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Avoidant Personality Disorder: Signs and Treatments


Avoidant Personality Disorder (AVPD, sometimes referred to as AvPD) is a second cluster C personality disorder (PD). The key characteristics of this disorder are extreme fear of rejection, and sense of inferiority. These core features of AVPD lead to widespread avoidance of social interaction.

Prevalence

The prevalence of AVPD in the general population is estimated to be between 0.8% to 5%. Some reports suggest a higher rate in females, however, a joint average in both men and women is estimated to be around 3.3%. The prevalence rate in the clinical population is much higher, given that AVPD is commonly accompanied by other neuropsychological disorders. * Clinicians and researchers note that the prevalence rates of PD should not be taken as an absolute truth, because it appears that AVPD often tends to be underdiagnosed and undertreated.

Causes

To date the causes of PD are not clearly defined; However, there is a consensus in the field acknowledging that PDs as a whole are majorly multicausal. This is also the case with AVPD, where several factors, specifically a combination of social, genetic, and psychological factors contribute to the development of PD.

Genes

The literature suggests that the temperamental characteristics of AVPD are inherited. Studies have indicated that family history of anxiety disorders, especially those that involve behavioral inhibitions (behaviors such as avoidance, shyness, fear, and extreme caution) manifesting during childhood and adolescent years may cause a genetic predisposition for developing AVPD. In addition, family studies report that the factor of heritability of AVPD ranges from 0.18 to 0.56. These rates are increased when looking at twin studies, with rates between 0.28 to 0.71, which indicates a high genetic component of PD. The weighted average from both family and twin studies suggests an overall rate of heritability at around 0.55.

Environment

Academic literature suggests that children who have been emotionally neglected by caregivers are associated with a higher risk of developing AVPD. Experiences such as peer group rejection, severe exclusion or alienation from associated groups and peers increase the risk of PD. It is theorized that individuals who have a high sensory sensitivity, i.e. tendency for pronounced vigilance to subtle changes in sensory signals together with being easily overwhelmed in a highly stimulating environment, and have undergone negative experiences, especially during childhood, may have a predisposition of developing AVPD later in life.

Symptoms

Individuals with AVPD rely on extreme avoidance of negative or perceived fearful experiences, for example novelty, responsibility. This should not be confused with responsible and cautious behaviors that most adults exhibit. Instead, in the case of AVPD, these coping behaviors are coupled with over pronounced feelings of inadequacy and inferiority, which leads to social isolation, regardless of the need and desire for interaction. Individuals with AVPD exhibit several or more of these symptoms:

  • Extreme sensitivity to criticism.
  • Limited social circle/interaction.
  • Avoidance of unexpected/unplanned social interaction, due to extreme fear of not being approved by others.
  • Extreme feelings of anxiety in social settings (-i.e., romantic, professional).
  • Avoidance of novel activities, changes like work environment, schools, or exploring new hobbies, may appear very shy or awkward in group settings.
  • Tend to be extremely self-conscious (e.g., worrying about behaving inappropriately, behaving wrongly, or being embarrassed, even though they are behaving correctly under normal circumstances).
  • Exhibit lack of self-esteem.
  • Overfocused on negative thoughts, or potential problems (may create disastrous scenarios, primarily happening in social contexts).

If left untreated AVPD can become a pervasive lifestyle, which results in complete social isolation. This will cause extreme difficulties in a variety areas of an individual's life, such as in social, personal, and professional settings. Individuals diagnosed with AVPD are also more likely to develop major depressive disorder and may be at increased risk of suffering from substance abuse disorders.

Help and treatment

Due to the core characteristics of AVPD, the individuals suffering from this PD are faced with added difficulties in regards to treatment. Given their avoidance of novelty, extreme social anxiety, adversity, and fear of criticism, they are unlikely to reach out for help themselves. Even when the initial contact with a clinician is made, they might drop out of treatment due to lack of affirmation from the clinician. However, studies suggest that support from family and friends is extremely important for individuals with AVPD, because they tend to stick with their treatment plan, since it is having the desired effect of helping to encourage the person to function during social interactions. If you believe someone you know or love might suffer from AVPD, you should suggest they contact a clinician, but if they refuse, you can consider advocating on their behalf.

The primary treatment for individuals with AVPD is therapy. Currently the most common therapy for AVPD individuals is cognitive behavioral therapy (CBT), however the treatment plan will be tailored individually, but primary focus remains on enhancing coping mechanisms, which help with avoidance behaviors and increasing one's self-esteem and worth. In some cases, medication is offered for anxiety and depression, but pharmacological approach will be most effective if done together with active therapy.

Key takeaways

AVPD is a cluster C personality disorder.

AVPD is caused by both inherited and environmental factors.

AVPD individuals experience intense social anxiety, however desire social contact.

The main treatment for AVPD is therapy, e.g. CBT.

Untreated AVPD can lead to severe isolation.

Resources:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Arlington, VA: American Psychiatric Association; 2013.

Eikenaes, I., Hummelen, B., & Wilberg, T. (2013). PERSONALITY FUNCTIONING IN PATIENTS WITHI AVOIDANT PERSONALITY DISORDER. Journal of personality disorders, 27(6), 746-763.

Lampe, L., & Malhi, G. S. (2018). Avoidant personality disorder: current insights. Psychology research and behavior management.

Reich, J., & Schatzberg, A. (2021). Prevalence, Factor Structure, and Heritability of Avoidant Personality Disorder. The Journal of Nervous and Mental Disease, 209(10), 764-772.

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