Avoidant personality disorder (AVPD) causes severe social anxiety and a fear of judgment. This leads to a person isolating themselves from others and avoiding social situations.

People with AVPD often exhibit extreme shyness, sensitivity to criticism, and feelings of inadequacy. They are usually unwilling to connect with others unless they are confident the person will like them.

It is an uncommon condition that affects around 1.5–2.5% of the population.

This article examines AVPD and its symptoms and causes. It also discusses how AVPD differs from social anxiety disorder (SAD) and how doctors treat it.

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AVPD is a mental health condition that causes extreme social inhibition and sensitivity to judgment from others. This, in turn, leads to avoidant behavior, affecting a person’s ability to participate in social events and form relationships.

The condition typically begins by early adulthood and belongs to a group of conditions known as personality disorders. These are conditions that have significant and pervasive effects on a person’s thoughts, feelings, and behaviors across all or most areas of their life.

People with AVPD tend to be shy, quiet, and have low self-esteem. They may act with restraint, speak very little about themselves, and withhold their feelings for fear people will expose, ridicule, or shame them.

They may avoid taking risks or engaging in new activities to avoid embarrassment in front of others, assuming that people will be critical until they prove otherwise.

AVPD can have a significant impact on a person’s happiness as a result. The person may turn down opportunities in their career, or to do things they enjoy, because of it.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), people with AVPD have four or more of the following symptoms:

  • avoidance of work-related activities with others due to fears of disapproval, criticism, and rejection
  • unwillingness to interact with people unless confident they will like them
  • restrained in intimate relationships for fear of people shaming or ridiculing them
  • preoccupations with criticism or rejection in social situations
  • self-conscious and withdrawn in new social environments due to feeling inadequate
  • perceiving themselves as personally unappealing, socially inept, and inferior to others
  • reluctance to take personal risks or engage in unfamiliar activities in case of embarrassment

Other models for diagnosing AVPD also include the internalization of distress, meaning a person directs their emotions inward and may blame themselves for them.

In addition to the main symptoms of AVPD, people may also have symptoms of other mental health conditions. Coexisting conditions are common among those with AVPD due to the impact it has on self-esteem and a person’s ability to lead the life they want to lead.

As a result, people with AVPD can also develop:

  • depression
  • substance misuse
  • eating disorders
  • suicidal thoughts or behavior

AVPD can also result in unhealthy perfectionism, which can increase the risk of postpartum depression.

Both AVPD and social anxiety disorder (SAD) cause anxiety in social situations, and there is a lot of overlap in the symptoms. People with SAD can also engage in avoidant behavior, for example.

However, AVPD has more significant and wide-reaching symptoms than SAD. For example, while a person with SAD might avoid specific situations that cause anxiety, such as public speaking or eating in front of others, a person with AVPD may avoid talking in general.

Additionally, while someone with SAD can be aware their fears of scrutiny are irrational, a person with AVPD may feel they are real. SAD is also more common than AVPD, affecting around 7.1% of adults in the United States.

Some researchers view SAD and AVPD as belonging to the same spectrum of social anxiety, with AVPD being the most severe form. At the moment, though, health organizations view them as distinct conditions.

Researchers do not fully understand the causes of AVPD. A combination of genetics, early environmental influences, and childhood temperament may play a role.

For example, a person’s attachment to their parent or caregiver may affect their likelihood of developing social anxiety or AVPD later on.

If a caregiver is often dismissive of a child’s distress, this could cause them to expect rejection when they ask for support, to learn that their emotions are bad or unimportant, and to distrust other people.

However, more research is necessary to understand the potential impact of attachment and parenting styles on AVPD.

There is little research on the treatment of AVPD specifically, but talk therapies such as cognitive behavioral therapy (CBT), help alleviate AVPD symptoms.

CBT works by helping a person understand how their beliefs influence their thinking, which in turn, influences their emotions and behavior. By addressing and gradually changing these deep-rooted beliefs, people can start to feel less afraid of others.

The Food and Drug Administration (FDA) has not approved any medications for AVPD, but some evidence indicates that medications for SAD may also improve AVPD-related symptoms.

Doctors may also recommend treatments for conditions that occur alongside AVPD, such as antidepressants for depression.

Anyone who finds that anxiety is interfering with their health or well-being should speak with a doctor or mental health professional. It is particularly important to seek help if a person finds it difficult to:

  • talk with friends and family
  • maintain important relationships
  • take care of themselves
  • work

With support, it is possible to reduce the symptoms of AVPD and improve quality of life.

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 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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AVPD is a personality disorder that causes problems with connecting with others due to feelings of inadequacy. A person may avoid many different social situations due to a fear of rejection, disapproval, embarrassment, or ridicule.

Unlike SAD, though, AVPD is more severe. It usually becomes apparent in early adulthood and affects much of how a person thinks, feels, and behaves.

Talk therapy with a qualified psychotherapist can help. However, more research that specifically focuses on AVPD’s causes and treatments is necessary to better understand the condition.