NEWSLETTERS

Personality Disorders Avoidant Personality

Disorder

Avoidant
Personality
Disorder: Getting
a Diagnosis
Avoidant personality disorder is a
debilitating form of conflict aversion
that causes social dysfunction and
isolation. AVPD, arguably the most
serious of the 10 personality
disorders, is thought to be
underdiagnosed.

Sep 13, 2022

Susan McQuillan, MS, RDN

Medical Reviewer: Jean Kim, MD

!Image: iStock)

ON THIS PAGE

• Diagnosable • DSMU5
Personality Checklist
Disorder
• Diagnostic
• What Is AVPD? Complications
• Distinguishing • Comorbidities
AVPD
• FAQs
• AVPD
Diagnosis

Everyone has personality traits—shy or

outgoing, humble or prone to bragging, leader
or follower—that may serve them well but may
also cause problems in their relationships with
themselves and others.

A DV E R T I S E M E N T

And many people have some of the traits of a

personality disorder, but they are not
considered to be a disorder because they
don’t interfere with the individual’s day-to-day
functioning or cause the individual significant
distress.

Those with a clinically defined personality

disorder have much more serious problems
with normal functioning that greatly diminish
their ability to form relationships in all areas of
their lives. People with avoidant personality
disorder DAVPDF and other personality
disorders are living with a disability. AVPD is
considered to be one of the most serious of
the personality disorders because of the
extreme social dysfunction of those affected.

DIAGNOSABLE PERSONALITY DISORDER

What is a Diagnosable
Personality Disorder?

Just because someone is “different,” and

doesn’t look or behave the same as most
others in a community, doesn’t mean they have
a personality disorder. In general, a personality
disorder is defined as a perpetual pattern of
both inner experiences (i.e. moods and
feelings) and awkward behavior that is notably
and significantly different from an individual’s
cultural norms and expectations. A personality
disorder is pervasive, inflexible, and leads to
great personal distress or impairment of
function and abilities.

QUIZ

Worried you may be

suffering from…
avoidant
Do personality
you have a pattern of social avoidance
or feelings of inadequacy? If so, take our
disorder?
quiz and see if you might have avoidant…
personality disorder.
TAKE THE QUIZ

For someone with a personality disorder, any

type of conflict, big or small, is overwhelmingly
challenging, which makes interpersonal
relationships extremely difficult. People with
personality disorders often end up isolated
and are at higher-than-normal risk of engaging
in harmful, self-destructive, or illegal activities.

Ten personality disorders are recognized and

explained in the American Psychiatric
Association's Diagnostic and Statistical Manual
of Mental Disorders, Fifth Edition DDSMU5F.²
These disorders are grouped into three
“clusters,” known as A, B and C.

Cluster A disorders are the more socially

detached with personality styles that are
considered odd or eccentric. These include
schizoid, schizotypal, and paranoid personality
disorders. Cluster B disorders are the most
emotionally unstable and include borderline
personality, antisocial, histrionic, and
narcissistic personality disorders. Cluster C
disorders, which include obsessive-
compulsive, dependent, and avoidant
personality disorders, exhibit the most anxiety
of them all.³

No one should try to diagnose themselves with

a personality disorder, because there are just
too many complicated symptoms.

What Is AVPD?

AVPD is thought to be prevalent in

approximately 1.5% to 2.5% of the population.
While it is also thought to equally affect men
and women, some studies have found a higher
risk for women.¹ Getting an accurate diagnosis
can sometimes be complicated by the fact that
the symptoms of personality disorders from
one cluster can overlap with those of another,
as can symptoms of different disorders within
the same cluster.

Marked by strong feelings of social inadequacy

and fear of rejection leading to extreme
anxiety, AVPD consistently affects every
aspect of a person’s life, including school,
social, and work activities, from the earliest
stages of childhood throughout adulthood.
The condition also affects family members,
who may want to be supportive but don’t
understand the condition and may or may not
recognize the need for professional help.

The core symptoms of AVPD—those that

involve anxiousness, withdrawal, and
detachment—can overlap with symptoms of
autism, social anxiety, schizoid personality
disorder, and many other mental health
conditions, especially the other personality
disorders. For someone with AVPD to lead a
productive, satisfying life, it is important to get
an accurate diagnosis from a psychiatrist,
psychologist, or other trained and qualified
mental health professional.

