BPD Avoidant Personality Disorder: Symptoms and Treatment What you should know about AVPD By Arlin Cuncic Arlin Cuncic Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." Learn about our editorial process Updated on November 10, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Akeem Marsh, MD Medically reviewed by Akeem Marsh, MD LinkedIn Twitter Akeem Marsh, MD, is a board-certified child, adolescent, and adult psychiatrist who has dedicated his career to working with medically underserved communities. Learn about our Medical Review Board Print Verywell / Brianna Gilmartin Table of Contents View All Table of Contents Symptoms Diagnosis Causes Impact Treatment Coping Avoidant personality disorder (AVPD) is an enduring pattern of behavior related to social inhibition, feelings of inadequacy, and sensitivity to rejection that causes problems in work situations and relationships. The disorder is characterized by extreme shyness and sensitivity to criticism from others and is known as a Cluster C personality disorder or one that involves anxious and fearful personality disorders. AVPD is often associated with other mental health conditions like anxiety disorders, in particular, social anxiety disorder. People with the disorder show a pattern of avoidance due to fear of rejection or disapproval, which they experience as extremely painful. The disorder affects about 2.5% of the population, with roughly equal numbers of men and women being afflicted. Symptoms of Avoidant Personality Disorder The following is a list of common symptoms associated with avoidant personality disorder: A need to be well-liked Anhedonia (lack of pleasure in activities) Anxiety about saying or doing the wrong thing Anxiety in social situations Avoiding conflict (being a "people-pleaser") Avoiding interaction in work settings or turning down promotions Avoiding intimate relationships or sharing intimate feelings Avoiding making decisions Avoiding situations due to fear of rejection Avoiding social situations or events Easily hurt by criticism or disapproval Extreme self-consciousness Failure to initiate social contact Fearful and tense demeanor Feelings of inadequacy Hypersensitivity to negative evaluation Lack of assertiveness Lack of trust in others Low self-esteem Misinterpreting neutral situations as negative No close friends/lacking a social network Self-isolation Social inhibition Unwilling to take risks or try new things Viewing oneself as socially inept or inferior Vigilant for signs of disapproval or rejection Recap The three primary symptoms of avoidant personality disorder are feelings of inadequacy, social inhibition, and excessive sensitivity to rejection or criticism. Diagnosis of Avoidant Personality Disorder Avoidant personality disorder can only be diagnosed by a trained mental health professional based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). While a family physician can be the first point of contact for a diagnosis, your doctor should make a referral to a psychologist, psychiatrist, or other mental health professional for diagnosis. Avoidant personality disorder is typically diagnosed in adults, as children's personalities are still developing and behaviors such as shyness can be normal experiences in childhood that are later outgrown. According to the DSM-5, a person must have a consistent pattern of avoiding social contact, being overly sensitive to rejection and criticism, and feeling inadequate, as displayed by at least four of the following criteria: Avoidance of occupational activities involving significant social contact out of fear of criticism, disapproval, or rejectionUnwillingness to become involved with others unless you are certain that they will like youHolding back in intimate relationships out of fear of being ridiculed or humiliatedPreoccupation with criticism or rejection in social situationsInhibition in new social situations due to feeling inadequateFeelings of being socially inept, unappealing, or inferior to othersHesitation to take risks or do new things out of fear of embarrassment Avoidant Personality Disorder vs. Social Anxiety Disorder Avoidant personality disorder can seem very similar to social anxiety disorder, with some overlap in symptoms. However, they are distinct conditions that have different causes. Like AVPD, social anxiety is a type of anxiety disorder that causes people to feel that they will be judged or rejected by others. However, social anxiety is driven by high levels of anxiety, while significant feelings of worthlessness cause AVPD. While