In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is avoidant personality disorder.
Avoidant personality disorder (AVPD) falls within the DSM-5‘s cluster C of anxious/fearful personality disorders. It’s characterized by intense feelings of inadequacy and fear of social rejection, and avoidance is relied upon as a coping strategy.
Symptoms
Avoidant personality disorder symptoms include:
- A persistent pattern of avoiding social contact, feeling inadequate, and being hypersensitive to criticism and rejection
- Avoids work that involves social interaction
- Reluctance to get involved with people unless sure of being liked
- Reserved in close relationships due to fear of ridicule/humiliation
- Preoccupied with, and hypervigilant for, criticism or rejection in social situations
- The self is seen as socially incompetent and inferior
- Avoids risk-taking out of fear of embarrassment
As with other personality disorders, symptoms of AVPD show up early and are well-established by adulthood, and tend to be consistent across time and in different contexts.
AVPD is similar to social phobia, but social phobia tends to be worse in particular types of situations, whereas AVPD is more across the board. Unlike schizoid PD, which also involves social avoidance, people with AVPD often strongly desire social relationships. AVPD can also overlap with the autism spectrum.
Other characteristics
An estimated 2.4% of the population have AVPD, and there’s no difference between genders. There’s often another co-occurring condition, such as a depressive disorder, anxiety disorder, or OCD. AVPD plus social phobia is a tag team that is particularly likely to cause disability. When AVPD co-occurs with PTSD, there may be significant self-harming behaviour.
AVPD appears to be a combination of innate traits and experiences of social rejection in childhood. Avoidance responses begin to emerge as young as age 2. Social rejection can come from one’s peer group, or it may involve emotional neglect by a parent. However, some people develop AVPD without any history of childhood neglect or abuse. High sensory processing sensitivity is suspected to play a role.
Treatment
Treatment options include cognitive behavioural therapy (CBT), psychodynamic psychotherapy, and medications (antidepressants and/or anti-anxiety medication).
Is this a disorder that you’re familiar with? I know my blogging friend Emilia has this disorder, and I hope she’ll share her experience in the comments.
References
Other personality disorders in the What Is… series
- Cluster A:
- Cluster B:
- Cluster C:
The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
Not familiar with it. Thanks once again for educating me.
Not familiar with the name of the disorder, but I am familiar with low self-esteem and anxiety. I’ve tried CBT and found it very helpful. Thank you for sharing Ashley 🙏
CBT has some excellent tools.
Thanks for sharing. I am somewhat familiar with AVPD but I learned a lot from this article.
Oh good!
Given as how so many mental health issues (and physical ones) show a difference between genders, it’s interesting AVPD doesn’t appear to. I imagine this is under-diagnosed. Our society makes us feel we’re weak or just being pathetic, ‘too sensitive’ or ‘too touchy’, which I really don’t think helps anyone, especially those with something like AVPD.
I completely agree.
Yeah, I have this weird thing. I’m very glad to see your post and that you’re spreading some awareness about it, as, ever since I got diagnosed with it, I’ve noticed that it’s not really talked about much, I believe because it might be underdiagnosed because of people being too scared of the diagnosis process and reaching out in general although that’s just my own little theory. I myself was diagnosed with it over three years ago, together with dysthymia, after quite a few years of me and also my then therapist not being sure what’s the actual/main problem here. When I finally got this diagnosis it felt like a lot of relief to know what’s going on and be able to feel less confused, even just being able to put a name to it felt a bit better, and I figured if there is such a diagnosis that they actually managed to diagnose me with, it’s not as bad as I thought. But also it still feels kind of weird to think that I have a PD, like, it makes total sense but it sounds a little scary. 😀
It’s all quite layered for me and I also have other more generalised anxiety issues so sometimes the AVPD part is difficult to set apart from the rest,, but generally I’d say it’s the most difficult to live with out of all the mental health issues I have, at least like on a daily basis.
