Avoidant Personality Disorder

Avoidant Personality Disorder is a type of personality disorder that is characterised by the persistent pattern of extreme social inhibition, feelings of inadequacy, and a heightened sense of negative evaluation or rejection from people. People with Avoidant Personality Disorder tend to avoid any social interaction and new experiences. They have this intense fear that they are going to be embarrassed, criticised or rejected. This kind of intense fear and avoidance leads to interference in day-to-day functioning. It leads to impairment in the individual’s personal, professional or occupational functioning. 

Avoidant Personality Disorder is classed as a personality disorder in Cluster C. Cluster C includes disorders that are characterized by anxious or frightening thinking or behaviour. It also includes personality disorders like obsessive-compulsive disorder and dependent personality disorder. All of these disorders have a common theme, they are characterised by anxiety, fear or apprehension. Research suggests that Avoidant Personality Disorder affects about 2.5% of the general population, though it might be higher in the clinical population. 

Read More: Psychology Behind Avoidant Personality

Key Symptoms of Avoidant Personality Disorder 

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the diagnostic criteria for Avoidant Personality Disorder are the presence of a pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative judgment, which should start in early adulthood and persist in a variety of settings. 

Individuals with this disorder usually avoid any kind of occupational activities that might involve contact and interaction with people. This avoidant behaviour is the result of fear of rejection, criticism and negative evaluation. They are also unwilling to be involved with people until they are very certain that they will like them. They also show hesitation in forming intimate relationships because of the fear of being shamed or ridiculed.

Also, they are always preoccupied with being criticised or rejected in social situations, which also prevents them from interacting efficiently with people. Their perception of self is often very negative and they view themselves to be inferior to other people. 

Comparison with Similar Disorders

• Social Anxiety Disorder (SAD): Avoidant Personality Disorder and Social Anxiety Disorder, share various characteristics, particularly in terms of the fear of social judgement and rejection and avoidance of social situations. However, SAD tends to be more situational and particular to the context, and it is less pervasive in different areas of life, unlike avoidant personality disorder. 
• Schizoid Personality Disorder: Schizoid Personality Disorder is characterised by a lifelong pattern of indifference to other people and social isolation. The main difference here is that people with Schizoid Personality Disorder typically lack any desire to make social relationships. However, people with Avoidant Personality Disorder have a deep desire for social connection, but avoid it out of your rejection. 
• Dependent Personality Disorder: Individuals with this disorder exhibit strong interpersonal feelings, but they tend to rely on others to an extensive degree and seek constant reassurance. In contrast, people with personality disorders tend to avoid relying on other people due to fear of rejection. 

Causes of Avoidant Personality Disorder 

1. Genetic factor 

Several scholars argue that hereditary variables play a role in the development of personality disorders. Various studies show that there is a moderate genetic component in the development of Avoidant Personality Disorder. Studies done on twins tend to show that genetic factors may account for about 35 to 40% of the variance in the development of an avoidant personality disorder. Biological vulnerability to the disorders plays a very important role in the development of avoiding personality disorders. However, biological factors are not the only ones that determine the development of the disorder. Environmental factors also tend to play a great role. 

2. Environmental factors 

Environmental factors, particularly occurring during childhood,d, have a great impact on the development of avoiding personal disorders. Experiencing adverse situations such as parental rejection, lack of warmth, criticism, and emotional neglect can increase the child’s fear of judgement and rejection. Studies have shown that individuals with avoidant personality disorder report being raised in an environment that lacked warmth, support, and encouragement from the parent or the caregiver. 

3. Psychological Factors 

Cognitive factors such as self-concept and coping mechanisms also play an important role. Individuals with this disorder tend to have cognitive distortion, meaning that they might distort or exaggerate their beliefs about rejection and the likelihood of negative judgment by others. This pattern often starts in childhood and individuals avoid social situations to minimise any threat to their self-esteem. 

4. Family Dynamics and Attachment Styles 

Parents or caregivers who are very emotionally distant can contribute to the development of avoidant behaviours. Children growing up in such environments develop avoidant coping mechanisms where they choose to withdraw from the relationship rather than face the potential criticism. If the parents are overprotective of the child, they may not develop enough confidence to engage in social situations reinforcing their avoidance. Alternatively, if the parents are overly critical or indifferent to the child, the child internally develops a sense of unworthiness, which translates into fear of social interactions in adulthood. To understand Avoidant Personality Disorder in great depth and also to understand how the symptoms might present in the clinical setting, let’s understand the following example. 

