What is avoidant disorder

Emotional abuse , criticism, ridicule, or lack of affection or nurturing by a parent or caregiver in childhood may result in the development of this personality disorder if other factors are also present. Rejection by peers may similarly be a risk factor. Often, 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 AVPD being the more severe form of the condition.

Avoidant personality disorder may co-occur and overlap with a variety of other conditions, including:. Most people with avoidant personality disorder do not seek treatment. Avoidant personality disorder can be hard to treat like other personality disorders because it is an enduring pattern of behavior and it can be difficult for the person living with the disorder to recognize that psychotherapeutic help is needed and can be beneficial.

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.

On the other hand, when treatment is successfully applied, it 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 for avoidant personality disorder may include cognitive behavioral therapy CBT , psychodynamic therapy, and schema therapy. CBT is helpful for learning 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.

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. One of the first steps in improving quality of life with avoidant personality disorder is to recognize the signs. 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 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database. 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.

Learn the best ways to manage stress and negativity in your life. Avoidant Personality Disorder. Cleveland Clinic. Paniagua FA. Handbook of Multicultural Health. Academic Press. Ashton M. Individual Differences and Personality Second Edition. Skodol A. Merck Manual for Professionals. Del Giudice M. Evolutionary Psychopathology: A Unified Approach. Oxford University Press. Children naturally want to bond with their parents, but due to the constant parental rejection and ridicule, it's virtually impossible for a healthy bond to form.

This leaves these children hungry for close relationships, yet lacking the skills to form and maintain them. They begin to develop a protective psychological shell that shields them from further parental ridicule and rejection. The resulting social awkwardness may cause peers to tease and ridicule them as well, contributing to the intense fear of social interactions.

Reports on avoidant personality disorder statistics suggest that about 1 percent of the U. People who think they may suffer from this mental health condition should seek help from a psychologist or psychiatrist. The clinician will compare symptoms, behaviors, and history to avoidant personality DSM criteria and make a diagnosis.

With long-term treatment, typically talk therapy combined with psychotherapy, people with the disorder can often develop some ability to relate with others and engage socially.

What Is Avoidant Personality Disorder? Medically reviewed by Harry Croft, MD. All Rights Reserved. Site last updated October 26, Samantha Gluck. What Is Avoidant Personality Disorder To answer the question -- what is avoidant personality disorder — it's important to first understand what it is not. It is also clear that negative self-concept is an important therapeutic target, and that it may be more complex than simply having low self-esteem.

A limitation to the generalization of this research, however, is that most of it was not conducted in samples selected for AVPD, and none of the studies specifically examined for the presence or absence of SAD.

Millon 35 and others 91 considered early interactions with parents as an important etiological factor in AVPD.

The likely importance of early caregiver experiences is underscored by adoption studies. Studies suggest that patients with AVPD are more likely to perceive parents as less affectionate, more rejecting, guilt-engendering, and less encouraging of achievement than matched controls.

However, there were some noteworthy differences: those with a primary diagnosis of AVPD reported fewer positive relationships with other adults and poorer parental social ability and less sexual abuse and physical neglect than a group of persons with other PDs. In summary, despite some variability of findings, there seems to be reasonable support for an association between neglect and emotional abuse, and perhaps less encouragement by early caregivers and later AVPD symptomatology.

Recall bias influenced by underlying hypersensitivity cannot be excluded as a contributor to these findings, but twin studies point to some role for environmental factors, 21 and negative experiences within the family would appear a likely candidate. Attachment provides an explanatory model for the link between temperament, adverse childhood environment, and PD. This attachment style may be associated with a negative self-concept and a fear of intimate relationships. A number of studies have confirmed the theorized relationship between AVPD and both anxious and avoidant strategies.

Research suggests that experiences with critical, demeaning, and neglectful early caregivers may increase the risk of developing a fearful attachment style. These findings are important because attachment style is highly relevant to assessment and treatment. For example, it is more difficult for a therapist to establish and maintain a relationship with an individual who is distrustful of others, who is hypersensitive to criticism and rejection, and who relies on avoidant coping strategies.

It has been proposed that a child may develop hypervigilance as a coping strategy when a parent is inaccessible or inconsistent, 91 , and this hypervigilance may then generalize to other social situations. This might be expected to apply equally to SAD.

Other authors suggest that repeated negative interactional experiences with parents might lead the child to expect unpleasant or distressing interactions, and to then employ avoidance as a coping strategy.

The resulting social isolation in turn predisposes to greater emotional distress. From a cognitive theory perspective, this would represent a cognitive mediational factor reinforcing avoidance as a coping strategy. Millon 35 viewed parental rejection or denigration as a critical factor in the erosion of self-esteem in the child p.

A role for temperamental factors has also been proposed. A relationship between attachment and temperament has also been described. For example, the amount and expression of distress an infant experiences upon separation from the early caregiver may be influenced by temperamental traits, and the responsiveness of the caregiver may influence attachment.

Genetic studies have the potential to offer insight into the relative contributions of genes and environment, as well as more specifically to inform the question of diagnostic validity. A heritability coefficient for AVPD of 0. In summary, these studies suggest a complex relationship between genes, temperament, early childhood environment, attachment style, and personality in AVPD, which remains to be fully elucidated. The research indicates some shared vulnerability with SAD, but also some points of difference.