I don’t know for sure what could cause it for me, but then I guess no one with a mental illness does. I’ll sometimes go into denial mode and feel like I don’t really have it, and my main argument is that to have a PD, you have to have some significant trauma, and I don’t consider myself someone who’s experienced significant trauma, even if some bits of my life were quite difficult. I have always had a lot of traits though that I think could predispose me to have this disorder and they’re present in my other family members too. I also had one major event in my early life that my Mum and me figured out I could have interpreted as rejection back then, even though now I don’t see it this way at all.
I don’t know if that’s common for AVPD people or not, I don’t know many, but I usually definitely try to hide it from people, otherwise it feels like I’m exposing myself way too much. Sometimes I’m more successful at it, sometimes less, it depends on all sorts of things, but usually I think I’m reasonably good at it.
The intensity of my AVPD symptoms tends to fluctuate a fair bit, they’re always there in the background, but sometimes they’re a lot worse than others, especially straight after social situations, or when I’m close to my period, or overwhelmed with a lot of feelings, especially negative feelings, etc. or just with no clear reason, and I call that either AVPD flares or just Maggie (my inner critic) taking things over. Basically I’ll feel super awful and depressed in a sort of dark way, it feels different than how I feel when it’s just dysthymia making me depressed, it’s more murky. Even if I had a very pleasant social interaction in general and not very exhausting from the introversion point of view, I’ll be analysing it over and over again and beat myself up over all the freakin’ things I did wrong or what people said vs what they actually meant, or what sort of influence something I did could have on them, maybe I hurt them or something, or things I didn’t do but I or someone else thought I should have done, all sorts of things. I also experience a lot of brain torture while I’m interacting with people or just being around other people, so that I could say it feels almost physically painful sometimes and it sucks loads of energy out of my brain. Also, when I have such an AVPD flare, I’ll feel increasingly more self-loathing. I mean, my self-esteem is usually low which is obvious with AVPD, sometimes it might go up for a short while when I’m really happy with something I did but it’s only on a superficial level I’d say. However, when Maggie’s more active than normal and I don’t do something to help things early enough the low self-esteem changes to self-loathing and I feel in a way that I don’t even know how to describe, and I feel a lot of anger which is all turned inwards. I don’t really know if outside people can see that in any way, my Mum sometimes will see that something is wrong with me and she thinks I’m sad, and I have a feeling that Misha picks up on that but I don’t know if he really does. Because I’d been bottling things up for a long time in my life and still haven’t fully unlearned this, I have a hard time letting it out in a healthy way, especially that at that point I often feel too overloaded to think about healthy and unhealthy ways and make a clear choice whether I want to do healthy or unhealthy, and communicating with people in a productive way/reaching out is difficult for all sorts of reasons. My thinking then is usually way too fast and jumbled to release myself in a satisfactory way via writing, which is usually my preferred healthy way of coping with emotional overload and with emotions in general. Thus, the easiest thing for me to do is to self-harm because I’m used to it as it was my main coping strategy for years, and, while I don’t nearly do it as often as I used to, usually these days when I self-harm it’s in an AVPD flare like that. It still feels like a really big deal when I manage not to do it. The longest I’ve gone without cutting so far is eight months but I still do things like nail biting and the like pretty much every day so there’s a long way to go for me. In an AVPD flare I’m also a lot more self-conscious than normally and feel very disconnected from other people. I usually do to some degree, but when there’s a flare it feels a lot more intense and I can’t even really connect with people with whom I normally more or less am able to. I try to fake it and that in turn makes me feel fake, so fun times really. 😀 And I struggle a lot with self-care when I’m feeling so awful about myself (because honestly, what’s the point of self-caring when you don’t actually care or even like yourself). Sometimes it’s just about hygiene and things like that or purposefully not doing things I normally enjoy but that I don’t need, and other times when I’m more unwell I won’t care if I’m hungry or cold or something unless I really have to for some more external reasons or seriously can’t ignore it any longer. And my inner monologue is way snarkier in such a flare.
