ADHD Comorbidities & Related Conditions

What is Avoidant Personality Disorder? Symptoms, Causes & Treatments

Avoidant personality disorder symptoms include feelings of inadequacy, fear of rejection, and withdrawal from social situations causing significant distress. AVPD is a serious Cluster C personality disorder with various causes and potential treatments.

A sad girl sits alone by the window while suffering from social anxiety disorder.
A sad girl sits alone by the window while suffering from social anxiety disorder.

What is Avoidant Personality Disorder?

Avoidant Personality Disorder (AVPD) causes feelings of inadequacy, fear of rejection, and sensitivity to potential negative feedback. People with AVPD may avoid potentially embarrassing social situations, as they view themselves as socially incompetent.

AVPD is one of 10 personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Along with obsessive compulsive and dependent personality disorders, AVPD is a Cluster C disorder, which causes affected individuals to appear more anxious and neurotic.

Research suggests that AVPD affects up to 2.5% of the U.S. population1.

Avoidant Personality Disorder Symptoms

Symptoms of avoidant personality disorder are rarely diagnosed before age 18, though they may appear earlier. According to the DSM-5, people with AVPD must experience at least four of the following symptoms:

  • Avoidance of social events due to fear of criticism, disapproval, or rejection
  • Engaging socially only when certain of approval
  • Restraint in intimate relationships stemming from fear of being ridiculed
  • Preoccupation with criticism and rejection
  • Inhibition in social situations caused by feelings of inadequacy
  • Belief that they are socially inept, unappealing, or inferior to others
  • Failure to take risks or engage in new activities due to fear of embarrassment2

[Take This Self-Test: Symptoms of Avoidant Personality Disorder]

Other Signs of AVPD

Though the DSM-5 symptom criteria listed above is used to diagnose AVPD, the following associated features may help clinicians support a diagnosis. These can include:

  • Hypervigilance. People with AVPD over-analyze the expressions and words of others to detect rejection.
  • Isolation. Because of their fear of rejection, people with AVPD avoid social contact.
  • Fantasizing about idealized relationships. People with AVPD desire affection and approval, and they may fantasize about the healthy relationships they lack3.

Causes of Avoidant Personality Disorder

Like all personality disorders, AVPD has a range of potential causes and is most likely caused by a mix of factors, potentially including the following:

  • Genetics. AVPD has shown to be heritable, but studies show a complex interplay between genetics and environment in the development of AVPD.
  • Attachment style. An avoidant attachment style, characterized by negative self-concept and fear of emotional intimacy, may contribute to the development of AVPD.
  • Abuse. Neglect and emotional abuse, in particular, have been associated with AVPD.
  • Parental relationship. People with AVPD remember their parents being more rejecting and less affectionate and encouraging than do others. Recall bias, however, may contribute to some of the difference4.

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Avoidant Personality Disorder vs. Social Anxiety

AVPD and social anxiety share many symptoms, such as avoidance of social situations, focus on rejection, and social inhibition. They are also often comorbid. In fact, psychologists consider the conditions so linked that the DSM-5 posits that they may simply be different conceptualizations of the same condition5.

The most common distinctions drawn between social anxiety disorder and AVPD involve generalization and self-concept. In social anxiety, anxiety is usually restricted to certain settings, while people with AVPD will demonstrate avoidance in almost all situations. In addition, people with social anxiety tend to be aware of their cognitive distortions, whereas people with AVPD have a deep sense of inadequacy and believe others see them the same way6.

Avoidant Personality Disorder and ADHD

Both child and adult ADHD have been associated with the development of AVPD. One study of 878 adults with ADHD, for example, found that about 19% of the group showed symptoms of AVPD7. More research, however, is warranted on the connection.

Like people with AVPD, those with ADHD may focus heavily on rejection from others. In people with ADHD, this is called rejection sensitive dysphoria (RSD). People with ADHD are more sensitive to emotional harm from others, which manifests as RSD. People with AVPD experience a similar reaction stemming from injury to their already low self-esteem.

Treating Avoidant Personality Disorder

Unlike some personality disorders, AVPD is ego dystonic, meaning that it is distressing to the individual and, as such, people with AVPD are more likely to seek treatment.

Treatment for AVPD consists primarily of psychotherapy. Though specific research into AVPD is small, graded exposure, cognitive behavioral therapy, social skills training, psychodynamic therapy, and schema therapy have all been found to have positive effects8.

In addition to psychotherapy, medication may be prescribed to treat specific symptoms. Antipsychotic medications, mood stabilizers, and antidepressants can also be used to treat comorbid conditions such as depression and anxiety.

Avoidant Personality Disorder: Next Steps

Sources:

1Lampe, L., & Malhi, G. S. (2018). Avoidant personality disorder: current insights. Psychology research and behavior management, 11, 55–66. https://doi.org/10.2147/PRBM.S121073
2American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 672, 673 https://doi.org/10.1176/appi.books.9780890425596
3American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 673, 674 https://doi.org/10.1176/appi.books.9780890425596
4Lampe L, Malhi GS. Avoidant personality disorder: current insights. Psychol Res Behav Manag. 2018;11:55-66, https://doi.org/10.2147/PRBM.S121073
5American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 674 https://doi.org/10.1176/appi.books.9780890425596
6Lampe, L., & Malhi, G. S. (2018). Avoidant personality disorder: current insights. Psychology research and behavior management, 11, 55–66. https://doi.org/10.2147/PRBM.S121073
7Jacob, C. P., Gross-Lesch, S., Reichert, S., Geissler, J., Jans, T., Kittel-Schneider, S., Nguyen, T. T., Romanos, M., Reif, A., Dempfle, A., & Lesch, K.-P. (2016). Sex- and Subtype-Related Differences of Personality Disorders (Axis II) and Personality Traits in Persistent ADHD. Journal of Attention Disorders, 20(12), 1056–1065. https://doi.org/10.1177/1087054714521293
8Lampe, L., & Malhi, G. S. (2018). Avoidant personality disorder: current insights. Psychology research and behavior management, 11, 55–66. https://doi.org/10.2147/PRBM.S121073


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