Avoidant personality disorder (AVPD) is a type of personality disorder characterised by pervasive feelings of social inhibition, inadequacy, and hypersensitivity to negative evaluation or criticism.1 People with avoidant personality disorder may avoid social situations and have difficulty forming close relationships due to an intense fear of rejection or disapproval, leading to emotional distress.
Avoidant personality disorder is a chronic condition that typically begins in adolescence or early adulthood and affects a large percentage of the general population. It is often diagnosed through a psychiatric evaluation and assessment. However, the exact causes of avoidant personality disorder is still not well understood, but research suggests that genetic, environmental, and psychological factors (such as neglect and abuse) may all play a role in its development.2
Overall, AVPD is a complex and challenging mental health condition that requires specialised treatment and support. With appropriate interventions, people with personality disorders learn to manage their symptoms and improve their overall quality of life.
Causes of avoidant personality disorder
The exact causes of AVPD are not fully understood, but research suggests that a combination of genetic, environmental, and psychological factors may contribute to its development.2
Here are some of the possible causes.
- Genetics- A growing body of research has suggested that there may be a genetic component to AVPD. Studies have found that people with AVPD are more likely to have a family history of anxiety disorders, suggesting that there may be an inherited vulnerability to developing this condition3
- Childhood experiences- Childhood experiences, such as emotional neglect, abuse, or overprotection, may also play a role in the development of AVPD. Research has found that individuals with AVPD are more likely to report childhood experiences of rejection or criticism, which may contribute to their fear of social situations and sensitivity to rejection4
- Personality traits- AVPD is classified as a personality disorder, which means that it is a long-standing pattern of behaviour that is deeply ingrained in a person's personality. Some researchers believe that certain personality traits, such as shyness, introversion, or neuroticism, may increase the risk of developing AVPD2
- Neurobiological factors- Some studies have suggested that abnormalities in certain brain regions, such as the amygdala or the prefrontal cortex, may contribute to the development of AVPD. For example, a study using functional magnetic resonance imaging (fMRI) found that individuals with AVPD showed increased activity in the amygdala, which is involved in the processing of emotional stimuli5
In conclusion, the exact causes of AVPD are complex and multifaceted, involving a combination of genetic, environmental, and psychological factors. While research in this area is ongoing, a better understanding of the underlying causes of AVPD may help to improve treatment and support for individuals with this condition.
Signs and symptoms of avoidant personality disorder
Avoidant personality disorder is a mental health condition characterised by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to criticism or rejection. People with AVPD often experience significant distress and impairment in their personal and professional lives.
Signs and symptoms of AVPD include:2
Social isolation: Individuals with AVPD may avoid social situations and activities that involve interacting with others. They may feel uncomfortable and anxious in social situations and may have difficulty making friends or forming close relationships.
Fear of rejection: People with AVPD are often extremely sensitive to rejection and criticism. They may avoid situations where they fear rejection or disapproval, and they may be reluctant to take risks or try new things.
Low self-esteem: Individuals with AVPD may have a persistent sense of inadequacy and low self-esteem. They may be overly self-critical and may have a negative view of themselves and their abilities.
Difficulty with intimacy: People with AVPD may have difficulty forming close relationships or intimate partnerships. They may feel uncomfortable with physical intimacy or emotional closeness, and they may struggle to express their feelings or needs.
Hypersensitivity to criticism: Individuals with AVPD may be extremely sensitive to criticism or perceived slights. They may take even mild criticism as a personal attack and may become defensive or withdraw from the situation.
- Avoidance of new activities: People with AVPD may be reluctant to try new activities or take on new challenges. They may feel anxious or overwhelmed by new situations and may prefer to stick with familiar routines or activities
Overall, AVPD can have a significant impact on a person's social functioning and quality of life. If you or someone you know is experiencing these symptoms, it is important to seek professional help and support to address these challenges. Treatment options, such as psychotherapy or medication, can be effective in managing symptoms and improving social functioning.
Management and treatment for avoidant personality disorder
Management and treatment of avoidant personality disorder typically involves psychotherapy, medication, and self-help strategies. The following are some of the commonly used approaches.
Psychotherapy is the most effective treatment for AVPD. Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) have been found to be effective in reducing AVPD symptoms and improving social functioning.6
CBT aims to identify and modify negative thought patterns and behaviours associated with AVPD, while IPT focuses on improving interpersonal relationships and communication skills.
Antidepressants and anti-anxiety medications may be prescribed to address symptoms of depression and anxiety that often co-occur with AVPD.7
However, medication alone is not sufficient to treat AVPD and should be used in conjunction with psychotherapy.
Self-help strategies such as mindfulness meditation, relaxation techniques, and assertiveness training may also be helpful in managing AVPD symptoms.8
These strategies can help individuals with AVPD learn to manage anxiety and improve self-confidence.
It is important to note that AVPD is a chronic condition that requires ongoing treatment and support. Treatment may take several months or years, and progress may be slow. However, with the right treatment and support, individuals with AVPD can learn to manage their symptoms, improve their social functioning, and lead fulfilling lives.
How is avoidant personality disorder diagnosed?
AVPD is diagnosed through a comprehensive psychiatric evaluation that includes a detailed medical history, psychological assessment, and observation of symptoms.