they are distinct, a person can be diagnosed with both conditions. Social anxiety disorder and avoidant personality disorder share similar symptoms and genetics, and AVPD is sometimes characterized as a more severe form of social anxiety. Causes of Avoidant Personality Disorder The causes of avoidant personality disorder are thought to involve genetic, environmental, social, and psychological factors. Some factors that can play a part in the development of the condition include: Emotional abuse Criticism Ridicule Lack of affection or nurturing by a parent or caregiver in childhood Rejection by peers Often, individuals with the disorder are very shy as children and do not outgrow this shyness as they age. Children who are high in behavioral inhibition may be more likely to have negative social experiences, which play a part in the development of thought patterns that increase their risk for developing AVPD. Related Conditions Avoidant personality disorder may co-occur and overlap with a variety of other conditions, including: Social anxiety disorder Dependent personality disorder Borderline personality disorder (BPD) Substance use disorder Depression Agoraphobia Impact of Avoidant Personality Disorder Unfortunately, the outlook for people with avoidant personality disorder who do not seek treatment is rather bleak. Typically, they become self-isolated and use avoidance as their only coping strategy. People with the condition may have few relationships and often become very isolated. This often leads to other long-term difficulties, including problems with work and school. It is not uncommon for people with this condition to avoid school or occupations that involve a lot of social contact. People with the condition may be more likely to experience alcohol and substance use disorders. Do people with AVPD want relationships? Some people with avoidant personality disorder want to form relationships with others, but they find them very difficult to maintain. Some research suggests that people with the condition long for connection but fear and dread getting close. Treatment of Avoidant Personality Disorder Most people with avoidant personality disorder do not seek treatment. When they do, it is often for a specific life problem they are experiencing or other types of symptoms such as depression and anxiety, and they will usually discontinue treatment if that problem is resolved. Like other personality disorders, avoidant personality disorder can be difficult to treat because it is an enduring pattern of behavior. It can be difficult for the person living with the disorder to recognize that psychotherapeutic help is needed and can be beneficial. Successful treatment can help to reduce symptoms and increase the range of coping strategies that the person can use to manage their anxiety. A person with avoidant personality disorder will probably always be somewhat shy, but avoidance won't dominate their thoughts. Talk Therapy Talk therapy for avoidant personality disorder may include cognitive behavioral therapy (CBT), psychodynamic therapy, and schema therapy. Group therapy and social skills training may also be helpful. CBT helps people learn how to change unhelpful thinking patterns. while psychodynamic therapy is aimed at being aware of how past experiences, pain, and conflict may be contributing to current symptoms. Schema therapy for avoidant personality disorder is an integrative approach that builds on CBT as well as many other therapeutic techniques. It has a focus on the therapeutic relationship between therapist and client, and a goal of improving daily functioning and gaining insight for change based on understanding and re-engineering of early life experiences. A key feature of schema therapy is "limited reparenting," in which the client expresses childhood needs and learns to develop and internalize a healthy parent voice. Main Concepts of Schema Therapy In schema therapy, the client learns about four main concepts:How maladaptive schemas are patterns that are repeated throughout life. These patterns are grouped into five areas: disconnection and rejection, impaired autonomy and performance, impaired limits, excessive responsibility and standards, over-vigilance, and inhibition.What coping styles were learned as a child (e.g., escape, fighting back).What schema modes are being used to cope and how they are unhelpful (e.g., avoidance, detachment, compliance, punishment).How to develop healthy adult modes of coping and get core emotional needs met. Medication While there are