AVPD also sometimes makes me a bit paranoid and I really dislike that. It’s nowhere near full paranoia, and I try my best that it wouldn’t influence my interactions with people and view of them, but it’s really yucky. I also think it can make me a bit manipulative sometimes although maybe it’s just my brain distorting things, I don’t really know.
I can definitely relate to the “avoids risk taking” bit as well. Recently I took a huge emotional risk, it didn’tturn out well and I’m definitely not gonna do anything similar any time soon. 😀 I’m also really scared of deep emotional closeness to the point where I don’t even think I want it. I mean, a lot of avoidants seem to feel both that they’re scared and really really want closeness, while for me, it is definitely a good thing but it’s too scary to think about it as something that I’d want.
There’s a lot that I think could be said about AVPD but these are just the most important things that come to my mind and I hope they help people see what it feels like to have it, even though I’ve no idea how different or similar overall it is to other people’s experiences with this disorder.
I used to do what I guess is called integrative Christian therapy or something like that for many years with that first therapist who helped me reach the diagnosis, I think she was mostly trained in CBT, then I worked for a short time with another CBT therapist who specialised in personality disorders among other things, which my initial T didn’t, and then I had a psychodynamic therapist also for a rather short time. I didn’t have the best experiences with those two last therapists, and over time as I’ve become more objective about it and mature, I’ve realised, with a bit of help from other people that my relationship with the first therapist wasn’t as great or healthy or exemplary as I used to believe and that many things were really off there, and I feel quite apprehensive about therapy now, so I’m just working with myself, which is difficult and I realise I probably can’t deal with everything this way, but I think I’ve already made some progress on my own, reading self-help books, practicing mindfulness, breathing exercises, trying to do more self-care when it doesn’t make me cringe too much and I have the energy, communicating with people on a more personal level and writing a lot as a way of processing things in my journal, on my blog and with people sometimes. Also I still have contact with my psychiatrist whom I see rarely, only when I need my anxiety medication prescription because she’s quite far and I can’t just drive there myself, but I know she’ll be supportive too if I really need it.
WordPress sent this to spam but I rescued it. You’re the only person I’ve ever known who’s been diagnosed with AVPD. I wonder if sometimes it’s semi-intentionally misdiagnosed as social phobia to avoid the personality disorder label. It’s weird that people seem very willing to think that childhood issues cause or feed into conditions like depression, but when it comes to personality disorders, there isn’t that same recognition.
Yay, my hard work wasn’t futile! 😀
I think this indeed may be a factor in AVPD potentially being underdiagnosed. Also, my therapist who helped me get diagnosed by a psychiatrist initially wasn’t really sure about AVPD when I originally brought it up because she said it’s just like social anxiety but more intense so she wasn’t sure how legit it is as a diagnosis in its own right and I’ve heard that there’s some controversy around this.
I suppose controversy is fine, as long as people are getting treatment.
Good point.
I’m not officially diagnosed with AVPD precisely because of the stigma of personality disorders. I also have/had social phobia so that’s on my medical records.
I’ve some really old posts on that stigma written when I started my blog. 😆
It’s so messed up that stigma has such an influence.
Yep, really messed up. BPD and other “difficult” conditions (usually with a trauma component) seem to be very stigmatised in countries like mine where public healthcare isn’t trauma informed.
I think personality disorders are really stigmatized by health professionals everywhere.
Yeah, personality disorders are so awfully stigmatised by them and laypersons. Yet my sister wants one lol. Like “you sure, sis?”
Oh wow, I guess my carefully thought through, detailed comment that I wrote a while ago didn’t even get through to your blog, probably was too long LOL!
Okay, I’ll try more concisely. I’m really glad that you wrote this post as I think AVPD gets a lot less attention than other PD’s and I wouldn’t be surprised if it was underdiagnosed.
