Avoidant personality disorder

What is avoidant personality disorder?

Avoidant personality disorder (AVPD) is one of a group of personality disorders. These disorders, in general, are persistent patterns of behaviour that do not fit in with the accepted cultural norms and so cause emotional pain for the 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 feelings of inadequacy and are very sensitive to being judged badly by others. Though they would like to interact with others, they tend to avoid social interaction due to the intense fear of criticism and disapproval, and being judged as unappealing or rejected in social situations.

How common is avoidant personality disorder?

It is estimated that about 1 in 25 people has avoidant personality disorder. Like other personality disorders, avoidant personality disorder symptoms may be noticed in childhood and often begin to create problems during adolescence or early adulthood.

Avoidant personality disorder usually isn’t diagnosed in people younger than 18 years of age, as there should be evidence that these patterns of behaviour are permanent and unlikely to fade with time.

Who does avoidant personality disorder affect?

Women appear at more risk for avoidant personality disorder in some studies but not all.

Avoidant personality disorder often occurs with depression and substance abuse, and is likely to be associated with increased risk of suicide. Avoidant personality disorder and obsessive–compulsive personality disorder (OCPD) are often found in people with eating disorders.

Avoidant personality disorder also often occurs with social anxiety disorder, or people with other personality disorders, such as dependent personality disorder or borderline personality disorder.

Causes of avoidant personality disorder

The exact cause of avoidant personality disorder isn’t known. However, it’s believed that both genetics and environment play a role. Shyness, often normal in young children, lasts into adolescents and adulthood in those with avoidant personality disorder.

Those with avoidant personality disorder often report past experiences of rejection by parents or other children, which can have a bad impact on self-esteem and sense of worth.

Symptoms of avoidant personality disorder

For people with avoidant personality disorder, the fear of rejection is so strong that they choose isolation rather than risk any form of rejection. The pattern of behaviour in people with this disorder can vary from mild to extreme.

In addition to their fear of humiliation and rejection, other common features of people with avoidant personality disorder include:

• Oversensitive and easily hurt by criticism or disapproval.

• Few, if any, close friends and reluctant to become involved with others unless certain of being liked.

• Extreme anxiety and fear in social settings and relationships, leading them to avoid activities or jobs that involve being with others.

• Tend to be shy, awkward, and self-conscious in social situations due to a fear of doing something wrong or being embarrassed.

• Tend to exaggerate potential problems.

• Seldom try anything new or take chances, feel inhibited in new social situations.

• Poor self-image, feeling inadequate and inferior.

Without treatment, a person with this disorder can become isolated from society, causing long-term difficulties with work and social functioning. They’re also at greater risk for depression and substance abuse.

How is avoidant personality disorder diagnosed?

If symptoms are present, a mental healthcare professional (such as a psychologist or psychiatrist) will make a thorough assessment of the nature and severity of symptoms, the difficulties caused by the symptoms, whether the symptoms fit with a diagnosis of avoidant personality disorder, and whether there are any other associated mental or physical health concerns.

Psychiatrists and psychologists often use specially designed interview and assessment tools to assess a person for a personality disorder like avoidant personality disorder.

Treatment of avoidant personality disorder

Treating personality disorders is difficult because people with these disorders have deep-rooted patterns of thinking and behaviour that have existed for many years.

However, people with avoidant personality disorder tend to do relatively well with treatment because most want to develop close relationships with other people, and this desire can be a motivating factor for people with avoidant personality disorder to follow their treatment plans. Treatment is most effective when family members are involved and supportive.

Psychotherapy

Psychotherapy focuses on helping to change a person’s thinking, such as cognitive behavioural therapy (CBT).

As with other personality disorders, psychotherapy is the main treatment for avoidant personality disorder.

Therapy is likely to focus on overcoming fears of criticism, disapproval or rejection, changing thought processes and behaviours, and so helping to reduce the avoidance behaviour.

Medication

Medication, such as an antidepressant, might be used to help manage anxiety and depression, but only in combination with psychotherapy.

What is the outlook for avoidant personality disorder?

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. With treatment, some people with avoidant personality disorder can learn to relate to others much more appropriately.