Everyone has a different personality, but some types of personalities are categorized as disorders. These personality types produce psychiatric symptoms that cause serious problems with relationships and work. People with avoidant personality disorder (APD) have a lifelong pattern of extreme shyness, feelings of inadequacy, and hypersensitivity to rejection. About five percent of adults have APD.
The cause of APD and other personality disorders is unknown. Researchers think genetic and environmental factors might play a role.
There is no way to know who will develop APD. However, it is known that people who have the disorder were very shy as children. But not every child who is shy goes on to develop the disorder. And not every adult who is shy has the disorder.
If you have APD, you were probably shy as a child. Most likely, your shyness grew as you got older to the point that you began to avoid other people and situations.
If you have APD, you might have difficulty interacting with others in social and work settings because you fear:
You may also have trouble believing that people like you. Because you are always on alert for people to reject or criticize you, you may misinterpret the neutral comments and actions of others as negative.
Your doctor will ask you questions to see if you meet the criteria for a diagnosis of APD. To meet these, your symptoms must have begun no later than early adulthood, and you must have at least four of the following symptoms:
- You avoid work activities that involve contact with others out of fear of criticism, disapproval, or rejection.
- You are unwilling to get involved with other people unless you are sure they like you.
- You hold back in relationships because you are afraid you will be ridiculed or humiliated.
- The fear of being criticized or rejected in social situations dominates your thoughts.
- You hold back in social situations—or avoid them altogether—because you feel inadequate.
- You think you are inferior to others, unappealing to others, and socially inept.
- You are unlikely to participate in new activities or take personal risks because you are afraid of embarrassment.
Psychotherapy is the most effective treatment for APD. The goal of psychotherapy is to help you identify your unconscious beliefs about yourself and how others see you. It also aims to help you function better in your social and work lives. Two types of psychotherapy your mental health therapist might use include:
Psychodynamic therapy is a form of talk therapy that helps you become self-aware about your unconscious thoughts and how your past experiences are influencing your current behavior. This allows you to examine and resolve past emotional pains and conflicts. Then you can move forward with a healthier outlook regarding yourself and how others see you. Psychodynamic psychotherapy produces lasting results, and the benefits of the therapy continue even after treatment.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a form of talk therapy. In CBT, your mental health therapist helps you to recognize your unhealthy beliefs and thought processes. The goal is to then replace them with healthier ones. Your therapist will encourage you to examine and test your thoughts and beliefs to determine if they have a factual basis. Your therapist will also help you to develop alternative, healthier views and thoughts.
Your doctor may prescribe antidepressant medications to help reduce your sensitivity to rejection. Medication is not a replacement for psychotherapy, but it can help relieve symptoms while you undergo therapy. A combination of therapy and medication might be the most effective treatment option.
Treatment does not change your personality. You will most likely always have shyness and difficulty with social and work interactions. However, treatment can improve your symptoms and help you develop the ability to relate to other people.
People who do not receive treatment for APD may become isolated from others. They may also develop another psychiatric disorder such as depression, agoraphobia, or a substance abuse problem.