So yeah I have AVPD and dysthymia and some other anxiety-related stuff but only AVPD and dysthymia are official.
Of course, AVPD is always there in my brain, but I have a thing that I call AVPD flares, when it’s really difficult to manage. During an AVPD flare, my normally self-esteem turns into intense self-loathing, and then emotional overwhelm quickly follows. Because I’d learnt to suppress my emotions at an early age, it’s still my default way of dealing with them, so even if I can find a better coping strategy when I’m feeling better, when I’m overwhelmed like that I often end up resorting to the thing that works best for me, that is self-harming. I also feel a lot more disconnected from people in a flare and everything about my AVPD is just a lot more intense.
I also find that in times of greater stress, healthier coping mechanisms can just totally go offline, and it’s only the unhealthy ones that are left.
Very true!
Not familiar with it, no. The list of symptoms sounds as though I might have a bit of it, though. Maybe a mild case, idk.
With any personality disorder it’s normal for people who don’t actually have the disorder to have some of the characteristics some of the time.
Right. I definitely don’t have all of those characteristics all of the time (or even some of them all the time, or all of them some of the time.)
Thanks for this. I’ve never seen it in practice; however, I brushed up on this disorder when I tested for my state license.
i’ve never come across it in practice either.
I’m familiar with it, as me and my therapist concluded some years ago that I have it. I managed to hide it at work as my social phobia got better, but it’s a lot harder to heal the underlying schemas that contribute to my AVPD. As I also have comorbid CPTSD (and so struggled with SH), and other anxiety disorders plus depression, I got to say it sucks. Interestingly several years ago I dug up a study on how AVPD is more commonly comorbid than BPD in OSDD-1/DID. I’m unsure if I’ll qualify for AVPD now, not just symptoms-wise but because a PD is only diagnosed as a comorbid if every alter in a OSDD-1/DID system qualify (at least where I am).
Oh that’s interesting – I’d never thought of how PDs would work in dissociative disorders.
Interestingly, dissociative amnesia is quite common with some PDs, including AVPD. And dissociative amnesia is also rather common in complex trauma survivors without a PD.
I think psychiatrists ought to quit seeing PDs (especially BPD) as “difficult patient, be harsh to them!”.
Absolutely.
I really struggle with the concept of personality disorder, as there’s so much stigma surrounding it, there’s no way I ever want to seek out a diagnosis. But I have to say I’ve always strongly related to AVPD, as avoidance is a major coping mechanism of mine.
I swing between thinking PD is an unhelpful label that is pathologising normal reactions to trauma, to believing maybe it is a thing when I’m struggling to be around people.
I would really like to see them overhaul the whole personality disorder diagnostic system. Even the words “personality disorder” are messed up. And PDs can arise from a combination of biology and environment just like any other mental illness, so the distinction seems pretty arbitrary.
That’s a good point about pathologizing normal reactions to trauma. I tend to look at diagnostic labels as being helpful only if they can point the way towards understanding what’s going on and identifying treatments that are likely to be helpful.
Yes me too, particularly as there’s this idea that they are “impossible” to recover from, which I don’t think is true.
I agree with you there too! People get reduced to their labels, of course diagnosis should be kept in mind, but it’s far more important to understand where the person is coming from and what they have experienced in their life.
Definitely.
Definitely not impossible to recover from a personality disorder but they tend to require long term therapy which many public health systems don’t favour despite the studies actually proving it will be cheaper in the long run.
Yeah, governments take a very short-term view when it comes to money.
It’s so frustrating that there isn’t enough investment in MH services, there’s loads of people without PD that would benefit from longer term therapy too.
For sure.
I have never heard about this disorder, of course that follows with most of them.
It seems that those with this must have a very difficult time in social settings.
I am better at one or two in a setting, but I don’t function well when there are many.
Smaller is better for me too.
Emilia is the only person I’ve known who has this disorder. It was good to read some more about it!