ConditionMental health & sleep
Avoidant Personality Disorder
Avoidant personality disorder (AvPD) is a long-standing pattern of extreme shyness, feelings of inadequacy and intense sensitivity to criticism or rejection. People with AvPD want close relationships but avoid them, along with jobs and activities involving other people, unless they are sure of being liked. It usually begins by early adulthood and affects about 1 to 2 in 100 people. It overlaps heavily with social anxiety disorder. Psychotherapy, especially cognitive behavioral and schema therapy, can lead to meaningful improvement.
Also called: AvPD, anxious personality disorder, anxious (avoidant) personality disorder
At a glance
- What it is
- A lasting pattern of social inhibition, feeling inadequate and fear of criticism.
- How common
- About 1 to 2% of adults.
- Onset
- Late adolescence or early adulthood; often shy as a child.
- Common companions
- Social anxiety disorder, depression, other anxiety disorders.
- Treatment
- Psychotherapy (CBT, schema therapy, group therapy); medicine for co-existing anxiety or depression.
When to get help
Call 911 or go to the ER
- Thoughts of suicide or self-harm: call or text 988 (US), or call 911 or your local emergency number
See a doctor within a day or two
- Withdrawal so severe that you cannot work, study or care for yourself
- Using alcohol or drugs to get through social situations
Book a routine appointment
- Long-standing avoidance of relationships, work or activities because of fear of rejection or ridicule
- Persistent feelings of being inferior, unappealing or socially inept
- Low mood, hopelessness or loneliness linked to isolation
Signs and symptoms
Doctors diagnose AvPD when at least four of these traits are present across many situations, starting by early adulthood:
- avoiding jobs or activities that involve significant contact with people, for fear of criticism, disapproval or rejection
- being unwilling to get involved with people unless certain of being liked
- holding back in intimate relationships for fear of being shamed or ridiculed
- being preoccupied with being criticized or rejected in social situations
- being inhibited in new social situations because of feeling inadequate
- seeing oneself as socially inept, unappealing or inferior to others
- being unusually reluctant to take risks or try new activities because they may prove embarrassing
In everyday life this can look like turning down promotions, staying in jobs below your ability, having few friends, rarely dating, staying quiet in groups, and reading neutral comments as criticism.
Avoidant personality disorder vs social anxiety disorder
The two overlap so much that many experts see them as points on a spectrum. Many people with AvPD also meet criteria for social anxiety disorder.
| Social anxiety disorder | Avoidant personality disorder | |
|---|---|---|
| Focus | Fear of specific social or performance situations | Pervasive sense of being inadequate as a person |
| Scope | May be limited to certain situations | Affects most areas of life and relationships |
| Self-view | "I will embarrass myself" | "I am inferior and unlikeable" |
| Severity | Variable | Usually more severe and long-lasting |
AvPD also differs from schizoid personality disorder, in which people have little desire for relationships, and dependent personality disorder, which centers on needing others to take care of you. People with AvPD want connection but fear it.
Causes and risk factors
There is no single cause. Contributing factors include:
- temperament: a shy, inhibited temperament in early childhood
- genetics: family history of anxiety disorders or personality disorders
- early experiences: rejection, criticism, ridicule or emotional neglect by parents or peers
- bullying during childhood or adolescence
Diagnosis
A psychiatrist, psychologist or other mental health professional makes the diagnosis through interviews and sometimes structured questionnaires. They will look at how long the patterns have existed, how pervasive they are, and whether other conditions such as depression, social anxiety or autism explain the symptoms better. Personality disorders are usually diagnosed in adults, because personality is still developing in adolescence.
Treatment
Psychotherapy
- Cognitive behavioral therapy (CBT): identifies and challenges beliefs such as "people will reject me," and uses gradual exposure to feared situations and social skills practice.
- Schema therapy: works on deep-rooted patterns from childhood, such as defectiveness and social isolation.
- Psychodynamic therapy: explores how past relationships shape current fears.
- Group therapy: provides a safe setting to practice relating to others, though it may feel daunting at first.
Building trust with a therapist can take time. Early sessions often focus on making therapy itself feel safe.
Medicine
No medicine is approved specifically for AvPD. SSRIs or SNRIs, such as sertraline, paroxetine or venlafaxine, can reduce social anxiety and depression and make it easier to engage in therapy.
Self-help strategies
- Set small, specific social goals and build up gradually.
- Keep a record of predictions ("they'll laugh at me") and what actually happened.
- Practice self-compassion and notice harsh self-criticism, a common driver of low self-esteem.
- Join structured activities based on interests, where conversation has a natural focus.
Outlook
AvPD tends to be long-lasting, but symptoms often lessen with age and treatment. Many people form close relationships and build satisfying careers with support. Untreated, it carries a higher risk of depression, substance use and social isolation.
Frequently asked questions
What are the main signs of avoidant personality disorder?
The main signs are avoiding social contact and work involving people for fear of criticism, holding back in close relationships, feeling inferior or socially inept, and being extremely sensitive to rejection. These patterns start by early adulthood and affect most areas of life.
What is the difference between avoidant personality disorder and shyness?
Shyness is a common personality trait that causes some discomfort but does not stop someone living the life they want. AvPD is persistent and pervasive, causing major distress and limiting relationships, work and daily activities.
Can avoidant personality disorder be cured?
It is usually considered a long-term condition, but therapy can bring substantial, lasting improvement. Many people learn to manage fear of rejection, build relationships and engage more fully in work and social life.
Is avoidant personality disorder the same as social anxiety?
They are closely related and often occur together. AvPD is generally more pervasive, involving a core belief of being inadequate across all relationships, while social anxiety disorder can be limited to particular situations. Treatments overlap.
Sources
This guide was written from current patient and clinical guidance, including:
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), avoidant personality disorder
- MedlinePlus: Avoidant personality disorder
- National Alliance on Mental Illness: Personality disorders
- NHS: Personality disorder
- Cleveland Clinic: Avoidant personality disorder