08.30.23
Do I Have Avoidant Personality Disorder or Am I Just Shy?
People avoid social stuff all the time. AVPD is different.
Those videos on TikTok that talk about avoidant personality disorder (AVPD) symptoms are scary relatable. Steering clear of social stuff and feeling insecure? Um, yep. Been there. Not wanting to interact with people because criticism really gets to you and you think they’ll pick you apart? Sure. It me. But, despite the made-you-feel-seen content, the reality is that only about 1.5 to 2.5% of people actually have this personality disorder, according to a review of research published in 2018.
Still, if those videos leave you wondering, Wait, do *I* have AVPD ? The answer is maybe—but, also, probably not. While you might avoid social stuff when you don’t feel like seeing (or smelling or hearing or talking to) other human beings, people with AVPD decline showing up to things such as parties, work events, and or public places like the grocery store because they truly believe others won’t accept them or will make fun of them. Basically, they’re scared of rejection across all areas of their lives, says licensed clinical psychologist Quintin Bailey, PsyD. That can impact their work or school, their relationships with friends and family, and their personal goals, Dr. Bailey explains.
Obviously, there’s a lot to unpack here. Below we explain more about what avoidant personality disorder is, what can cause it, and how it’s treated.
One quick thing before we dive into the details: Mental health is complex and everyone has a unique experience, so don’t go diagnosing yourself just because you read a few articles on the internet (though, we do appreciate you stopping by to learn a few things). If this resonates with you, consider it a jumping-off point in your journey to getting care. OK, let’s get into it...
So, what is avoidant personality disorder?
While some mental health pros view AVPD as a more severe form of social anxiety disorder, a condition where people avoid social situations because they’re scared of being judged or embarrassed, per the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), AVPD is its own thing.
Sure, there’s lots of overlap here, but someone with AVPD is generally afraid of socializing on a deeper level than someone trying to deal with social anxiety. They’re convinced who they are as a person will get rejected, says psychologist Shirley Yen, PhD, president of the North American Society for the Study of Personality Disorders and a psychology professor at Harvard Medical School and Beth Israel Deaconess Medical Center. “[People with social anxiety] might be afraid of speaking in groups that they don't know or with their classmates, but they can talk at home with their family,” Dr. Yen explains. “With avoidant personality disorder, it can bleed into their intimate relationships too.”
In general, people with AVPD have low self-esteem and live their lives by trying to dodge any possibility of being dismissed by others—even though they crave the acceptance that comes with being out in the world, according to the American Psychological Association.
Getting an official AVPD diagnosis requires meeting at least four of the seven criteria laid out in the DSM-5-TR. (For what it’s worth, not all mental health pros agree with the DSM-5-TR ’s indicators for personality disorders. But, for now, this is what we’re working with.) That can include—but is not limited to!—dipping out of work activities to avoid criticism/disapproval/rejection, thinking they suck at being social or just as a person, feeling like they can’t control how much they worry about what others think, and passing on new experiences because they don’t want to get embarrassed. Sensing a theme here? And, like other personality disorders, AVPD is typically only diagnosed in people 18 and up since kids’ personalities change a ton, says psychologist Andrew Twardon, PhD, director of Mount Sinai’s Center for Intensive Treatment of Personality Disorders.
When someone with AVPD plans to (or just has to) do a social thing, they often prep for hours, going over what might happen and practicing how to talk and act, according to research published in the Journal of Clinical Psychology. And when they finally come face to face with people, the anxiety’s still kicking. Even something relatively small, like the way their therapist looks at the time during a session, can make them feel unwanted, says Dr. Bailey. Plus, their fear of getting judged can make it hard to speak up or get deep with others unless they know those people will accept them, per the DSM-5-TR. So, instead of trying to make conversation, they might try their best to blend in (avoid eye contact, keep their heads down, or hide) because they don’t want to be noticed, according to that same Journal of Clinical Psychology research.
The DSM-5-TR doesn’t say exactly how long this has to be going on to warrant an AVPD diagnosis, but those symptoms aren’t just a one-time thing. Instead, they’d have to last for a while across a bunch of areas of a person’s life. Oftentimes it’s been at least two years, says Dr. Twardon.
What causes avoidant personality disorder?
It's still unclear what can trigger or lead to AVPD, but it's probably a combination of factors like genes and stuff that happens in childhood, suggests a review of research. One study found a link between AVPD symptoms and a history of sexual abuse or being bullied. The theory is that when someone’s emotionally abused or neglected as a kid (whether it’s sexual abuse, bullying, or something else), they’re more likely to believe that people will just automatically reject or ridicule them, Dr. Bailey notes. “Through this lens we can see AVPD as a survival strategy from childhood that no longer keeps one safe in adulthood and becomes the source of suffering,” he adds.
How avoidant personality disorder is treated.
Since someone with avoidant personality disorder, uh, avoids…it makes sense that they might not be so thrilled at the idea of getting help, notes Dr. Yen. But the best way to deal is by working with a mental health pro who can assist you in figuring out what’s causing a fear of rejection and how to handle it.
There isn’t one gold-standard therapy proven to treat avoidant personality disorder, but a few kinds could help. One option is cognitive behavioral therapy, which teaches people how to challenge their thoughts and behaviors with things like exposures, says Dr. Yen. Yes, that means actually doing social stuff and getting to know people instead of avoiding.
Mental health medication, including anti-anxiety meds or antidepressants, can help manage symptoms too, Dr. Yen adds.
That said, you don’t need to have avoidant personality disorder to seek support for AVPD-like symptoms, says Dr. Bailey. If you stay up at night reliving a stranger honking at you in the drive-thru line or you get super scared to do anything social, speaking to a mental health professional can really help.
Yeah, it might seem scary, but seeking treatment can help decrease your symptoms more than you thought possible, says Dr. Bailey. “I’ve had the privilege of witnessing the healing journey of many folks who [come to] my office meeting criteria for a personality disorder and leave no longer meeting those criteria [later on],” he notes. It’s worth a shot!
Wondermind does not provide medical advice, diagnosis, or treatment. Any information published on this website or by this brand is not intended as a replacement for medical advice. Always consult a qualified health or mental health professional with any questions or concerns about your mental health.
