Avoidant personality disorder (AVPD): symptoms, testing, and treatment

We all experience moments of shyness or awkwardness from time to time. For people with avoidant personality disorder (AVPD), however, those feelings are almost always present––and amplified to the point of distress on a day-to-day basis. 

People with AVPD are extremely inhibited in social situations due to feelings of shame, inadequacy, and low self-esteem. They’re so worried about being rejected or criticized in a social setting that it leads them to avoid social interaction as much as possible. This interferes with their ability to maintain relationships and detracts from their quality of life. 

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AVPD is a personality disorder characterized by chronic feelings of discomfort, fear, and lack of confidence in social situations. Nearly one in every 30 people have AVPD, and it’s more common in women (Fariba, 2021). 

People with AVPD want to connect with others and engage in social situations, but are so fearful of rejection or judgment that they tend to hold back or withdraw instead (Weinbrecht, 2016).  

People with AVPD are deeply afraid of social rejection, embarrassment, criticism, and ridicule. Their symptoms make it hard to believe that people like them. Individuals with AVPD often feel unwelcome, even in situations where people are genuinely happy to see them. 

AVPD may make it difficult to speak up in group conversations out of fear of being laughed at for saying the wrong thing. As mentioned, those with AVPD are hypersensitive to rejection, which can lead them to misinterpret comments as criticism. 

AVPD interferes with a person’s ability to form and maintain friendships and romantic relationships. These individuals may avoid seeking out new friendships unless they’re absolutely certain the other person already likes them. 

In an intimate relationship, they may be fearful of opening up and sharing their feelings. When relationships don’t work out, they often place the blame on themselves, which increases feelings of suffering and inadequacy. This contributes to a vicious cycle that makes the person wish to avoid interpersonal contact even more (Fariba, 2021; Weinbrecht, 2016).

AVPD is marked by a chronic avoidance of social interactions, hypersensitivity to judgment, and feelings of shame in social situations. Symptoms of AVPD may include:

• Avoiding social, professional, and school activities due to fear of rejection or criticism

• Difficulty connecting with other people and forming close relationships due to fear of rejection

• Discomfort and inhibition in social situations

• Fear of saying or doing the wrong thing

• Looking to others for signs of approval or rejection

• Low self-esteem or feelings of inadequacy

• Perception of being unwelcome or rejected, even when that’s not the case

• Reluctance to try new activities or take personal risks due to fear of embarrassment or rejection

• Self-awareness of their discomfort and feelings of inferiority

• Tendency to withdraw and self-isolate

Personality disorders like AVPD are distinguished by chronic patterns of behavior that affect all aspects of a person’s life. 

While some people may grow out of their childhood shyness, a person with AVPD demonstrates ingrained patterns of behavior that intensify as they carry into early adulthood (Weinbrecht, 2016; Fariba, 2021).

Originally identified as a form of social phobia, AVPD is now recognized by the American Psychiatric Association as a Cluster C personality disorder, along with obsessive-compulsive disorder and dependent personality disorders. These conditions all share features of fearful or anxious thinking and behaviors.

To be diagnosed with AVPD, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recommends a person meet at least four of the following criteria (Fariba, 2021):

• Avoidance of activities due to fear of criticism, rejection, or disapproval

• Hesitancy to form relationships unless there is absolute certainty the person likes them

• Difficulty forming close relationships due to fear of shame or ridicule

• Preoccupation with social rejection or criticism

• Inhibition in new social situations due to self-consciousness and feelings of inadequacy

• Self-identification as socially inept or inferior

• Reluctance to try new things due to fear of embarrassment

Researchers suggest a combination of factors that could cause AVPD. Some include an individual’s genetics, temperament, attachment style, and early childhood experiences.

Infants who are hypersensitive or reluctant to try new things may be more likely to develop AVPD later in life, as can children with extreme shyness (Fariba, 2021; Lampe, 2018).  

The relationship a person has with their parents may also impact their likelihood of developing AVPD later in life. If the child views their parent as dismissive, neglectful, abusive, or overly critical, they may lose trust in them. That could cause them to develop an anxious or fearful attachment style. To prevent themselves from getting hurt, they may rely on coping strategies like avoidance or hypervigilance, which can lead to AVPD later on. 

Childhood experiences of rejection or ridicule may have a similar effect. AVPD may also overlap with social anxiety disorder, borderline personality disorder, dependent personality disorder, and depression.

Left untreated, people with AVPD may further self-isolate, increasing their risk for things like substance abuse, eating disorders, and depression (Fariba, 2021). 

Fortunately, psychotherapy––including cognitive behavioral therapy and schema therapy––can be very effective at relieving symptoms. 

People with AVPD want to connect with others but have ingrained ways of thinking about themselves that prevent them from doing so. This desire for connection can motivate them to adhere to treatment. By working with a therapist, they can learn to trust in relationships and overcome fears of social rejection.

Cognitive behavioral therapy (CBT) focuses on helping someone recognize the automatic thought processes contributing to their suffering. Therapists also teach you techniques to help develop healthier thought patterns. 

You’ll also work on recognizing behaviors in social interactions––like scanning the room for signs of approval or rejection––to work on replacing them with more positive, prosocial actions. 

CBT can be done in individual or group therapy settings. Techniques taught may include role-playing, social skills training, or desensitization. Between 40-90% of people with AVPD say their symptoms improved as a result of CBT (Weinbrecht, 2016).

Schema therapy is a form of psychotherapy that focuses on helping you recognize something called schema modes. 

Schemas are a set of thoughts, emotions, and coping behaviors that develop when a person doesn’t have their basic needs met in early childhood. In schema therapy, therapists work with patients to practice healthier coping methods. 

One study found that after schema therapy, over 80% of people no longer met the diagnostic criteria for AVPD (Weinbrecht, 2016).

In addition to therapy, serotonin-specific reuptake inhibitors (SSRIs) or other antidepressants may also be recommended. These drugs can help manage symptoms of conditions that coexist with AVPD, like depression or anxiety. 

For most people, AVPD is a lifelong disorder. However, treatment can significantly relieve symptoms and help people with AVPD feel more comfortable in social situations (Fariba, 2021).  

If you or a loved one are hurting, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-(800) 662-4357 for support and treatment options in your area.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

August 05, 2021

Written by

Amelia Willson

Fact checked by

Yael Cooperman, MD

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About the medical reviewer

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.