Sarah is a 29-year-old woman living alone in a small apartment on the outskirts of the city. She always felt very different from her peers but over the years those differences became very overwhelming to lead a normal life. From a very young age, she was shy, avoiding the playgrounds or birthday parties because she felt she feared other children wouldn’t like her or they would make fun of her for being shy. While some of the children grew out of this fear, for Sarah this fear only intensified. Even in our high school, a fear of rejection led her to avoid extracurricular activities. 

Even her home environment wasn’t the best. Her parents were emotionally very distant. Father was a perfectionist, often pointing out her flaws without recognising her achievement. These experiences left her feeling constantly inadequate and feeling that she wasn’t good enough.

In the early 20s, her avoidant patterns became even more pronounced. She took a job as a data entry clerk, refusing any promotional opportunity out of the thought of being in the spotlight or facing potential criticism. Her fear of negative evaluation was all-consuming. At work, even mild suggestions or neutral feedback from her manager or peers felt like an attack. Once when her boss mentioned an error in her report, she was devastated and ruminated on that comment for days, convinced that her boss thought she was incompetent.

In social settings, she was very hyper-vigilant, scanning for any sign that people might be judging her. Sarah’s personality disorder impacted nearly every aspect of our lives. She always assumed that others didn’t want her around. She maintained minimal contact with family members who had grown frustrated with her constant excuses of avoiding gatherings. Her romantic life was non-existence as she couldn’t imagine anyone would find her attractive or interesting. The thought of trying new things, such as joining a gym or taking a class, was out of the question. She avoided any activities where she might be seen or judged.

She started experiencing depressive episodes, and it became too overwhelming that she finally sought help. Her therapist helped her to understand her fears of inadequacy and rejection were rooted in her childhood experiences and learn patterns of avoidance. Over time she began working through her fear of rejection, learning to challenge negative thought patterns about herself. 

This example gives us a very nuanced understanding of how this disorder can present in real life. This disorder has very detrimental effects on the individual’s work life, personal life and occupational life as well. Apart from experiencing intense avoidance of social situations, individuals can experience depression as a result of such behaviours. 

Treatment Approaches for Avoidant Personality Disorder 

Therapists widely use Cognitive Behavioural Therapy to treat Avoidant Personality Disorder. The focus of CBT is to identify and challenge any kind of distorted thinking pattern that might lead to avoidant behaviour. Therapists might work on Cognitive Reconstruction and challenge the negative and irrational beliefs about how they are perceived as inadequate and the fears of rejection. 

Therapists might also include Exposure Therapy, where they expose individuals to their feared social situations in a controlled manner to reduce avoidant behaviours. They may also require certain skill training at times. These include social skills that are important for the individual to navigate interactions. These social skill training might include training in communication skills, assertiveness or how to handle social situations more effectively. 

Therapists use Schema Therapy for individuals with chronic and ingrained personality disorders, such as Avoidant Personality Disorder. Schema Therapy integrates elements of CBT, psychodynamic therapy, and attachment theories to address deep-rooted emotional patterns or schemas individuals form during childhood. Schema Therapy allows the client to understand their unmet needs from childhood and recognise these unmet needs. Individuals can start working towards meeting these unmet needs in a healthier way rather than through avoidance. The therapist provides a very safe nurturing environment to “reparent” the client which helps them to develop healthy coping mechanisms. This therapy helps the individual to improve their daily functioning. 

Therapists often use CBT as a major modality to treat Avoidant Personality Disorder, and pharmacotherapy can also help manage certain comorbid disorders that might exacerbate its symptoms. Most disorders that are comorbid with avoidant personality disorders are anxiety and depression. Doctors often prescribe selective serotonin reuptake inhibitors to individuals with Avoidant Personality Disorder who experience social anxiety and depression. This helps the individual by increasing the Serotonin levels in their brain by reducing the reuptake process of serotonin. Doctors sometimes use serotonin-norepinephrine reuptake inhibitors, which work on both serotonin and norepinephrine pathways to help regulate mood and anxiety.

Avoidant Personality Disorder is a chronic and persuasive condition that can affect the individual, social and occupational functioning and reduce the overall quality of life. Recognising and diagnosing Avoidant Personality Disorder along with its treatment is very important to improve its long-term outcomes.