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Avoidant Personality Disorder

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People with avoidant personality disorder believe that they are inadequate and very sensitive to negativity, such as rejection or criticism.  These feelings are so strong that a person with avoidant personality disorder will go to great lengths to avoid social situations.

There are many similarities between avoidant personality disorder and social anxiety disorder.  As with avoidant personality disorder, patients with social anxiety disorder will be shy or timid is social situations and may seek to avoid all social situations.  Both disorders also share similar causes, signs, and treatments. However, there are some differences between the two disorders.  With avoidant personality disorder, the focus is on the person’s feelings of inadequacy and sensitivity.  The person does not fear the social situation itself but rather fears rejection.  Many people with avoidant personality disorder will take part in social situations so long as acceptance is guaranteed – such as at group counseling sessions.  With social anxiety disorder, patients are fearful of the actual social situation and will assume the worst possible outcomes, such as being publically humiliated.

Characteristics of avoidant personality disorder also overlap with those of schizoid personality disorder.  However, the main difference is that schizoid personalities do not want close relationships.  People with avoidant personality disorders want close relationships (sometimes desperately) but do not seek them because of feelings of inadequacy and fear of rejection.

How prevalent is avoidant personality disorder?

Avoidant personality disorder can overlap with other disorders.

Avoidant personality disorder is not common in the general population.  Estimates put its occurrence at less than 1% of people.  However, there are some estimates which put its prevalence as high as 2.36%.  Avoidant personality disorder can be seen in approximately 1% of uncommitted outpatients. 

What are the characteristics of avoidant personality disorder?

People with avoidant personality disorder will be characterized as shy or timid. They will be preoccupied with their inadequacies and will assume that others will not like them.  Even though people with avoidant personality disorder crave personal relationships, they will choose not to connect with others rather than risk being rejected.  People with avoidant personality disorder will have few or no intrapersonal relationships, even amongst close family.  Even a minor criticism or failure will be a major setback to people with this disorder and they are unlikely to excel in careers because of their social avoidance.

How is avoidant personality disorder diagnosed?

Because of the nature of the disorder, most people with avoidant personality disorder do not seek treatment.  If you suspect that you or someone you know has avoidant personality disorder, it is very important to seek help from a licensed therapist.  Only a therapist can diagnose avoidant personality disorder and recommend a course of treatment.  According to the ICD-10, a patient must have a minimum of 4 of these traits to be diagnosed with avoidant personality disorder:

  1. persistent and pervasive feelings of tension and apprehension;
  2. belief that one is socially inept, personally unappealing, or inferior to others;
  3. excessive preoccupation with being criticized or rejected in social situations;
  4. unwillingness to become involved with people unless certain of being liked;
  5. restrictions in lifestyle because of need to have physical security;
  6. avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection.

What causes avoidant personality disorder?

The exact causes of avoidant personality disorder are not known. Researchers accept that the disorder begins in childhood or adolescence and is carried into adulthood.  There is evidence that some people are predisposed to social avoidance and introversion can be hereditary.  While biological factors may contribute to avoidant personality disorder, it is most commonly believed that psychosocial factors cause the disorder.

Children who were criticized or experienced rejection from loved ones can have a lower sense of self worth which then causes them to avoid social situations. In children, shyness or timidity can be considered endearing traits.  However, these traits are usually looked upon negatively in adulthood and may be ridiculed.  This ridicule only furthers the person’s sense of inadequacy and worsens the social avoidance.

As an alternative, avoidant personality disorder may start in children who use avoidance to help manage their impulses.  Rather than show anger, embarrassment, or guilt, the children instead learn to avoid situations where those emotions could occur. This is even more likely in children who have handicaps or other physical limitations.

How is avoidant personality disorder treated?

Psychotherapy is thought to be the most effective treatment for avoidant personality disorder.  In order for therapy to succeed, the therapist must make considerable efforts to gain the patient’s trust.  Otherwise, the patient may fall back on negative feelings and avoid treatment completely.  Studies show that patients are very responsive to psychotherapy.  If they are able to overcome their initial difficulties in forming a relationship with the therapist, then they can learn to overcome these difficulties with other relationships.

Other possible treatments for avoidant personality disorder can include cognitive therapy and group therapy in which the patient’s beliefs about low self worth are challenged.  Group therapy can also be used to help a patient learn better social skills.  Exposure therapy can be used to introduce the patient to social situations on a step-by-step basis.

In some cases, medications may be prescribed for treating avoidant personality disorder.  The isolation of avoidant personality disorder could lead to other psychological problems, such as major depression.  It may be necessary to treat these secondary psychological problems with medications.

References:

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC: Author.

Million, Theodore, Alexandra Martinez. “Avoidant Personality Disorder.” The DSM-IV personality disorders. Ed. W. John Livesley. Guildford Press, NY: 1995.