
A shy person might not readily engage in some social situations like large parties or jobs that require them to interact with a high number of people every day. However, they can perform satisfactorily at work or school and engage in other social situations that make them more comfortable, as small gatherings with intimate friends and family in more quire settings. Shyness does not disrupt their daily life and does not cause intense feelings of fear and anxiety.
Contrarily, someone with AVPD experiences a level of disruption in their daily life. They are more ready to avoid social situations not out of preference but to relieve the powerful negative feelings arising from interacting with other people. In reality, they crave social connections, but it’s extremely difficult for them to establish them.
Like other personality disorders, AVPD usually begins manifesting in adolescence or early adulthood. While it might be observed in children, it isn’t diagnosed in children under 18 years of age.
Often, changes in a patient’s life during their teenage years and early adulthood, such as moving away from home or getting their first job, can aggravate symptoms or make them more apparent.
For a person with AVPD, the fear of rejection or ridicule from others is so overpowering that they choose to avoid social situations altogether. This avoidance becomes a pattern of behavior, with different degrees of severity.
Other traits found in people with AVPD are:
- Social inhibition keeps them from trying anything new or taking risks
- Awkwardness, shyness, self-consciousness in social situations
- An intense fear of criticism, rejection, or disapproval
- Strong anxiety in social situations stemming from their fear of rejection or ridicule
- Low self-esteem and self-confidence
- Few, if any, friendships and close relationships
- Aggrandizes problems and obstacles
- Feelings of inferiority and inadequacy
The exact cause of AVPD is still unknown. However, medical professionals agree it stems from a combination of environmental and genetic factors.
Some patients may be genetically susceptible to developing a personality disorder like AVPD. This predisposition means that AVPD may run in families. Sometimes, life experiences and other external factors act as a trigger or a contributing factor.
In particular, childhood experiences often play a crucial role in developing personality disorders as adults. Situations such as rejection by parents or friends can affect the patient’s self-esteem, which in some people may contribute to developing AVPD in the future.
Because the exact cause of AVPD is not known, it’s difficult to pinpoint specific risk factors.
However, medical experts have observed a few common traits among people who develop AVPD.
Among these factors are:
- A history of shyness as a child, although not all shy children grow up to present AVPD
- An unstable or abusive family situation
- Bullying or rejection from peers as a child
- A previous diagnosis of a conduct disorder in childhood
Anyone suspecting they may have Avoidant Personality Disorder needs to be evaluated by a mental health professional to confirm a diagnosis.
During the consultation, the provider may perform a physical exam and consult the patient’s medical history. The doctor or mental health provider needs to have a thorough understanding of the patient’s past and current health conditions to ensure a physical illness isn’t causing the symptoms.
They will also carry out a psychiatric evaluation. The physician may ask questions about your behavior, thoughts, and feelings to narrow down a diagnosis.
The goal of the examination is to assess aspects of the patient’s personality such as their perception of themselves and the world around them, their attitude and behaviors toward others, and impulse control.
Because symptoms may overlap with those of other personality disorders or mental health conditions, getting a diagnosis isn’t always straightforward.
In particular, AVPD may overlap with the following conditions:
- Schizoid personality disorder.
As another Cluster C personality disorder, it also presents social isolation and anxiety. The difference lies in the cause of isolation. While people with AVPD often crave close relationships, the powerful fear of rejection and ridicule makes them avoid interacting with others. In contrast, people with schizoid personality disorder isolate themselves from others because they are not interested in others.
- Social anxiety disorder.
At its core, social phobia and AVPD share the avoidance of social situations because of a fear of ridicule or rejection. The differences are subtle, which makes it difficult to distinguish between the two. One key difference is which situations cause fear and anxiety. People with social phobia often fear that an action they perform will make others reject them. In contrast, people with AVPD avoid socializing because they believe there is something inherently wrong with them that will make people automatically reject them. For example, a person with social phobia might avoid a job interview out of fear of saying the wrong thing. Someone with AVPD may do so because they believe they are not intelligent enough to do the job.
AVPD may cause major disruptions in the patient’s work, school, and relationships. It makes it difficult for them to build a strong support network, making it hard for them to receive emotional support and care.
For this reason, one complication of AVPD is the use of drugs or alcohol to cope with the symptoms.
Some patients may use substances to help them in social situations. For example, by drinking alcohol excessively to be more outgoing at a party. Over time, using substances as aids for social interaction may result in substance abuse and addiction.
Fear of social situations can severely hinder the patient’s performance at work or school. They may struggle to go to class or the office. Over time, it may be an obstacle to complete their studies or get a job.
Because the cause of AVPD is still unknown, it’s not possible to prevent its onset. However, the sooner the symptoms are treated, the better the outcome for the patient.
If during a physical exam the physician doesn’t find a physical condition that explains the symptoms, they will refer the patient to a mental health professional.
Depending on the person’s situation and severity of the symptoms, psychiatrists, psychologists, nurses, and social workers may be involved in the treatment to ensure all the patient’s needs are met. For example, someone with more severe symptoms may need support to gain the social and occupational skills to find and maintain a steady job.
The primary treatment for AVPD is psychotherapy. The goal of psychotherapy is to change the person’s maladaptive patterns of thoughts and behaviors and replace them with healthy ones.
Therapy helps people overcome fears, reduce or eliminate unhealthy behaviors, and develop healthy coping skills. While therapy is carried out most often in individual sessions, some persons might benefit from group sessions with other patients or with friends and family.
Sometimes medication may be used alongside therapy. There are no specific medications for AVPD, but some may help ease symptoms. The most common medications involved in treating AVPD symptoms include anti-depressants, anti-anxiety medication, and mood stabilizers. Only a medical doctor can prescribe medication.
People who present severe symptoms and cannot take care of themselves may need to be admitted to a hospital for psychiatric treatment.
Following the treatment is vital to manage AVPD and reduce symptoms.