Avoidant personality disorder is marked by poor self-esteem and an intense fear of rejection. People with the condition often avoid social situations to avoid these feelings. Avoidant personality disorder is treatable with psychotherapy (talk therapy). Medication may help as well.
Avoidant personality disorder (AVPD) is a mental health condition that involves chronic feelings of inadequacy and extreme sensitivity to criticism. People with AVPD would like to interact with others, but they tend to avoid social interactions due to their intense fear of rejection.
AVPD is one of a group of conditions called “Cluster C” personality disorders. They involve anxiety and fear. Personality disorders are lasting patterns of behavior that are out of touch with cultural norms (how we’re expected to act) and develop in childhood or adolescence. They cause distress for the person with the condition and/or those around them.
Avoidant personality disorder and social anxiety disorder (SAD) share similar features and behaviors. But they’re distinct conditions.
Social anxiety disorder (social phobia) happens when you have an intense and ongoing fear of being judged and watched by others. This leads people with SAD to avoid social situations.
People with AVPD also avoid social situations and relationships. But it has more to do with their low self-esteem than with anxiety. Anxiety is the core feature behind SAD, but it doesn’t have to be present with AVPD
Researchers once thought that AVPD was a severe form of SAD. But studies show that roughly two-thirds of people with AVPD don’t meet the standard diagnostic criteria for SAD according to the DSM-5.
But a person can have both AVPD and SAD. People with both conditions have more severe symptoms than those with just one.
Researchers estimate that about 1.5% to 2.5% of the U.S. population has avoidant personality disorder.
Avoidant personality disorder usually begins in your late teens or early 20s. AVPD is also more likely to affect people with any of the following mental health conditions:
The main sign of avoidant personality disorder is having such a strong fear of rejection that you choose isolation over being around people. This pattern of behavior can vary from mild to extreme.
Other signs and behaviors of avoidant personality disorder include:
Personality disorders, including AVPD, are among the least understood mental health conditions.
Researchers are still trying to figure out the cause exact of them, but they think AVPD develops due to several factors, including:
Personality continues to evolve throughout child and adolescent development. Because of this, healthcare providers don’t typically diagnose someone with avoidant personality disorder until after the age of 18. Providers need evidence that these patterns of behavior are enduring and inflexible and don’t fade with time.
Personality disorders, including avoidant personality disorder, can be difficult to diagnose. This is because most people with one don’t think there’s a problem with their behavior or way of thinking.
When they do seek help, it’s often due to conditions such as anxiety or depression from the problems created by their personality disorder, like isolation or a lack of friends.
When a mental health professional, such as a psychologist or psychiatrist, suspects someone might have avoidant personality disorder, they often ask broad, general questions that won’t create an environment that the person might think of as critical or embarrassing. They ask questions that will shed light on:
A person suspected of having avoidant personality disorder may lack insight into their behaviors and thought patterns. So, mental health professionals often work with the person’s family and friends to collect more information about their behaviors and history.
Mental health providers base a diagnosis of avoidant personality disorder on the criteria for the condition in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Diagnostic criteria for avoidant personality disorder involve a persistent pattern of at least four of the following behaviors:
Treating personality disorders is difficult because people with these conditions have deep-rooted patterns of thinking and behavior that have existed for many years.
However, people with avoidant personality disorder tend to be good candidates for treatment because the condition causes them significant distress. And most people with AVPD want to develop relationships. This desire can be a motivating factor for people with AVPD to follow their treatment plans, which will likely include psychotherapy and, potentially, medication.
Treatment for people with this condition is most effective when family members are involved and supportive.
Psychotherapy (talk therapy) is the treatment of choice for personality disorders. The goal of treatment is to help you uncover the motivations and fears associated with your thoughts and behavior. In addition, you can learn to relate to others more positively.
Two specific types of psychotherapy that can help people with AVPD include:
There’s currently no medication that can treat personality disorders. But there’s medication for depression and anxiety, which people with avoidant personality disorder may also have. Treating these conditions can make it easier to treat AVPD.
For the best results, however, you should take medication in combination with psychotherapy.
You can’t prevent avoidant personality disorder. But treatment can help lessen the issues it causes. Seeking help as soon as symptoms appear can help decrease the disruption to the person’s life, family and friendships.
The prognosis (outlook) for AVPD depends on if it’s treated or not.
Left untreated, AVPD may result in:
People with AVPD also experience higher rates of suicidal ideation and suicide attempts. If you or a loved one are thinking about suicide, dial 988 on your phone to reach the Suicide and Crisis Lifeline. Someone is available to help you 24/7.
Treatment for avoidant personality disorder is a long process. Your willingness to seek and stay with treatment can have a significant effect on your outlook. With treatment, some people with AVPD can learn to relate to others more healthily.
It’s important to remember that avoidant personality disorder (AVPD) is a mental health condition. As with all mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions to your life. Mental health professionals can offer treatment plans that can help you manage your thoughts and behaviors.
The loved ones of people with AVPD often experience stress, depression and isolation. It’s important to take care of your mental health and seek help if you’re experiencing these symptoms.
Last reviewed by a Cleveland Clinic medical professional on 09/28/2023.
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