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

Avoidant personality disorder is a long-term and often debilitating condition. It typically has its roots in a person’s formative years. Early childhood environment, infantile temperament, and a genetic predisposition can all play a role in developing the disorder.

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

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Avoidant personality disorder happens when a fear of rejection and feelings of inadequacy cause an individual to avoid social interaction extensively. 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 1.5–2.5%, with the rate slightly higher among females than males.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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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 disorder

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

Additional contributing factors may include:

  • caregiver-guilt engendering
  • abuse
  • minimal parental encouragement
  • neglect

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

  • desperate efforts to avoid abandonment
  • restraint in intimate relationships
  • avoidance of involvement 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 changes
  • intense anger

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

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

In addition, the evaluation rules out other potential diagnoses and looks at whether an individual has co-occurring conditions. It also determines whether abnormal behavior patterns are chronic and affect most areas of life.

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

The treatment for avoidant personal disorder typically centers around forms of psychotherapy.

Cognitive behavioral therapy

One of the core principles of cognitive behavioral therapy (CBT) is that psychological problems are due to unhelpful ways of thinking. CBT helps people identify negative thoughts and teaches them how to respond to challenging situations more effectively.

CBT may be beneficial in treating avoidant personality disorder. However, the research into its efficacy is limited.

Learn more about CBT.

Interpersonal therapy

Some experts recommend interpersonal therapy (IT) for developing trust and overcoming social anxiety. IT helps someone understand their emotions and use this understanding to improve social interactions.

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

Learn more about interpersonal therapy.


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

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

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

Prompt diagnosis and management of the condition are critically important for an individual to have a good quality of life.

People with avoidant personality disorder demonstrate extensive avoidance of social situations. The symptoms include feelings of inadequacy, fear of rejection, and hypersensitivity to criticism.

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

The treatment typically involves CBT and IT. Although medications are not a treatment option for avoidant personality disorder, doctors may use them to treat co-occurring conditions, such as depression.

The outlook for those with the condition varies, but some will see improvements in their symptoms with time and treatment.