Apart from case reports, there is little research into the treatment of AVPD specifically. There are mixed findings: some studies report no effect on treatment outcome, — while others report less likelihood of remission from SAD and failure to reach normative levels of functioning; , some studies suggest an increased risk of persistent symptoms of SAD when comorbid with AVPD.

Pharmacotherapy is generally not thought to be effective in personality disorder, and there are no trials of its use specifically in AVPD reported in the literature. However, clinical recommendations exist for using similar pharmacotherapeutic approaches as for SAD. In terms of psychological treatment, graded exposure, cognitive behavior therapy CBT , social skills training, psychodynamic psychotherapy, schema therapy, and supportive—expressive psychotherapy have all been reported to be helpful, although the number of studies is small.

Case reports of successful therapy emphasized a formulation that included experiential avoidance as a key maladaptive coping strategy requiring recognition by the therapist and targeted intervention. In relevant cognitive research, a more threat-avoidant attention focus, compared to threat-focused, has been reported in association with poorer outcome in SAD and may therefore be a relevant consideration for CBT.

Currently, it appears that a problem-focused approach is the best basis for treatment planning. Selection of treatment strategies should be based on a comprehensive, individualized formulation that takes account of symptoms, emotional functioning including mentalization and alexithymia , relational functioning including attachment style , and current coping strategies including behavioral and experiential avoidance.

Development and testing of interventions which specifically target the identified symptoms and difficulties of AVPD is urgently needed. The research into social cognition appears particularly promising for AVPD and other personality disorders. AVPD is a common condition associated with considerable distress and impairment. It has, for some time, been viewed as essentially a more severe variant of SAD, with criterion overlap likely exacerbating the problem.

An increasing body of research is demonstrating meaningful points of difference from SAD, including attachment pathology and self-concept. The field of social psychology offers a number of insights that appear highly relevant to AVPD and may represent a fruitful avenue of further study. In particular, social cognition, including reflective functioning, theory of mind, and affect consciousness offer promise.

Further research into the meaning of rejection and the nature of the sense of inferiority and personal inadequacy that is said to characterize AVPD may yield information of relevance to better delineating AVPD. In turn, this may inform changes to diagnostic criteria to better differentiate the condition.

An understanding of attachment difficulties in AVPD appears especially relevant to treatment, and the literature suggests that many of the CBT strategies used for SAD are also likely to be helpful. Targeting self-concept, experiential avoidance, and maladaptive schemas may also be helpful. However, optimal treatment has yet to be empirically established. If a domain-based model of classification is adopted, an understanding of the broad symptomatology and vulnerability factors in disorders of social anxiety can inform decision-making.

National Center for Biotechnology Information , U. Psychol Res Behav Manag. Published online Mar 8. Lisa Lampe 1 and Gin S Malhi 2. Author information Copyright and License information Disclaimer. This work is published and licensed by Dove Medical Press Limited.

By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. This article has been cited by other articles in PMC. Abstract Avoidant personality disorder AVPD is a relatively common disorder that is associated with significant distress, impairment, and disability.

Keywords: avoidant personality disorder, social anxiety disorder, social cognition, psychotherapy, attachment. Introduction Avoidant personality disorder AVPD , as conceptualized in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition DSM-5 , is characterized by extensive avoidance of social interaction driven by fears of rejection and feelings of personal inadequacy. Aim This review interpreted current insights from two perspectives: summarizing key information and opinion about AVPD and presenting novel insights from a broad literature.

Relationship to schizoid personality disorder Some concern was expressed about possible overlap of AVPD with schizoid personality disorder, because of its historical relationship conceptually with schizophrenia.

Relationship to social anxiety disorder One important influence on research into the overlap between SAD and AVPD has been the changes in diagnostic criteria for both disorders across different versions of the DSM. Relationship to dependent personality disorder DSM-IV attempted to link behaviors with motivations eg, lack of confidence in personal abilities in dependent personality disorder [DPD] and fear of rejection in AVPD in order to better characterize personality disorders and reduce overlap.

Phenomenology The key cognitive features of AVPD are a sense of inferiority coupled with a fear and expectation of rejection. Social cognition The social psychology literature has reported on a range of findings that may be of relevance to AVPD and might form the basis of novel and potentially fruitful new research approaches in AVPD.

Fear of rejection The fear of rejection, although a central construct in AVPD, has received surprisingly little attention from researchers. Toward an understanding of etiological factors Early childhood experiences Millon 35 and others 91 considered early interactions with parents as an important etiological factor in AVPD.

Attachment style Attachment provides an explanatory model for the link between temperament, adverse childhood environment, and PD.

Links between early childhood experiences and the core features of AVPD: hypervigilance, avoidance, low self-esteem, and negative self-concept It has been proposed that a child may develop hypervigilance as a coping strategy when a parent is inaccessible or inconsistent, 91 , and this hypervigilance may then generalize to other social situations.

Genetic factors Genetic studies have the potential to offer insight into the relative contributions of genes and environment, as well as more specifically to inform the question of diagnostic validity.

Conclusion AVPD is a common condition associated with considerable distress and impairment. Footnotes Disclosure The authors report no conflicts of interest in this work. References 1. American Psychiatric Association. The relationship between generalized social phobia and avoidant personality disorder in a national mental health survey.

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