Avoidant personality disorder (AVPD) may not be a condition you’ve heard a whole lot about, but it’s a crippling condition that can have crushing effects on a person’s life. The research on the disorder is slim, but the few studies conducted on the condition describe its prevalence as relatively common. It’s associated with significant impairment, distress, and disability, and its nearest relative is social anxiety disorder. The reasoning behind this is multifactorial but relates to the ongoing questions about the legitimacy of avoidant personality disorder as a distinct disorder.
It was initially believed that avoidant personality disorder occurred in conjunction with social anxiety disorder. However, large community studies found that nearly two-thirds of those with avoidant personality disorder didn’t meet the criteria for social anxiety disorder. Studies of major depression with and without a personality disorder found that 29% of the respondents were diagnosed with the condition. In comparison, 48% of those diagnosed with avoidant personality disorder met the criteria for social anxiety disorder.
The studies suggest that avoidant personality disorder commonly occurs alongside social anxiety disorder, which raises the probability that the current criteria for diagnosis are separate and different from social anxiety disorder. With that said, an estimated 1.5% to 2.5% of people in the United States have the condition, but its estimated incidence is to be as low as 0.8% or as high as 9.3%. Some studies found that women were more affected than men by avoidant personality disorder.
Avoidant personality disorder is often comorbid with substance abuse and depression. It’s also commonly associated with the increased chances of suicidal ideation and attempts, which explains why the condition may be a predictor of chronic depression. The disorder has also been found to increase the risk of postpartum depression due to raised levels of antepartum depression and anxiety. AVPD is also found in conjunction with obsessive-compulsive disorder (OCD), binge eating disorder, and anorexia nervosa.
Those diagnosed with avoidant personality disorder will avoid social situations because they fear rejection and being judged by their peers. However, most of those with the condition want to develop relations. However, it requires a lot of work to reach that point through psychotherapy. If you’re concerned about avoidant personality disorder in yourself or someone else, it’s important to learn more about it.
What Is Avoidant Personality Disorder?
Avoidant personality disorder is part of a group of conditions known as a personality disorder. Generally speaking, these disorders are enduring patterns of behavior out of keeping with cultural norms. Unfortunately, the condition causes suffering for a person as well as those around them. Avoidant personality disorder is coupled with other personality disorders marked by nervousness and fear.
Those battling the condition chronically feel inadequate and are highly sensitive to being judged by others negatively. Despite their desire to interact with others, they’ll avoid social interactions because of the irrational and intense fear of being rejected.
As mentioned earlier, studies have been slim on the topic since it affects a relatively small portion of the population. Similar to other personality disorders, avoidant personality disorder symptoms may appear in childhood and cause discomfort by adolescence or early adulthood. It’s not typically diagnosed in those under age18 like other personality disorders because evidence of these patterns of behavior are enduring and remain over time.
Avoidant Personality Disorder in Children
As mentioned previously, avoidant personality disorder often develops through childhood. Adverse experiences, childhood trauma, poor relationships with adults, and an inability to make friends can severely damage a person’s social and emotional confidence. The condition will fully manifest itself when a child with negative experiences transitions into adulthood and isn’t capable of functioning in common social situations.
An individual’s early childhood can predict whether a child develops avoidant personality disorder as it has a significant impact. Relationships and positive interactions with both the mom and dad are vital for building relationship-making skills and social confidence. Those who develop the condition commonly had parents or guardians who disapproved of their choices, made them feel guilty, weren’t encouraging, or lacked affection.
Causes of Avoidant Personality Disorder
The specific cause of avoidant personality disorder is unknown, but genetics and the environment a person lives in play a role. Avoidant personality disorder is believed to be passed down in families through genes. However, this hasn’t been proven. Environmental factors, specifically in childhood, play a crucial role. Shyness, which is normal in children, will persist into adolescence and adulthood in those with the condition. Those diagnosed with avoidant personality disorder report instances that damaged their self-esteem and self-worth.
Avoidant Personality Disorder and Co-Occurring Disorders
It’s common for a person with AVPD to be diagnosed with other psychological conditions as well. Symptoms of the disorder commonly overlap with and even co-occur in conjunction with conditions like social anxiety disorder.
As mentioned above, before research on the topic was a bit more widespread than it is today, AVPD was believed to be a form of social anxiety disorder. However, it’s recognized today as a distinct condition apart from social anxiety disorder. However, it’s not the only condition that commonly co-occurs with avoidant personality disorder.
Other mental health disorders that co-occur along avoidant personality disorder include the following:
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- Agoraphobia: Agoraphobia is an anxiety disorder that involves intense anxiety and fear of any situation or place where making an escape might be challenging. Agoraphobia consists of avoiding situations that include traveling in a car, bus, or airplane, being alone outside of your home, or being in a crowded area.
