Avoidant personality disorder (AVPD) and social anxiety disorder (SAD) share features when it comes to interpersonal situations, but differences in scope and impact on daily life set these conditions apart.
It’s natural to feel anxious when you’re being assessed. Extreme feelings of self-consciousness and a debilitating fear of embarrassment or criticism, however, can suggest your experience goes beyond what’s typical for social jitters.
Avoidant personality disorder (AVPD) and social anxiety disorder (SAD) are mental health conditions that present with these types of primary symptoms. While they’re often confused for one another or used interchangeably, they’re separate diagnoses.
Social anxiety disorder (SAD), once referred to as social phobia, is listed as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders 5th edition, text revision (DSM-5-TR), the clinical guidebook used by mental health professionals in the United States.
SAD features impairing symptoms of anxiety, fear, and avoidance related to social situations that open you up to the scrutiny of others.
Examples include meeting new people, giving a lecture, or eating in public. Any situation you believe may lead to embarrassment, humiliation, or rejection can be a source of intense negative emotions in SAD.
Ultimately, SAD can cause you to avoid certain social experiences completely. If you do have to participate, social situations are endured with intense anxiety or fear.
According to the Anxiety & Depression Association of America (ADAA), SAD affects approximately 15 million American adults and is the second most commonly diagnosed anxiety disorder.
SAD signs and symptoms
To receive a diagnosis of SAD, you must meet the following criteria outlined in the DSM-5-TR:
- marked fear or anxiety in at least one social situation involving the scrutiny of others
- negative feelings are driven by a fear of acting in a way or revealing anxiety that will lead to embarrassment, humiliation, rejection, or offense of others
- specific social situations almost always cause anxiety or fear
- specific social experiences are avoided or endured with extreme anxiety or fear
- anxiety or fear is out of proportion to the action threat
- fear, anxiety, or avoidance is persistent, typically present for 6 months or longer
- fear, anxiety, or avoidance causes clinically significant impairment in important areas of function
- no substances or other medical or mental conditions can account for symptoms
Signs that you may be experiencing SAD emerge when you’re faced with specific scenarios, like giving a speech or having dinner with coworkers.
Signs can include:
- spending days fixated on the upcoming situation
- rehearsing behaviors or conversations over and over
- overwhelming feelings of self-consciousness
- rapid heartbeat
- skin flushing, sweating, or trembling
- nausea
- feeling as if your mind has “gone blank”
- rigid posture
- difficulty speaking up or engaging in conversation
- avoiding eye contact
Avoidant personality disorder, or AVPD, is defined by the DSM-5-TR as a persistent pattern of social inhibition, hypersensitivity to negative evaluation, and feelings of inadequacy. It belongs to the group of cluster C personality disorders along with obsessive-compulsive personality disorder and dependent personality disorder.
Each of the cluster C personality disorders features similarities related to underlying fear and anxiety. Like all personality disorders, AVPD involves emotional, cognitive, interpersonal, and behavioral responses considered outside of what’s typical.
AVPD symptoms
A diagnosis of AVPD is given under the DSM-5-TR when long-standing patterns of social impairment, negative evaluation sensitivity, and feelings of inadequacy lead to four or more of the following criteria:
- avoidance of occupational activities
- an unwillingness to become involved with people without certainty of being liked
- maintaining distance in intimate relationships
- reoccupation with being criticized or rejected in social situations
- difficulty forming new interpersonal connections
- self-perception of inferiority, being unappealing, or being incapable
- reluctance to take personal risks or try new activities
Signs you may be living with AVPD include:
- feeling extremely hurt even at minor criticism or disapproval
- reluctance to speak up or voice an opinion
- shy, quiet, or timid behaviors
- mistrust of others’ intentions
- regular exaggeration of potential dangers in ordinary situations
- living a restricted, predictable lifestyle
- regularly canceling plans, job interviews, doctor appointments, and other obligations
- physical symptoms of anxiety, like rapid heart rate, sweating, nausea, or skin flushing
While
Currently, one of the biggest differences between these conditions is their scope. SAD tends to be related to specific social experiences, like giving a speech or using a public restroom, while AVPD involves the majority of interpersonal interactions and affects almost every aspect of daily life.
Anxiety’s role is also an important differentiator.
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SAD and AVPD are separate diagnoses, but you can live with them simultaneously. In fact, according to the DSM-5-TR, SAD is the most common co-occurring anxiety disorder with AVPD, and AVPD is the most common co-occurring personality disorder with SAD.
Both AVPD and SAD can feature symptoms of:
- anxiety or fear about social events
- physical symptoms, like nausea or sweating
- avoidance behaviors
You may be living with both conditions when symptoms are pervasive in all areas of life, like in AVPD, but become more severe when dealing with a specific type of social situation, like in SAD.
AVPD and SAD can both be treated with psychotherapy and medication.
Cognitive behavioral therapy (CBT) is a psychotherapy framework used in both conditions. CBT utilizes different approaches to help restructure unhelpful thoughts and behaviors into beneficial ones.
In both SAD and AVPD, CBT seeks to help you recognize negative thoughts and feelings and understand how they influence your behaviors.
While there are many different types of CBT, SAD is commonly treated using two CBT formats:
AVPD also utilizes CBT, though research into specific formats is limited. AVPD can affect many different areas of personal function and is often treated with multiple approaches, including:
- CBT
- interpersonal therapy (IPT)
- dialectical behavior therapy (DBT)
- group therapy
- psychoeducation
Both conditions may benefit from the use of medications such as:
AVPD and SAD are separate mental health conditions that share primary features. Both involve impaired social function with a fear of negative feedback, but SAD is specific to certain social scenarios, whereas AVPD affects almost all areas of life.
It’s possible to live with both SAD and AVPD. Psychotherapy and medication can help treat these conditions, though approaches may vary based on individual challenges and underlying psychological mechanisms.