currently no medications specifically approved for treating avoidant personality disorder, if a person has other related disorders such as depression or anxiety, medication may be prescribed to help with those symptoms. For example, antidepressant medication can be helpful for improving mood and anhedonia, decreasing anxiety symptoms, and may also reduce sensitivity to rejection. The Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. Coping With Avoidant Personality Disorder One of the first steps in improving quality of life with avoidant personality disorder is to recognize the signs. By understanding your specific symptoms, you’ll be able to better work with your therapist to find ways to work around them. Consider involving friends and family in your therapy, too, so they have a better understanding of what you’re going through and how to help. Self-care is also essential, including finding healthy coping skills that prevent you turn to drugs or alcohol, smoking, overeating, or self-harm when you’re having a hard time. If you think someone you know or love may be living with avoidant personality disorder symptoms, it is important to encourage that person to seek help. Without professional treatment such as talk therapy, it is unlikely that the symptoms and their related impacts on relationships will improve. If you or a loved one are struggling with avoidant personality disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. 15 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Overview. Avoidant Personality Disorder. Cleveland Clinic. 2017. Paniagua FA. Culture-bound syndromes, cultural variations, and psychopathology in Paniagua FA, Yamada AM (Editors). Handbook of Multicultural Health. Academic Press. 2013. Ashton M. Individual Differences and Personality (Second Edition). Academic Press. 2013. Skodol A. Avoidant Personality Disorder (AVPD). Merck Manual for Professionals. 2018. Lampe L, Malhi GS. Avoidant personality disorder: current insights. Psychol Res Behav Manag. 2018;11:55-66. doi:10.2147/PRBM.S121073 Del Giudice M. Evolutionary Psychopathology: A Unified Approach. Oxford University Press. 2018. Eggum ND, Eisenberg N, Spinrad TL, et al. Predictors of withdrawal: possible precursors of avoidant personality disorder. Dev Psychopathol. 2009;21(3):815-838. doi:10.1017/S0954579409000443 Frandsen FW, Simonsen S, Poulsen S, Sørensen P, Lau ME. Social anxiety disorder and avoidant personality disorder from an interpersonal perspective. Psychol Psychother. 2019. doi:10.1111/papt.12214 Dimaggio G, D'urzo M, Pasinetti M, et al. Metacognitive interpersonal therapy for co-occurrent avoidant personality disorder and substance abuse. J Clin Psychol. 2015;71(2):157-66. doi:10.1002/jclp.22151 Management and Treatment. Avoidant Personality Disorder. Cleveland Clinic. 2017. Sørensen KD, Råbu M, Wilberg T, Berthelsen E. Struggling to be a person: Lived experience of avoidant personality disorder: SØRENSEN et al. J Clin Psychol. 2019;75(4):664-680. doi:10.1002/jclp.22740 Hales RE, Yudofsky SC, Gabbard GO. Essentials of Psychiatry (Third Edition). American Psychiatric Publishing. 2011. Rafaeli E, Bernstein DP, Young J (Editors). Schema Therapy: Distinctive Features. Routledge Taylor & Francis Group. 2011. Pellerone M, Iacolino C, Mannino G, Formica I, Zabbara SM. The influence of parenting on maladaptive cognitive schema: A cross-sectional research on a group of adults. Psychol Res Behav Manag. 2017;10:47-58. doi:10.2147/PRBM.S117371 Roediger E, Stevens BA, Brockman R. Contextual Schema Therapy: An Integrative Approach To Personality Disorders, Emotional Dysregulation & Interpersonal Functioning. Context Press. 2018. Additional Reading American Psychiatric Association. Diagnostic and Statistical Manual, Fifth Edition. Arlington, VA: American Psychiatric Publishing, 2013. National Institute of Mental Health. Personality disorders. Reichborn-Kjennerud T, Czajkowski N, Torgersen S, et al. The relationship between avoidant personality disorder and social phobia: a population-based twin study. Am J Psychiatry. 2007;164(11):1722-8. doi:10.1176/appi.ajp.2007.06101764 Reich J. Avoidant personality disorder and its relationship to social phobia. Curr Psychiatry Rep. 2009;11(1):89-93. doi:10.1007/s11920-009-0014-0 Weinbrecht A, Schulze L, Boettcher J, Renneberg B. Avoidant personality disorder: A current review. Curr Psychiatry Rep. 2016;18(3):29. doi:10.1007/s11920-016-0665-6 By Arlin Cuncic Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." 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