Avoidant Personality Disorder
Many people struggle with shyness, but a small segment of the population suffers from shyness so severe that it brings about extreme social inhibition. In avoidant personality disorder, extreme shyness and fear of rejection make it difficult for people to interact socially and professionally.
People with avoidant personality disorder may avoid work activities or decline job offers because of fears of criticism from others. They may be inhibited in social situations as a result of low self-esteem and feelings of inadequacy. Additionally, they may be preoccupied with their own shortcomings and form relationships with others only if they think they will not be rejected. Loss and rejection are so painful to these individuals that they will choose loneliness rather than risk trying to connect with others.
According to the DSM-5, common signs of avoidant personality disorder include:
- Easily hurt by criticism or disapproval
- No close friends
- Reluctance to become involved with people
- Avoidance of activities or occupations that involve contact with others
- Shyness in social situations out of fear of doing something wrong
- Exaggeration of potential difficulties
- Showing excessive restraint in intimate relationships
- Feeling socially inept, inferior, or unappealing to other people
- Unwilling to take risks or try new things because they may prove embarrassing
People with avoidant personality disorder have an intense fear of rejection, which makes it very difficult to form or sustain relationships with family, friends, and partners. Lacking significant relationships and constantly finding reasons to avoid social interactions are two key signs that someone may have avoidant personality disorder.
Social anxiety disorder and avoidant personality disorder both involve fearing and avoiding social situations. The two diagnoses overlap, but they may have different roots. Social anxiety disorder is driven by a fear of saying or doing something that could lead to shame and embarrassment. Avoidant personality disorder is driven less by performance anxiety and more by negative self-evaluation in comparison to others. Low self-esteem is a central component: Just as people with avoidant personality disorders don’t like themselves, they assume others will reject them as well, almost to a paranoid extent.
The cause of avoidant personality disorder is unknown. Genetics and environmental factors, such as rejection by a parent or peers, may play a role in the development of the condition.
The avoidant behavior typically starts in infancy or early childhood with shyness, isolation, and avoidance of strangers or new places. Most people who are shy in their early years tend to grow out of the behavior, but those who develop avoidant personality disorder become increasingly timid as they enter adolescence and adulthood.
About 2.4 percent of the U.S. population has avoidant personality disorder, according to the DSM-5. The rates are similar for men and women.
Psychotherapy, particularly cognitive-behavioral approaches, may be helpful. Antidepressant medication can often reduce sensitivity to rejection. A combination of medication and talk therapy may be more effective than either treatment alone.
People with avoidant personality disorder may have some ability to relate to others, and the ability can be reinforced and improved with treatment. Without treatment, those with avoidant personality disorder may become resigned to a life of near or total isolation. They may go on to develop a second psychiatric disorder such as substance abuse or a mood disorder such as depression. While shyness is not a disorder, help from a healthcare provider or a psychiatrist is important if shyness or fear of rejection overwhelms a person's ability to function in life and form relationships.
A trained mental health professional will diagnose avoidant personality disorder based on the criteria listed in the DSM-5, such as avoiding activities that involve social contact and a preoccupation with being criticized or rejected. The clinician may also assess the patient’s family history and medical history.
Individuals with avoidant personality disorder have often learned to rely on themselves. They may struggle with emotional awareness, emotion regulation, vulnerability, intimacy, and communication. They may isolate themselves, particularly in times of stress. Unless someone doesn’t need a high level of emotional intimacy from a partner, people with avoidant personality disorder are often unable to maintain romantic relationships.