- Panic disorder: Those with panic disorder have sudden and repeated attacks of fear that may last several minutes or more often referred to as panic attacks. Panic attacks are characterized by a fear of disaster or losing control when there’s no imminent danger. Panic attacks might also warrant a strong physical reaction during a panic attack, which could feel like a heart attack. Those with panic disorder become discouraged or feel ashamed when they can’t carry out normal routines like going to work, school, driving, or going to the grocery store.
- Dependent personality disorder: Dependent personality disorder (DPD) is an anxious personality disorder where a person can’t be left alone. Those with the condition develop anxiety symptoms when they’re not around others and rely on people for reassurance, comfort, advice, and support. Those without the disorder may deal with insecurity, but a person with DPD needs reassurance from others in order to function.
- Obsessive-compulsive disorder: Obsessive-compulsive disorder (OCD) is a mental health condition where the individual has thoughts (obsessions) and rituals (compulsions) continuously. Unfortunately, they’ll have no control over them. Some examples include a fear of losing or misplacing something, fear of germs, aggressive thoughts toward yourself or others, or needing things lined up in a specific way; otherwise, you’ll feel that something bad will occur. Obsessive-compulsive disorder is another condition that can leave you feeling paralyzed. It’s something that requires help to overcome.
- Schizophrenia: Schizophrenia is a severe mental illness that affects how a person feels, thinks, and behaves. Those with the disease appear to have lost touch with reality, causing significant distress for themselves, friends, and family members. When left untreated, the symptoms can be persistent and disabling.
- Eating disorders: Eating disorders are commonly misunderstood and believed by many to be a lifestyle choice. However, these are severe and often fatal illnesses associated with severe disturbances in eating behaviors, emotions, and thoughts. The preoccupation with body weight, food, weight, and shape can also signal eating disorders. The most common are bulimia nervosa, anorexia nervosa, and binge-eating disorder.
- Gelotophobia: Gelotophobia is a rare condition where people are afraid of laughter. This condition is relatively unexplored by the scientific world.
Avoidant Personality Disorder and Substance Abuse
As you’d expect with so many other disorders, those with avoidant personality disorder are more prone to developing a substance use disorder. Extreme isolation and stress cause a person to turn to drugs or alcohol for comfort and escape. The rate at which someone has avoidant personality disorder and a co-occurring substance use disorder is high and ranges anywhere from 12% to 35%.
Drugs and alcohol serve as an escape, and self-medicating is a common practice for a person with a severe anxiety condition. When you can’t feel comfortable in your own skin, looking for a way out is often the option. If you’re battling any form of anxiety, it’s important to see a professional medical opinion to help you overcome your battle with avoidant personality disorder. Developing a substance use disorder can lead to even more problems and compound your problems.
What Is a Personality Disorder?
A personality disorder is a form of mental illness that affects how someone thinks, feels, and behaves, causing them difficulties handling emotions and interacting with others. This type of condition involves long-term partners of behavior that don’t change with time. A majority of those diagnosed with a personality disorder will have debilitating effects.
There are 10 types of personality disorders, which are broken down into three primary categories:
- Cluster A
- Cluster B
- Cluster C
As a Cluster C personality disorder, avoidant personality disorder shares the category with dependent personality disorder and obsessive-compulsive disorder.
Avoidant Personality Disorder and Social Anxiety Disorder
Avoidant personality disorder and social anxiety disorder are separate mental health disorders, but they share common features. Since the two conditions appear in similar ways, it’s not uncommon for one to be mistaken as the other. Sometimes seeking help is more beneficial than a specific diagnosis, but some find it important to know what’s happening to them. In other cases, the best approach to getting help is different for the type of mental health issue, so misdiagnosis will affect treatment, making it harder for the individual to get better.
Social anxiety, often classified as social phobia, is a specific anxiety type where people fear social situations. A person with social anxiety is worried about embarrassing themselves while out in public or doing something that will cause them to stand out and be judged negatively. Feeling embarrassed in public is common, but the intense feelings of anxiety and fear that occur with a social phobia will become so distressing, a person will avoid work, school, and other parts of their lives. An estimated 75% of those with social anxiety are diagnosed between the ages of eight and 15.
Social anxiety is very similar to avoidant personality disorder, but the latter is much more severe. Avoidant personality disorder is a cluster personality disorder. Personality disorders are specific types of mental health conditions that affect daily life, and those with them have trouble with creating a stable life for themselves because they have a hard time understanding other people and conventional situations.
Avoidant Personality Disorder Relationship with Other Conditions
There is some concern about a possible overlap of avoidant personality disorder and schizoid personality disorder due to its historical relationship conceptually with schizophrenia. Research suggests the criteria for avoidant personality disorder is distinct from schizoid personality disorder, but also points to a potential relationship with schizophrenia. The findings also found an association with social anxiety in schizophrenia-spectrum disorders.
What Are the Symptoms of Avoidant Personality Disorder?
