How to diagnose avoidant personality disorder

How to diagnose avoidant personality disorder

Avoidant personality disorder facts.

A lot of people with avoidant personality disorder (avoidant PD, AvPD or APD) live with this disorder for a long time without being aware of it. Even when people with avoidant PD eventually visit a psychiatrist or psychologist the avoidant personality disorder diagnosis is often missed by the professional. The avoidant PD symptoms are very similar to (severe) social phobia, causing the latter to be made earlier than AvPD. Being able to trust the therapist is a vital ingredient for avoidant PD treatment, because people with APD in general have trust issues already. And trust issues cause them to withdraw and lead a more isolated life.

A proper avoidant personality disorder diagnosis is important, because it makes it easier for people with AvPD to understand their mental disorder, to get the right treatment, and to work towards a recovery. Recovery often involves posttraumatic stress disorder (PTSD) treatment for the traumatic experience in the past, as well as cognitive behavioural therapy (CBT) techniques such as behavioural experiments to learn to trust people and to reduce others avoidant PD symptoms.

Here is a list of the avoidant personality disorder symptoms as listed by the DSM V.

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At Barends Psychology Practice, we offer (online) therapy for avoidant personality disorder. Contact us to schedule a first, free of charge, online session. (Depending on your health insurance, treatment may be reimbursed).

Avoidant personality disorder diagnosis – the symptoms

How to diagnose avoidant personality disorder

In order for a professional to make an avoidant personality disorder diagnosis someone needs to show at least four of the following criteria:

  • (A1) The person avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection. Examples of such situations are: social activities with coworkers outside of work; giving presentations; having lunch together. Avoiding harm is more important for these people than pursuing desires.
  • (A2) The person is unwilling to get involved with people unless he or she is certain of being liked. People with avoidant PD are so preoccupied with (possible) rejection that they rather not meet with someone if they are not certain of being liked. And if they meet with others they pay a lot of attention to the other person’s (nonverbal) behaviour to see if these people reject them.

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  • (A3) The person shows restraint within intimate relationships because of his or her fear of being shamed or ridiculed. Someone with APD may be very insecure about their physical appearance (despite working out a lot) or about their performance in bed. Because of their sensitivity to rejection or being shamed or ridiculed, they pay a lot of attention to signs of potential rejection of their partner.
  • (A4) The person is preoccupied with being criticized or rejected in social situations. This can cause someone with avoidant PD to be more withdrawn in social situations. It could happen that someone with APD ends up doing something (like watching a movie) they dislike, because they don’t dare to give their honest opinion (out of fear of being criticized or rejected).
  • (A5) The person is inhibited in new interpersonal situations because of his or her feelings of inadequacy. Someone with avoidant PD may have the feeling they are not interesting enough or can’t keep a conversation going. This may result in a self fulfilling prophecy.
  • (A6) The person views himself/herself as socially inept, personally unappealing, or inferior to others. It could happen that someone with APD is preoccupied with the way he or she comes across. Being to much aware of their own behaviour, they can easily start feeling more socially inept, inferior to others and unappealing.
  • (A7) The person is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing. An example of personal risk is participating in a game or match.

    (B) This enduring pattern of inner experience and behavior must deviate markedly from the expectations of the individual’s culture. Remember that someone’s behaviour must be judged against his or her own cultural background. If someone comes from a cultural background where being introvert is normal, then it’s likely that this person is more introverted by nature, compared to people from a different cultural background.

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    (C) This enduring pattern is inflexible and pervasive across a broad range of personal and social situations. If someone is afraid of rejection, shame and ridicule at work, but not at home or among friends, then it’s likely more situational rather than personality.

  • (D) This enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning. If someone doesn’t experience any clinically significant distress or impairment in someone’s functioning in any way, then there is no reason for this person to change at all.
  • NOTE: Avoidant personality disorder must be present for more than 1 year.
    There is an overlap between avoidant personality disorder traits and schizoid personality disorder traits. Make sure your therapist takes this personality disorder into consideration as well.
    If you have questions regarding the avoidant personality disorder diagnosis, please contact us.

