What Is Avoidant Personality Disorder (AVPD)?

By Olivia Guy-Evans, published May 20, 2022 | Fact Checked by Saul Mcleod, PhD

Psychopathology - Mental Health Disorder - Avoidant Personality Disorder - woman sitting on violet floor with hand on face

Avoidant personality disorder (AVPD) is characterised by feelings of social inadequacy, hypersensitivity to criticism, and social withdrawal.

Approximately 2.4% of the United States population have AVPD and it appears to affect men and women equally.

People with AVPD experience extreme social awkwardness, spend a lot of time ruminating on their perceived shortcomings and are hesitant to form relationships with others where rejection could occur.

AVPD can be very distressing for individuals, and they will often choose to isolate from others for fear of criticism, rejection, or embarrassment.

Personality disorders are enduring patterns of behaviour that are out of keeping with cultural norms, is inflexible, and that cause significant distress to an individual or those around them.

Personality disorder diagnoses are organised by group or ‘cluster’. AVPD is a Cluster C personality disorder alongside dependant personality disorder and obsessive-compulsive personality disorder.

These personality disorders are conditions in which characteristics involve being particularly anxious or fearful.

Like other personality disorders, AVPD symptoms may be noticed in childhood and often begin to cause distress in adolescence or early adulthood.

The disorder is often generalised to all areas of life and can have a negative impact on social relationships, academic, and occupational opportunities.

People with AVPD may desire to be social but are significantly held back by their feelings of being inferior to others.

Symptoms and Diagnosis

Below is a list of some of the common symptoms associated with AVPD:

  • Feelings of inadequacy

  • Intense fear of criticism

  • Socially withdrawn

  • Intense fear of rejection

  • Excessive shyness

  • Inhibited when forming new relationships

  • Isolate for fear of rejection and criticism

  • Excessive monitoring of internal reactions 

  • Constantly thinking about how other people view them

  • Avoiding anything that can lead to failure and ridicule

  • Low self-esteem 

  • Avoid conflicts and will often people please

  • Feel unwelcome in social situations 

  • Analysing others for signs of approval or rejection 

  • Lack of assertiveness 

  • Failure to initiate social contact

The patterns of behaviour for people with AVPD can vary from mild to extreme.

Some people may avoid socialising with others completely or will only socialise if they know that others will like then, due to their fear of rejection.

They may avoid all social events or meetings with co-workers for fear of being judged. In social situations, someone with AVPD may be afraid to speak up for fear of saying the wrong thing, blushing, stammering, or getting embarrassed.

Often, they will avoid work, social, or school activities for fear of criticism or rejection.

Those with AVPD would want to ensure that there is no possible way that they will ever experience something negative from others. 

Someone with AVPD may constantly doubt themselves, especially in social situations since they see themselves as inferior to others.

Because of their feelings of inadequacy and fear of criticism, they may socially withdraw to lessen these fears. 

To receive a diagnosis of AVPD, an individual must have experienced the following components by the time they reach early adulthood:

  • Social inhibition

  • Feelings of inadequacy

  • Sensitivity to criticism or rejection

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), certain criteria must be met for someone to be diagnosed with AVPD. They must experience at least four of the following symptoms to meet the diagnostic criteria:

  1. Avoidance of activities that involve interpersonal contact due to fear of criticism or rejection.

  2. Unwillingness to interact with others unless certain they will receive a positive response. 

  3. Hesitancy in intimate relationships due to fear of shame or being ridiculed. 

  4. Preoccupation with criticism in social situations.

  5. Feeling inadequate and being inhibited in new social situations. 

  6. Perception of self as inept, unappealing, and inferior to others. 

  7. Unusual reluctance to take risks or engage in activities that might result in embarrassment. 

A diagnosis will require a psychological evaluation by a mental health professional who will run through the diagnostic criteria. this evaluation will also rule out the possibility of other potential diagnoses or determine whether a person has more than one diagnosis.

Mental health professionals will also look at an individual’s long-term history of their symptoms and patterns of behaviour to determine whether symptoms are persistent and generalised to most or all areas of life. 

Although AVPD may be commonly seen in children or adolescents, a diagnosis of a personality disorder cannot be made in childhood while an individual’s personality is still developing.

Likewise, being shy, fearful of strangers, socially awkward, and being sensitive to criticism are often a normal part of child and adolescent development and do not necessarily mean that they have AVPD.

Diagnosis is therefore often delayed until later in life when these symptoms persist, worsen, and begin to seriously interfere with overall functioning. 