For those with avoidant personality disorder, the fear of rejection is so fierce that the individual would rather be isolated than risk being rejected in any type of relationship. The pattern of behavior in those with the condition can range anywhere from mild, to moderate, to extreme. On top of the fear of rejection and humiliation, other common symptoms of avoidant personality disorder include the following:
- The individual has few, if any, close friends and refuses to become involved with others unless they’re certain they’ll be liked.
- The individual is oversensitive and easily hurt by disapproval or criticism.
- The individual experiences extreme fear and anxiety (nervousness) in social situations and relationships, causing them to avoid activities like working or being with others.
- The individual is awkward, shy, and self-conscious in a social setting because of a fear they’ll do something wrong or that will embarrass them.
- The individual rarely takes chances or tries anything new.
- The individual will exaggerate potential problems in their life.
- The individual has a poor self-image, and sees themselves as inferior or inadequate.
The individual will also have trouble believing anyone can like them. If you’re sensitive to criticism and rejection, you’ll likely misinterpret neutral comments and actions as negative ones.
How Is Avoidant Personality Disorder Diagnosed?
When you schedule an appointment and meet with your physician, they’ll be asking you questions to determine if you have avoidant personality disorder or one of the other conditions we’ve discussed above. In order to be diagnosed with avoidant personality disorder, the symptoms must appear no later than in early childhood.
In order to earn a diagnosis, you must also show four of the following characteristics.
- You’re unwilling to get involved with others unless you’re sure they like you.
- You’ll avoid anything that involves contact with others, including work, school, or vital obligations due to a fear of rejection, disapproval, or criticism.
- You never give your all in relationships due to a fear of being ridiculed or humiliated.
- You either hold back or avoid social situations altogether because you feel inadequate around others.
- Your thoughts are dominated by the fear of criticism or being rejected in social situations.
- You believe you’re inferior to others, inept, and unappealing.
- You seldom take part in new activities or take personal risks because you’re in fear of being embarrassed.
How Is Avoidant Personality Disorder Treated?
If you’ve been diagnosed with avoidant personality disorder, now it’s time to start healing. The most effective means of treating the condition is psychotherapy, and your doctor might use psychodynamic psychotherapy or cognitive behavioral therapy (CBT) to help you achieve your goals. The treatment objective is to help you identify the unconscious beliefs about yourself and distinguish how others view you. It also is designed to help you function better in social settings and at work.
Psychodynamic Psychotherapy
Psychodynamic therapy is a type of talk therapy, allowing you to become aware of your unconscious thoughts. Its goal is to help you understand how past experiences influence your current behavior. You will be able to move forward with a healthier outlook about how others see you, and most importantly, how you see yourself. Psychodynamic therapy is responsible for producing lasting results with benefits that continue long after treatment ends.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) is another form of talk therapy that will change your thoughts and turn them into actions. During CBT, therapists will help you understand and replace unhealthy beliefs and thoughts. The therapist will encourage you to test your thoughts and examine your beliefs to see if they’re factual. It’ll also help you develop an alternative, healthier thought process.
Dialectical Behavior Therapy (DBT)
This form of therapy closely resembles cognitive behavioral therapy. It typically involves a combination of group sessions and individual talk therapy to learn skills and manage your symptoms.
Psychoeducation
This form of therapy allows you to focus on your condition and understand what it involves. Knowing is just one part, but this allows you to understand and search for answers on how to get better.
Medication
There are currently no FDA-approved medications to treat avoidant personality disorder. However, depending on the situation, your doctor could approve antidepressant medication if you have co-occurring depression or anxiety. Anti-anxiety drugs might also help manage the symptoms of perfectionism or dread. Mood stabilizers can help prevent mood swings and reduce aggression and irritability.
Antipsychotics would typically be reserved for those who start losing touch with reality by hearing or seeing things that aren’t there, which is possible if someone isolates themselves enough. Make sure to speak with your doctor and let them know everything that is going on. It’s the only way you can get the help you need.
Can Avoidant Personality Disorder Be Prevented?
Unfortunately, it doesn’t appear that avoidant personality disorder can be prevented. However, starting treatment early on can help a child recognize the symptoms and hopefully manage them as they get older. As a parent, you must keep a watchful eye on your child’s mannerisms, as shyness is a normal part of growing up. However, avoidant personality disorder is much more severe.
What Is the Outlook for Avoidant Personality Disorder?
If you’ve been diagnosed with avoidant personality disorder but don’t seek treatment, it’s possible you’ll isolate yourself and compound the problem. As a result, it may cause you to develop other psychiatric disorders, including the following:
- Agoraphobia
- Depression
- Substance use disorder (SUD)
Keep in mind that treatment won’t change your personality. You’ll likely remain shy and have challenges with social and work interactions. However, treatment aims to improve your symptoms and help you to develop the ability to relate with others.