    Overview

    What is avoidant personality disorder?

    Avoidant personality disorder is one of a group of conditions known as personality disorders. These disorders, in general, are enduring patterns of behavior out of keeping with cultural norms that cause suffering for an individual or those around them. Avoidant personality disorder is grouped with other personality disorders marked by feelings of nervousness and fear. People with avoidant personality disorder have chronic feelings of inadequacy and are highly sensitive to being negatively judged by others. Though they would like to interact with others, they tend to avoid social interaction due to the intense fear of being rejected by others.

    How common is avoidant personality disorder?

    It is estimated that about 2.4% of the U.S. population has avoidant personality disorder. It appears to affect men and women equally. Like other personality disorders, avoidant personality disorder symptoms may be noticed in childhood and often begin to create discomfort in adolescence or early adulthood. Avoidant personality disorder is usually not diagnosed in people younger than 18 years of age like many other personality disorders as there should be evidence that these patterns of behavior are enduring and inflexible that do not readily fade with time.

    Symptoms and Causes

    What causes avoidant personality disorder?

    The exact cause of avoidant personality disorder is not known. However, it is believed that both genetics and environment play a role. It is believed that avoidant personality disorder may be passed down in families through genes but this has not yet been proven. Environmental factors, particularly in childhood, do play an important role. Shyness, often normal in young children, lasts into adolescents and adulthood in those with avoidant personality disorder. Those with the disorder often report past experiences of parental or peer rejection, which can impact a person’s self-esteem and sense of worth.

    What are the symptoms of avoidant personality disorder?

    For people with this disorder, the fear of rejection is so strong that they choose isolation rather than risk being rejected in a relationship. The pattern of behavior in people with this disorder can vary from mild to extreme. In addition to their fear of humiliation and rejection, other common traits of people with this disorder include the following:

    • They are oversensitive and easily hurt by criticism or disapproval.
    • They have few, if any, close friends and are reluctant to become involved with others unless certain of being liked.
    • They experience extreme anxiety (nervousness) and fear in social settings and in relationships, leading them to avoid activities or jobs that involve being with others.
    • They tend to be shy, awkward, and self-conscious in social situations due to a fear of doing something wrong or being embarrassed.
    • They tend to exaggerate potential problems.
    • They seldom try anything new or take chances.
    • They have a poor self-image, seeing themselves as inadequate and inferior.

    Diagnosis and Tests

    How is avoidant personality disorder diagnosed?

    If symptoms are present, a healthcare provider will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests to rule out physical illness as the cause of the symptoms.

    If the provider finds no physical reason for the symptoms, they might refer the person to a psychiatrist or psychologist, healthcare professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder like avoidant personality disorder.

    Management and Treatment

    How is avoidant personality disorder treated?

    Treating personality disorders is difficult, because people with these disorders 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 their disorder causes them significant distress, and most want to develop relationships. This desire can be a motivating factor for people with avoidant personality disorder to follow their treatment plans.

    As with other personality disorders, psychotherapy is the main treatment for avoidant personality disorder. Psychotherapy is a type of individual counseling that focuses on changing a person’s thinking (cognitive therapy) and behavior (behavioral therapy). Therapy is likely to focus on overcoming fears, changing thought processes and behaviors, and helping the person better cope with social situations. Medication—such as an antidepressant or anti-anxiety drug—might be used to help manage the anxiety felt by people with this disorder. For the best results, however, medication therapy should be done in combination with psychotherapy. Treatment for people with this disorder is most effective when family members are involved and supportive.

    What are the complications of avoidant personality disorder?

    Without treatment, a person with this disorder can become isolated from society, causing long-term difficulties with work and social functioning. They are also at greater risk for depression and substance abuse.

