Avoidant Personality Disorder

Avoidant Personality Disorder

Avoidant Personality Disorder

Avoidant personality disorder is a condition marked by a crippling fear of disappointing others or being criticized, causing them to never put themselves in that position.

The social fear, isolation, and shyness that might seem natural in childhood grows worse with age.

Prevalence

Avoidant personality disorder affects approximately 2% of the general population and rates are higher in females than in males.

Avoidant personality disorder often coexists with other conditions such as social anxiety disorder, generalized anxiety disorder, obsessive compulsive disorder, and post-traumatic stress disorder.

Symptoms of Avoidant Personality Disorder:

Avoidant personality disorder is characterized by the avoidance of any trigger that reinforces a person’s fear about him or herself. Symptoms include:

  • Severe social anxiety and avoidance of social interactions or relationships, despite a deep yearning for inclusion and intimacy
  • Feelings of inadequacy, incompetence, and inferiority that often include self-hatred or contempt
  • Extreme sensitivity to negative appraisal or disapproval and avoidance of any task that might open the door to that
  • Fear of loss, rejection, embarrassment, humiliation, and being disliked
  • Avoidance of friendships, no close friends, tendency to reject others before they can be rejected by them
  • Alcohol and substance abuse or dependence

Causes of Avoidant Personality Disorder:

The exact cause of avoidant personality disorder remains unknown; however, the inheritance of an excessively shy temperament and adverse childhood experiences — such as emotional neglect and rejection by parents or peer groups — have been implicated in the development of this condition.

About half of those with an anxiety disorder might also have avoidant personality disorder.

Risk Factors for Avoidant Personality Disorder:

Avoidant personality disorder can discourage people from seeking employment opportunities or, if in work already, can be a barrier to career progression. Avoidant personality disorder can impose severe restrictions on a person’s social life. It can also prevent people from entering and developing romantic relationships.

People with avoidant personality disorder may resort to abusing illicit substances as a coping mechanism, and they are also at increased risk of self-harm and suicidal behavior.

Diagnosing Avoidant Personality Disorder:

Four of the following seven specific symptoms should be present for a diagnosis of avoidant personality disorder to be made:

  1. Avoidance of job-related activities that involve significant relational or social contact because of fears of criticism, disapproval, or rejection
  2. An unwillingness to get involved with people unless certain of being liked
  3. Restraint within intimate relationships because of the fear of being shamed or ridiculed
  4. A preoccupation with being criticized or rejected in social situations
  5. Holding back in new social or relational situations because of feelings of inadequacy
  6. Views self as socially incompetent and awkward, personally unappealing, or inferior to others
  7. A reluctance to take personal risks or to engage in any new activities because they may prove embarrassing

Treatment of Avoidant Personality Disorder:

As with other types of personality disorders, avoidant personality can have a poor outlook if left untreated since it is a chronic and longstanding condition. The various treatment options include psychotherapy and medication (for other disorders, if present):

Individual therapy and social skills group training

  • Social skills group training – a safe way to learn how to communicate and interact with others.
  • Talking therapy such as cognitive behavioral therapy – to identify and address negative thoughts and beliefs, identify emotional triggers, and change the chosen responses to behaviors that are more constructive, based on new information.
  • Graded exposure therapy and imagery – a very gradual introduction to facing fearful situations through guided visualization techniques before moving into guided real-life situations.

The primary purpose of both individual therapy and social skills group training is for people with avoidant personality disorder to begin challenging their exaggerated negative beliefs about themselves.

Medication

Medication also plays a role in the treatment of avoidant personality disorder, and antidepressants such as selective serotonin reuptake inhibitors can often reduce sensitivity to rejection or depression.

Symptoms of Avoidant Personality Disorder:

Avoidant personality disorder is characterized by the avoidance of any trigger that reinforces a person’s fear about him or herself. Symptoms include:

  • Severe social anxiety and avoidance of social interactions or relationships, despite a deep yearning for inclusion and intimacy
  • Feelings of inadequacy, incompetence, and inferiority that often include self-hatred or contempt
  • Extreme sensitivity to negative appraisal or disapproval and avoidance of any task that might open the door to that
  • Fear of loss, rejection, embarrassment, humiliation, and being disliked
  • Avoidance of friendships, no close friends, tendency to reject others before they can be rejected by them
  • Alcohol and substance abuse or dependence

Causes of Avoidant Personality Disorder:

The exact cause of avoidant personality disorder remains unknown; however, the inheritance of an excessively shy temperament and adverse childhood experiences — such as emotional neglect and rejection by parents or peer groups — have been implicated in the development of this condition.

About half of those with an anxiety disorder might also have avoidant personality disorder.

Risk Factors for Avoidant Personality Disorder:

Avoidant personality disorder can discourage people from seeking employment opportunities or, if in work already, can be a barrier to career progression. Avoidant personality disorder can impose severe restrictions on a person’s social life. It can also prevent people from entering and developing romantic relationships.

People with avoidant personality disorder may resort to abusing illicit substances as a coping mechanism, and they are also at increased risk of self-harm and suicidal behavior.

Diagnosing Avoidant Personality Disorder:

Four of the following seven specific symptoms should be present for a diagnosis of avoidant personality disorder to be made:

  1. Avoidance of job-related activities that involve significant relational or social contact because of fears of criticism, disapproval, or rejection
  2. An unwillingness to get involved with people unless certain of being liked
  3. Restraint within intimate relationships because of the fear of being shamed or ridiculed
  4. A preoccupation with being criticized or rejected in social situations
  5. Holding back in new social or relational situations because of feelings of inadequacy
  6. Views self as socially incompetent and awkward, personally unappealing, or inferior to others
  7. A reluctance to take personal risks or to engage in any new activities because they may prove embarrassing

Treatment of Avoidant Personality Disorder:

As with other types of personality disorders, avoidant personality can have a poor outlook if left untreated since it is a chronic and longstanding condition. The various treatment options include psychotherapy and medication (for other disorders, if present):

Individual therapy and social skills group training

  • Social skills group training – a safe way to learn how to communicate and interact with others.
  • Talking therapy such as cognitive behavioral therapy – to identify and address negative thoughts and beliefs, identify emotional triggers, and change the chosen responses to behaviors that are more constructive, based on new information.
  • Graded exposure therapy and imagery – a very gradual introduction to facing fearful situations through guided visualization techniques before moving into guided real-life situations.

The primary purpose of both individual therapy and social skills group training is for people with avoidant personality disorder to begin challenging their exaggerated negative beliefs about themselves.

Medication

Medication also plays a role in the treatment of avoidant personality disorder, and antidepressants such as selective serotonin reuptake inhibitors can often reduce sensitivity to rejection or depression.

Sources PATHWAYS – What Is Graded Exposure Therapy | PSYCHOLOGY TODAY – Avoidant Personality Disorder | WSU.edu – Clinical Presentation of Avoidant Disorder | DSM-5 – Avoidant Personality Disorder | HEALTH LINE – Avoidant Personality Disorder | NIH – The Connection Between Substance Use Disorders and Mental Illness | UNSW.edu – Personality and Substance Abuse | EMEDICINE – Avoidant Personality Disorder | Hoeksema, Nolen (2014). Abnormal Psychology (6th ed.). McGraw Education. p. 275. | Sanderson, William C.; Wetzler, Scott; Beck, Aaron T.; Betz, Frank (February 1994). “Prevalence of personality disorders among patients with anxiety disorders”. Psychiatry Research. 51 (2): 167–174.