Avoidant personality disorder
Shyness and sensitivity to criticism are completely natural in human beings, but for some people these emotions are intensified and can severely impact their way of life.
Individuals who hold back from forming relationships and living life to the full due to an overwhelming fear of criticism, humiliation or rejection may in fact be suffering from a psychological condition known as avoidant personality disorder (AVPD). This anxious disorder is quite complex - especially as there is no known cause - and research suggests it affects between 1.8% and 6.4% of the UK population.
This page will look further into avoidant personality disorder, exploring symptoms and risk factors, as well as the importance of counselling for helping sufferers to function more effectively in their work and social lives.
On this page
- What is avoidant personality disorder?
- Living with avoidant personality disorder
- Avoidant personality disorder symptoms
- Avoidant personality disorder causes
- When is it time to seek help for avoidant personality disorder?
What is avoidant personality disorder?
Avoidant personality disorder is a life-long pattern of extreme social anxiety and shyness. Sufferers experience persistent feelings of inadequacy, lack of self-confidence, inferiority and lack of self-worth and have a tense and anxious demeanor. They tend to be incredibly sensitive - particularly to rejection - and consider themselves to be incapable of relating to others and being socially successful.
This can be very distressing for sufferers, especially as they fear embarrassing themselves, blushing, or being criticised if they attempt to bond with others. As a result, people with AVPD will attempt to remove themselves from everyday social situations and will seek out jobs that involve little contact with others.
People who are diagnosed with avoidant personality disorder tend to be depressed and many show signs of other personality disorders, such as borderline, paranoid, schizotypal and schizoid personality disorder. Although AVPD is similar to social phobia, it's ultimately more about fear of social relationships and intimacy than of social situations.
Living with avoidant personality disorder
Living with avoidant personality disorder can be very stressful and isolating. Normal life experiences such as making new friends, attending school and accepting a promotion at work can strike fear into those with AVPD. Sufferers often minimise the value of themselves and their abilities, thus criticism is inevitable.
Typically, people with AVPD consider any disagreement or criticism to be a form of ridicule, shaming or rejection, which can be so painful that they often choose to be alone rather than risk connecting with others. Any interaction sufferers do have tends to be with those who are sure to like them and accept them unconditionally. This is why they are unlikely to have close relationships outside of their family circle.
As avoidant personality disorder is relatively unheard of and one of the rarer forms of personality disorder, to others, individuals with the condition can come across as extremely shy, unfriendly, lonely, resistant to change and inhibited. This perception often creates the very ridicule that the sufferer wanted to avoid in the first place. Friends and family may recognise that something is not quite right, but often do not know what to do and may be unaware that there is even a name or diagnosis for such behaviour.
As a result, living with someone who has AVPD can be very difficult. Loved ones may find it frustrating to see sufferers become socially inhibited and use withdrawal as a form of emotional control over others. They may also find it hard to understand and accept the way people with the disorder tend to over-exaggerate the potential difficulty of new situations to rationalise avoiding them. Ultimately it is important to recognise that symptoms of AVPD cannot be controlled as they are an enduring pattern of inner behaviour and experience that require specialist help and intervention to overcome.
Avoidant personality disorder symptoms
As briefly aforementioned, people with AVPD will exhibit a variety of common traits and characteristics. Although these may vary slightly from person to person, generally avoidant personality disorder symptoms are quite specific. This does not mean however that someone who shows signs of avoidant behaviour has the disorder. Everyone from time to time may feel hypersensitive and antisocial, and only those who exhibit a number of AVPD traits can qualify for a diagnosis.
The most common avoidant personality symptoms are:
- Avoidance of occupational activities.
- Easily hurt and offended by criticism or disapproval.
- No close friends.
- Strong reluctance to get involved with other people.
- Strong reluctance to take personal risks or engage in new activities.
- Very shy in social situations.
- Preoccupied with criticism.
- Exaggeration of potential difficulties.
- Holding back in intimate relationships.
- Perception that they are socially inept.
- Constantly using 'always' and 'never' statements.
- Blaming others for creating a problem rather than dealing with the problem.
- Catastrophizing - always assuming the worst case scenario.
- Depression and mood swings.
- Escaping to fantasy worlds and daydreaming about ideal relationships.
- Fear of abandonment.
- Hardly speaking when forced to participate in a social situation.
- Hypervigilant - having an unhealthy obsession with the actions, thoughts and interests of others.
- Passive-aggressive behaviour.
- Self-loathing and self-victimisation.
- Tunnel vision - can only focus on a single concern while ignoring priorities.