    Prevention

    Can avoidant personality disorder be prevented?

    Although it might not be possible to prevent this disorder, it might be helpful to begin treatment in people as soon as they begin to have symptoms.

    Outlook / Prognosis

    What is the outlook for people with avoidant personality disorder?

    As with other personality disorders, treatment for avoidant personality disorder is a long process. The willingness of the individual to seek and stay with treatment can have a significant effect on treatment success and, therefore, the outlook. With treatment, some people with avoidant personality disorder can learn to relate to others more appropriately.

    Last reviewed by a Cleveland Clinic medical professional on 10/06/2020.

    References

    • Skodol AE, Bender DS, Gunderson JG, Oldham JM. The American Psychiatric Publishing Textbook of Psychiatry, Sixth Edition. Chapter 25. Personality Disorders. March 2014.
    • American Psychiatric Association. What are Personality Disorders? (https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders) Accessed 10/7/2020.
    • Lampe L, Malhi GS. Avoidant personality disorder: current insights. Psychol Res Behav Manag. 2018 Mar 8;11:55-66. doi: 10.2147/PRBM.S121073. PMID: 29563846; PMCID: PMC5848673.
    • Merck Manual Professional Version. Avoidant Personality Disorder (AVPD). (https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/avoidant-personality-disorder-avpd?query=avoidant%20personality%20disorder) Accessed 10/7/2020.
    • Sadock, BJ., et al. Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Science/Clinical Psychiatry. Wolters Kluwer, 2015.

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    Published: 10/18/2011 | Author: Admin

    People with avoidant personality disorder believe that they are inadequate and very sensitive to negativity, such as rejection or criticism. These feelings are so strong that a person with avoidant personality disorder will go to great lengths to avoid social situations.

    There are many similarities between avoidant personality disorder and social anxiety disorder. As with avoidant personality disorder, patients with social anxiety disorder will be shy or timid is social situations and may seek to avoid all social situations. Both disorders also share similar causes, signs, and treatments. However, there are some differences between the two disorders. With avoidant personality disorder, the focus is on the person’s feelings of inadequacy and sensitivity. The person does not fear the social situation itself but rather fears rejection. Many people with avoidant personality disorder will take part in social situations so long as acceptance is guaranteed – such as at group counseling sessions. With social anxiety disorder, patients are fearful of the actual social situation and will assume the worst possible outcomes, such as being publically humiliated.

    Characteristics of avoidant personality disorder also overlap with those of schizoid personality disorder. However, the main difference is that schizoid personalities do not want close relationships. People with avoidant personality disorders want close relationships (sometimes desperately) but do not seek them because of feelings of inadequacy and fear of rejection.

    How prevalent is avoidant personality disorder?

    Avoidant personality disorder is not common in the general population. Estimates put its occurrence at less than 1% of people. However, there are some estimates which put its prevalence as high as 2.36%. Avoidant personality disorder can be seen in approximately 1% of uncommitted outpatients.

    What are the characteristics of avoidant personality disorder?

    People with avoidant personality disorder will be characterized as shy or timid. They will be preoccupied with their inadequacies and will assume that others will not like them. Even though people with avoidant personality disorder crave personal relationships, they will choose not to connect with others rather than risk being rejected. People with avoidant personality disorder will have few or no intrapersonal relationships, even amongst close family. Even a minor criticism or failure will be a major setback to people with this disorder and they are unlikely to excel in careers because of their social avoidance.

    How is avoidant personality disorder diagnosed?

    Because of the nature of the disorder, most people with avoidant personality disorder do not seek treatment. If you suspect that you or someone you know has avoidant personality disorder, it is very important to seek help from a licensed therapist. Only a therapist can diagnose avoidant personality disorder and recommend a course of treatment. According to the ICD-10, a patient must have a minimum of 4 of these traits to be diagnosed with avoidant personality disorder:

    1. persistent and pervasive feelings of tension and apprehension;
    2. belief that one is socially inept, personally unappealing, or inferior to others;
    3. excessive preoccupation with being criticized or rejected in social situations;
    4. unwillingness to become involved with people unless certain of being liked;
    5. restrictions in lifestyle because of need to have physical security;
    6. avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection.

