What is Avoidant Personality Disorder (APD)?

Avoidant personality disorder is one of the Cluster C type conditions called anxious personality disorders (DSM V), which also include dependent personality disorder and obsessive-compulsive personality disorder.

People with APD have feelings of nervousness, fear, poor self-esteem, intense fear of rejection and being negatively judged by others. These feelings make people with APD very uncomfortable in social situations. Leading them to avoid group activities and contact with others.

This behaviour is usually noticeable by early adulthood and occurs in most situations. About 2.5 percent of the population has avoidant personality disorder and it can affect men and women equally. It is usually not diagnosed until someone is over 18 years of age but it generally begins in infancy and childhood.

Symptoms Of APD.

For people with this disorder, the fear of rejection is so strong that they choose isolation rather than risk being rejected. The pattern of behaviour in people with this disorder can vary from mild to extreme.

Those affected display a pattern of:

1. Severe social anxiety. Few, if any, close friends and are reluctant to become involved with others unless certain of being liked.
2. Social inhibition.
3. Fear in social settings and in relationships. Leading them to avoid activities or jobs that involve being with others.
4. Feelings of inadequacy and inferiority.
5. Extremely sensitive to social evaluation. They tend to be shy, awkward, and self-conscious in social situations due to a fear of doing something wrong or being embarrassed.
6. Fear of rejection, of being ridiculed, humiliated, rejected, or disliked.
7. Avoidance of social interaction despite a strong desire for intimacy.
8. Consider themselves to be socially inept or personally unappealing.
9. Tend to exaggerate potential problems.
10. Seldom try anything new or take chances.
11. A need to be well-liked.
12. Avoiding intimate relationships or sharing intimate feelings.
13. Turning down promotions at work.
14. People-pleaser.
15. Low self-esteem.
16. Lack of assertiveness.
17. Lack of trust in others.
18. Avoiding making decisions.
19. Misinterpreting neutral situations as negative.

What Causes APD?

The exact cause is still unknown. But many factors are thought to contribute to avoidant personality disorder. These include genetic, environmental, social, and psychological factors.

Some researchers have theorized certain cases of APD may occur when individuals with innately high sensory processing sensitivity, alongside high levels of empathy. It is thought that APD may run in families or is passed on through their genes.

Childhood neglect by parents, emotional abuse, criticism, ridicule, a lack of attention or nurturing by parents will impact a child’s self-esteem and sense of self-worth. Rejection by peers may similarly be a risk factor.

Individuals with the disorder are very shy as children and do not outgrow this shyness as they age. Social anxiety disorder and avoidant personality disorder share similar symptoms and genetics. With APD being the more severe form of the condition.

How Is Avoidant Personality Disorder Diagnosed?

Your first port of call is as always your GP who will need to do an evaluation including a complete medical history and physical examination. If no physical illness is causing the symptoms then the GP will refer you to a psychiatrist or psychologist who will carry out an assessment.

The psychiatrists or psychologists will use a specially designed interview and assessment tools to evaluate a person for a personality disorder. In order to meet the diagnosis for APD the person has to meet at least four of the following criteria from the Diagnostic and Statistical Manual (DSM) V.

These include the following criteria:

1. Avoidance of occupational activities involving significant social contact out of fear of criticism, disapproval, or rejection.
2. Unwillingness to become involved with others unless you are certain that they will like you.
3. Holding back in intimate relationships out of fear of being ridiculed or humiliated.
4. Preoccupation with criticism or rejection in social situations.
5. Inhibition in new social situations due to feeling inadequate.
6. Feelings of being socially inept, unappealing, or inferior to others.
7. Refusing to take risks or do new things out of fear of embarrassment.

How Is Avoidant Personality Disorder Treated?

Treating personality disorders is difficult as the person has some deep-rooted thinking and behaviours by the time they come for treatment. But with the right treatment they can learn to interact more appropriately with others.

APD individuals will generally have a high level of motivation to get treatment by the time they are seen. As they want to reduce their stress and most want to develop relationships. This level of motivation will help them stick to and adhere to treatment plans.

Psychotherapy is the main treatment for avoidant personality disorder. Psychotherapy is a type of individual counselling that focuses on changing a person’s thinking and their behaviour. Medication—such as an antidepressant or anti-anxiety drug—might also be used to help manage the anxiety if necessary. Family therapy may also be needed and it does benefit the person if their family is supportive at this time.

What Are The Complications Of Avoidant Personality Disorder?

Without treatment, a person with this disorder can become increasingly isolated from society. This may cause long-term difficulties with work and social functioning. They are also at greater risk for depression, social anxiety, and substance abuse (Alcohol or Drugs).

For Family And Friends

Living with or dealing with a person with a personality disorder can be very stressful to deal with. I strongly recommend that you get therapy whether your loved one does or not. You will need to learn some skills that can help support you and skills that help you cope better with the person you are involved with.

You may lose trust and confidence in yourself as this may take a beating. It can be an emotional roller-coaster. Again I would highly recommend you enter therapy immediately. This will begin your recovery process, aid you in building healthier boundaries and your trust in yourself again.

Work With Me.

Remember you are allowed to ask for support. No one is an island. If you need extra support then you can also work with me. We all struggle with stress and overwhelm from time to time. If you find this has become a problem for you and you’d like some support then schedule an appointment with me.