What is the social impact of AVPD?

A fear of rejection can make it difficult to interact with and connect to others. Someone with AVPD may be hesitant to seek out friendships unless they are certain that the other person will like them.

They could also fear intimate relationships for the same reason. Someone with AVPD may be too scared to share too much personal information or talk about their feelings with a potential romantic partner, which can make it hard to build a strong relationship. 

People with AVPD often desire to have meaningful social interactions but fear placing their well-being in the hands of others.

As they tend to limit their interactions with people, they can be relatively isolated and do not have a strong social network that can help them out when they need it.

It can therefore be very lonely for someone who has AVPD and is stuck in a cycle of avoiding people for fear of rejection or criticism. 

Why do people with AVPD struggle to seek treatment?

Many people with AVPD may struggle to seek and stick to treatment plans since the very nature of their condition makes it so they avoid seeking support from others.

They may not want to talk to a therapist for fear of being criticised or judged. As they may feel unworthy of love and inferior to others, they may believe that any mental health professional is criticising them and will believe they do not deserve help. 

The person with AVPD may over-analyse what the mental health professional says and how they act. They may also take any feedback too personally which could cause them to eventually drop out of any treatment they may have. 

Someone with AVPD may only choose to seek treatment when they need help with a specific problem such as wanting to build a strong relationship and managing the distress in their lives. 

Is avoidant personality disorder the same as social anxiety disorder?

Often, AVPD has been thought of as a more severe type of social anxiety disorder (SAD) due to their similarities in traits. Some researchers argue that AVPD does not exist at all and is a stronger manifestation of SAD.

However, evidence does support the idea that these two disorders are distinct and that both can exist within people. A significant percentage of people with AVPD do not meet the criteria for SAD. 

AVPD is more thought of as pervasive and persistent whereas someone with SAD may experience a debilitating fear of some social situations but not others.

Someone with AVPD will have feelings of being inept and inferior to others whereas someone with SAD may not necessarily feel this way. 

There are differences between AVPD and SAD in the levels of suspiciousness. Those with AVPD are more likely to be suspicious of other’s motives whereas someone with SAD is more likely to have insight and are less likely to mistrust others. 

Those with SAD are also more likely to see that the trigger of their social anxiety is irrational whereas someone with AVPD is less likely to see it as irrational. 

What can happen if AVPD is left untreated?

Without treatment, a person with AVPD can become isolated from society, causing long-term difficulties with social functioning.

They may limit what opportunities they have for work or not be able to hold down any kind of work at all if it involves having to work with others. They may miss opportunities for friendships as well as romantic relationships.

If someone is isolated from society, this can cause a myriad of further complications, making them at a greater risk for depression and anxiety.

They may become agoraphobic or rely on substances to cope with their avoidance, which could result in substance use disorders. 

What conditions are often comorbid with AVPD?

As it shares traits with other mental health disorders, there are often conditions that co-exist alongside AVPD.

Sometimes, the other Cluster C personality disorders may co-exist, those being dependant and obsessive-compulsive personality disorder. 

The disorder that often stands out as being the most comorbid with AVPD is social anxiety disorder (SAD). This is a disorder which is characterised by an intense fear of social situations, with some traits that overlap with AVPD. 

Other disorders which can be comorbid with AVPD include:

  • Other anxiety disorders

  • Depressive disorders

  • Posttraumatic stress disorder

  • Borderline personality disorder

  • Agoraphobia 

  • Substance use disorder

Some of these conditions, such as depression, agoraphobia, and substance use disorders may develop as a result of being socially isolated from others. 

What causes AVPD?

There is not one known reason for why someone would develop AVPD, but it is thought that genetics and environmental factors can play a role. 

Genetic causes

It could be that if someone has an immediate family member with AVPD, such as a parent, they themselves may be more likely to also develop the disorder. 

A trait called behavioural inhibition may be a causal factor for someone developing AVPD. This is where somebody is shy, avoids new experiences, avoids strangers, and has increased sensitivity and anxious reactions.

This is thought of as a temperament which is genetic. It would make sense to think that someone who is behaviourally inhibited is likely to develop AVPD compared to someone who is not shy and is open to new experiences.

That being said, not every child who is shy will go on to develop AVPD, in the same way that not every adult who is shy has the disorder. 

Environmental causes

Those with AVPD often report past experiences of parental or peer rejection which can impact on a person’s self-esteem and sense of worth.