A mental health professional may use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria to diagnose AVPD, which includes criteria such as persistent feelings of inadequacy and social inhibition, avoidance of social situations, and hypersensitivity to negative evaluation.9
The diagnosis may also involve ruling out other mental health conditions that may present with similar symptoms.
Can avoidant personality disorder be prevented?
There is no known way to prevent AVPD. However, early intervention and treatment may help individuals with AVPD learn coping skills and strategies to manage their symptoms and improve their social functioning.
Who is at risk of developing avoidant personality disorder?
AVPD can affect anyone, but certain factors may increase the risk of developing the disorder. These factors include:2
- Childhood experiences of neglect or rejection
- Experiences of trauma and abuse
- Low self-esteem
- A family history of mental illness
In some studies there was evidence that people assigned female at birth were at higher risk of developing AVPD, however, there is small evidence to support that.2
How common is avoidant personality disorder?
AVPD is a relatively uncommon condition, affecting approximately 2.5% of the general population, although there is a report of a significantly higher number up to 9.3% of diagnosed cases of AVPD globally.2
When should I see a doctor?
If you are experiencing persistent feelings of social inhibition, low self-esteem, and avoidance of social situations, it may be helpful to consult a mental health professional. Seeking treatment early can improve the likelihood of effective treatment and improve your quality of life.
Additionally, if you are experiencing symptoms of anxiety or depression that are impacting your daily life, it may be helpful to consult a mental health professional for an evaluation and appropriate treatment. Also, visit this NHS website for information in relation to accessing mental health services in the UK
Avoidant Personality Disorder (AVPD) is a personality disorder characterised by pervasive feelings of inadequacy, social inhibition, and hypersensitivity to negative evaluation.
AVPD is diagnosed through a comprehensive psychiatric evaluation, and effective treatment typically involves psychotherapy, medication, and self-help strategies.
The causes of AVPD are not fully understood, but research suggests a combination of genetic, environmental, and psychological factors may contribute to its development. Individuals with a history of childhood neglect or rejection, low self-esteem, and a family history of mental illness may be at increased risk of developing AVPD.
Seeking early intervention and ongoing support is crucial to improving outcomes for individuals with AVPD, and it is important to recognize the signs and symptoms of AVPD in order to seek appropriate professional help and take steps towards a better mental health and well-being.
- Wilson S, Stroud CB, Durbin CE. Interpersonal dysfunction in personality disorders: A meta-analytic review. Psychological Bulletin [Internet]. 2017 Jul [cited 2023 Feb 24];143(7):677–734. Available from: http://doi.apa.org/getdoi.cfm?doi=10.1037/bul0000101
- Lampe L, Malhi GS. Avoidant personality disorder: current insights. Psychol Res Behav Manag [Internet]. 2018 Mar 8 [cited 2023 Feb 24];11:55–66. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5848673/
- Reichborn-Kjennerud T. The genetic epidemiology of personality disorders. Dialogues in Clinical Neuroscience [Internet]. 2010 Mar 31 [cited 2023 Feb 24];12(1):103–14. Available from: https://www.tandfonline.com/doi/full/10.31887/DCNS.2010.12.1/trkjennerud
- Staebler K, Helbing E, Rosenbach C, Renneberg B. Rejection sensitivity and borderline personality disorder. Clin Psychol Psychother [Internet]. 2011 Jul [cited 2023 Feb 24];18(4):275–83. Available from: https://onlinelibrary.wiley.com/doi/10.1002/cpp.705
- Holt DJ, Cassidy BS, Yue X, Rauch SL, Boeke EA, Nasr S, et al. Neural correlates of personal space intrusion. J Neurosci [Internet]. 2014 Mar 19 [cited 2023 Feb 24];34(12):4123–34. Available from: https://www.jneurosci.org/lookup/doi/10.1523/JNEUROSCI.0686-13.2014
- Alden LE, Taylor CT. Interpersonal processes in social phobia. Clinical Psychology Review [Internet]. 2004 Nov [cited 2023 Feb 24];24(7):857–82. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0272735804000996
- Kvarstein EH, Antonsen BT, Klungsøyr O, Pedersen G, Wilberg T. Avoidant personality disorder and social functioning: A longitudinal, observational study investigating predictors of change in a clinical sample. Personality Disorders: Theory, Research, and Treatment [Internet]. 2021 Nov [cited 2023 Feb 24];12(6):594–605. Available from: http://doi.apa.org/getdoi.cfm?doi=10.1037/per0000471
- Sng AAH, Janca A. Mindfulness for personality disorders: Current Opinion in Psychiatry [Internet]. 2016 Jan [cited 2023 Feb 24];29(1):70–6. Available from: http://journals.lww.com/00001504-201601000-00012
- Hummelen B, Ulltveit-Moe Eikenæs I, Wilberg T. Is the alternative model for personality disorders able to capture avoidant personality disorder according to Section II of the DSM–5? A systematic review. Personality Disorders: Theory, Research, and Treatment [Internet]. 2022 Jul [cited 2023 Feb 24];13(4):412–7. Available from: http://doi.apa.org/getdoi.cfm?doi=10.1037/per0000553