    What causes avoidant personality disorder?

    The exact causes of avoidant personality disorder are not known. Researchers accept that the disorder begins in childhood or adolescence and is carried into adulthood. There is evidence that some people are predisposed to social avoidance and introversion can be hereditary. While biological factors may contribute to avoidant personality disorder, it is most commonly believed that psychosocial factors cause the disorder.

    Children who were criticized or experienced rejection from loved ones can have a lower sense of self worth which then causes them to avoid social situations. In children, shyness or timidity can be considered endearing traits. However, these traits are usually looked upon negatively in adulthood and may be ridiculed. This ridicule only furthers the person’s sense of inadequacy and worsens the social avoidance.

    As an alternative, avoidant personality disorder may start in children who use avoidance to help manage their impulses. Rather than show anger, embarrassment, or guilt, the children instead learn to avoid situations where those emotions could occur. This is even more likely in children who have handicaps or other physical limitations.

    How is avoidant personality disorder treated?

    Psychotherapy is thought to be the most effective treatment for avoidant personality disorder. In order for therapy to succeed, the therapist must make considerable efforts to gain the patient’s trust. Otherwise, the patient may fall back on negative feelings and avoid treatment completely. Studies show that patients are very responsive to psychotherapy. If they are able to overcome their initial difficulties in forming a relationship with the therapist, then they can learn to overcome these difficulties with other relationships.

    Other possible treatments for avoidant personality disorder can include cognitive therapy and group therapy in which the patient’s beliefs about low self worth are challenged. Group therapy can also be used to help a patient learn better social skills. Exposure therapy can be used to introduce the patient to social situations on a step-by-step basis.

    In some cases, medications may be prescribed for treating avoidant personality disorder. The isolation of avoidant personality disorder could lead to other psychological problems, such as major depression. It may be necessary to treat these secondary psychological problems with medications.

    References:

    American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC: Author.

    Million, Theodore, Alexandra Martinez. “Avoidant Personality Disorder.” The DSM-IV personality disorders . Ed. W. John Livesley. Guildford Press, NY: 1995.

    How to diagnose avoidant personality disorder

    • What Is Avoidant Personality Disorder?
    • How Common Is AVPD And Addiction?
    • Why Turn To Drugs And Alcohol?
    • Diagnosing AVPD And Addiction
    • Treatment Options
    • Find Dual Diagnosis Treatment

    The occurrence of addiction and Avoidant Personality Disorder (AVPD) is common. When these conditions occur together, they require specialized treatment.

    How to diagnose avoidant personality disorder

    Avoidant personality disorder (AVPD) is a common disorder that is associated with significant social distress, impairment, and disability.

    The disorder is characterized by long-term behaviors of social anxiety, fear of rejection, feelings of isolation and inadequacy.

    The occurrence of AVPD and substance abuse disorder is common. Significant personal distress and negative emotions caused by the disorder may lead an individual to abuse drugs and alcohol.

    When avoidant personality disorder and substance occur together they require specialized dual diagnosis treatment.

    What Is Avoidant Personality Disorder?

    Avoidant Personality Disorder is a condition characterized by feelings of inadequacy, social inhibition, and hypersensitivity to criticism and rejection.

    This condition causes extreme distress and problems in affected individuals.

    People who have this condition will exhibit a long-term pattern of social avoidance, fear of speaking up for themselves, discomfort in social situations, and fears surrounding personal relationships.