Early childhood neglect, emotional abuse, and trauma can be a large factor in the development of AVPD.

Negative childhood factors which could influence the development of AVPD include:

  • A low amount of love expressed by parents

  • A low amount of pride expressed by parents 

  • Increased amounts of intolerance by parents

  • Parents who try to shame or guilt a child 

A person who experienced these types of parenting as a child can feel that they are unworthy of being loved and are less likely to see others as safe or supportive.

Because of this, they are more likely to develop feelings of mistrust towards others, even when other people do not give them a reason to mistrust them. 

The mistrust can come across as arrogant or rude and it can make other people not want to interact with that person, which in turn can cause further isolation.

The increased isolation leads back to a lower level of trust. Thus, there is a cycle that gets started with the abuse and neglect and carries on into adolescence and adulthood. 

However, it is important to note that not everyone who has AVPD was abused or neglected as a child. In the same way, not everyone who was abused or neglected as a child will go on to develop AVPD. 

What treatment options are available for someone with AVPD? 

Treating personality disorders can be difficult since people with these disorders have deep-rooted patterns of thinking and behaviour which have existed for many years.

A lot of people with AVPD do not seek treatment, and when they do it is often for a specific life problem or other types of symptoms such as depression and anxiety. 

It is important to note that treatment for AVPD will not change someone’s personality. It is likely that someone who is naturally shy will always have some difficulty with social interactions, so it is useful to have realistic outcomes in mind when seeking treatment.

Treatment should aim at improving the symptoms of those with AVPD and can help them to develop the ability to relate to others. 

Therapy 

Psychotherapy is the main treatment for AVPD. Together in therapy, the client and therapist can practice challenging negative beliefs and explore the small but significant steps that can be taken to build solid friendships, be more engaged at work, and develop intimate relationships with others. 

Cognitive behavioural therapy 

Cognitive behavioural therapy (CBT) is a popular type of psychotherapy which focuses on identifying negative and unhelpful thought patterns and behaviours, and changing these into more realistic, helpful ones. 

Clients of CBT can learn to be more aware of when they are falling into unhelpful thinking patterns and can challenge themselves with the therapist to change these.

This can involve building social skills and graded exposure to situations that would otherwise be avoided for fear of criticism or rejection. 

Psychodynamic therapy 

Psychodynamic therapy is often focused on childhood experiences which may be useful for people with AVPD who experienced neglect or abuse in early life.

This type of psychotherapy is aimed at being aware of how past experiences, pain, and conflict may be contributing towards current symptoms. 

Schema therapy 

Schema therapy is an integrative approach that builds on CBT as well as many other therapeutic techniques.

It has the goal of improving daily functioning and gaining insight for change based on understanding and restructuring early life experiences. 

A key feature is ‘limited reparenting’ in which the client expresses childhood needs and learns to develop and internalise a healthy parent voice.  The main concepts of schema therapy are:

  • Understanding how maladaptive schemas are patterns that are repeated throughout life. 

  • Understanding what coping styles were learned as a child.

  • Identifying what schema modes are being used to cope and how they are unhelpful.

  • Learning how to develop healthy adult modes of coping and getting core emotional needs met. 

Group and family therapy

Often, group therapy is used to help people with AVPD who have similar challenges. This helps to create a safe space to build solid relationships with others. 

Family therapy can also prove useful s that family members understand the condition and can provide a supportive home environment that promotes growth and healthy risk-taking.

Treatment for people with AVPD is most effective when family members are involved and supportive. 

Medications

There is very limited research demonstrating that medication is effective in treating AVPD. Often, medications can be used to treat some of the symptoms of AVPD or symptoms associated with comorbid conditions such as anxiety and depression.

These medications can include antidepressants and anti-anxiety medications. For the best results, it is often recommended that medication is taken in combination with therapy. 

Fact Checking

Content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication.

This article has been fact checked by Saul Mcleod, PhD, a qualified psychology teacher with over 17 years' experience of working in further and higher education. He has been published in psychology journals including Clinical Psychology, Social and Personal Relationships, and Social Psychology.

Cite this Article (APA Style)

Guy-Evans, O. (2022, May 20). What Is Avoidant Personality Disorder (AVPD)? . Simply Psychology. www.simplypsychology.org/avoidant-personality-disorder.html

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Weinbrecht, A., Schulze, L., Boettcher, J., & Renneberg, B. (2016). Avoidant personality disorder: a current review. Current psychiatry reports, 18(3), 1-8.