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Avoidant Personality Disorder

What is avoidant personality disorder?

People with avoidant personality disorder (APD) have a lifelong pattern of extreme shyness. They also feel inadequate and are hypersensitive to rejection. APD can cause psychiatric symptoms that create serious problems with relationships and work.

Prevalence
About 5 percent of adults have APD, according to the National Institute of Mental Health.
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Symptoms

What are the symptoms of avoidant personality disorder?

If you have APD, you might have difficulty interacting in social and work settings. This is because you may fear any of the following:

  • rejection
  • disapproval
  • embarrassment
  • criticism
  • getting to know new people
  • intimate relationships
  • ridicule

You may also have trouble believing that people like you. When you’re sensitive to rejection and criticism, you may misinterpret neutral comments or actions as negative ones.

Causes

What causes avoidant personality disorder?

The cause of APD and other personality disorders is unknown. Researchers think genetic and environmental factors might play a role.

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Risk factors

Who is at risk of avoidant personality disorder?

There is no way to know who will develop APD. People who have the disorder are typically very shy as children. However, not every child who is shy goes on to develop the disorder. Likewise, not every adult who is shy has the disorder.

If you have APD, your shyness most likely grew as you got older. It may have gotten to the point that you began avoiding other people and certain situations.

Diagnosis

How is avoidant personality disorder diagnosed?

Your doctor may refer you to a mental health professional who will ask you questions to determine if you have APD. To be diagnosed with APD, your symptoms must begin no later than early adulthood.

You must also show at least four of the following characteristics:

  • You avoid work activities that involve contact with others. This is due to fear of criticism, disapproval, or rejection.
  • You’re unwilling to get involved with other people unless you’re sure they like you.
  • You hold back in relationships because you’re afraid you’ll be ridiculed or humiliated.
  • The fear of being criticized or rejected in social situations dominates your thoughts.
  • You hold back or completely avoid social situations because you feel inadequate.
  • You think you’re inferior to others, unappealing, and inept.
  • You’re unlikely to take part in new activities or to take personal risks because you're afraid of embarrassment.
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Treatment

How is avoidant personality disorder treated?

Psychotherapy is the most effective treatment for APD. Your therapist may use psychodynamic psychotherapy or cognitive behavioral therapy. The goal of therapy is to help you identify your unconscious beliefs about yourself and how others see you. It also aims to help you function better socially and at work.

Psychodynamic psychotherapy

Psychodynamic therapy is a form of talk therapy. It helps you become aware of your unconscious thoughts. It can help you understand how past experiences influence your current behavior. This allows you to examine and resolve past emotional pains and conflicts. Then you can move forward with a healthier outlook about yourself and how others see you. Psychodynamic psychotherapy produces lasting results with benefits that continue after treatment.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is another form of talk therapy. In CBT, a therapist helps you recognize and replace unhealthy beliefs and thought processes. Your therapist will encourage you to examine and test your thoughts and beliefs to see if they have a factual basis. They’ll also help you develop alternative, healthier thoughts.

Medication

The FDA hasn’t approved any medications to treat personality disorders. However, your doctor may prescribe antidepressant medications if you have co-occurring depression or anxiety.

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Outlook

What is the outlook for avoidant personality disorder?

People who don’t receive treatment for APD may isolate themselves. As a result, they may develop an additional psychiatric disorder, such as:

Treatment doesn’t change your personality. You’ll most likely always be shy and have some difficulty with social and work interactions. But treatment can improve your symptoms and help you develop the ability to relate to others.

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