“AVPD and schizoid personality disorder

DSZPDF are both disorders of introversion, for
example, so the symptoms can overlap”
explains Daniel Winarick, PhD, assistant clinical
professor of psychiatry in the Icahn School of
Medicine at Mount Sinai Hospital in New York.
“The difference is that the motivation for
people with AVPD is fear of negative
evaluation, humiliation, or rejection while the
motivation for people with SZPD is a lack of
desire for social relationships.”

An accurate diagnosis ensures the best and

most appropriate treatment plan for AVPD. A
clear diagnosis can not only help with
symptom management but also with the
prevention of a common avoidant personality
comorbidity, such as depression, substance
abuse, an eating disorder, even suicide
attempts.

DISTINGUISHING AVPD

Distinguishing AVPD from

Other Personality
Disorders

Like other personality disorders, AVPD differs

from common shyness or social awkwardness
in that it is a chronic condition. Shyness, in and
of itself, doesn’t necessarily lead to social
isolation, professional problems, health issues,
or more drastic, negative behaviors and self-
harm, as is often the case with AVPD.

Shyness and many associated personality

traits, such as sensitivity, can improve and
even disappear with age and life experience,
while AVPD persists through adulthood and
will only worsen without appropriate treatment.

At the same time, people with one personality

disorder often suffer from symptoms of
another, co-existing disorder. It may be
another personality disorder or any number of
other mental health disorders.

What distinguishes one personality disorder

cluster from another is the personality style
noted in all the disorders within each group.
What differentiates AVPD from the other two
Cluster C disorders is the core feeling of being
inadequate and unlikable that drives the
anxious, avoidant behavior. Unlike, for
instance, the core need to be taken care of
and fear of having to take care of themselves
that drives the anxious behavior of someone
with dependent personality disorder. Or the
extreme perfectionism, rigidity, and need for
control that drives anxiety in someone with
obsessive-compulsive personality disorder.

The feelings of inferiority that lead to specific

personality traits and behavior inevitably
interfere with an avoidant’s personal and
professional success.

An avoidant personality diagnosis performed

by a mental health professional involves a
differential diagnosis, which means comparing
and contrasting similar conditions that may be
causing AVPD symptoms in order to clearly
differentiate one from the other. By
considering all the possible disorders that
could be causing specific symptoms, asking
pertinent questions about feelings and mood,
and listening carefully to the answers, a
qualified health professional can rule out other
conditions and narrow down the diagnosis to
AVPD.

For instance, AVPD symptoms may overlap

with symptoms of schizoid personality
disorder since they share similar thinking
patterns and behavioral symptoms, such as
expecting rejection, experiencing constant
restlessness, and practicing defensive
detachment—avoiding people and close
relationships. Defensive detachment is a form
of self-protection for those who equate
attachment to others with feelings of rejection,
being ostracized, and not being liked or loved.

One key difference between AVPD and

schizoid disorder is that even though they are
detached, someone with AVPD wants to be
accepted and wants to have close
relationships; the reason they don’t is that they
don’t believe themselves to be worthy. The
aspects of their condition that prevent them
from forming attachments cause them great
emotional pain. Someone with schizoid
disorder, on the other hand, tends to just not
be as interested in social relationships as they
are with their own specific interests. And that
is the reason they don’t make an effort and
often appear not to care.

It is important for a mental health professional

to distinguish between AVPD and conditions
such as schizoid disorder because the
treatment plans and goals will ultimately be
different for each disorder.

AVPD DIAGNOSIS

Getting an AVPD Diagnosis

Most AVPD diagnoses are made in people who

are at least 18 years old, to be sure that an
individual’s personality is fully developed. For
AVPD to be diagnosed in someone younger
than 18, symptoms meeting the criteria must
have been present for at least one year,
according to the DSMU5. The onset of a
personality disorder is usually no later than
early adulthood, even if a diagnosis isn’t made
until much later on in life.