    Diagnosing AVPD

    For the condition to be diagnosed by a trained mental health professional, the majority of the following symptoms must be present:

    • avoidance of social interaction due to extreme fears of rejection
    • aversion to interacting with others due to fear of rejection, interactions based on the guarantee of positive response
    • reluctance to establish intimate relationships due to fear of rejection, shame, or inadequacy
    • hypersensitivity to social situations that results in hyper-focused and hyper-vigilant behavior
    • long-term feelings of inadequacy
    • low self-esteem and self-worth
    • disruption of personal relationships

    People diagnosed with Avoidant Personality Disorder may feel comfortable and relaxed when they are not exposed to social situations that present the risk of experiencing rejection.

    Find the right dual diagnosis treatment program today.

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    People with AVPD often want to establish relationships, however, symptoms of the disorder dissuade them from pursuing necessary interaction.

    How Common Is Co-Occurring Avoidant Personality Disorder And Addiction?

    Avoidant personality disorder and addiction commonly occur together. At least 2.5 million Americans suffer from AVD. The disorder affects both genders equally.

    Avoidant personality disorder typically develops in adolescence before the occurrence of substance abuse disorder.

    People with the condition may abuse drugs and alcohol to reduce negative feelings and fears of rejection and inadequacy.

    Why Do People With AVPD Turn To Drugs And Alcohol?

    Avoidant personality disorder often disrupts an individual’s work and professional life.

    The condition often results in disrupted relationships, lack of motivation, or complete avoidance of social interaction.

    People with long-term fears surrounding establishing relationships and thriving in social environments may seek drugs and alcohol to reduce symptoms of their disorder.

    Unfortunately, drug and alcohol abuse will lead to adverse effects and the exacerbation of symptoms.

    A person may turn to substance abuse to:

    • reduce fears of inadequacy and rejection
    • reduce anxiety
    • self-medicate depression
    • numb negative emotions

    Chronic abuse of drugs and alcohol often leads to the development of substance abuse disorder and addiction.

    When AVPD and substance abuse occurs together, it increases an individual’s risk of health and personal damages, as well as experiencing adverse side effects.

    Diagnosing Co-Occurring Avoidant Personality Disorder And Addiction

    To be diagnosed with AVPD, a person must meet at least two of the 11 criteria of the disorder. Further, a person must meet specific criteria to be diagnosed with a substance abuse disorder.

    If a person is seeking substance abuse treatment and has not yet been diagnosed with AVPD, it may be necessary to complete detox and withdrawal before being diagnosed with the condition.

    Diagnosing these disorders is based on:

    • an individual’s medical history
    • evaluation of mental health
    • evaluation of the family medical history
    • other personal and psychological factors

    Treatment For Co-Occurring AVPD And Substance Abuse

    Treatment for substance abuse and avoidant personality disorder often involves a combination of medication and psychotherapy in a group setting.

    Further, depending on the severity of addiction and the substance of abuse, substance abuse treatment may involve integrated therapies to treat both disorders.

    Social exposure, medication, detoxification, and dual diagnosis treatment that implements an integrated approach to treat underlying causes of both disorders is crucial for recovery.

    Dual diagnosis treatment may involve:

    • medically-supervised detox
    • cognitive behavioral therapy (CBT)
    • psychodynamic therapy
    • group therapy
    • family therapy
    • exposure therapy
    • social skills training
    • medication

    A combination of treatments may be used to achieve better outcomes when treating the co-occurring disorders of substance abuse and AVPD.

    Getting Treatment For Avoidant Personality Disorder And Addiction

    At least 38 percent of Americans suffer from substance abuse disorder and a co-occurring mental disorder.

    While it may be challenging for a person to seek dual diagnosis treatment for these disorders, it is necessary to achieve recovery.

    If you or a loved one is struggling with AVPD and addiction, help is available.

    Find dual diagnosis treatment at:

    • inpatient and outpatient treatment centers
    • residential rehab centers
    • individual treatment providers

    If you or someone you love wants to learn more about co-occurring disorders or to find a dual diagnosis treatment program for AVPD and addiction, please call our helpline today.

    Written by the Addiction Resource Editorial Staff

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