Like most personality disorders, these symptoms tend to decrease with age. This means people with AVPD who are in their 40s and 50s tend to display very few of the extreme symptoms. It is uncommon for avoidant personality disorder to be diagnosed in adolescence or childhood, because at this age someone's personality is still developing. If however the disorder is diagnosed in young people, the symptoms will have been present for at least 12 months.
Avoidant personality disorder causes
It is not known what specifically causes avoidant personality disorder, although there are many theories that certain risk factors may contribute to its development. Most experts believe the many cases of AVPD are biologically and genetically predetermined, and then triggered by social, environmental and psychological factors which shape a person - their thoughts and behaviours - as they grow and develop. The complex intertwined nature of all of these factors is what increases a person's risk of developing the disorder and potentially increases the chances of them passing it on to their children.
When is it time to seek help for avoidant personality disorder?
Experts agree that seeking help as soon as possible is essential for effective treatment of personality disorders such as AVPD. Early diagnosis can pave the way for early treatment, which can help to prevent sufferers from developing any of the common complications of AVPD, such as depression or alcohol/drug addiction. These problems will only add to the difficulty of living with the condition and will put further strain on a sufferer's mental health.
Drug and alcohol abuse in particular is a common side effect of avoidant personality disorder and a key sign that an individual needs to seek help. Many sufferers will resort to alcohol and drugs to help them deal with social situations and manage routine tasks such as talking to coworkers without their fear of being rejected or judged getting in the way. Because people with avoidant personality disorder tend to spend a great deal of time on their own, it can be easy for them to fall into a pattern of drinking and drug taking.
If you are worried that you may be suffering from avoidant personality disorder, you may be feeling anxious about the idea of talking to someone about your concerns. It is important to remember that recognising you may have a problem is a crucial first step toward recovery, and that health care professionals will be completely understanding of your concerns and fears. Your GP will know how to help and will be able to discuss with you the appropriate forms of treatment that will enable you to start taking back control of your life and happiness.
Diagnosing avoidant personality disorder
As many individuals may experience characteristics of avoidant personality disorder at some point in their lives, there is specific criterion health professionals must refer to in order to determine whether or not someone has the disorder. It is important to note that personality traits and characteristics only qualify as avoidant personality disorder symptoms when they begin to have a long-term negative impact on a person's lifestyle, health and well-being.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), at least four of the following criteria should be met to accurately diagnose avoidant personality disorder:
- Avoidance of occupational activities that involve significant interpersonal conflict due to fear of rejection.
- Unwillingness to become involved with others unless acceptance is definite.
- Restraints within relationships due to an unreasonable fear of being ridiculed.
- Preoccupation with criticism or possible rejection in social situations.
- Inhibition in interpersonal situations due to feelings of inadequacy.
- Low self-esteem and perception of self as impersonal or inferior to others.
Health professionals will also be looking out for signs that someone is suffering from other mental health issues, including social phobias and mood/anxiety disorders. This is because avoidant personality disorder usually occurs in conjunction with these conditions. For example, people with depression may begin to withdraw from social situations and experience feelings of inadequacy and worthlessness, which are common symptoms of AVPD. Alternatively, the isolation and insecurity that characterises avoidant personality disorder may trigger feelings of depression.
Avoidant personality disorder treatment
Counselling and psychotherapy is generally the recommended form of avoidant personality disorder treatment. This can be offered through a range of approaches, including cognitive behavioural therapy (CBT) and group therapy - although the specific course of treatment will depend on the client and their individual needs. For example, it may be particularly difficult for people with AVPD to take part in group sessions early on in the therapeutic process.
Healthcare professionals working with individuals who have AVPD will be committed to devising a treatment programme that involves a detailed evaluation of a client's history and symptoms. This will ensure treatment is tailored to deal with specific problems that may be underlying the disorder. Therapists will be particularly sensitive to forming a solid therapeutic relationship with their client in order to make them feel comfortable and secure in therapy. They will also need to take extra care when exploring new material and issues as these may be particularly difficult for the client to deal with.
Overall, the aim of avoidant personality treatment is to help sufferers:
- Vocalise their concerns about interacting with others.
- Confront those worries directly.
- Find and learn new ways to soothe their fears when they feel anxious and stressed.
- Slowly become more comfortable with social situations and in dealing with criticism.
What should I be looking for in a counsellor or psychotherapist?
Whilst there are no official rules and regulations in place that stipulate what level of training and experience a counsellor needs to treat avoidant personality disorder, we do recommend that you check to see if your therapist is experienced in the area for which you are seeking help.
The NHS recommends psychotherapy as a form of treatment for personality disorders.
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