A primary care physician or mental health

professional could be the first health
professional to recognize a personality
disorder. There are no lab tests for personality
disorders, but a physician can perform a
physical examination and use diagnostic tests
to rule out a physical illness that could be
causing symptoms similar to those seen in
people with AVPD.

While mental health professionals do not use a

formal psychiatric “test” to screen for AVPD,
diagnosis ultimately must include confirmation
of at least four of the criteria listed in the DSMU
5, as well as a look at the individual’s long-term
history of symptoms and patterns of behavior.

DSM-5 CHECKLIST

Avoidant Personality
Disorder DSM 5 Criteria

Avoidant personality diagnostic criteria are

found in the following checklist of feelings and
behaviors described in the DSMU5. When at
least four of these criteria are noted during a
professional interview, AVPD can be
diagnosed:

• Avoidance of any work that requires social

contact due specifically to a fear that others
will criticize or reject them.

• Avoidance of any involvement with other

people unless certain they will be liked.

• Restrained behavior in close relationships

because they are afraid of being shamed or
ridiculed.

• Deep concern about being criticized,

disapproved of or rejected in social settings.

• Shyness and withdrawn behavior in new

situations out of fear of not meeting others’
expectations or not being good enough.

• Feelings of ineptitude or inferiority to others

based on low self-esteem.

• Avoidance of necessary risks normally taken

to engage in new social contacts or other
personal or professional pursuits, for fear of
feeling ashamed.

DIAGNOSTIC COMPLICATIONS

Diagnostic Complications
of Avoidant Personality
Disorder

Sometimes, a person’s personality meets the

criteria for more than one personality disorder
but not for one specific disorder. In addition,
mental health professionals must rule out
personality disturbances and changes that are
due to another medical condition, such as
damage to the brain, or an undiagnosed
substance abuse disorder.

There can also be diagnostic issues due to

culture or gender. Some personality disorders
occur more frequently in men, and some are
diagnosed more often in women. The DSMU5
warns mental health professionals who
diagnose a personality disorder not to make
decisions based on typical gender behavior
and social stereotypes about gender roles.
Similarly, ethnicity, cultural or religious
differences, and individual social experiences
can create problems for immigrants and others
with backgrounds that differ from the majority
that could mistakenly be viewed as personality
issues.

“What is most difficult for someone with a

personality disorder is their unmet longing for
relationship,” says Candace Orcutt, PhD,
author of The Unanswered Self: The
Masterson Approach to the Healing of
Personality Disorders. “Any therapist working
with such patients must avoid appearing
intrusive but at the same time must be a very
attentive listener, and very receptive and
acknowledging of the person.”

COMORBIDITIES

Avoidant Personality
Comorbidities

According to the DSMU5, the conditions that

are most often diagnosed along with AVPD
include depression, bipolar disorder, and
anxiety disorders, especially social anxiety
disorder.

Research suggests "both AVPD and social

anxiety disorder are associated with the
temperamental factor 'behavioral inhibition,'
which is characterized by avoidance of
strangers and novelty, shyness, heightened
sensitivity and anxiety reactivity." While both
disorders are marked by fear of scrutiny or
ridicule in social situations, adults with social
anxiety disorder may still engage in social
situations—albeit with intense anxiety—while
those with AVPD flat out avoid social activities
or relationships, or situations in which they
may risk embarrassment.

AVPD may be complicated by the presence of

other conditions, such as depression and
substance dependency or misuse. These
comorbidities may develop after years of
coping with the original disorder.

Likewise, AVPD has often been seen as a

comorbidity in people with other personality
disorders, particularly dependent personality
disorder, borderline personality disorder,
paranoid personality disorder, schizoid
personality disorder, and schizotypal
personality disorder. Studies also have linked
AVPD comorbidity with conditions such as
post-traumatic stress disorder DPTSDF or
dysthymic disorder, characterized by
persistent, low-level depression.

A number of studies have linked avoidant

personality disorder with suicidal thoughts,
suicide attempts and death by suicide.⁴˒⁵
Elderly men and women with dysthymic
disorder and co-existing symptoms of AVPD
often report suicidal thoughts. However, just
having AVPD is considered an independent risk
factor for suicide, even earlier in life.

FAQS

Frequently Asked
Questions about AVPD

Frequently Asked
Questions