Avoidant Personality Disorder: Causes, Symptoms, and More

Avoidant personality disorder is the avoidance of social situations and interpersonal relationships due to fear of rejection or criticism.

Avoidant personality disorder is a long-term and often debilitating condition. It usually has its roots in a person’s formative years. The early childhood environment, childhood temperament, and a genetic predisposition can all play a role in the development of the disease.

Keep reading to learn more about the causes, symptoms, diagnosis, and treatment of avoidant personality disorder, as well as the outlook for people with the condition.

Avoidant personality disorder occurs when a fear of rejection and feelings of inadequacy provoke a person to largely avoid social interactions. Hypersensitivity to criticism and the need for reassurance also characterize the condition, which can lead to considerable impairment and disability.

Some people with avoidant personality disorder may have co-occurring depression and substance use disorders and an increased risk of suicidal behavior. Other possible comorbidities include social anxiety disorder and certain eating disorders.

Research suggests that the prevalence of avoidant personality disorder is in the range of 1.5 to 2.5%with a slightly higher rate in women than in men.

The development of avoidant personality disorder can result from a complex mix of environmental factors, Personality traits, and genetics. The following can all play a key role:

  • fearful or anxious childhood attachment styles
  • early childhood environment, which may involve deficits in parental or caregiver affection
  • infantile temperaments, such as hypersensitivity and rigidity
  • family history of the disease

The relationship between the above factors is also significant. For example, if a distressed child receives a dismissive response from a parent or caregiver, this can potentiate maladaptive behavior. Additionally, early negative interactions with caregivers can lead to fear of intimacy and promote hypervigilance.

Other contributing factors may include:

  • helping-blaming
  • abuse
  • minimal parental encouragement
  • neglect

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) lists the symptoms avoidant personality disorder as follows:

  • desperate efforts to avoid abandonment
  • restraint in intimate relationships
  • avoidance of getting involved with others
  • preoccupation with criticism or rejection in social encounters
  • inhibition in new interpersonal interactions
  • reluctance to engage in new activities
  • an unstable sense of self
  • temporary paranoia
  • rapid mood swings
  • intense anger

A mental health professional will ask about the person’s history and perform a psychological evaluation to diagnose the disorder.

To reach the diagnostic threshold, a person must have persistent patterns of hypersensitivity and unstable relationships and have at least four symptoms from the list in the DSM-5.

Additionally, the evaluation rules out other potential diagnoses and examines whether an individual has any co-occurring conditions. It also determines whether abnormal behaviors are chronic and affect most areas of life.

Although some symptoms are common during childhood and adolescence, a person’s personality is still developing at this time. For this reason, doctors may delay a diagnosis until symptoms persist and interfere with general functioning.

The treatment of avoidant personal disorder usually revolves around forms of psychotherapy.

Cognitive-behavioral therapy

One of the fundamental tenets of Cognitive Behavioral Therapy (CBT) is that psychological problems are caused by unhelpful thought patterns. CBT helps people identify negative thoughts and teaches them how to react more effectively to difficult situations.

CBT may be beneficial in the treatment of avoidant personality disorder. However, the to research in its effectiveness is limited.

Learn more about CBT.

Interpersonal therapy

Some experts recommend interpersonal therapy (IT) to build confidence and overcome social anxiety. Computer science helps someone to understand their emotions and to use this understanding to improve social interactions.

A small study 2022 found that combining IT with mentalization-based group therapy produced positive treatment results.

Learn more about interpersonal therapy.


The Food and Drug Administration (FDA) did not approve any medication for the condition. However, anecdotal reports suggest that certain medications for social anxiety disorder may relieve symptoms. An example is selective serotonin reuptake inhibitors (SSRIs), such as citalopram (Celexa).

Additionally, medications can help reduce symptoms of co-occurring conditions, such as depression.

Avoidant personality disorder is a long-lasting condition. However, research noted that with time and treatment, symptoms can sometimes improve to the point where they no longer meet diagnostic criteria.

Prompt diagnosis and management of the disease is of crucial importance for an individual to have a good quality of life.

People with avoidant personality disorder exhibit significant avoidance of social situations. Symptoms include feelings of inadequacy, fear of rejection, and oversensitivity to criticism.

The basis of a diagnosis is the presence of at least four recognized symptoms manifesting in early adulthood.

Treatment usually involves CBT and informatics. Although medications aren’t a treatment option for avoidant personality disorder, doctors can use them to treat co-occurring conditions, such as depression.

The outlook for people with the condition varies, but some will see their symptoms improve with time and treatment.

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